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  • We've seen how, from around 400 BCE to CE 1300, ideas in astronomy, math, and engineering

  • were traded all the way from Beijing to Delhi, and from Baghdad to Constantinople.

  • In the next episodes, we're going to dive into how some specific kinds of knowledge

  • evolved over time.

  • First up: healing.

  • The history of medicine is about two of our big questions: one, what is life?

  • What makes it so special, so fragile, sogoopy!?

  • Two, how do we know what we know?

  • Why should I take my doctor's advice?

  • Why are deep-fried Oreos bad for me?

  • It may be tempting to look at medicine as a science that has simply progressed over

  • timethat medicine used to be bad, and its history is a story of how it got better.

  • And don't get me wrong: we love modern medicine!

  • You'll have to take my word for it untilCrash Course: Deep-Fried Everything

  • drops, but the science behind lipid transport is just fascinating.

  • Focusing on progress, though, obscures what worked in the past.

  • Ancient and medieval medicine worked for millions of people.

  • They understood their bodies as bounded by rules.

  • And regardless of what worked, early medical systems allowed people to make sense of bodies

  • and health.

  • You may think that medicine is a technē, or practically oriented knowledge.

  • But today, we're going to focus on systems of medicine as world-ordering theories, or

  • epistēmē.

  • These theories were built up into a textual tradition, in which doctors wrote down what

  • they saw and cited earlier doctors when explaining their treatments.

  • So let's turn to medical education.

  • What textbooks would a would-be doctor read in a given place and time?

  • [Intro Music Plays]

  • Let's say you lived in Song Dynasty China: you'd study machine-printed textbooks on

  • traditional Chinese medicine, or TCM.

  • In this system, humans are small pieces of one vast organism called the Entire Dang Universe.

  • All things within this system are composed of five elements: fire, earth, metal, water,

  • and wood.

  • In TCM, health means a balance between two forces, yin and yang, representing dark and

  • light, femininity and masculinity, hot and cold, and so on.

  • Disease means imbalance.

  • Thus healthcare means restoring balance, in TCM, by manipulating the energy that flows

  • through living bodies, called qi.

  • You, the would-be doc, would learn all about how to move qi around using acupuncture and

  • acupressure, herbal therapies, exercise, and prescription diets.

  • If you lived in Gupta Dynasty India, you'd also get down with a five-element theory of

  • matter.

  • But you would study the science of life, Ayurveda.

  • You'd probably pick up the popular textbook Charaka Samhita, or one of the other samhitaor

  • collections”—that could help you memorize hundreds of named body parts.

  • In addition to anatomy, the samhitas would also teach you etiology, or what causes different

  • diseases, and symptomatology, or what diseases look like.

  • When it came to treatment, your samhita would have information on the eight specialites:

  • the diseases of children, those of the elderly, mental diseases, diseases of the sense organs,

  • surgery, poisons and antidotes, and aphrodisiacs.

  • You would learn the five karmas or actions that were used for removal of toxins from

  • body tissues.

  • And, to prepare treatments, you'd learn a lot about plants, minerals, and animals.

  • But treating patients is only part of Ayurveda.

  • The science of life concerns healthful living in general, including how to prevent disease

  • and influence hygiene and diet.

  • What if you lived in, say, fourteenth-century Bologna, Italyhome to one of the oldest

  • universities in the world, which opened in CE 1088!

  • You would attend lectures, and you'd have a hand-copied textbook, not made by a press

  • as in Song China.

  • The medical theories in your textbook would be founded on Aristotelian biology and physics.

  • Bodies are composed of four special bodily humors.

  • Each of these corresponds to one of the four elements of Empedocles: blood, made of air,

  • phlegm, made of water, yellow bile, made of fire, and black bile, made of earth.

  • Illness is an imbalance in the humors.

  • Too much black bile, for example, causes depression.

  • Treatment means restoring the right humoral balancelike, with bloodletting.

  • When too much of one humor built up in the body, one way to restore a balance was to

  • let some of the excess drain off.

  • But the most common treatment, then as now, was simply offering good dietary advice.

