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The Earliest Medicine
The Earliest Medicine
In the field of the History of Medicine, which civilization should be considered as having produced the earliest practice and documents? Abundant data led the Historians to show that Egypt has the primacy in this field as in many others. Yet, as far as scientific methods are concerned, most of the modern physicians were taught that Greek medicine was the first, due to such figures as Asclepios as the Patron of Medicine and Hippocrates (460-375 BC, 5th-4th cent. BC) as the founder and pioneer of scientific approach to healing methods. However, we should not forget that the Greeks (i.e. Solon, Pythagore) used to study medicine in Egypt and that Hippocrates himself, after spending several years studying in Egypt, was obviously influenced by Egyptian medical texts in writing his treatise.
In Earlier Antiquity, Egyptian Physicians were reputed as highly reliable: in 900 BC, Homer, in his Odyssey, speaks of Egyptian doctors as follows: " In medical knowledge the Egyptian leaves the rest of the world behind."
The Egyptian god Thut was the first Patron of Wisdom and Medicine in Human History, and the Egyptian Architect Imhotep, the Minister of the Pharaoh Jeser (3rd dynasty, 28th c. BC) is the earliest Medical Practitioner known.
For a long time and till the nineteenth century, our knowledge of Ancient Egyptian Medicine mainly depended on the reports of Herodotus, Strabon (c.58 BC-25 AD) and Diodorus the Sicilian (1st cent. BC) as well as that of Clement of Alexandria. With the achievement of the decipherment of Hieroglyphics in 1822 by J.-F. Champollion, the Egyptian Medical documents could be translated and then appreciated by our modern world from the second half of the nineteenth century onwards : the German scholar Brugsch began to translate the medical texts in 1853; he was followed by others, but it is the publication of the American scholar Breasted in 1930 which began to demonstrate the importance of medical sciences in Ancient Egypt.
Beside the names of over one hundred physicians from Pharaonic Egypt which were found in papyry, ostraca, stele, tombs, temples or on various personal objects (vases, rings etc.), our main sources on Ancient Egyptian Medicine relies on about a dozen of papyri. Most of them are dated from the New Kingdom, 16th c. BC. However, their style, phrases and vocabulary are related to the Middle Kingdom, as well as their physical aspects : length (two to six meters), width (between 30 and 35 cm). Some of them have drawn their origin from the Old Kingdom. This means that many of these papyri are copies of earlier texts.
They are the papyrus Smith, Ebers, Hearst, Kahoun, Berlin, Brooklyn, London, London-Leyde, Chester-Beatty, Carlsberg, Erman and Ramesseum. They include diagnosis and treatment of diseases and surgery as well as pharmacological receipts and formulas; some of them describe hopeless cases of illness and accidents, or deals with mental disturbances or spiritual problems ( psychiatric and neurological cases). Eventually, we can find relatively few documents dealing with magical practices.
The following list of papyri is introduced in alphabetical order.
The Berlin Papyrus
The Brooklyn Papyrus
The Carlesberg Papyrus VIII
The Chester Beatty Papyrus
The Ebers Papyrus
The Edwin Smith Papyrus
The Erman Papyrus
The Hearst Papyrus
The Kahun Papyrus
The Leiden Papyrus
The London Papyrus
The Ramesseum Papyri III, IV and V
The Medical Ostraca
The Zwiga Ostraca 278
Were Ancient Egyptian Practioners Magicians?
At the beginning of our century, a lot of polemics took place among Egyptologists concerning the Physicians and Healers of Ancient Egypt; some scientists charged them with being mainly concerned with witchcraft and magical practices, while others pointed to the fact that the Ancient Egyptians, who were such fantastic architects and mathematicians, could not have been so ignorant in the field of Human health.
These polemics were due to the fact that some of the Ancient Egyptian medical texts are indeed mixed up with what was commonly called "magical texts". These polemics came to an end in the thirties, when an American Egyptologist, James Henry Breasted, who was a good philologist dealing both with hieroglyphics and hieratic texts, managed to give a good study and translation of the Edwin Smith Papyrus, also called "The mysterious Book of the Physicians".
This translation contributed to cast new light upon other important Papyri such as the Ebers, Kahoun, Hearst and the others. Until the beginning of the 20th c., these documents had been considered, as we said before, as "magical texts". Two reasons may explain this:
The first reason lies in the inadequacy of the translations: the first translators obviously lacked comparative vocabulary and documentation in the field of medicine, so that these translations were more or less given in form of magical incantations, calling on the names of particular deities to heal the patients by performing special behaviors and gesture.
