The history of medicine is both a study of medicine throughout history as well as a multidisciplinary field of study that seeks to explore and understand medical practices, both past and present, throughout human societies. The history of medicine is the study and documentation of the evolution of medical treatments, practices, and knowledge over time. Medical historians often draw from other humanities fields of study including economics, health sciences, sociology, and politics to better understand the institutions, practices, people, professions, and social systems that have shaped medicine. When a period which predates or lacks written sources regarding medicine, information is instead drawn from archaeological sources. This field tracks the evolution of human societies' approach to health, illness, and injury ranging from prehistory to the modern day, the events that shape these approaches, and their impact on populations. Early medical traditions include those of Babylon, Egypt, China and India. Invention of the microscope was a consequence of improved understanding, during the Renaissance. Prior to the 19th century, humorism (also known as humoralism) was thought to explain the cause of disease but it was gradually replaced by the germ theory of disease, leading to effective treatments and even cures for many infectious diseases. Military doctors advanced the methods of trauma treatment and surgery. Public health measures were developed especially in the 19th century as the rapid growth of cities required systematic sanitary measures. Advanced research centers opened in the early 20th century, often connected with major hospitals. The mid-20th century was characterized by new biological treatments, such as antibiotics. These advancements, along with developments in chemistry, genetics, and radiography led to modern medicine. Medicine was heavily professionalized in the 20th century, and new careers opened to women as nurses (from the 1870s) and as physicians (especially after 1970).
Prehistoric medicine
Prehistoric medicine is a field of study focused on understanding the use of medicinal plants, healing practices, illnesses, and wellness of humans before written records existed. Although styled prehistoric "medicine", prehistoric healthcare practices were vastly different from what we understand medicine to be in the present era and more accurately refers to studies and exploration of early healing practices. This period extends across the first use of stone tools by early humans c. 3.3 million years ago to the beginning of writing systems and subsequent recorded history c. 5000 years ago. As human populations were once scattered across the world, forming isolated communities and cultures that sporadically interacted, a range of archaeological periods have been developed to account for the differing contexts of technology, sociocultural developments, and uptake of writing systems throughout early human societies. Prehistoric medicine is then highly contextual to the location and people in question, creating an ununiform period of study to reflect various degrees of societal development. Without written records, insights into prehistoric medicine comes indirectly from interpreting evidence left behind by prehistoric humans. One branch of this includes the archaeology of medicine; a discipline that uses a range of archaeological techniques from observing illness in human remains, plant fossils, to excavations to uncover medical practices. There is evidence of healing practices within Neanderthals and other early human species. Prehistoric evidence of human engagement with medicine include the discovery of psychoactive plant sources such as psilocybin mushrooms in c. 6000 BCE Sahara to primitive dental care in c. 11,900 BCE (13,000 BP) Riparo Fredian (present-day Italy) and c. 7000 BCE Mehrgarh (present-day Pakistan). Anthropology is another academic branch that contributes to understanding prehistoric medicine in uncovering the sociocultural relationships, meaning, and interpretation of prehistoric evidence. The overlap of medicine as both a root to healing the body as well as the spiritual throughout prehistoric periods highlights the multiple purposes that healing practices and plants could potentially have. From proto-religions to developed spiritual systems, relationships of humans and supernatural entities, from Gods to shamans, have played an interwoven part in prehistoric medicine. A significant example of sophisticated prehistoric self-medication is the case of Ötzi the Iceman (c. 3230 BC). According to archaeologist Patrick Hunt, Ötzi carried a deliberate "prehistoric medical kit" to treat his numerous documented ailments. This kit included Piptoporus betulinus (birch polypore fungus), which Hunt suggests was used as both a vermifuge for intestinal parasites and an antibiotic for his Lyme disease; poppy seeds as an analgesic; sloe berries to treat vertigo and eczema associated with Lyme disease; and sphagnum moss as an antiseptic wound dressing.
