illustrations of medicine in ancient egypt: ‘in egypt the men are more skilled in medicine than...
TRANSCRIPT
Journal of Audiovisual Media in Medicine 1980,3,4-13
Illustrations of medicine in ancient Egypt ’In Egypt the men are more skilled in medicine than any of the human kind .’ Homer
CAROLE REEVES
The seed of civilization sprouted in Egypt around 5000 BC when man the cultivator took the first step of a 20 century march that led to the dazzling Egypt of history.
By 3500 BC the Neolithic farming villages of Egypt had become cities, then city-states, then two separate king- doms of Upper and Lower Egypt which faced each other in uneasy coexistence. Then, in 3100 BC the first Pharaoh, Menes, united the Upper and Lower Kingdoms, and in 2800 BC, the Pharaoh Djoser built the first pyramid at Saqqara. Between then and 2563 BC, the three most famous pyramids of all were built by Kings Cheops, Kephren and Mycinerus. This was the Old King- dom of Egypt which handed down t o its successors the invention of the calendar, the foundations of mathematics, sur- veying and thus geometry, irrigation, paper and writing.
The Middle Kingdom, from about 2100 BC to 1500 BC, saw the beginnings of foreign trade and influence into Egypt, along with the invasion of a people from Asia Minor, the Hyksos, who ruled for over 200 years, in the course of which they were gradually Egyptianized. Then a new Egyptian king, Amenophis I, broke their power and founded the New Kingdom, in which Egypt rose t o her greatest power, only to succumb, from about 1000 BC in her Late Period, to Libyan, Ethi- opian and Persian conquerors, to Alexander the Great, and finally to the Romans.
In these thousands of years of con- stant change, there arose, was devel- oped, and perfected the lore of Egyptian medicine.
The Egyptians possessed a knowledge of anatomy and physiology in a far greater measure than their contempor-
aries. Embalming gave them the op- portunity to familiarize themselves with the appearance, nature and mutual pos- itions of the internal organs, and al- lowed comparative anatomy as animals were also embalmed. Figure 1 shows the mummy of a n ibis bird, and a great number of quills of bird feathers can be seen through a tear in the cloth. The
Figure l a and b. The mummy of an ibis bird
craneocaudal radiograph shows that the bird was embalmed with symmetry.
In the Egyptian language there are over 100 anatomical terms. Every part of the alimentary canal had its separate name, although the Egyptians did not understand the nerves, muscles, arteries and veins. However, they did know that the heart was the centre of the vascular
Carole Reeves, AIIP, is Senior Medical Photo- grapher in the Department of Medical Illus- tration, St Bartholomew’s Hospital, West Smithfeld, London EClA 7BE.
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Figure 4. Imhotep.
system and that all the vessels were dependent upon it, but attached no im- portance to the brain. Injuries of pal- pable and intelligible origin were dealt with rationally and often successfully, but many diseases, producing headache, fever, swellings or skin eruptions were wholly mysterious and attributed to possession.
At least 15 distinct diseases of the abdomen, 11 of the bladder, 10 of the rectum and anus, 29 of the eyes, six of the ears, and 18 of the skin were diag- nosed and treated on definite principles. From the symptoms described in the papyri, about 250 different kinds of disease can be distinguished.
Here are two extracts on diagnosis and treatment translated from the Edwin Smith Papyrus (Thorwald 1962).
‘When you examine a man with a fracture of his two collarbones, with the one shortened and in changed pos- ition opposite the second . . . then you must say about it: a man with a frac- ture of his two collarbones; this is a sickness I can treat. Then you must lay him down outstretched on his back, with something folded between his two shoulder blades. Then you must spread out his two shoulder blades so that his two collarbones stretch, so that the fracture falls into its proper place. Then you must make him two compresses of cloth. Then you must place one of them inside against his upper arm, the other below his upper arm. Then you must bandage it.’ (Thorwald 1962a.)
And the second one:
Figure 2. A stone slab which was found in the tomb of a doctor of around 2600 BC.
Figure 3. A wall-carving of Sekhet-n- ankh.
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Figure 5 (top left). A reconstruction of a medical school based on an excavation at Edfu.
Figure 6 (top right). A wall carving of surgical instruments.
Figure 7 (above). A watl carving show- ing circumcision.
Figure 8 (right). A clay statuette found a t Aswan showing the classic symptom of Potts disease.
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‘When you examine a man with a wound on his head which goes to the bone; his skull is broken, broken open is the brain of his skull . . . these windings which arise in poured metal. Something is there . . . that quivers and flutters under your fingers like the weak spot in the head of a child which has not yet grown hard. This quivering and fluttering under your fingers comes because the brain of his skull is broken open. Blood flows from his two nostrils. Then you must say: a man with a gaping wound in his head; a sickness which cannot be treated.’ (Thorwald 1962b.)
From Egypt we have the earliest medical books, the first observations in human and comparative anatomy, the first experiments in surgery and phar- macy, the first use of splints, bandages, compresses and other applicances, and the first anatomical and medical vo- cabulary - and that a n extensive one.
Figure 10. A wall carving showing a flattering depiction of a king (left), and, possibly, a more realistic portrayal of obesity in the servant on the right.