  • Aristotle linked the four elements with the humors, but he wasn't a doctor.

  • The oldest nuggets of humoral wisdom in Western Eurasian medical textbooks were attributed

  • to a physician named Hippocrates of Cos, which meansGregory Housein classical Greek.

  • We know something of his lifehe died when Aristotle was in his teensbut we don't

  • have many surviving works by him.

  • What we do have is a collection of texts of various age and unknown authorship called

  • the Hippocratic corpus.

  • According to the corpus, Hippocrates I was a fan of the Pythagoreans.

  • (Remember, the secret math cult?)

  • But his skepticismor doubt that certain knowledge is possibleset Hippocratic medicine

  • apart from a lot of Greek natural philosophy.

  • Hippocrates emphasized reason, observation, and medical prediction.

  • He emphasized that diet and the environment influence health, not the direct will of the

  • gods.

  • And his oath—“do no harm”—still underpins medical education.

  • Hippocrates was the Jimi Hendrix of Eurasian and North African medicine, innovating a new

  • style that challenged traditional ideas.

  • But Hippocratic physicians had to compete among many schools of healers.

  • It was a Roman named Galen who became medicine's Michael Jacksonthe popularizer of a standard

  • humorism that would last until the 1800s.

  • Galen's system absorbed the smaller, uneven Hippocratic corpus.

  • Galen was born around CE 130 in Pergamon.

  • But he made his career in Rome, treating gladiators.

  • This gave him lots of experience peeking into the body while sewing up wounds.

  • Eventually he got the offer of a lifetime: court physician to Emperor Marcus Aurelius,

  • who was a battle-hardened general, Stoic philosopher, and all-around hardcore dude.

  • Galen wrote a huge number of influential textssupposedly five hundred!

  • Though only eighty-three survive today.

  • These show that Galen built on the systems of Hippocrates and Aristotle, but also made

  • detailed notes on human anatomy drawn from experience.

  • He accurately observed how the larynx works and demonstrated the the lungs fill up with

  • air.

  • Oh ya, and he innovated cataract surgery.

  • But Galen definitely got some things wrong.

  • One reason is that human dissection was illegal in imperial Rome and the states that succeeded

  • it.

  • So a lot of anatomy was still guesswork based on observations of animals.

  • For example, dissecting sheep heads, Galen identified a circulatory organ called a rete

  • mirabile orwonderful netthat is found in animals like sheep and dolphinsbut

  • doesn't actually exist in humans.

  • After Galen, the most notable medical theorists in the Greater Mediterranean weren't Greeks

  • or Romans, but Arabs or Persians who had access to both Greek and Indian sciences.

  • First among was the Persian polymath Abū Bakr al-Rāzī —whose name also meansGregory

  • House.”

  • Born in CE 854, al-Rāzī was prolific: he wrote dozens of books, including detailed

  • accounts of his cases.

  • He is considered by many historians to be one of the founders of several disciplines,

  • from psychology to opthamology.

  • And he was the first to describe smallpox and measles as distinct diseases.

  • Al-Rāzī also wrote for general audiences, educating them about health and disease.

  • Many of his works were encyclopedias based on Greek humoral medicine and natural philosophy.

  • His big one, al-Hawi al-Kabir or The Virtuous Life, was a large, influential medical encyclopedia.

  • Al-Rāzī was a unique dude who did exactly what he wanted.

  • Although he was one of the most scientific doctors of his time, he also wrote works of

  • Islamic prophetic medicine, al-tibb al-nabawi.

  • This discipline, an alternative to the HippocraticGalenic system, advocated traditional medical practices

  • mentioned in the Qur'an.

  • Al-Rāzī also influenced medicine by becoming the first fan of Greco-Roman humoral medicine

  • to beef with Galen!

  • He wrote a book called Shukuk 'ala alinusorDoubts About Galenin which he said that his own

  • observations contradicted some of Galen's claims.

  • Remember nullius in verba—“on the word of no one”—the motto of the Royal Society

  • of London, founded in 1660?