Ancient medicine
Ancient history covers time between c. 3000 BCE to c. 500 CE, starting from evidenced development of writing systems to the end of the classical era and beginning of the post-classical period. Sociocultural and technological developments could differ locally from settlement to settlement as well as globally from one society to the next. Ancient medicine covers a similar period of time and presented a range of similar healing theories from across the world connecting nature, religion, and humans within ideas of circulating fluids and energy. Although prominent scholars and texts detailed well-defined medical insights, their real-world applications were marred by knowledge destruction and loss, poor communication, localized reinterpretations, and subsequent inconsistent applications.
Ancient Mesopotamian medicine The Mesopotamian region, covering much of present-day Iraq, Kuwait, Syria, Iran, and Turkey, was dominated by a series of civilisations including Sumer, the earliest known civilisation in the Fertile Crescent region, alongside the Akkadians (including Assyrians and Babylonians). Overlapping ideas of what we now understand as medicine, science, magic, and religion characterised early Mesopotamian healing practices as a hybrid naturalistic and supernatural belief system. The Sumerians developed one of the earliest known writing systems in the 3rd millennium BCE, and created numerous cuneiform clay tablets regarding their civilisation. These included detailed accounts of drug prescriptions and operations, as well as exorcisms. These were administered and carried out by highly defined professionals including bârû (seers), âs[h]ipu (exorcists), and asû (physician-priests). An example of an early, prescription-like medication appeared in Sumerian during the Third Dynasty of Ur (c. 2112 BCE – c. 2004 BCE). Following the conquest of the Sumerian civilisation by the Akkadian Empire and the empire's eventual collapse from a number of social and environmental factors, the Babylonian civilisation began to dominate the region. Examples of Babylonian Medicine include the extensive Babylonian medical text, the Diagnostic Handbook, written by the ummânū, or chief scholar, Esagil-kin-apli of Borsippa, in the middle of the 11th century BCE during the reign of the Babylonian king Adad-apla-iddina (1069–1046 BCE). This medical treatise devoted great attention to the practice of diagnosis, prognosis, physical examination, and remedies. The text contains a list of medical symptoms and often detailed empirical observations along with logical rules used in combining observed symptoms on the body of a patient with their diagnosis and prognosis. Here, clearly developed rationales were developed to understand the causes of disease and injury, supported by theories, agreed upon at the time, of elements we might now understand as natural causes, supernatural magic and religious explanations.
Most known and recovered artefacts from the ancient Mesopotamian civilisations centre on the neo-Assyrian (c. 900 – 600 BCE) and neo-Babylonian (c. 600 – 500 BCE) periods, as the last empires ruled by native Mesopotamian rulers. These discoveries include a huge array of medical clay tablets from this period, although damage to the clay documents creates large gaps in our understanding of medical practices. Throughout the civilisations of Mesopotamia there are a wide range of medical innovations, including evidenced practices of prophylaxis, measures to prevent the spread of disease, accounts of stroke, and an awareness of mental illnesses.
Ancient Egyptian medicine
Ancient Egypt, a civilisation spanning the valley of the river Nile (throughout parts of present-day Egypt, Sudan, and South Sudan), existed from its unification in c. 3150 BCE to its collapse via Persian conquest in 525 BCE and ultimate downfall from the conquest of Alexander the Great in 332 BCE.
Ancient Egyptians developed a complex, experimental, and communicative medical tradition that has been uncovered through surviving documents, most made of papyrus, such as the Kahun Gynaecological Papyrus, the Edwin Smith Papyrus, the Ebers Papyrus, the London Medical Papyrus, to the Greek Magical Papyri. Herodotus described the Egyptians as "the healthiest of all men, next to the Libyans", because of the dry climate and the notable public health system that they possessed. According to him, "the practice of medicine is so specialized among them that each physician is a healer of one disease and no more." Although Egyptian medicine, to a considerable extent, dealt with the supernatural, it eventually developed a practical use in the fields of anatomy, public health, and clinical diagnostics.
