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ROOTS of the profession of medicine are buried far back before the dawn of history.
Nearly as old as mankind itself, practice of medical procedures in some from has
paralleled man’s development. In not a few instances, the quality or lack
of medical service has profoundly influenced the quality of medical service has
profoundly influenced the course of civilizations. Throughout the dawning millennia
and much of their recorded history, medicine was intimately associated with the
magico-religious practices of various peoples groping for the light knowledge and
a better way of life.
The most ancient records presently known indicate the existence of two centers of
civilizations having nearly equal development in two of the world’s great
river systems: in Mesopotamia, between the Tigris and the Euphrates; and in the
Nile valley of northeastern Africa. Organized peoples, enjoying the natural habitational
advantages of these areas, were flourishing 6,000 years ago.
Methods of recording events began some ten centuries later, about 3000 B.C., and
from that point on, history has for its base a series of factual foundations. However,
when recorded history dawned, medicine was already a well-developed profession,
and its practitioners had a heritage of experience, knowledge and beliefs handed
down from a long line of predecessors by precept and word –of-mouth through
countless centuries.
Egypt first became an organized nation about 3000 B.C. Medical interest centers
upon a period in the Third Dynasty (2980-2900 B.C.) When Egypt had an ambitious
Pharaoh named Zoser; and Zoser, in turn, had for his chief counselor and minister
a brilliant noble named Imhotep (whose name means “he who cometh in peace”).
Imhotep is said to have constructed the famous step pyramid of Sakkarah, near Memphis,
for Pharaoh Zoser. A versatile man, Imhotep seems to have been a priest, a magician,
and a poet. But in the Egyptian writings of the Greco-Roman period (third century,
B.C.) Imhotep is represented as a physician, is assigned the role of god of medicine
in Egypt. The Greeks identified him with their Asclepios, to whom was attributed
a similar regard. In this later period, temples were erected to Imhotep in which
patients looked for and supposedly found relief in their sleep.
There is a close association in Egyptian medicine between religion and magic. Egyptian
physicians used many drugs, but thought their effects primarily magical. The papyri
(so Called because they were written on sheets prepared from the papyrus plant)
dealing exclusively with medicine abound with magic formulas and prayers. “In
some cases in which human help seemed to be impossible,” observes Hermann
Ranke, a last attempt was made to get help from a supernatural source. .”
a practice not imcompatible with that of the religious-minded physician of today
who through prayer seeks aid and guidance. The gods of the Egyptians were no less
real to them than is our deity to us.
Physicians of ancient Egypt were probably trained in the temples, as were the priest-
magicians and sorcerers. However, they formed a distinct profession, organized in
a rigid hierarchy with court physicians at the top. Egyptian medicine was subdivided
into many specialties. A proctologist had the poetic name of “shepherd of
the anus,” and was much in demand in view of prevalent pathogenic theories.
Egyptian specialization seems to have been hangover of primitive conditions rather
than a precursor of modern specialization.
Medicine as practiced by the ancient Egyptians was not primitive, however. Just
as they had transcended primitive levels in statecraft, agriculture, technology
and especially architecture and art, so did the Egyptians also reach higher levels
in medicine. Some medical papyri are predominantly religious, but others are predominantly
empiric rational. Strangely enough, those recording the more rational observations
stem from the earliest periods (1600-1500 B.C.). Among these are the Edwin Smith
Papyrus and the Ebers papyrus. The first was intended primarily for the use of a
surgeon; the latter is a collection of recipes for the physician. Each of these
documents, though ancient in its own right, appears by language and explanations
to reflect traditions much older. Says Ranke of the Smith papyrus: “That the
bulk of the main text goes back to the Old Kingdom (about 2500 B.C.) is shown by
a great number of glosses (explanatory notes) added to the text of some of the cases,
which explains words that in the course of time had become obsolete.” Breasted
dates the Smith papyrus in the seventeenth century B.C., but states that it is a
copy of a document at least one thousand years older.
Dealing primarily with wounds, the Edwin Smith papyrus is admired for the diagnostic
acumen exhibited in the case histories detailed, where symptoms such as feeble pulse
(2500 years before reference to the pulse appears in Greek medical treatises), palsy,
and deafness are all recorded and referred to as due to one common cause- a head
wound. In addition to many surgical conditions, a great number of recognizable internal
afflictions are reported in the papyri, such as worms, eye diseases, diabetes, rheumatism
and schistosomiasis. The ancient existence of some of these conditions is confirmed
by paleopathology (the examination of bones and tissues of mummies for evidence
of disease); and, unfortunately, those afflictions are still prevalent in Egypt.