Through the distinctive custom of mum- mification aided by favourable climatic conditions, hundreds of bodies, many accurately dateable, have carried down to us the earliest actual cases of the effects of disease. Mummification rec- onciled the popular mind for more than 20 centuries to the idea of cutting open the dead human body. It was in Egypt that it became possible for the Greek physicians and anatomists of the Ptolemaic age t o practise for the first time openly and unhampered the sys- tematic dissection of the human body, which religious and popular odium and prejudice forbade in their own country, and in all other parts of the world.
The first accounts of Egyptian medi- cine which have come down to us were written by a Greek historian called Herodotus who lived and wrote about 450 BC. H e wrote of Egyptian medi- cine; ‘medicine is practised among the Egyptians on a plan of separation. Each physician treats a single disorder and no more. Thus, the country swarms with medical practitioners, some undertaking to cure diseases of the eye, others of the head, others of the teeth, others of the intestines and some those which are not local.’ (Thorwald 1962~). This specializ- ation was not confined to later periods of Egyptian history but to the Old King- dom also. Figure 2 shows a stone slab which was found in the tomb of a doctor (of around 2600 BC) who was ‘eye-doctor’ of the palace; doctor of the abdomen, and guardian of the royal bowel movement.’ Figure 3 shows a wall-carving of Sekhet-n-ankh who was ‘nose-doctor’ of King Sahure, of about 2550 BC. Imhotep, (Figure 4) who de- signed King Djoser’s step pyramid at Saqqara, was probably the greatest of Egyptian physicians and was worshiped as the god of Healing throughout the history of Egyptian civilization. Temples of healing were dedicated to him and incubation was practised. Those people who recovered or gained relief from his treatment presented gifts to the temple, and in some cases models of the diseased organ, such as an eye, an
Figure 9. A statuette of an Egyptian potter showing the t ypica / s ymp toms of ma In u tr ition.
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Figure 13. A carving of a poor doorkeeper named Ruma [of about 1300 BC).
Figure 11. Achondroplasia.
Figure 12. A noble seated wi th his wi fe and apparently normal-limbed children.
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Figure 14. A statue of Akhenaton.
ear, a foot or even a head were dedi- cated to the God Imhotep.
Figure 5 shows a reconstruction of a medical school based on an excavation at Edfu, and there is written proof that medical schools were in existence in Egypt, for we have the report of Chief Physician User-Hor-Resinet of 500 BC when the Persians conquered Egypt. ‘His majesty, Darius I , lord of all lands and of Egypt also, ordered me to go to Sais in Egypt. He instructed me to re- store the ‘houses of life’ which had fallen into disrepair. I filled them with students from the families of the nobles. I placed them in the charge of wise men. His majesty commanded me to provide them with the best of everything, SO that they would be able to learn and to work. I equipped them with all that they
needed, with all instruments, according to the drawings of the old times. His majesty did this because he recognized the usefulness of this art, to keep all sufferers alive. For this purpose the temples and their incomes are to be restored.’ (”horwald 1962d). The phrase - ‘equipped them with all instruments’ - suggests that surgery may have been a part of their instruction, and Figure 6 shows a wall carving of surgical instru- ments. Several sets of instruments have been found such as those for blood- letting and a knife used in circumcision. There is little doubt that circumcision was of Egyptian origin although there seems to be no accounting for the fact that one king or priest was circumcised and others were not (Figure 7).
The extreme fluctuations in tempera- ture between night and day, the scanty clothing and poor nourishment of the Egyptian peasant favoured the develop- ment of arthritis, rheumatism, pneu- monia and tuberculosis, and Figure 8 depicts a clay statuette of later Egyptian period found at Aswan showing the classic symptom of Potts disease - tuberculosis of the spinal column. The poor little Egyptian potter in Figure 9 with swollen feet, haggard face and protruding eyes exhibits the typical symptoms of malnutrition.
The upper class Egyptians certainly imposed no restrictions upon themselves with regard to the consumption of food, alcohol and other pleasures, and depic- tions of kings, queens and priests seem to be flattering rather than factual, as was, no doubt, the intent of the artist. Studies of the skin foIds of mummies of many kings show them to have looked more like the gentleman on the right of Figure 10 rather than the king on the left.
Of course, Egypt must have had a numerous number of people suffering from congenital deformities, not least amongst the royalty due to almost total inbreeding. Achondroplasia (Figure 1 1) is probably the most depicted of these, and, as has almost always been the case, such people were treated with great def- erence by the Egyptians. Figure 12 de- picts a noble shown seated with, his wife and apparently normal-limbed children.
There is some controversy over Figure 13 which shows a carving of a poor doorkeeper named Ruma of about 1300 BC. Is his lameness evidence of polio- myelitis in ancient Egypt? The question remains unanswered. The statue of Akhenaton, in Figure 14, who was the uncle of Tutankhamen is interesting. It
Figure 15. A statue of Tutankhamen (with apparent gynaecomastia).
Figure 16. A carving of a blind mu- sician.
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Figure 17 (above). A painting of an Egyptian doctor setting a dislocated shoulder on a building site.