Medical information in the Edwin Smith Papyrus may date to a time as early as 3000 BCE. Imhotep in the 3rd dynasty is sometimes credited with being the founder of ancient Egyptian medicine and with being the original author of the Edwin Smith Papyrus, detailing cures, ailments and anatomical observations. This papyrus is regarded as a copy of several earlier works and was written c. 1600 BCE. It is an ancient textbook on surgery almost completely devoid of magical thinking and describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments. The Kahun Gynaecological Papyrus treats women's complaints, including problems with conception. Thirty-four cases detailing diagnosis and treatment survive, although some of them are mere fragments. Dating to 1800 BCE, it is the oldest surviving medical text of any kind. Medical institutions, referred to as Houses of Life, are known to have been established in ancient Egypt as early as 2200 BCE. The Ebers Papyrus is the oldest written text mentioning enemas. Many medications were administered by enemas and one of the many types of medical specialists was an Iri, the Shepherd of the Anus. The earliest known physician is also credited to ancient Egypt: Hesy-Ra, "Chief of Dentists and Physicians" for King Djoser in the 27th century BCE. Also, the earliest known woman physician, Peseshet, practiced in Ancient Egypt at the time of the 4th dynasty. Her title was "Lady Overseer of the Lady Physicians."
Ancient Chinese medicine
Medical and healing practices in early Chinese dynasties were heavily shaped by the practice of traditional Chinese medicine (TCM). Starting around the Zhou dynasty, parts of this system were being developed and are demonstrated in early writings on herbs in Classic of Changes (Yi Jing) and Classic of Poetry (Shi Jing). China also developed a large body of traditional medicine. Much of the philosophy of traditional Chinese medicine derived from empirical observations of disease and illness by Taoist physicians and reflects the classical Chinese belief that individual human experiences express causative principles effective in the environment at all scales. These causative principles, whether material, essential, or mystical, correlate as the expression of the natural order of the universe. The foundational text of Chinese medicine is the Huangdi Neijing, (or Yellow Emperor's Inner Canon), written 5th century to 3rd century BCE. Near the end of the 2nd century CE, during the Han dynasty, Zhang Zhongjing, wrote a Treatise on Cold Damage, which contains the earliest known reference to the Neijing Suwen. The Jin dynasty practitioner and advocate of acupuncture and moxibustion, Huangfu Mi (215–282), also quotes the Yellow Emperor in his Jiayi jing, c. 265. During the Tang dynasty, the Suwen was expanded and revised and is now the best extant representation of the foundational roots of traditional Chinese medicine. Traditional Chinese medicine that is based on the use of herbal medicine, acupuncture, massage and other forms of therapy has been practiced in China for thousands of years. Critics say that TCM theory and practice have no basis in modern science, and TCM practitioners do not agree on what diagnosis and treatments should be used for any given person. A 2007 editorial in the journal Nature wrote that TCM "remains poorly researched and supported, and most of its treatments have no logical mechanism of action." It also described TCM as "fraught with pseudoscience". A review of the literature in 2008 found that scientists are "still unable to find a shred of evidence" according to standards of science-based medicine for traditional Chinese concepts such as qi, meridians, and acupuncture points, and that the traditional principles of acupuncture are deeply flawed. There are concerns over a number of potentially toxic plants, animal parts, and mineral Chinese compounds, as well as the facilitation of disease. Trafficked and farm-raised animals used in TCM are a source of several fatal zoonotic diseases. There are additional concerns over the illegal trade and transport of endangered species including rhinoceroses and tigers, and the welfare of specially farmed animals, including bears.
