Medicine, the knowledge and treatment of human illness, is as old as the human race, which has been heir to sickness from the beginning. Prior to recorded history there is evidence of medical intervention in primitive societies in the management of various forms of disease from osteoarthritis to dental carries as well as trauma including fractures. Skull trephining was found to be widely practiced.

Initially, human society had three, classes of leaders: rulers, warriors and priest-healers. Because primitive societies developed with a strong sense of the influence of the sacred on all of their activities it is not illogical that healer should intercede with these sacred forces in the management of illness. As a matter of fact, modem medicine may be overlooking this primal emotional human need when it focuses entirely on the pathophysiological and ignores the spiritual dimension of the human person.

Most primitive human societies are I animistic, that is they perceive the sacred in concrete objects around them: the sun, moon, and animals become godlike. The shaman, who mediated between his people and these sacred objects, was the logical person to treat the sick person who clearly was at variance with the natural order, and whose illness had to be reconciled with the gods who were involved with its occurrence.

As societies developed the physician relied more on experience and observation in managing illness. Two disparate civilizations: Egypt and China had physicians recognized for their knowledge of disease and who reflected the healing traditions of their ancient societies.

Imhotep, the most famous physician in pharonic Egypt lived around 2900 BC. In China, Nei Chang, practicing around 2500 BC, began the long and current practice of traditional medicine of reconciling opposites (ying and yang) to achieve harmony.

Up to this point medicine had a strong religious component. A less religious practice of medicine began later (around 1200 BC). In Greece when Aesculapius treated disease in temples, the first hospitals.

The more scientific, as opposed to religious, approach to healing began in Athens and is attributed to Hippocrates: He was an astute observer, who by trial and error managed various diseases. He had many followers who began the Hippocratic tradition which is, articulated in the Hippocratic writings, many of which were probably written by his disciples.

Roman medicine was essentially a continuation of Greek medicine. While it had its religious component in that the God of healing was placated, the empirical aspect of observation and experiment continued to be emphasized. Medicine was more an art than a science. Much of the pathophysiology of disease was unknown so the emphateric and compassionate aspects of the doctor-patient relationship were emphasized.

Catholic healthcare is unique in human history in its contribution to the alleviation of human suffering, both physical and mental. No culture has put a higher priority on healing than has the Catholic Church. This is so because Christ was defined as a healer and even a physician. Of Christ's thirty described miracles no less than twenty of 66% were acts of curing physical illnesses. Christ's message of love was primarily to heal the spiritual, moral and emotional effects of sin, but also, where possible, to alleviate physical pain and suffering.

This command was transferred to His disciples at Pentecost and healthcare was a ministry of His Church from apostolic times. Deacons in the early Church had the responsibility of looking after the physically ill members of the community. They were responsible for the tradition of "hospitalitas" which later resulted in what we know as hospitals. There was an organized care of the sick with a system of hospitals at the time of Constantine the First. The Council of Nicaea (325 AD) mandated (Cannon 75) facilities for the care of the sick.

With the recognition of | Christianity as a religion in the Roman Empire, by the Edict of Milan (313 AD), Catholic healthcare, particularly hospitals, expanded greatly, usually in conjunction with monasteries. There was a big increase in hospitals in the 11th and 12th centuries, most run by religion orders. The knights of Malta were founded in 1108 to nurse the sick, only secondarily becoming a military s power. In England there were 980 hospitals in 1300.

This commitment to healthcare was taken when there was no industry and little capital. It was unique to Christianity and was a result of the mission of the Church. There was a preferential option for the poor and outcasts, as reflected in the | institutions for the care of lepers. This concern for healing was not reflected to the same extent in other cultures such as the Buddhist or Hindu.

Modern medicine began with the Enlightenment's emphasis on inductive science. Prior to about 1500 science had been deductive in the mode of Aristotle. Now the testing of hypotheses by observation of phenomena and statistical analyses became the norm. This was applied to anatomy, biochemistry, and physiology. The normal functioning of the human body was described and the causes of pathologic conditions gradually revealed. While the scientific aspects of diseases were being elucidated the art of medicine: the empathy and compassion, continued to play a predominant role.

Advances in chemistry and physiology accelerated in the 7th and 8th centuries. But it was the one hundred years between 1850 and 1950 that practical advances occurred. These included anesthesia, antibiotics, and roentgenology. Effective anesthesia allowed expanded surgical procedures. Antibiotics significantly reduced mortality from infectious diseases, the most common cause of mortality. X-ray opened the era of bodily imaging.

The most recent fifty years have witnessed more changes in medicine than the previous 2500. These include molecular biology, the most immediate result of which is the human genome project. This project may allow us to correct genetic disease heretofore simply palliated.

But of perhaps more importance have been the social impact on medicine. Because of a variety of factors from healthcare financing, to technological innovation, to government intervention, but most importantly, the concept of personal autonomy, the Hippocratic tradition appears to have ended. The doctor-patient relationship, the emphasis on empathy and compassion, indeed the human aspect of medicine appears to be a thing of the past. But thus should not be allowed to happen.

We present a brief outline of Chinese medicine because most medical schools do not discuss it, in part because of the assumption that our modern western medicine has nothing to learn from other cultures. This is an unfortunate act of hubris.

Medicine is more of an art than a science. That is, medicine is more a practical skill than an abstract intellectual construct. This being the case recorded Chinese medicine is at least 2000 years older than Greek medicine and therefore had more accumulated practical clinical wisdom than the founders of Western medicine.

Chinese medicine began in 2953 BC with Fu Hsi and medicine writings called Nei Ching. The principle of Yin and Yang, or harmony, are reflected in all Chinese medicine. Physical diagnosis depended upon observation and meticulous evaluation of the pulse. Of great importance, even to subsequent Western medicine, was the extensive Chinese pharmacopeia. They first described the value of iron, castor oil, kaolin, camphor, ephedrine and reserpine. Bodily energy would be utilized to treat disease by the use of acupuncture.

Chinese medical ethics is derived from Confucian, Buddhist, and Taoist teachings. Demons, but more importantly,ancestors influenced the health of the Chinese in their folk medicine. The first specifically ethical writings were by Sun Ssu-Miao (581-682). He emphasized benevolence and compassion. The physician was to maintain life regardless of the social status of the patient or the disease type. A Taoist principle was do good and avoid evil. Abortion was considered an evil practice.

The principle contribution of Chinese medicine is the importance of harmony between the human person and nature. Balance, be it dietary or environmental, was essential for Chinese health. In our dependence on science and technology we have ignored the harmony between the patient and the environment necessary for health that Chinese medicine emphasized.

Indian medicine was first described in the sacred Vedas as far back as the second millennium BC. They described TB, dropsy, seizures, cancer, and leprosy, among other diseases. The golden age of Indian medicine was the Brahmanistic Period (5OO BC to 1000 AD) and the principle physicians were Caraka and Sushruta. They described "Ayurvedic" medicine, or knowledge of vitality and long life. Diagnosis was more detailed than it was for the Chinese. Diet took precedence over herbs for Indian physicians. They also employed the "five procedures": emetics, purgation, water and oil enemas and sneezing powders. Indian medicine excelled in surgical procedures including lithotomy and plastic surgery.

Hindus medical ethics was dominated by the basic concept of "ahimsa" or non-violence. Abortion was considered a sin in early medical texts. The sanctity of life in the medical ethical code was but one corollary of ahimsa.

Continue on to General Ethics...