  • Al-Rāzī advocated this approach to medicine circa the year 900, over seven hundred years

  • earlier!

  • But, if you were really a medieval Italian medical student, the book you'd read probably

  • wouldn't be by Hippocrates, Galen, or al-Rāzī.

  • Instead, you'd read a translated encyclopedia featuring all of them.

  • In doing so, you'd participate in the scientific wonder called Scholasticismor learning

  • through close readings of approved texts that recorded the observations and theories of

  • earlier thinkers.

  • Take it away, Thought Bubble!

  • One of the all-time greatest hits of medical education was al-Qānūn fī al-Ṭibb, or

  • The Canon of Medicine.

  • The Canon was written by another Persian polymath, Ibn Sina, born in 980.

  • Ibn Sina was widely seen as the best writer to summarize and comment on the Greco-Roman

  • doctors.

  • His Canon became one of the most important medical textbooksand introductions to Aristotle's

  • physicsfor six hundred years.

  • Your textbook is really a mashup of several different books.

  • Each page is like an onion: at its heart, one punctum or big idea by Aristotle, or Hippocrates

  • or Galen.

  • These are surrounded by layer upon layer of annotatio, or notes, by famous physicians

  • from distant cities such as Baghdad.

  • Your main throughline are the summaries by Ibn-Sina, whose name has been latinized as

  • Avicenna”.

  • But there are notes by Latin translators such as Gerard de Cremona or Constantinus Africanus,

  • plus outer layers of notes by other medical students.

  • Maybe you even jot down your own.

  • Thusway before WebMDyou're in conversation with doctors from all across space!

  • And time!

  • In universities such as Bologna or Salerno, you might also have access to another textbook,

  • this one bywait for it… a lady!

  • Trota of Salerno wrote Practical Medicine According to Trota and Treatments of Women,

  • one of books of the The Trotula Ensemble.

  • This group of three texts from around 1200 traveled widely throughout medieval Europe.

  • The Trotula became foundational to gynecology and all other topics related to women's

  • health.

  • But you might not know that this foundational text on women's health was written by a

  • woman, because her identity was systematically written out of history until the late twentieth

  • century.

  • Because of course it was.

  • Thanks Thought Bubble!

  • So what waslifefor many educated people in Asia and North Africa between roughly 400

  • BCE to CE 1300?

  • Life was a universal property of which humans were just interesting examples.

  • Life was linked to the movements of special fluids, which were the objects of medical

  • treatments.

  • Life was ultimately built out of a smaller number of elements, and good health meant

  • balancing fluids and elements in the right way.

  • How did we know what life is?

  • For some physicians in classical Greece or imperial Rome, careful observation and comparison

  • to animals were crucial methods.

  • Persian doctors, influenced by both Greek and Indian ideas, synthesized earlier ideas,

  • expanded evidence for them, and challenged and reworked them.

  • Why did you, medieval citizen, trust this information?

  • Because books told you to!

  • And with that, dear student, we leave you to deal withthe Black Plague of 1347.

  • Bummer!

  • Next timewe'll deep-dive into the eternal question ofwhat is stuffwith a group

  • of thinkers who tried tosciencelead into goldthe alchemists.

  • Crash Course History of Science is filmed in the Dr. Cheryl C. Kinney studio in Missoula,

  • Montana and it's made with the help of all this nice people and our animation team is

  • Thought Cafe.

  • Crash Course is a Complexly production.

  • If you wanna keep imagining the world complexly with us, you can check out some of our other

  • channels like Scishow Psych, Animal Wonders, and The Art Assignment.

  • And, if you'd like to keep Crash Course free for everybody, forever, you can support

  • the series at Patreon; a crowdfunding platform that allows you to support the content you

  • love.

  • Thank you to all of our patrons for making Crash Course possible with their continued

  • support.

We've seen how, from around 400 BCE to CE 1300, ideas in astronomy, math, and engineering

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古代と中世の医学。クラッシュコース 科学の歴史 #9 (Ancient & Medieval Medicine: Crash Course History of Science #9)

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    林宜悉 に公開 2021 年 01 月 14 日
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