Ancient Indian medicine
The Atharvaveda, a sacred text of Hinduism dating from the middle Vedic age (c. 1200–900 BCE), is one of the first Indian texts dealing with medicine. It is a text filled with magical charms, spells, and incantations used for various purposes, such as protection against demons, rekindling love, ensuring childbirth, and achieving success in battle, trade, and even gambling. It also includes numerous charms aimed at curing diseases and several remedies from medicinal herbs, overall making it a key source of medical knowledge during the Vedic period. The use of herbs to treat ailments would later form a large part of Ayurveda. Ayurveda, meaning the "complete knowledge for long life" is another medical system of India. Its two most famous texts (samhitas) belong to the schools of Charaka and Sushruta. The Samhitas represent later revised versions (recensions) of their original works. The earliest foundations of Ayurveda were built on a synthesis of traditional herbal practices together with a massive addition of theoretical conceptualizations, new nosologies and new therapies dating from about 600 BCE onwards, and coming out of the communities of thinkers which included the Buddha and others. According to the compendium of Charaka, the Charakasamhitā, health and disease are not predetermined and life may be prolonged by human effort. The compendium of Sushruta, the Sushruta Samhita, defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Sushruta Samhita is notable for describing procedures on forms of surgery, including rhinoplasty, the repair of torn ear lobes, perineal lithotomy, cataract surgery, and other excisions and surgical procedures. Susruta also described more than 125 surgical instruments in detail. Sushruta had a penchant for scientific classification: his medical treatise consists of 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to aging and mental illness. The Ayurvedic classics mention eight branches of medicine: kāyācikitsā (internal medicine), śalyacikitsā (surgery including anatomy), śālākyacikitsā (eye, ear, nose, and throat diseases), kaumārabhṛtya (pediatrics with obstetrics and gynaecology), bhūtavidyā (spirit and psychiatric medicine), agada tantra (toxicology with treatments of stings and bites), rasāyana (science of rejuvenation), and vājīkaraṇa (aphrodisiac and fertility). Apart from learning these, the student of Āyurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis. The teaching of various subjects was done during the instruction of relevant clinical subjects. For example, the teaching of anatomy was a part of the teaching of surgery, embryology was a part of training in pediatrics and obstetrics, and the knowledge of physiology and pathology was interwoven in the teaching of all the clinical disciplines. Even today Ayurvedic treatment is practiced, but it is considered pseudoscientific, some ayurvedic medicines have been found to contain toxic substances. Both the lack of scientific soundness in the theoretical foundations of ayurveda and the quality of research have been criticized.
Ancient Greek medicine
Humors The theory of humors was derived from ancient medical works, dominated Western medicine until the 19th century, and is credited to Greek philosopher and surgeon Galen of Pergamon (129 – c. 216 CE). In Greek medicine, there are thought to be four humors, or bodily fluids that are linked to illness: blood, phlegm, yellow bile, and black bile. Early scientists believed that food is digested into blood, muscle, and bones, while the humors that were not blood were then formed by indigestible materials that are left over. An excess or shortage of any one of the four humors is theorized to cause an imbalance that results in sickness; the aforementioned statement was hypothesized by sources before Hippocrates. Hippocrates (c. 400 BCE) deduced that the four seasons of the year and four ages of man that affect the body in relation to the humors. The four ages of man are childhood, youth, prime age, and old age. Black bile is associated with autumn, phlegm with winter, blood with spring, and yellow bile with summer. In De temperamentis, Galen linked what he called temperaments, or personality characteristics, to a person's natural mixture of humors. He also said that the best place to check the balance of temperaments was in the palm of the hand. A person that is considered to be phlegmatic is said to be an introvert, even-tempered, calm, and peaceful. This person would have an excess of phlegm, which is described as a viscous substance or mucous. Similarly, a melancholic temperament related to being moody, anxious, depressed, introverted, and pessimistic. A melancholic temperament is caused by an excess of black bile, which is sedimentary and dark in colour. Being extroverted, talkative, easygoing, carefree, and sociable coincides with a sanguine temperament, which is linked to too