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EGYPTIANS, NOT GREEKS WERE TRUE FATHERS OF MEDICINE

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Author Topic: EGYPTIANS, NOT GREEKS WERE TRUE FATHERS OF MEDICINE  (Read 16438 times)
Bianca
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« Reply #15 on: July 03, 2007, 09:30:15 am »



Ancient Egyptian Medicine



Surviving medical texts, such as the Edwin Smith and Ebers Papyri, show the high level of medical practice that the ancient Egyptian physicians attained. George M. Burden M.D. looks at some unexpectedly modern-sounding case histories and finds that treatments surprisingly similar to modern ones are documented.

In ancient Egypt, a clever pharaoh could earn kudos by dispatching one of his top medical specialists to help a neighbouring monarch, often having been requested to do so specifically, such was the reputation of the ancient medics. Of course this sometimes backfired. Herodotus reports in his Histories that an eye specialist sent to the court of the Persian king Cambyses became so annoyed with his pharaoh for separating him from his family, that he incited the Persian monarch to invade Egypt successfully. In another case, Herodotus tells how the Persian king Darius was about to execute all his Egyptian doctors for mishandling his injured ankle. The Greek doctor who successfully treated Darius implored the king to spare his colleagues, to which he agreed. Perhaps we can attribute the recorded ninety-four year long reign of Pharaoh Pepy II at least partly to the ministrations of his doctors. He is still on record as the longest ruling monarch in history beating others such as Queen Victoria, Louis XIV of France and Franz Josef of Austria by many years.

On a recent trip to Egypt I had the opportunity to see and photograph various medically-related subjects, ranging from artistic depictions of surgery and surgical instruments to sculptures and paintings showing actual pathology. Perhaps the most ancient existing depictions of surgery are found in the Old Kingdom tomb of Ankh-Ma-Hor at Saqqara. Over four thousand years old, these reliefs depict surgical procedures on the toes and circumcision. At the temple of Kom Ombo, in Lower Egypt, I came across a carved wall depicting an array of surgical instruments that would not look out of place in a surgical theatre today. This included a variety of scalpels, curettes, forceps and dilators, as well as scissors and medicine bottles. The Coptic Museum in Cairo has an actual display of bronze medical instruments of all types dating from the days of Ptolemaic and Roman Egypt.

There is no shortage of depictions of pathology in pharaonic Egyptian art. I discovered several representations of achondroplastic dwarfism, including the famous sculpture of the dwarf Seneb and his family in the Egyptian Museum in Cairo. Seneb became an affluent and respected member of his society, indicating that his condition did not present an insurmountable barrier to advancement, even in ancient Egypt. I also found dwarves depicted making jewellery on the walls of the Old Kingdom tomb of Mereruka at Saqqara. They were reputed to be quite skilled at this craft, due to their tiny hands.

                             


The first known image of a doctor? Wooden relief of Hesira, dating to the Third Dynasty, and found at Saqqara. Hesira was a scribe, possibly at the time of Djoser, but is also described as a doctor and dentist. The panel is now in the Egyptian Museum, Cairo.
Photo: RP.

Visiting the Egyptian Museum in Cairo, in the Amarna room one could be forgiven for thinking that theories of extra-terrestrial influences on ancient Egypt might actually be based on fact. The Eighteenth Dynasty pharaoh Akhenaten is depicted as having a bizarre elongated feminine body shape with a narrow face and long tapering digits. His six daughters were sculpted with oddly elongated heads. Today it is generally believed this was simply a new artistic/religious convention. In the past others have speculated that Akhenaten may have suffered from Marfan’s Syndrome, a hereditary condition associated with a body shape remarkably similar to Akhenaten’s, as depicted in his statuary.

Additionally, I found examples of art works that may represent microfilariasis, a parasitic infestation that can block the lymphatic system. The result is huge distention of parts of the body, usually the legs, known as elephantiasis. A possible example of this disease is shown in a painted relief from a chapel of Queen Hatshepsut’s temple, which documents her trade expedition to Punt (probably present-day Somalia). The Queen of Punt is shown as having a massive lower body, which some speculate could be due to microfilariasis.

