History of nursing/Antiquity

The care of humanity in the ancient period varies by location. We describe nursing in the following areas: Egypt, India, China, Greece and Rome.

= Egypt = The idea of ​​healing and treating the sick can be formed from the ancient papyri, which are the most valuable source of the knowledge of the ancient Egyptians:

Cahun papyrus
It dates back to 1900 BC and is currently housed at University College London. It was discovered by Sir William Mathew Flinders Petrie in 1889 in poor condition in the ruins of the Pharaoh's palace at Kahun. It is a comprehensive document dealing with women's diseases, it describes methods for determining pregnancy, determining the sex of the fetus. There is also a veterinary section.

The Smith Papyrus
It is deposited in the New York Academy of Medicine. It was acquired in 1862 by the young American Egyptologist Edwin Smith. This papyrus is said to come from the same tomb in the Theban necropolis as the Ebers papyrus and dates to the beginning of the 18th dynasty. It is a copy of an older papyrus, as the grammatical arrangement of the text indicates. The total length is 4.68 m, the width is 33 cm and it has 12 leaves. It dates back to about 1700 BC. However, its origin is considerably older, it is believed that the found document is a copy and the original comes from Imhotep, a prominent physician. This papyrus is a traumatology textbook and discusses the surgical care of injuries to the head, nose, chin, ears, lips, bones and spine. Each observation of the patient is based on a precise and unchanging plan: clinical description, determination of the final diagnosis, expression in terms of prognosis and recommended method of treatment.

Papyrus of Ebers
It dates back to 1500 BC. It was discovered in 1862 in Thebes by George Ebers (1837–1898), who bought it from an Egyptian. The papyrus is 20 meters long, 30 cm wide, and contains 108 pages of 20-22 lines. The text is dated to the 9th year of the reign of King Amenhotep I (approximately 1550 BC). It is safe to say that it is a copy of an older work from the Old Kingdom period. It contains 875 diverse recipes in no logical order. It discusses children's, skin, ear, eye, and women's diseases. There are also texts of prayers to ward off evil spirits, causing possession and the first mentions of mental disorders. It is the most insignificant and longest papyrus, stored today in the library of the University of Leipzig. This papyrus mentions the care of the mentally ill, who were cared for in the temples with various exercises, walks in beautiful gardens, the sick also took part in rides on the Nile. Listening to music, dancing, and entertainment were also common.

Other papyri
There are other medical papyri - the London Papyrus, the Berlin Papyrus, the Leyden Witchcraft Papyrus (magic formulae) and others.ry

Characteristics of care in Egypt
According to preserved documents, there were doctors in the Old Kingdom - physicists who received their education at medical schools. The treatment and care of the sick consisted in the administration of diuretics, laxatives, and medicines against intestinal parasites. Cosmetic ointments were applied. In the Egyptian pharmacy, there were medicines that are still used today - wormwood, poppy seeds, castor oil, animal fats, etc. Suppositories were also applied, bowel and vaginal lavages were performed, fumigants were widely used. E.g. it was smoked at the time of childbirth to strengthen the mother's uterine contractions. The women sat on a pot in which a certain remedy was heated. The doctors prepared the medicines themselves. No nurses assisted the doctors (the literature does not yet document their existence), but there are evidence of "bandagers", wound healers, masseuses, and lay healers.

Caring for a woman in labor
Wealthy women gave birth in a large temple, where they were entrusted to the care of a priestess. She had the role of midwife. Women gave birth squatting on bricks, which were used as a primitive maternity bed. Hippopotamus dung was smoked to induce labor. Various cultic and magical rites were performed during childbirth. The papyrus does not mention births. Probably because he wasn't a doctor's business. It was considered a normal part of human life and a doctor did not have to assist with it. Several midwives were present at the birth. Usually three or four women were present to help the mother. In various depictions, the baby during birth is shown with its head down and its upper limbs extended. There is no information about ligation of the umbilical cord in the Egyptian literature. The placenta was sometimes kept in a dried state until the death of the individual.

Only some midwives were professionally educated and had the necessary knowledge and skills to successfully manage childbirth. This occupation was impure and not highly valued. That is why we lack obstetricians among doctors in ancient times. They were invited to births only in case of complications. Whether the newborn would die or not was judged by the strength of the cry and facial expression. Great care was given to breastfeeding. Noble ladies in particular had several nurseries at their disposal.