Figure 18 (left). A doctor, or doctor’s helper, applyinga leech to a patient.
shows that he must have suffered from an endocrine disorder. A theory of hy- pogonadism has been put forward, but as he was the father of six daughters this may be discounted. His features are acromegalic but his hands are of normal size, Note also that Tutankhamen was Akhenaton’s nephew, and Figure 15 shows a statue of the young king with apparent gynaecomastia. The Egypt- ians’ greatest scourge, apart from the intestinal Bilharzia worm (which makes falling into the Nile a cause for con- cern), was, and still is, eye disease - everything from conjunctivitis, glau- coma and cataract t o trachoma, which is still called Egyptian eye disease. Blindness was rife and Figure 16 depicts a carving of a blind musician.
The Egyptians used copper, alum, aluminous clay and compresses of mud
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Figure 19. An extract from a textbook (found by Sir Flinders Petrie in 1898) on gynaecology and obstetrics.
Figure 20. Showing a woman giving birth.
and soil in their treatment of glaucoma. Copper and alum were used extensively until 1948 when the new drug Auro- mycin was discovered which proved to be particularly effective in the treatment of trachoma - i t was extracted from soil.
Strangely enough, the rudiments of a health service existed in Egypt. Diodorus Siculus, a Greek historian, wrote - 'In wartime and on journeys anywhere within Egypt, the sick are treated free of charge because the doc- tors are paid by the state and scrupulous
pbservance of the prescriptions drawn j up by great doctors of the past is in-
cumbent on them.' (Margotta 1968.) There were also doctors on site during
the building of the great pyramids where up to a 100,OOO men at a time were labouring. Of course, it would make
sense to have a reasonably healthy crew with only a minimum of expendables if you wanted a twenty-year building task finished before you died. Figure 17 shows a painting of an Egyptian doctor setting a dislocated shoulder on a build- ing site.
It used to be thought that the Greeks were the first to use leeches around 130 BC until the wall-painting in Figure 18 (dated about 1300 BC) was found. This depicts a doctor, or doctor's helper, applying to a patient a leech which he has taken from a bowl on the floor.
The first written textbook on gynae- cology and obstetrics was found at Kahoun by the archaeologist Sir Flinders Petrie in 1898, and was dated at 2100 BC. Figure 19 shows a page from it dealing with bladder disturbances in pregnancy, maladies of the legs and
abdominal cancer, one symptom of which is described as a 'smell of roast.' Women gave birth on a birthing stool in the sitting or standing position, (Figure 20) and motherhood, if the child and mother survived the ordeal, was pretty much the same as it always has been. (Figure 21).
A particularly interesting translation from the Ebers Papyrus reads:
'You must put wheat and barley in a cloth bag. The women is to urinate on it daily. If both germinate, she will bear. If the wheat germinates she will bear a boy. If the barley germinates she will bear a girl.' (Thornwald 1962e.)
In 1933, Julius Manger at the Pharma- cological Institute in Wurzburg in Ger- many, demonstrated that the urine of
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pregnant women who later gave birth to boys accelerated the growth of wheat, while that of women who later gave birth to girls accelerated the growth of barley.
The Egyptians were great drug-givers and prescription-makers. They knew about, and used, a t least one third of the medicinal plants listed in modern pharmacopaeia - a great feat consider- ing the size of the civilized world and the time taken to travel. Some 900 prescrip- tions were set forth in the Ebers Papyrus. In Figure 22 Queen Nefertiti is holding u p a mandrake root to her husband Akhenaton, although what ef- fect she hopes it will have is not written down.
Of course, there was much magic and sacrifice to the gods in order to be healed, and men such as the one in
Figure 23 offering gifts to the god Horus may also have worn the amulet in Figure 24 to ward off sickness.
Finally, for those who have always admired the legendary beauty of Cleopatra, and to whom for some the history of Egypt is synonomous, Figure 25 may put the record straight!
References Margotta, Roberto, (1968) An Illus- trated History of Medrcrne (Paul Lewis Ed ), Paul Hambryn, Institute of Neur- ology, London
Thorwald, Ju rgen , (1962) Soence and Secrets of Early Medicrne, Thames and Hudson, London (1962a and b - p 54, 1962c - p 26,1962d - p 28,1962e - P 100)
Figure 21. h i s feeding Horus.
Figure 22. Queen Nefertiti holding up a mandrake root to her husband Akhenaton.
Figure 23. A man offering gifts to the god Horus.
Figure 24. An amulet - used to ward off s ic k ness.
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Figure Acknowledgements The author would like to give acknow- Figures 2, 3, 5, 6, 8, 9, 10, 13, 16, 17, 18, Figures 12 and 14 - Readers Digest ledgernentsfor the following Figures: 21, 22, 23 and 25 - Thames and Publications Ltd Figure l a and b - Cuenca, Esteban HudsonLtd Figure 15 - George Rainbird Ltd/ Llagostero, Kodak Madrid Figures 4 , 7 , 1 1 , 2 4 - Paul Harnlyn Ltd Times Newspapers Ltd
Figure 25. Cleopa tra - goitre and all!
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