Another example of disease found in the Egyptian Museum is a small figurine depicting an individual with a marked kyphosis, or forward curvature of the spine. The male figure appears too young to be suffering from osteoporosis, the softening of the bones that usually occurs in old age. Perhaps this is a congenital kyphosis, or perhaps it is due to pathological bone fracture from untreated infection, such as tuberculosis. He does not seem to have enough of a twist to his spine to warrant the diagnosis of adolescent kypho-scoliosis, a developmental disorder where the spine gradually grows in the form of an S-shaped curve in adolescence.

Probable cases of polio are also depicted on reliefs from many eras, where we see men leaning on sticks with what appear to be shrunken, atrophic limbs. Examination of the royal mummy Siptah also reveals characteristics of this wasting viral disease.

Crusted lesions on the faces and upper bodies of the mummies of Rameses V and Amenhotep II are felt to represent smallpox, a viral infection that has plagued mankind for millennia.

The ancient Egyptians had a lively interest and acquaintance with medicine and pathology. Many believe they laid the foundations for modern medical practice. Even today physicians and pharmacists still use the R/ symbol. This figure, which looks like a capital "R" with a line through the oblique portion of the letter forming an "x", has prefaced most prescriptions for centuries. Few of today’s medical personnel realize that they are in fact asking the blessing of the god Horus, whose eye it represents.

One physician who would have recognized the significance of the Eye of Horus was the author of the Edwin Smith Papyrus. It is the oldest surgical text in the world, most likely written during the third millennium BC, and it is composed of forty-eight concise orthopedic and neurosurgical cases. The injuries described may have been taken from casualties ensuing during the construction of the pyramids. Egyptologist Edwin Smith purchased the papyrus in 1862 after it was discovered between the legs of a mummy from the Upper Egyptian necropolis of Thebes. No doubt a prized possession of the deceased owner, this version was transcribed during the seventeenth century BC with a "modern" commentary after each case.

The papyrus was translated by Professor J. Breasted in 1930 with the help of a physician colleague and the now famous text finally ended up in the collection of the New York Academy of Sciences. Any modern physician will find the unknown author’s format quite familiar, with sections devoted to history and physical examination, followed by a diagnosis, prognosis and treatment plan. Though ancient Egypt’s priests often had medical training, there is no evidence in this text of the prayers and amulets that often were used by this class. Instead our anonymous surgeon laid out elegant and simple diagnostic and treatment programs some paralleling those of modern medicine almost exactly.

For example in case 12, "A Break in the Nasal Bones", treatment is described as follows: "Thou shouldst force it to fall in, so it is lying in place, and clean out for him the interior of both his nostrils with two swabs of linen until every worm [clot] of blood which coagulates in the inside of his two nostrils comes forth. Now afterward thou shouldst place two plugs of linen saturated with greases and put into his nostrils. Thou shouldst place for him two stiff rolls of linen, bound on. Thou shouldst treat him afterward with grease, honey and lint every day until he recovers." In other words the nose is set, clot evacuated and splints of stiffened linen are applied. Non-stick grease soaked dressings are used to pack the nose. This is much the same approach a modern otolaryngologist would use.

In case 35, "A Fracture of the Clavicle", treatment of a patient is described in this way: "Thou shouldst place him prostrate on his back, with something folded between his two shoulder blades; thou shouldst spread out his two shoulders in order to stretch apart his collar bone until the break falls into place. Thou shouldst make for him two splints of linen, and thou shouldst apply one of them both on the inside of his upper arm. Thou shouldst bind it …" In other words draw the shoulder blades back and fit the patient with a "figure of eight" splint, exactly what a modern orthopedics text would advise.

The twenty-first century (AD) intern confronted with a dislocated jaw need look no further than case 25 of the Edwin Smith Papyrus. "If thou examinest a man having a dislocation in his mandible, shouldst thou find this mouth open and his mouth cannot close for him, thou shouldst put thy thumbs upon the ends of the two rami of the mandible in the inside of his mouth and thy two claws [meaning two groups of fingers] under his chin, and thou shouldst cause them to fall back so they rest in their places." This is exactly the technique I learned in the Emergency Room!