Children were highly valued in Egypt, they were considered a gift from God. Nurses and educators also took care of the children.

Wound healing
The Egyptians contributed to mechanical methods of wound healing. Splints were used to immobilize the injured limb and thus prevent further damage. They also tried to bring the edges of the wound closer to each other and sew them together with a needle and thread, fix them together with cloaca and strips of cotton fabric (primitive Steristrip). They also "stitched" the wounds with the help of giant ants. In this case, the ant applied to the wound, the edges of which were drawn to each other, and when the ant bit, the body was twisted. Several physician assistants are attested to tending to the wounded on construction sites—applying splints to broken limbs, treating scorpion bites, moving around construction sites, and intervening when needed. Lighter injuries - a bandage made of fresh meat was applied on the first day and a bandage made of a mixture of lard, honey and herbal tampons on the following days. Injuries to the supraorbital arch were sutured with linen thread or fine tapes made from animal intestines. Fractures and dislocations were treated as they are today: first set and then immobilized with wooden splints and bandages.

Social customs in Egypt
The clothing of the Egyptians was simple. Due to the warm weather, it was not of particular importance. The common people ate 3 times a day. Pork was not eaten. This was considered impure. Otherwise, the diet was varied and balanced. Fish, poultry, but also goat meat were popular. Advanced beekeeping dates back to at least 4500 BC. In addition to honey, figs, dates, and raisins were also used as sweeteners. Sugarcane was cultivated in India in prehistoric times, and sugar began to be refined in Venice in the 15th century. Honey was the most important sweetener in all ancient civilizations.

Hygienic care
Some households had bathrooms and flush toilets. However, sewage from the houses flowed in the middle of the street. Hygienic regulations were observed in Egypt and the inhabitants took good care of their bodies. They washed twice a day and before meals. They didn't know soap. They cleaned their skin with oil or sand and smeared it with ointments. Most common Egyptians have never known a bathroom. They cleaned their teeth with wooden sticks and chewed balls of myrrh. In this way, bad breath was removed. They wore their hair short to prevent insects from settling in it. The Egyptians painted them with perfumed ointments and oils. Women's cosmetics represented a high degree of perfection. Recipes against hair loss were also known. The Egyptians used wooden brushes to clean their teeth.

The decline of care for the sick
With the advent of the New Empire, the prosperous slave society declines and the primitive scientific component disappears in the care of the sick, replaced by superstitions, belief in supernatural forces and demons. Doctors - physicists are replaced by priests - spellcasters. Exorcism takes its place. The administration of medicines containing animal feces is also documented. In Egypt, there was an idea that diseases are caused by another being (demon, spirit, worm) that enters the human body. With the help of these "medicines" (however absurd it may seem to us from our point of view) an aversion to the human body was to be induced and the being was to leave the human body.

Note: Imhotep (around 2900 BC) represents an important figure in Egyptian history. He worked as a doctor, war surgeon, court minister of Pharaoh Djoser, and as an architect. He is the author of the stepped pyramid in Saqqara. Later he was promoted to the god of medicine, he was called the physician of gods and men.

= India = In the Indus River basin around the middle of the 3rd millennium BC. the oldest advanced civilization called Harappan (according to the site of Harappa) arose. We know about healing and caring for the sick from books called the Vedas - books of knowledge. E.g. Ayurveda was a book about long life. It mentions how to heal and how to maintain health. Anatomical knowledge at the time was poor, although dissection was permitted. Autopsies were performed by maceration, i.e. dead bodies were soaked in running water and decomposition and the maceration process were described. The care of the sick was closely linked to religion.

Causes of diseases
Human life was conditioned by the existence of three substances - air, blood, mucus. Their disturbed balance causes physical illness. It also arises as a consequence of sins committed in an earlier life.

Mental illness
They were caused by supernatural forces - evil spirits and demons who, when angered, enter a person's body to possess their mind. The care of the patient consisted in the application of various plants (garlic, fennel, ginger, hemp) or mineral substances (alum, iron sulphide). About 700 medicinal preparations were known in the form of decoctions, poultices, ointments, enemas...