much blood. Finally, a choleric temperament is related to too much yellow bile, which is actually red in colour and has the texture of foam; it is associated with being aggressive, excitable, impulsive, and also extroverted. There are numerous ways to treat a disproportion of the humors. For example, if someone was suspected to have too much blood, then the physician would perform bloodletting as a treatment. Likewise, if a person believed to have too much phlegm should feel better after expectorating, and someone with too much yellow bile would purge. Another factor to be considered in the balance of humors is the quality of air where one resides, such as the climate and elevation. Also, the standard of food and drink, balance of sleeping and waking, exercise and rest, retention and evacuation are important. Moods such as anger, sadness, joy, and love can affect the balance. During that time, the importance of balance was demonstrated by the fact that women lose blood monthly during menstruation, and have a lesser occurrence of gout, arthritis, and epilepsy than men do. Galen also hypothesized that there are three faculties. The natural faculty affects growth and reproduction and is produced in the liver. Animal or vital faculty controls respiration and emotion, coming from the heart. In the brain, the psychic faculty commands the senses and thoughts. The structure of bodily functions is related to the humors as well. Greek physicians understood that food was cooked in the stomach; this is where the nutrients are extracted. The best, most potent and pure nutrients from food are reserved for blood, which is produced in the liver and carried through veins to organs. Blood enhanced with pneuma, which means wind or breath, is carried by the arteries. The path that blood take is as follows: venous blood passes through the vena cava and is moved into the right ventricle of the heart; then, the pulmonary artery takes it to the lungs. Later, the pulmonary vein then mixes air from the lungs with blood to form arterial blood, which has different observable characteristics. After leaving the liver, half of the yellow bile that is produced travels to the blood, while the other half travels to the gallbladder. Similarly, half of the black bile produced gets mixed in with blood, and the other half is used by the spleen.
People Around 800 BCE Homer in the Iliad gives descriptions of wound treatment by the two sons of Asklepios, the admirable physicians Podaleirius and Machaon and one acting doctor, Patroclus. Because Machaon is wounded and Podaleirius is in combat Eurypylus asks Patroclus to "cut out the arrow-head, and wash the dark blood from my thigh with warm water, and sprinkle soothing herbs with power to heal on my wound". Asklepios, like Imhotep, came to be associated as a god of healing over time.
Temples dedicated to the healer-god Asclepius, known as Asclepieia (Ancient Greek: Ἀσκληπιεῖα, sing. Ἀσκληπιεῖον, Asclepieion), functioned as centers of medical advice, prognosis, and healing. At these shrines, patients would enter a dream-like state of induced sleep known as enkoimesis (ἐγκοίμησις) not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery. Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing. In the Asclepeion of Epidaurus, three large marble boards dated to 350 BCE preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium. Alcmaeon of Croton wrote on medicine between 500 and 450 BCE. He argued that channels linked the sensory organs to the brain, and it is possible that he discovered one type of channel, the optic nerves, by dissection. Hippocrates of Kos (c. 460 – c. 370 BCE), considered the "father of modern medicine." The Hippocratic Corpus is a collection of around seventy early medical works from ancient Greece strongly associated with Hippocrates and his students. Most famously, the Hippocratics invented the Hippocratic Oath for physicians. Contemporary physicians swear an oath of office which includes aspects found in early editions of the Hippocratic Oath. Hippocrates and his followers were first to describe many diseases and medical conditions. Though humorism (humoralism) as a medical system predates 5th-century Greek medicine, Hippocrates and his students systematized the thinking that illness can be explained by an imbalance of blood, phlegm, black bile, and yellow bile. Hippocrates is given credit for the first description of clubbing of the fingers, an important diagnostic sign in chronic suppurative lung disease, lung cancer and cyanotic heart disease. For this reason, clubbed fingers are sometimes referred to as "Hippocratic fingers". Hippocrates was also the first physician to describe the Hippocratic face in Prognosis. Shakespeare famously alludes to this description when writing of Falstaff's death in Act II, Scene iii. of Henry V. Hippocrates began to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence."
