I
Health and disease are familiar notions, commonly
used in a complementary sense, viz., health as absence
of disease and disease as a lack of health. But any
attempt at a precise definition of these two concepts
meets with considerable difficulties and throws doubt
on the validity of the popular usage.
A person suffering from an ordinary cold may de-
clare himself ill, whereas the same person laid up with
a broken leg may claim to be in perfect health. These
common examples indicate the complexity behind the
concepts of health and disease, a complexity apparent
throughout the history of mankind. Health and disease
have been experienced by almost every human being,
and the emotional as well as rational reactions have
differed and have manifested themselves differently.
The history of these two ideas must, therefore, take
into account definitions and explanations by philoso-
phers and physicians, as well as the reactions and usage
of others. Within this vast history, any order can be
achieved only by neglecting innumerable details, by
paradigmatic use of relatively few opinions and prac-
tices, and by admitting that a different point of view
may show a different panorama.
The myths of many ancient civilizations tell of a
golden age, free from ills, then followed by troubled
and disease-ridden times. Before Pandora's box was
opened, men lived on earth “without evils, hard toil,
and grievous disease.” But now that the lid is off,
“thousands of miseries roam among men, the land is
full of evils and full is the sea. Of themselves, diseases
come upon men, some by day and some by night, and
they bring evils to the mortals” (Hesiod, Works and
Days, 90-103). Sickness here is just one among the
many forms of suffering to which man has been sub-
jected at all times. When and where he began to sepa-
rate illness from other kinds of suffering we do not
know, and down to our own days the demarcation
has remained uncertain.
In the Atharva-Veda of ancient India there is a
prayer for a mad person, that the gods might “uncraze”
him, as the translator has it. “Crazed from sin against
the gods, crazed from a demon—I, knowing, made a
remedy, when he shall be uncrazed.” It seems impossi-
ble to tell whether the crazy person is believed “sick”
or whether he falls into a different category. The
Atharva-Veda is not a medical work; it contains prayers
against many ills and sings the praise of many things.
In this case it is not easy to maintain a sharp distinction
between disease and other kinds of suffering.
Evidence of very early specialization in ancient
Egypt suggests, on the other hand, that some groups
of people learned how to remedy certain painful or
incapacitating conditions and bequeathed such limited
knowledge without any theories or even clear notions
of disease.
The manner in which illness was approached in the
archaic civilizations of Egypt and Mesopotamia shows
considerable similarities. Disease is described as a
complex of symptoms; often the localization in a spe-
cial part of the body is stated. There are many different
complexes of symptoms, of what may “befall” the
person (the meaning of the Greek word sumptoma),
and there are consequently many diseases, which may
be given names or may be connected with actions of
demons and deities. The disease pictures can offer
indications for the outcome, for death or recovery; they
also offer a basis for action.
Most of the types of disease are described as symp-
toms or syndromes presenting themselves at a certain
moment. For instance, the surgical Edwin Smith
Papyrus, whose original composition probably goes
back to the Old Kingdom, tells what the physician will
find when he examines injured men. The descriptions
vary with the kind of injury and its location, and there
is something approaching a diagnosis, and a prognosis,
and there is, of course, therapy. Examination of the
patient has led to a recognition of the nature of the
case. The text then adds that the ailment is one “which
I will treat,” or “with which I will contend,” or “not
to be treated,” verdicts connected with a forecast of
the disease as curable, uncertain, or incurable. Analogy
with the development of prognosis in the times of
Hippocrates (ca. 400 B.C.) suggests the possibility of
a social motive for such forecasts. The physician may
have felt the need to protect himself against possible
later reproach, especially if he undertook the cure of
a patient who then died.
While an injury invited examination and an immedi-
ate decision, internal ailments also were described in
both Egypt and Mesopotamia as pictures presenting
themselves at the height of the illness. However, such
a static view was not the only one. In Mesopotamia,
where the reading of omens was developed into an
art, the symptoms of the disease were understood as
omens too, just as a potsherd found by the exorciser
on his way to the sick man could be of ominous portent.
The symptoms need not all appear at once; they could
be observed over a length of time or could change.
“If, at the beginning of the disease, the temples show
heat and if, afterwards, heat and transpiration disap-
pear, (it is) an affection due to dryness; after suffering
from it for two or three days, he will recover” (Labat,
1951). The reference to dryness points to the realm
of observation and to reasoning in terms of natural
phenomena. But in a subsequent case, the demon
“râbisu” is accused of having attached himself to the
sick man, feeding on his food and drinking his water.
Disease in Mesopotamian medical texts often was
connected with “the hand” of some deity, and “the
hand” of such a god was also recognized in nonmedical
contexts (Labat, 1951). Similarly, Leviticus 13 describes
a skin condition diagnosed as Zara'ath, which is usually
translated as leprosy. Not only is this identification
medically doubtful, but Zara'ath was more than a
human disease; it could be found in houses and gar-
ments as well. It was a term denoting ritual impurity,
sometimes inflicted as punishment by God, as in the
case of Miriam (Numbers 12:10) and of Gehazi, the
servant of Elisha (II Kings 5:27).
Disease receives meaning when placed in man's
moral universe when its occurrence within a scheme
of creation and right and wrong actions is accounted
for. In the archaic civilizations of Egypt, India, Israel,
and Mesopotamia, this universe was comprised of
everyday life, as well as of magic and religion. Disease
was punishment for trespass or sin, ranging from in-
voluntary infraction of some taboo to wilful crime
against gods or men. Disease could also be due to the
evil machinations of sorcery. Gods or demons could
cause disease without taking possession, or they could
represent the disease within the body. The magic and
religious interpretations of disease did not necessarily
exclude naturalistic explanations. Archaic civilizations
were not logical systems rejecting what did not fit into
the dominant scheme of things. Mesopotamian medical
works have been characterized as mere literary fixation
of old medical lore (Oppenheim, 1962). For ancient
Egypt it has been contended (Grapow, 1956) that no
single concept could be found to cover the different
approaches to disease. Yet there were beginnings to-
ward a speculative rather than magical view of disease.
The connection of heart beat with pulse beat was
recognized, and systems of blood vessels were invented,
thought to carry disease to various parts of the body.
Possibly a noxious agent (Wḫdw) was assumed, which
spread putrefaction and indeed forced the body or its
parts to undergo the very process against which em-
balming was to protect the corpse (Steuer, 1948).
Wḫdw could also be a demon, and this has suggested
the transfer from an originally demonistic to a more
physiological principle. If this interpretation (Steuer,
1948) is correct, we see here the beginning of the
metamorphosis of archaic into the rationalized and
systematic thought of the medical and philosophical
works of classical India, China, and Greece. But no
arbitrary end can be assigned to the archaic ways of
looking upon health and disease; many features even
survive in the superstitions and the unconscious moti-
vations of modern man.