Surgical care
Surgery was indeed of a high standard in ancient India. From this time we know amputations, plastic surgery of ears, lips, and nose. The Indians introduced caesarean section and obstetrical turns of the fetus. The surgical instruments received considerable perfection, there were about 120 of them – probes, trocars, scalpels, magnets for removing metal bodies.

Hygiene
In India, the cleanliness of vessels, bodies, and teeth were cleaned with special brushes and powders. According to the law, leftover food and other impurities had to be taken away from the dwellings. These rules were fully binding, especially for members of the upper classes. Emphasis was also placed on the right lifestyle. Exercise that prevented obesity was preferred. In the same way, many diseases were prevented by proper nutrition.

In the collection of medical knowledge, there is a mention: "The doctor, the medicine, the nurse, the patient are four agents, if the treatment is to be successful, each must have four qualities: the nurse must be devoted, clean, skilled, educated..."

= China = In the third millennium BC, the first state entity with a developed culture began to form even on the territory of China in the basin of the Chuang-che River. The influence of cultism did not play a significant role, so it did not greatly affect the care of the sick in ancient China. This was based on natural healing and the use of medicinal plants. Anatomical findings were quite poor, autopsies were not performed. Priests were called to treat and heal the sick, because only they know the mysterious wishes of the gods and are mediators between them and man.

Diseases arise when these two principles are in disharmony. When yang predominated, disease arose from increased organ function. Due to the predominance of yin, the disease arose from the reduced function of the body's organs. The treatment was also based on this - fever was treated with cooling.
 * The Chinese recognized two principle
 * yin, the feminine principle – death, darkness, weakness, cold, softness
 * yang, male principle – life, sun, sky, light, strength, heat, hardness

Palpation of the pulse was a peculiar examination method. The Chinese knew and recognized more than 150 types of pulse, each specific to a certain disease. The tongue and all body openings (mouth, nose, ears) were also important for establishing the diagnosis.

The care of the sick consisted in administration
 * herbal medicines - laxatives, emetics...
 * mineral drugs - arsenic, iron... ...

A special method was acupuncture, i.e. inserting needles into vital points of the body. There were 360 ​​of them. After injecting into these points, the defect in the flow of energy through the body was supposed to be removed. Moxa (moxibustion) is the burning of the patient's body with burning twigs of medicinal plants and herbs. The first prophylactic intervention was introduced - rubbing powder from smallpox scabs into the noses of healthy children.

Strict hygiene rules in ancient China were based on the fact that disease enters the body through the mouth. The rules imposed regularity in work, rest, sleep, food. Moderation was recommended in all. According to the opinions of this time, a person was responsible for his health not only to himself, but also to the whole society.

= Greece = Care of the sick in the period of ancient Greece had a considerable influence on the development of treatment and nursing in European countries. The peak period of care for the sick can be recorded in the period 5-3. century BC The roots of caring for the sick are largely rooted in rich Greek mythology.

Asklepios
Asclepius (12th century BC) was considered the god of medicine. He could cure all diseases and raise the dead, and since no one was dying, Zeus killed him with a lightning bolt. In myth, he was associated with the god Apollo, who gave his son Asclepius to be raised by the Centaur Cheiron, from whom Asclepius learned the art of medicine. Asclepius' sons Machaon and Podaleiris were famous physicians of the Achaeans before Troy. His daughter was the goddess of health Hygieia. His daughters Hygieia, Meditrine and Panakeia symbolized the different aspects of health: purity, healing and healing. The son of Telesforos represented the powers of healing.

He is usually depicted as a bearded man with a dog and a staff wrapped around a snake. One snake symbolizes one path to healing. This symbol can still be found today at doctors, pharmacies and hospitals.

Asklepios established shelters for the sick - asklepions - at some temples. Here the sick were treated. Upon arrival, the sick person was bathed, anointed, then he could enter the long colonnade called the abaton. Careful attention was paid to sleep, baths, body massages, physical exercises. The patients also followed a diet. Attention was paid to psychological treatment, which consisted of listening to songs or attending a theater performance. Theaters were also part of the temples. Asklepiones were built in beautiful nature, where there were natural water springs. The care was therefore more reminiscent of balneological care.