The Greek Galen (c. 129–216 CE) was one of the greatest physicians of the ancient world, as his theories dominated all medical studies for nearly 1500 years. His theories and experimentation laid the foundation for modern medicine surrounding the heart and blood. Galen's influence and innovations in medicine can be attributed to the experiments he conducted, which were unlike any other medical experiments of his time. Galen strongly believed that medical dissection was one of the essential procedures in truly understanding medicine. He began to dissect different animals that were anatomically similar to humans, which allowed him to learn more about the internal organs and extrapolate the surgical studies to the human body. In addition, he performed many audacious operations—including brain and eye surgeries—that were not tried again for almost two millennia. Through the dissections and surgical procedures, Galen concluded that blood is able to circulate throughout the human body, and the heart is most similar to the human soul. In Ars medica ("Arts of Medicine"), he further explains the mental properties in terms of specific mixtures of the bodily organs. While much of his work surrounded the physical anatomy, he also worked heavily in humoral physiology. Galen's medical work was regarded as authoritative until well into the Middle Ages. He left a physiological model of the human body that became the mainstay of the medieval physician's university anatomy curriculum. Although he attempted to extrapolate the animal dissections towards the model of the human body, some of Galen's theories were incorrect. This caused his model to suffer greatly from stasis and intellectual stagnation. Greek and Roman taboos caused dissection of the human body to usually be banned in ancient times, but in the Middle Ages it changed. In 1523 Galen's On the Natural Faculties was published in London. In the 1530s Belgian anatomist and physician Andreas Vesalius launched a project to translate many of Galen's Greek texts into Latin. Vesalius's most famous work, De humani corporis fabrica was greatly influenced by Galenic writing and form.
Herophilus and Erasistratus
Two great Alexandrians laid the foundations for the scientific study of anatomy and physiology, Herophilus of Chalcedon and Erasistratus of Ceos. Other Alexandrian surgeons gave us ligature (hemostasis), lithotomy, hernia operations, ophthalmic surgery, plastic surgery, methods of reduction of dislocations and fractures, tracheotomy, and mandrake as an anaesthetic. Some of what we know of them comes from Celsus and Galen of Pergamum. Herophilus of Chalcedon, the renowned Alexandrian physician, was one of the pioneers of human anatomy. Though his knowledge of the anatomical structure of the human body was vast, he specialized in the aspects of neural anatomy. Thus, his experimentation was centered around the anatomical composition of the blood-vascular system and the pulsations that can be analyzed from the system. Furthermore, the surgical experimentation he administered caused him to become very prominent throughout the field of medicine, as he was one of the first physicians to initiate the exploration and dissection of the human body. The banned practice of human dissection was lifted during his time within the scholastic community. This brief moment in the history of Greek medicine allowed him to further study the brain, which he believed was the core of the nervous system. He also distinguished between veins and arteries, noting that the latter pulse and the former do not. Thus, while working at the medical school of Alexandria, Herophilus placed intelligence in the brain based on his surgical exploration of the body, and he connected the nervous system to motion and sensation. In addition, he and his contemporary, Erasistratus of Chios, continued to research the role of veins and nerves. After conducting extensive research, the two Alexandrians mapped out the course of the veins and nerves across the human body. Erasistratus connected the increased complexity of the surface of the human brain compared to other animals to its superior intelligence. He sometimes employed experiments to further his research, at one time repeatedly weighing a caged bird, and noting its weight loss between feeding times. In Erasistratus' physiology, air enters the body, is then drawn by the lungs into the heart, where it is transformed into vital spirit, and is then pumped by the arteries throughout the body. Some of this vital spirit reaches the brain, where it is transformed into animal spirit, which is then distributed by the nerves.
Ancient Roman medicine
The Romans invented numerous surgical instruments, including the first instruments unique to women, as well as the surgical uses of forceps, scalpels, cautery, cross-bladed scissors, the surgical needle, the sound, and speculas. Romans also performed cataract surgery. The Roman army physician Dioscorides (c. 40–90 CE), was a Greek botanist and pharmacologist. He wrote the encyclopedia De materia medica describing over 600 herbal cures, forming an influential pharmacopoeia which was used extensively for the following 1,500 years. Early Christians in the Roman Empire incorporated medicine into their theology, ritual practices, and metaphors.
