The first tendency of many of us is to view the diagnoses and treatments of ancient medicine as weird and outlandish, clearly a product of ignorance and superstition, although with an occasional lucky discovery that actually "worked." Evaluation is based upon the standards of western scientific medicine (biomedicine): what resembles the diagnoses and treatments of biomedicine, or seems to be on the road to these, is considered "rational," perhaps even "scientific," while those ideas and practices that do not fit this pattern are labeled "superstition" or "sorcery," and de-emphasized. To some extent, this is the approach of Guido Majno, whose book, The Healing Hand, provides the basic text of this course. Majno presents sketches of ancient surgery and medicine, and includes fascinating information about the healing properties of many ancient wound drugs as tested by the methods of biomedicine. But the selective singling out of biomedically acceptable elements misses seeing the total healing activities of a culture (including the aspects that we classify as "superstitious" or "magical") as an interconnected system, a health care system. by searching out as many aspects as possible of a particular health care system, we can gain valuable insights into that culture as a whole.

The health-care-system approach has been applied to modern cultures and to the problems of intercultural diagnosis and treatment in an especially clear and interesting fashion in a number of books and articles by Harvard's Arthur Kleinman, especially Patients and healers in the context of culture. An exploration of the borderland between anthropology, medicine, and psychiatry, Berkeley: University of California Press, 1980. Kleinman describes the health care system as "a local cultural system composed of three overlapping parts: the popular, the professional, and folk sectors."(50)

Another important concept in Kleinman's scheme is that of Explanatory Models of illness. An Explanatory Model (EM) is the explanation a person gives for a sickness episode; this is especially important because people in the various sectors tend to have different, and sometimes conflicting, EMs. For example, I may believe that I caught flu from getting my feet wet, while my doctor blames a virus and the multiexposures characteristic of the classroom; one of my students may think that it is just compensation for my giving him a low grade, and another may suggest that a visit to a church healing ceremony would help. In today's medical practice, understanding the difficulties of communication and finding ways to overcome them are the most important effects of a recognition of the concept of EMs; for the historian, the differences in such models provide useful characterizations of particular medical systems (the Mesopotamians blamed the gods, the Hippocratic doctors an infalance of humors, while the ancient Chinese were concerned about the flow of Ch'i).

Types of Evidence

Our knowledge about disease and medicine in past cultures come primarily from the study of textual sources, artistic representations, and human remains. Of the three, skeletal remains and extant soft tissue, the study of which is called paleopathology, is arguably the most revealing about past cultures, and most certainly in preliterate societies. Both written and artistic sources incorporate the biases of the authors or artists. Certain aspects of disease may be selectively represented while others are neglected. Human remains provide relatively concrete evidence that a disease process has occurred. This does not mean that paleopathological analysis rarely provokes debate or disagreement, quite the contrary. It is important that pseudopathology and the evidence of disease itself be separated before any conclusions are made. Skeletal material removed from an archaeological context can exhibit convincingly obvious pathologies, but are revealed to be the result of rodents activity, insect infestation, or roots when subjected to more intensive analysis. The difference between the study of human remains and other sources lies in the fact that paleopathological evidence has not been preselected as is the case of both textual information and artistic representations An excellent example for the use of paleopathology is the study of trauma.

Like all rigid materials, bone will break when sufficient force is applied to it. The exact distribution of skeletal trauma throughout the body, as well as the overall frequency of trauma in a given population, provides indication of cause. Evidence of trauma to the skull as well as the middle of the radius and ulna (forearm) is characteristic of personal violence. On the other hand, damage to the femur (upper leg), the tibia and fibula (lower leg), and carpals (wrist) is usually indicative of accidental injury.

Despite the pivotal nature of paleopathology, both literary and artistic sources provide invaluable information as to the state of health and disease within a given society. Textual evidence such as the Homeric writings and Egyptian medical papyri provide useful information concerning medicine, cultural values regarding disease and medical treatment, as well as patterns of disease.