The second reason for including these magical aspects in medical texts, on the part of the physicians themselves, may have been a therapeutic "technique" aimed at favoring the patients' healing by psychological conditioning. It should indeed be mentioned that, according to Ancient Egyptians, the human body is naturally healthy, and that illness is necessarily caused by an external agent, which may be a bad deity, a divine punishment or a curse; it was then necessary for the medical practitioner to neutralize such bad influence before dealing with the illness itself.
What is now certain and acknowledged by all Egyptologists is that these unrational aspects did not interfere with the scientific skill of the Physicians; on the contrary, it was a good psychological help and mental therapy of the patients.
In the case of consulting an oracle, the consultant priests used to tell frankly what the deity had decided for the illness of the patient, of course according to the priests own knowledge of the illness: whether the illness of the concerned person would be healed, or the illness of another person was incurable. This practice was more religious than clinical or rational, although in most cases they were right, due to their high medical knowledge, even if they attributed it to divine revelation.
Medical Studies And Specializations
From the first Dynasty (c. 3100 BC) onwards, it was possible to study medicine in specialized Institutes, per-ankh (house of life); some of them were very famous and would gain international reputation, such as the Imhotep per-ankh in Memphis or that of Saïs in the Delta during the New Kingdom and afterwards. These schools were protected by the pharaohs themselves: Thutmosis 3rd (18th dyn.), paid good attention to doctors; Ramses IVth used to visit regularly the per-ankh house of Abydos to consult the books.
Women were not excluded from medical studies. The first known lady doctor (Sinw.t) in history is Peseshet, 6th Dynasty, 25th cent. BC; not only was she a doctor, but even the head of a team of practitioners!
Physicians could be General Practitioners, but specialization was extremely developed, each part of the body being the subject of specialized studies, as witnessed by abundant monuments, and also by the father of Historians, Herodotus (5th c. BC): "The art of medicine thus divided amongst them; each physician applies himself to only one disease, and not more. All places abound in physicians; some physicians are for the eyes, others for the head, others for the teeth and others for the parts concerning the belly and others for internal disorders." There were also surgeons, gynecologists, ophthalmologists, internists, proctologists, doctors for the cemeteries (hygiene and anatomy), rhinologists and dentists and even makers of false teeth, considered as craftsmen.
According to the available data, part of veterinary work, such as supervising and curing cattle, was ascribed to physicians; however, most of the veterinary practice was performed by laborers who had special experience and skillfulness.
Pharmacology used to be a part of the physicians' studies and knowledge; however, it was sometimes attributed to a special cast of chemists.
Medical Organization And Hierarchy
The general name for practitioners was Sinw; this word is at the origin of the word "medicine". Medicine was for everybody, the poor as well as the rich. Some practitioners were dedicated to ordinary people while others, called Sinw pr-c3, were dedicated to the Royal household and members of the Palace staff. Some of the latest bore the title of "Physicians delegated to foreign Lands"; they could be sent abroad by the Pharaoh upon the request of a foreign king looking for a reputed Egyptian Practitioner to heal his illness or the illness of one or some of his close people.
Another kind of doctors was the Sa.u, who had a spiritual function, close to that of psychiatrists; most of them were priests. Indeed, medical affairs were divided between a professional body of physicians and a therapeutic clerical body. They were complementary.
The army could have its own physician, as well as the boats or some social groups such as laborers, miners, etc.
The medical hierarchy was rather elaborate: at the bottom of the scale was the ordinary physician, Sinw, then the Chief Physician, Wr-sinw, then a Medical Inspector, Sah-sinw, above whom was the Director of Physicians (Overseer), Imj-ra sinw and eventually the Commander (Controller, master) of Physicians, Hr-tp-sinw. This classification is mainly attested in the Old Kingdom (2800-2300 c. BC).
Social Status Of Practitioners
Medicine was highly considered in Ancient Egypt, to the point that some Pharaohs added the title of Practitioners to their list of titles for praise. However, textual evidence shows big differences between the various kinds of practitioners.
The doctors attached to teams of workmen seem to have been treated on the same level as their patients: on the lists of food provided to these manual workmen, their doctors are mentioned at the end, with the same quantities as the workmen. Other physicians were associated with the clergy in processions or on other occasions, which means they may have had the same type of high social rank.
As far as financial standing is considered, big gaps appear between the various categories of physicians: whereas the workmen doctors received small rations of food for their work, other physicians were granted precious gifts; some of them would become very wealthy and could buy real estates or properties or beautiful tombs in the Necropolis, or cars (chariots dragged by two horses or more). Some kings or high officials could also grant "decorations" or rewards to their favorite practitioner. The State, or private persons provided salaries to many physicians, and private medicine flourished at some periods.