                             

The head of the mummy of Rameses V, which might exhibit the signs of smallpox.
Photo from Elliot Smith The Royal Mummies.

In many cases the treatment was beyond the capability of the time and the surgeon simply states that this is "… an ailment not to be treated", i.e. with a very poor prognosis. Nevertheless he meticulously describes the physical findings of such injuries as in case 31, "Dislocation of a Cervical Vertebra", where he writes if "… thou find him unconscious of his two arms and his two legs on account of it, while his phallus is erected … and urine dribbles from his member without him knowing it … ; it is a dislocation of a vertebra of the neck extending to his back-bone …" This is the world’s first known description of quadriplegia.

In case 6, "A Gaping Wound in the Head With Compound Comminuted Fracture of the Skull and Rupture of the Meningeal Membranes", we get the first description the brain and its gyri, and the meninges. "If thou examinest a man having a gaping wound in his head, penetrating to the bone, smashing his skull, and rending open the brain … , thou shouldst palpate that smash which is in his skull like those corrugations [i.e. gyri] which form in molten copper, and something therein throbbing a fluttering under the fingers …" The pulsation of the brain is described and later the author observes that its absence is a very serious sign (which indeed it is, representing serious brain compression).

In case 8, "Compound Comminuted Fracture of the Skull Displaying No Visible External Injury", the ancient surgeon articulately describes hemiplegia (paralysis on one side of the body) secondary to a head injury: "Shouldst thou find that there is a swelling protruding … while his eye is askew because of it [conjugate deviation of the eyes], on the side of him having that injury which is in his skull; and he walks shuffling with his sole on the side of him having that injury which is in his skull ...", the author further states, "thou shouldst account him one whom something entering from outside has smitten …" It appears here that he may be trying to differentiate hemiplegia caused by an "outside" injury as opposed to similar findings that may occur from an "inside" cause such as a stroke.

In other parts of the text the ancient surgeon describes suturing lacerations, and treatment of infection and wounds with nonstick dressings and hyperosmotic agents (animal grease and honey respectively). In case 39 it is suggested that an abscess that "… arises in his breast dries up as soon as it opens of itself." In other words, as my old surgery professor said, "Pus under pressure should be punctured." The text appears to differentiate between breast tumors and infections, describing the former in case 45, "Bulging Tumors on the Breast", as "… very cool, there being no fever at all therein when thy hand touches them; they have no granulation, they form no fluid, they do not generate secretions of fluid, and they are bulging to thy hand." Is this the first description of a breast cancer?

The Edwin Smith Papyrus is only one of a number of remarkable Egyptian medical texts discovered. Almost as famous is the the Ebers Papyrus, also first purchased by Edwin Smith and subsequently sold to Egyptologist George Ebers, after whom it is named. It is one hundred and ten pages in length, the longest discovered. It is to family doctors what the Smith Papyrus is to surgeons. In addition to a surgical section, it contains descriptions of the heart and its vessels, and discussions of various diseases such as those of the stomach, anus, teeth, ear nose and throat, and skin. Skin diseases are divided into ulcerative, irritative and exfoliative.

A section on pharmacy includes various treatments including the use of castor oil as a laxative. There’s even a section on medical philosophy.

Another text, the Kahun Gynecological Papyrus, deals with diseases of women and dates from the nineteenth century BC. It contains sections on topics such as contraception and the diagnosis of pregnancy.

It’s easy to see why the Egyptians were revered in the ancient world for their medical knowledge. It boggles the mind to think that these texts pre-date the Roman Empire by as many millennia as Rome pre-dates us. To Egyptians, even Hippocrates was a mere upstart.

The ancient Egyptian physicians at their best show a logical and suprisingly up-to-date approach to the diagnosis, classification and treatment of disease. Perhaps "modern" medical thought is not as modern as we once thought.





George Burden

Dr Burden is a family physician who has practised in the Atlantic Canadian town of Elmsdale for over twenty-five years. He is also Chairman of the Quebec/Atlantic Canada branch of the Explorers’ Club, an avid freelance travel and adventure journalist and co-author of the book Amazing Medical Stories.

 Ancient Egypt Magazine -
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Your mind understands what you have been taught; your heart what is true.
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