The papyri prescribe many rational methods of treatment, such as diet, physiotherapy
and drugs. Many of the drugs named undoubtedly were worthless, but some, such as
tannic acid, turpentine, gentian, senna, and lead, and copper salts, are still used
in medical practice. Castor oil, used externally and internally, was a great favorite
with the doctors of Egypt. The style used in prescription writing today is pretty
much the same as then.
The cases of the Edwin Smith papyrus are not only systematically constructed; each
within itself, but their arrangement throughout is a systematic one. First comes
a superscription, which briefly gives the name of the illness. This is followed
by a careful description, which always begins with the words, “ If you examine
a man who…” has this or that illness. Then comes a diagnosis that always
begins with the words, “You should say” he suffered from this or that
ailment. This diagnosis always ens with the words: “An ailment which…’
and then one of three possibilities follows. The Surgeon may say: “An ailment
which I shall treat, “or, “An ailment which I shall combat,” or,
“An ailment which I will not treat.” (The latter discrimination was
practiced by some physicians in almost all periods and was regarded as ethical up
to the eighteenth century.) Except in entirely hopeless cases, there followed a
method of treatment, beginning with the words, You must do…” this or
that. Then the healing substances are given.
Of the 48 surgical dissertations in the Smith papyrus, Case 7 is of particular interest.
According to Breasted’s translation, it reads, in part;
“If thou examinest a man having a gaping wound in his head, penetrating to
the bone, and perforating the sutures of his skull, thou should palpate his wound,
although he shudders exceedingly. Thou shouldst cause him to lift his face; if it
is painful for him to open his mouth, and heart beats feebly; if thou observe his
spittle hanging at his two lips and not falling off, while he discharges blood from
both his nostrils and from both his ears; he suffers with stiffness in his neck,
and is unable to look at his two shoulders and his breast, thou shouldst say regarding
him: {here the findings are restated}. An ailment with which I will contend.”
Directions for treatment follow:
“Now as soon as thou findest that the cord of that man’s mandible, his
jaw, is contracted, thou shouldst have made for him something hot, until he is comfortable,
so that his mouth opens. Thou shouldst bind it with grease, honey, and lint, until
thou knowst that he has reached a decisive point.”
Two other possible examinations are outlined- the second, in which;
“the flesh of that man has developed fever… his countenance is clammy,
the ligaments of his neck tense, his face is ruddy, and… the odor of the
chest of his head [crown] is like the urine of sheep, his mouth is bound…”
This, the ancient author admonishes, is “An ailment not to be treated.”
“If, however, thou findest that that man has become pale and already has shown
exhaustion… Thou shouldst have made for him a wooden brace padded with linen
and put into his mouth. Thou shouldst have made for him a draught of the…
fruit [probably a nutritious fruit or grain]. His treatment is sitting, placed between
two supports of brick, until thou knowest he has reached a decisive point.’
This early physician evidently recognized that if tetanus had invaded the wound,
there was little he could do; but until he was certain, he would try to improve
the patient’s condition.
Egyptian physicians were highly respected all over the ancient world for thousands
of years. Homer regarded them as the best in his time. Egyptian physicians were
called to the courts of Persian emperors and other Eastern potentates; and only
in the sixth century B.C. were they replaced by Greek physicians. Beyond the psychotherapeutic
values of magic and religion, Egyptian medical men made solid advances in observation
and rational treatment. Their contributions are worthy of a place beside other accomplishments
of this great ancient civilization. The dominant position occupied by Egyptian medicine
for 2,500 years seems fully justified.
THE PICTURE
A moment in the life of an Egyptian physician of the Eighteenth Dynasty (1500-1400
B.C.) is captured in this painting. The physician is confronted with a patient having
symptoms paralleling those cited in the third diagnosis of the seventh case history
recorded in the Edwin Smith papyrus. Most of the elements of ancient Egyptian medicine
are here: The physician, clothed in clean white linen and a wig, as becomes the
dignity of his status. The patient, likely a member of a noble household, supported
by a “brick chair.” Treatment is proceeding under the sure, sympathetic
hands of the physician in accordance with the course prescribed in the scroll held
in the hands of an assistant. Magico-religious rites are being observed by priests
trained in this adjunctive specialty. The best care that the science and knowledge
of the day can provide is focused on the patient.
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