Post-classical medicine
Middle East
Places
Byzantine medicine
Byzantine medicine encompasses the common medical practices of the Byzantine Empire from about 400 CE to 1453 CE. Byzantine medicine was notable for building upon the knowledge base developed by its Greco-Roman predecessors. In preserving medical practices from antiquity, Byzantine medicine influenced Islamic medicine as well as fostering the Western rebirth of medicine during the Renaissance. Byzantine physicians often compiled and standardized medical knowledge into textbooks. Their records tended to include both diagnostic explanations and technical drawings. The Medical Compendium in Seven Books, written by the leading physician Paul of Aegina, survived as a particularly thorough source of medical knowledge. This compendium, written in the late seventh century, remained in use as a standard textbook for the following 800 years. Late antiquity ushered in a revolution in medical science, and historical records often mention civilian hospitals (although battlefield medicine and wartime triage were recorded well before Imperial Rome). Constantinople stood out as a center of medicine during the Middle Ages, which was aided by its crossroads location, wealth, and accumulated knowledge. The first ever known example of separating conjoined twins occurred in the Byzantine Empire in the 10th century. The next example of separating conjoined twins would be recorded many centuries later in Germany in 1689. The Byzantine Empire's neighbors, the Persian Sassanid Empire, also made their noteworthy contributions mainly with the establishment of the Academy of Gondeshapur, which was "the most important medical center of the ancient world during the 6th and 7th centuries." In addition, Cyril Elgood, British physician and a historian of medicine in Persia, commented that thanks to medical centers like the Academy of Gondeshapur, "to a very large extent, the credit for the whole hospital system must be given to Persia."
Islamic medicine
The Muslim world rose to primacy in medical science as its physicians contributed significantly to the field of medicine, including anatomy, ophthalmology, pharmacology, pharmacy, physiology, and surgery. Islamic civilization's contribution was a process that took hundreds of years. During the Umayyad Caliphate (661–750 CE), these fields were in their very early stages of development, and little progress was made. One reason for limited advancement in medicine was the Caliphate's focus on expansion after the death of Muhammad (632 CE). The focus on expansionism redirected resources from other fields, such as medicine.
Islamic medicine grew significantly when the Abbasid Caliphate (750–1258 CE) overthrew the Umayyad Caliphate in 750 CE. This change in dynasty served as a turning point towards scientific and medical developments. A large contributor to this was that, under Abbasid rule, much of the Greek legacy was transmitted into Arabic which by then, was the main language of Islamic peoples. Many Islamic physicians were heavily influenced by the works of Greek scholars of Alexandria and Egypt and were able to expand on those texts to produce new medical knowledge. This period of time is known as the Islamic Golden Age where there was development and flourishment of technology, commerce and sciences, including medicine. The creation of the first Islamic Hospital in 805 CE by the Abbasid caliph Harun al-Rashid in Baghdad was a significant development. This hospital provided educational opportunities for Islamic physicians.