Nursing the sick was in the hands of privileged priests. It consisted in a suggestive effect on the sick, who were supposed to believe in the healing power of Asklepios. Asklepios appeared in dreams to the sick during their sleep. He either healed the sick or gave him advice on what to do to get rid of his ailments.

Hippocrates
Hippocrates (460–377 BC) was the greatest physician of ancient Greek culture and the founder of scientific medicine. He was born on the island of Kos. He lived at a time when science and art flourished in Ancient Greece. There is a decline in the influence of the cult in medicine. The progress of scientific medical thought finds support in two schools existing on the island of Kos and Knidos. The Knid school preferred to focus attention only on the disease, it did not pay attention to the person. It was less successful than Kósk. Hippocrates left school in Kos. His father, Heraclitus, taught the art of medicine here. Fenaret's mother was a midwife.

With his conception of medicine, he rejected mystical, religious and non-scientific ideas about man and health. He did not look for the cause in supernatural forces, but in internal – humoral conditions. human life and in external conditions – in the influences of the environment. He emphasized correct diagnosis, individual treatment and an individual approach to the patient. The whole person needs to be treated, not just the disease. According to Hippocrates, four basic juices operate in the body - phlegm, blood, yellow bile, black bile, which determine a person's temperament. The juices are constantly replenished with food. It must be in balance both qualitatively and quantitatively. When they are out of balance and flood the brain, mental and other disorders arise. The care of the patient then consists in removing the excess amount of juice, which consisted of injecting it into a vein, administering laxatives or purgative preparations. Laxatives included watermelon, cabbage, castor. Diuretics included parsley, fennel, celery, asparagus, garlic, onions. Soporific substances were roll, mandrake, dried poppy juice (opium = Greek juice). In addition, opium was used in smoke ceremonies in temples, but also as an intoxicant during orgies and drinking parties.

Soporific substances were roll, mandrake, dried poppy juice (opium = Greek juice). In addition, opium was used in smoke ceremonies in temples, but also as an intoxicant during orgies and drinking parties.

Galenos (a Greek physician working in Rome) later considered opium to be the most powerful medicine, but it could pose a significant danger to the patient. Can cause death in overdose. Another treatment he preferred was exercise, swinging on a hanging bed and walking - all of which helped to calm the mind.

Hippocrates described delirious states and memory disorders during tuberculosis, malaria, dysentery. Other ways of caring for the sick were the use of warm wraps, which were supposed to induce sweating. Wraps were prepared from barley flour with wine and oil.

After the death of Hippocrates, there was stagnation in the state for about 300 years, but also in medicine and the care of the sick. Medicine was exclusively practiced by men. Women volunteered as midwives. In Greece, it mattered whether a boy or a girl was born. The Greeks were great warriors, so they were interested in having enough boys, a girl was not so desirable. Postponing female newborns or even killing them was a common procedure performed by midwives. Available sources do not provide any evidence of nurses other than midwives.

Hygiene in cities
Similar to other ancient civilizations, communal hygiene was not of a high standard everywhere. Greek cities did not have waterworks and water supply systems were few and far between. Sewage is poured onto the street from windows or doors into an open drain in the middle of the street. Sewage with underground pipes begins to appear gradually from the 5th to the 2nd century BC. Latrines did not exist for a long time. Potties were used, which spilled onto the street or into nature. Epidemics were not uncommon in ancient Greece.

Personal hygiene
It was possible to bathe in the numerous fountains, but it was not allowed to bathe in the reservoirs holding the water (prevention of infection). In the 6th century, bathing in a fountain was common, in the 5th century it was exceptional, because people preferred to bathe at home. The bathrooms were modest, but they were equipped with sinks for bathing the feet. Other basins, on high legs, were intended for washing hands. The obligation to wash hands before eating was commonplace in Greece.

Buildings of public baths were developed mainly in the 4th century BC. Since the baths are heated, poor people stayed here to warm themselves. Some halls were reserved for women only. However, Greek baths cannot be compared to Roman thermal baths. The ancient Greeks did not know soap. Some rubbed themselves with sand, the Athenians used soda instead of soap.

