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« Reply #15 on: June 02, 2007, 06:42:36 pm »

                                            C U R E S   F O R   T H E   P H A R A O H

The Sakakini Palace in Cairo is currently undergoing restoration prior to being turned into a medical museum. Jill Kamil traces Egypt's medical heritage.

The idea of turning the palatial home of a pasha into a Medical Museum was initiated when a grandson of the original owner, himself a doctor, donated his inherited share of the Sakakini Palace to the Ministry of Health. Following lengthy deliberations it was decided to convert it into a museum devoted to the development of medicine from the time of the pharaohs through to the present day. This project is now underway and a book by one of Egypt's most distinguished physicians, Nabil I Ebeid, goes a long way towards explaining what can be expected. Egyptian Medicine in the Days of the Pharaohs, published five years ago by the General Egyptian Book Organisation, is a valuable compendium. A comprehensive yet concise study of pharaonic medicine, it reveals the art of healing in early times and the high levels of perfection it reached. As we shall see, it concerns much more than just mummies.

A beautiful feature of the Palace

The ancient Egyptians, who embalmed their dead so carefully, must have had a profound knowledge of anatomy. This is evidenced in tomb reliefs that show surgeons at work on patients and in famous learned medical texts such as the Ebers and Edwin Smith papyri. These facts, though, do not provide enough information for a synopsis of medical practice in ancient times. Fortunately, Ebeid's book fills in some of the gaps. "We know that the Egyptians were brilliant mathematicians, and were no less advanced in chemistry. It was their knowledge of chemistry that enabled them to discover the materials they needed for embalming, as well as for producing medicines and drugs," writes Ebeid, who is internationally acclaimed for his work in industrial medicine, in the preface to his book. "Technical skills, intellectual capacities, and social values must be passed from generation to generation."

He categorises an assortment of medical problems and diseases, the skills of Egyptian healers, the medical care of workers and other related medical subjects. From this 490-page publication I have learnt more about ancient health hazards, diseases, operations and the treatment of wounds than I had ever known before. I have learnt about ancient Egyptian attitudes towards the disabled and the active manner in which they participated in society. I had, of course, seen statues and reliefs of the handicapped, including dwarfs, but I had no idea that these handicaps had been categorised.

Latching onto Ebeid's study, I was reminded of what I had seen earlier. I embarked on a tour of ancient sites and, less far afield, the Egyptian Museum. I saw handicapped individuals working as farmers in Old Kingdom tombs, dwarfs employed in the pharaoh's laundry and even, in the temple of Edfu, carvings of medical tools.

Ebeid's research takes him beyond the translation of medical papyri -- of which there are many more than I realised -- to other literary, political, religious and secular works such as paintings and sculpture "which, by accident or design provide insight into health and healing in ancient Egypt". He cites studies made by the ancient Egyptians themselves.

The medical papyri, of which there are more than a score, are clear indication of the advances in the medical field from early times. Some of the texts dating from the Middle and New Kingdoms (from about 2000 BC) were copies, sometimes third and fourth hand, of earlier texts; archaic grammar and obsolete words point to their antiquity as well as certain references to earlier periods. The Edwin Smith Surgical Papyrus, believed to be the earliest, was studied by scholars in the 19th and 20th centuries. The text deals with 48 carefully arranged surgical cases of wounds and fractures, detailing a dispassionate examination of the patient and prescribing cures. No ailment was ascribed to the activity of a demonic power, and there was very little magic -- although belief in the potency of spells or exorcisms doubtless supplemented the treatment. Ancient Egyptian medical practitioners were not witch doctors who gave incantations. They were physicians who prescribed healing remedies and conducted operations. Although some of these prescriptions might be considered somewhat fanciful -- such as the extract of a hair of a black cat to prevent greying -- others were famous for their efficacy, as Ebeid's book makes clear.

There is no doubt that there was a firmly established medical tradition at an early date. When Weshptah, builder and friend of the fifth Dynasty Pharaoh Neferirkare, suffered a stroke in the pharaoh's presence, the ruler showed great solicitude for his stricken friend and ordered his officials to consult medical documents for a remedy to help his vizier regain consciousness. Doctors were well paid for their services; in one case the reward was "a false door of limestone for that tomb of mine in the necropolis".