Muslims were influenced by ancient Indian, Persian, Greek, Roman and Byzantine medical practices, and helped them to develop it further. Galen & Hippocrates were pre-eminent authorities. The translation of 129 of Galen's works into Arabic by the Nestorian Christian Hunayn ibn Ishaq and his assistants, and in particular Galen's insistence on a rational systematic approach to medicine, set the template for Islamic medicine, which spread throughout the Arab Empire. Its most famous physicians included the Persian polymaths Abu Bakr al-Razi and Avicenna, who wrote more than 40 works on health, medicine, and well-being. Taking leads from Greece and Rome, Islamic scholars kept medicine moving forward. Persian polymath Avicenna has been called the "father of medicine" and wrote The Canon of Medicine which became a standard medical text in medieval European universities, considered one of the most famous books in the history of medicine. The Canon of Medicine presents an overview of medicine in the medieval Islamic world, which had been influenced by earlier traditions including Greco-Roman medicine, Al-Rāzi was one of the first to question the Greek theory of humorism, which nevertheless remained influential in medieval Western and Islamic medicine. Some volumes of al-Rāzi's work Al-Mansuri, namely "On Surgery" and "A General Book on Therapy", became part of the medical curriculum in European universities. He has been described as a doctor's doctor, the father of pediatrics, and a pioneer of ophthalmology. In addition to contributions to understanding human anatomy, Islamic physicians played a role in the development of the modern hospital system. During the Safavid Empire (16th–18th centuries) in Iran and the Mughal Empire (16th–19th centuries) in India, Muslim scholars transformed the institution of the hospital, creating an environment in which developing medical knowledge could be passed among students and teachers from a range of cultures. There were two main schools of thought with patient care. These included humoral physiology from the Persians and Ayurvedic practice. After these theories were translated from Sanskrit to Persian and vice-versa, hospitals could have a mix of culture and techniques. Hospitals became increasingly common as wealthy patrons commonly founded them. Many features still in use today, such as emphasis on hygiene, a staff dedicated to the care of patients, and separation of individual patients were developed in Islamic hospitals before they came into practice in Europe. The patient care aspect of hospitals in Europe had then not taken effect. European hospitals were places of religion rather than science. As was the case with much of the scientific work done by Islamic scholars, many of these novel developments in medical practice were transmitted to European cultures, after they had long been used throughout the Islamic world. Although Islamic scientists were responsible for discovering much of the knowledge that allows the hospital system to function safely today, European scholars who built on this work still receive the majority of the credit. Before the development of scientific medical practices in the Islamic empires, medical care was mainly performed by religious figures such as priests. Without an understanding of how infectious diseases worked and why sickness spread from person to person, these early attempts at caring for the ill and injured often did harm. With the development of new and safer practices by scholars and physicians in hospitals of the Islamic world, ideas vital for the effective care of patients were developed, learned, and transmitted. Hospitals developed concepts and structures, still used today: separate wards for male and female patients, pharmacies, medical record-keeping, and personal and institutional sanitation and hygiene. Much of this knowledge was recorded and passed on through Islamic medical texts, many of which were carried to Europe and translated for the use of European medical workers. The Tasrif, written by surgeon Abu Al-Qasim Al-Zahrawi, was translated into Latin; it became one of the most important medical texts in European universities during the Middle Ages and contained useful information on surgical techniques and spread of bacterial infection. The hospital was a typical institution included in most Muslim cities, and although they were often physically attached to religious institutions, they were not themselves places of religious practice. Islamic hospitals, along with observatories used for astronomical science, were some of the most important points of exchange for the spread of scientific knowledge.
Europe
After 400 CE, the study and practice of medicine in the Western Roman Empire went into deep decline. Medical services were provided, especially for the poor, in the thousands of monastic hospitals that sprang up across Europe, but the care was rudimentary and mainly palliative. Most of the writings of Galen and Hippocrates were lost to the West, with the summaries and compendia of St. Isidore of Seville being the primary channel for transmitting Greek medical ideas. The Carolingian Renaissance brought increased contact with Byzantium and a greater awareness of ancient medicine, but only with the Renaissance of the 12th century and the new translations coming from Muslim and Jewish sources in Spain, and the fifteenth-century flood of resources after the fall of Constantinople did the West fully recover its acquaintance with classical antiquity. The Carolingian Renaissance served as a starting point for incorporating ancient medicine into the early Middle Ages. One work which stands out in the historical timeline is the Lorscher Arzneibuch, a product of the scriptorium at the Lorsch monastery, copied between 784 through the early 9th century. To bolster confidence in medicine, the author of this apologetic work reasoned that medicines were created from earth materials, and that some of these materials, such as balm, were mentioned in Scripture. This example of borrowing late antique texts was part of how the Carolingian Empir