The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter

place at Lerida in 1391; Vienna held its first in 1404. In England and Germany anatomy teaching with a human corpse did not become routine before 1550.

      Anatomy had an impact upon medical illustrations – a subject bedevilled by modern prejudices about ‘realism’, for medievals who drew ‘childish’ images of the bones and arteries have been adversely contrasted with the new ‘scientific’ artists of the Renaissance (notably Leonardo da Vinci), admired for their realistic anatomical drawings. But the comparison is misleading. For one thing, Leonardo at times followed tradition rather than his eye, adopting, for instance, the standard five-lobed liver. For another, it is wrong to think that the apparent crudity of medieval images reveals ineptitude. Late medieval illustrations were not meant to depict minute documentary detail; they were diagrammatic teaching aids, schematically representing general truths – mnemonic rather than photographic.

      The most common type of medieval medical illustration was the ‘Zodiac man’: a male figure marked up with blood-letting points or with the zodiac signs (Taurus controlled and cured diseases of the neck and throat, Scorpio the genitals, Capricorn the knees, Pisces the feet, and so forth). The right way and place to let blood was gauged by study of the constellations and the moon. There was also the group known as the ‘five-picture series’, standing for the five systems: arteries, veins, bones, nerves and muscles. Squatting figures with legs astride were occasionally used to show diseases, wounds and the influence of the stars and planets on body parts. There were also charts explaining how to examine urine. The success of such images is evident: they survived into the age of print, wound-men in particular continuing to crop up in surgery texts.

      The late Middle Ages wear a gloom-laden appearance: painters gave Death a mocking grin and portrayed him accosting peasants, merchants and princes. Perhaps for this reason, and because it was roundly disparaged by Renaissance humanists, medieval medicine has never enjoyed a good press. Proud of recovering Hippocrates and Galen in the original Greek, humanists chid and despised their muddle-headed predecessors.

      We should not blindly accept these judgments. Much was afoot before 1500: in particular the fifteenth century brought a rise in practical medicine, associated with the books of practica and case-histories (consilia) produced by Italian professors. Bedside consultations, autopsies and the spread of dissection gave Italian medical training an increasingly hands-on emphasis. It is ironic that from the 1490s the medical humanists reverted to theory, to philology and medicine’s ‘sacred’ books, notably through the Galen revival.

      The later Middle Ages also consolidated the role of medicine in European society, with new institutions and regulations. At the time when the Salerno school was founded, physicians were to be found only in monasteries and palaces; five hundred years later they had infiltrated society (remember the physician on Chaucer’s pilgrimage) and were facing competition from other practitioners like barber-surgeons, professional bickering being but one sign of this growing medical presence. Other domains of life were falling under medical control: health officials directed urban hygiene and combated plague. From birth to death – and even beyond, if one had the misfortune to be cut up for a public anatomy display – medicine gained a hold that it had previously lacked or lost.

* Take for instance this section in the English translation by Sir John Harington (1561–1612) (who was, incidentally, the inventor of the water-closet):

      Although you may drink often while you dine,

      Yet after dinner touch not once the cup, …

      To close your stomach well, this order suits,

      Cheese after flesh, Nuts after fish or fruits.

       CHAPTER VI INDIAN MEDICINE

      EACH AREA OF THE GLOBE has created a medicine of its own. The neolithic revolution in India and China produced civilizations comparable in complexity and achievements to the developments discussed in the Middle East, the Levant and the eastern Mediterranean, like these, founded upon an agrarian economy sustaining, and sustained by, political overlords and large urban settlements. In the great Asiatic empires social hierarchy and the consequent division of labour facilitated the emergence of specialist healers, together with priests, wise men and bureaucrats.

      The consolidation of writing encouraged learned traditions which helped to give permanence to particular corpuses of medical (as well as religious and philosophical) erudition. As with the writings of Hippocrates and Galen in the West, the result tended to be a glorification of tradition, and the associated belief that a fixed, permanent and perfect medicine had, in a quasi-divine manner, been handed down from some far-distant origin. It was the duty of successors to uphold such a tradition, protecting and purifying it against the threat of corruption. Such values imparted into Asian medical systems a great durability; they certainly gave no encouragement to innovation. Indian and Chinese medicine alike proved tenacious and encouraged myths of an essential unchangingness – though this was actually belied by developments. The consequence was that both traditional Indian and traditional Chinese medicine continued in place; yet both experienced in due course a tense and ambiguous encounter with western ‘scientific medicine’, which left them compelled to take aspects of it on board.

      EARLY INDIA

      As in many other parts of the world, the first settled agricultural communities in India appeared at the end of the last Ice Age about ten thousand years ago; around 3000 BC, as archaeology reveals, developments took place around the Indus river leading to elaborate civilization. Excavations of the imposing Indus cities of Harappa, Mohenjo-daro and Lothal have revealed what must have been a complex urban social order, with well-defined social and occupational hierarchies. As well as priests, healers must have existed: perhaps the function was twinned. Remains of great public water tanks in these cities suggest communal bathing and hence cleansing rites, perhaps linking ritual to hygiene.

      Around 1500 BC, this Indus civilization seems to have fallen into decay; the explanation for this may lie in climatic and environmental changes affecting the water courses. Meanwhile, the Indo-European peoples were migrating into south Asia, and their civilization achieved a position of dominance in the subcontinent. Brotherhoods of hereditary priests (brahmana) grew powerful, becoming the masters and guardians of Sanskrit religious teachings called veda (the knowledge). Though there is no distinctive ‘Vedic medicine’, such religious writings shed some indirect light on contemporary beliefs about health and healing.

      It seems that a magico-religious outlook on illnesses and treatments became established which broadly parallels Mesopotamian or Egyptian practices. Distinctive healing powers were associated with particular deities, it being believed that diseases could be produced by wicked spirits or by happenstance. The deities who brought disease visitations were to be propitiated by rites involving mantra (incantations), supplications and expiation. Herbs were valued for their therapeutic powers, while injuries and broken bones were attributed to everyday causes; but some diseases – conditions like yaksma (perhaps consumption) and takman (fevers associated with the monsoon season) – were judged to be signs of demonic and magical interventions. Beliefs about the body and its workings came from various sources. Vedic rites involved the use of animal and human sacrifice, and the ceremonial texts contain some listings of anatomical parts. Some basic forms of surgery were also recorded, cauterization being employed to stanch wounds, and reeds were used as catheters to relieve the retention of urine. Vedic writings speak of the value of water, whether to be bathed in, drunk or ritually applied.

      From perhaps 1000 BC, Veda constituted the main faith of north India. Other groups also were appearing, seemingly dedicated to making religion a more spiritual matter and placing emphasis upon the need to lead a life of moral uprightness. Alongside many individual ascetics, the chief and best known of such groups was the Buddhist community, founded by Gautama Sakyamuni (the Buddha, 563–483 BC). Others included those subsequently called the Jains. These gatherings gave rise to new medical practices.

      The monastic rule