We know from mummified bodies that dental surgery was practised from early times; some have teeth extracted, and an Old Kingdom mummy of a man shows two holes beneath a molar of the lower jaw, apparently drilled for draining an abscess. The discovery in a grave at Giza of a body with several teeth wired together suggests that dental treatment was already well advanced in the Old Kingdom. Sesa's tomb at Saqqara (known as the "doctor's tomb") shows the manipulation of joints, while the "physician's tomb", that of Ankhmahor (also at Saqqara), shows an operation on a man's toe and the circumcision of a youth. Ebeid points out that this was practised on boys between six and 12 years old, and adds: "all criteria indicate that female circumcision was never practiced in ancient Egypt."

Ancient Egyptians delighted in the birth of a child and babies were probably breast-fed into the subsequent pregnancy. The Kahun and Ebers papyri outline the treatment of gynaecological problems and recommend a birthing-stool for delivery either in a squatting or kneeling position. They also describe how to induce labour if necessary, cut the umbilical cord and care for the new-born child.

Cancer, it appears, is not a disease of modern civilisation. There is a paucity of evidence of its incidence in ancient Egypt; nevertheless, some indication of tumours does exist from early times right through to the Ptolemaic period. Ebeid points out in his chapter on surgery that the ancient Egyptians used the scalpel, "and a heated knife or cautery for extirpating the tumours, taking care so as not to bleed afterwards". He quotes Ebers Papyrus 872 which reads: "This [i.e. tumour] is a swelling of vessels, a disease that I treat... then you must perform for it a knife-treatment, it (the knife) is heated in the fire...".

On antiseptics Ebeid informs us that "wine was used in embalming as a disinfectant and preservative... Frankincense and date-wine were prescribed as anti- pruritics, astringents and antiseptics in local applications." As for surgical instruments, the Edwin Smith Papyrus contains a list of surgical instruments including scalpels, scissors, needles, forceps, hooks, pincers, as well as bandages, swabs and adhesive plaster. The first evidence of surgical stitching is also found in Egypt.

The medical practices of ancient Egypt have been somewhat undermined by claims made by classical scholars. There are continued assertions that there is no clear evidence that the ancient Egyptians practised surgery, amputated limbs, operated on skulls, performed eye surgery, or used knives to cure ailments such as hernias.

However, in Egyptian Medicine in the Days of the Pharaohs Ebeid makes a point of quoting scholars who maintain that the ancient Egyptians did indeed carry out surgical operations. He argues that "a mere glance at mummification shows how neatly the left side is sutured, and how [the ancient Egyptians] drew the brain through the nostrils, or how they evacuated it through the foramen magnum... at the end of the twentieth century surgeons apply the same technique in removing a pituitary adenoma through the nostrils."

He quotes an article by J T Rowling published in Science in Egyptology entitled "Some speculations on the rise and decline of surgery in dynastic Egypt". In it, Rowling discusses how surgery reached its zenith in the Old Kingdom, became a "doubtful expedient" in the Middle Kingdom ("we have no evidence that such operations as those for repair of herniae or tubeculous nodes in the neck mentioned in the Ebers Papyrus were ever performed after the Middle Kingdom"), and a "hallowed tradition" in the New Kingdom.

Ebeid also refers to the many cases of the distinguished Egyptologist W P Pahl "which demonstrate trepanation" and adds that cases of operative surgery may have been performed but not recorded in available papyri. He states that circumcision is "sure evidence of surgical intervention".

As to whether surgical operations were performed in ancient Egypt, Ebeid, quoting Dr Paul Ghaliongui, refers to the names and procedures given to surgical instruments in Ebers Papyrus 875: a tumour being removed "with a ds knife and seized with a hnw -instrument (forceps)... thou shalt remove it with [a] ds knife without taking away those enclosures (the fibrous capsule)". He comments that these names are not synonyms, and the second knife in that operation is given a name different from that of the first. "Ghaliongui suggests that it is a curette," he writes, but H H Grapow translates "and seized with a hnw -instrument" as "thou shalt dress it with hnw -ointment". Which all goes to show how confusing it is for the non-professional.

American researchers at Brigham Young University recently discovered a screw 23cms long fixed into a 2,600- year-old mummy, joining the thigh and calf bones. This suggests one of two things: "either the person suffered from fracture during his life, or it occurred during embalming and the relatives wanted him to meet God with physical integrity."

Ebeid concedes that his book is a trial to explore medical science by reviewing the papyri and other sources of information, and writes that he hopes other scholars will fill gaps in our knowledge of related problems, such as the effect of work and the environment on the health of ancient Egyptians, wartime medicine and the prevalence of addiction.

In Egyptian Medicine in the Days of the Pharaohs Ebeid explores new horizons in the study of health and health care in ancient Egyptian life. Let us hope the opening of the new Medical Museum in the Sakakini Palace will provide the impetus for further research and study.
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