Food
The Greeks ate three meals a day. Breakfast was light, lunch was simple and light. The most carefully prepared meal was dinner. The usual menu was vegetarian and modest - lots of fruit, legumes, cheese and other dairy products. Commoners ate little meat because, apart from pork, it was an expensive food. More fish meat was eaten than mammal meat. The Greeks did not have much patience for lavish feasts. They had neither the means nor much appetite for it. The only luxury used to be wine.

= Rome = Until the arrival of Greek doctors in Rome in the 2nd century B.C. the care of the sick had a non-scientific character. The Romans were mainly concerned with military, statesmanship and construction problems. They did not allow themselves to worry about the sick. Therefore, care for the sick was not at the same level as in other ancient civilizations. Many foreign doctors worked in Rome, first from Greece, later also from Alexandria. Some of them were prisoners of war. It wasn't until the first century AD that Rome began to devote itself to the care of sick citizens. Until the arrival of the first Greek doctors, the Romans explained the cause of disease in the wrath of God. Therefore, the care of the sick consisted in propitiating the gods with religious ceremonies, sacrifices and prayers. The Romans founded hospitals - valetudinaria (from the Latin valetudo = health). At first they were intended for slaves, later for sick residents and wounded soldiers.

In Rome, as in Greece, women were employed only as midwives. Galénos documents the existence of a kind of Originea that was able to prepare medicines against coughs and stomach problems. According to Soranus, a Roman physician, a midwife should be a literate, spirited, hardworking, honorable woman without sensory defects. She was supposed to have healthy limbs, a strong body and long slender fingers with short nails. The nature of the midwife is calm, without prejudice, she should not be greedy for money, so that she does not provide substances that cause abortion for money.

Caring for soldiers
For their constant military conquests, the Romans (as well as other civilizations) had to develop the perfect care for wounded soldiers. Military infirmaries were established. It also included a spa with an elaborate sewage system. In battles, several doctors and wound healers were always available to help the wounded immediately.

Hygiene
Communal hygiene and body care were of a much higher standard than in Greece. Water supply, bathroom and sewage were in almost every house. The Laws of the Twelve Tablets (valid from the 5th century BC) paid attention to the burial of dead bodies, forbade burial within the city, the mentally ill should have their own guardian, and ordered caesarean sections for deceased mothers. At the beginning of the 3rd century AD, the first spa was founded.

The first beginnings of quarantine can be dated back to the 3rd century BC, when plague patients were separated from the healthy to prevent the spread of the disease. In later times, a leprosalia was founded for patients with leprosy.

Asklepiades
The first really successful physician in Rome was Asklepiades (124-56 BC), (124-40 BC). He was a highly educated Greek physician who studied in Alexandria and Athens. He came to Rome no later than 91 BC. His medical methods were successful and, above all, pleasant, which is why he soon gained fame. He rejected the Hippocratic humoral theory and was a supporter of Epicurus' philosophy and Democritus' doctrine of atomism. Asclepiades combined their philosophical views with his professional knowledge and claimed that a healthy person is conditioned by the constant movement of solid material particles of atoms, of which the body is composed. In his care for the sick, he focuses on sweating, washing and bathing. He was an adherent of public baths and physical exercises. He refused IVs when caring for the mentally ill. He preferred showers, bathing, massages, exercise, swinging on a suspended bed, constant employment of the patient, change of lifestyle, and diet tests. His medical motto was citó, tutó, iucunde – quickly, safely/certainly, pleasantly. Asclepiades also promoted the healing effects of wine and emphasized sufficient recovery. He taught that a good doctor should be able to promptly determine two or three types of medicine for any disease. He was also said to be a skilled surgeon, which is evidenced by the fact that his followers were credited with performing the first tracheotomy (the opening of the trachea performed in case of obstruction of the upper airways).

Galen
Galénos (130–200 AD) was a physician from Greece. He was born in Pergamum (today Bergama in Turkey). He served as the court physician of Marcus Aurelius. He was the most famous Roman physician. It is said that he was a contradictory personality - unpopular with his colleagues, conceited of his fame and greedy. But Galénos was also very far-sighted, clever and hard-working. He wrote 600 treatises, from which medieval medicine drew. He advocated natural therapy, i.e. treatment based on the theory of opposites – for example, applying cold compresses for fever.