Physicians were assisted by various aids, who are largely attested in the textual data: they were nurses, masseurs, bandagists, embalmers, manicurists, hairdressers. Some of them had their own books, such as "the Book of the bandagists". It is also clear that doctors were assisted by a young training person, whose job was to help and serve them.
Through this short survey on Medical practitioners in Ancient Egypt, we can see how developed was the field of Medicine, which is one of the major aspects of human civilization. As in many other fields, the modern world is indebted to Ancient Egyptians in the knowledge of the human body, diseases and healing.
Examples Of Medical Treatments
I – WOMEN
In describing the sexual act, a medical text mentions that "the man laid his heart in the woman". This means that the Egyptians were aware of the maternal contribution to the fetus ; they understood that the sperm traveled to the uterus ; we don't know whether they knew the ovaries, but it is clear that they considered the mother's nutritional role via the placenta.
The exact duration of the pregnancy was known to them : an undated text specifies "up to the first day of the tenth month", while another mentions 294 days (about 9 months). A 10 months gestation is mentioned in a couple of texts from the Roman period, in connection with the legitimacy of heirs. Another text mentions a shorter time of 182/200 days, that is 6 or 7 months.
From the Kahun Gynecological Papyrus, 1900 BC. :
Some documents from the Middle and New Kingdom indicate how to made a diagnosis of pregnancy, and how to know whether a woman can conceive : a first text advises to investigate the "vessels" of her breasts ; a second one states that the likelihood of becoming pregnant is proportional to the number of times a woman vomits while sitting on a floor that has been covered with the lees or sediment of beer and date mash. A third text specifies that a woman can become pregnant if on the day after an onion has been inserted into her vagina, the onion's characteristic smell can be detected in her breath.
The Medical Papyri mention several receipts for contraception : they advise to insert into the vagina peccaries made of honey with a pinch of nation, a crocodile organ (?) in sour milk or sour milk alone or accacia gum ; all these products have been recognized as spermatocidal in the presence of vaginal lactic acid, and is is conceivable that sour milk might be an effective spermatocide.
How to know the sex of an unborn child, according to the Berlin Papyrus n. 3038, 18th dynasty, 1300 BC.
Bring wheat and spelt ; let the pregnant woman wet it daily with her urine, in two different bags. If they both grow, she will bear ; if the wheat grows , it will be a boy ; if the spelt grows, it will be a girl. Recent investigations inferred that the pregnant woman urine samples might contain a substance that inhibit seed germination; Ancient Egyptians may have been close to the truth. This method provided correct predictions of the newborn baby's sex in 19 per 40 cases, that is nearly 50%.
Some medical texts deal with medical problems that may arise at the time of delivery : Ebers Papyrus suggests a number of oil salts and aromatic resins for hastening birth when inserted into the vagina, as well as two magical procedures for preventing miscarriage ; the same papyrus also notes that if the baby says nj at birth, he will live ; if he says mbj or moans or turns his face downwards, he will die.
Women were delivered while squatting on two large bricks or sitting in a chair from which the center of the seat has been removed, as would become customary in medieval Europe.
Women in labor were assisted by two or three other women, not necessarily by a swnw (doctor) ; midwives and birth stool were frequent, most of the Egyptian pictures of birth show the infant emerging with his head first.
The Physicians knew that amenorrehea and dysmenorrhea (absence or painful menses, respectively) were abnormal and they administrated a variety of soothing aromatic oils and ointments for inflammation for the internal and external genitalia.
Many remedies for women's diseases are described in both Ebers and Kahun Papyri; in Kahun can be found some texts concerning the eyes, mouth and legs as well as the lower abdomen and the public area (uterus). Treatments of uterine symptoms relied largely on methods that physicians thought would force it back to its usual alignment ; they did not use manipulation but rather drugs which were supposed to act directly, through various methods : having the patient sit or stand over the burning ingredients or directly inserting the remedies into the vagina or through the mouth .
II - SURGICAL INSTRUMENTS
Surgeons would use various cutting tools for their operations : sharp knives, blades struck from obsidan flint from the Old Kingdom which developed during the New Kingdom.
From the New Kingdom onwards, they used small metal knives of particular shapes and sizes, as well as tools such as hooks, forceps and "disposable" lancets and blades fashioned from reed stems, spatulas, spoons.
In some medical texts, we find "fire drill" which consisted of a stick and board used for starting fires by friction, as a cauterizing tool..
The surgical table of Kom Ombo
An interesting document can be seen in the temple of Kom Ombo, from the time of the Roman domination (1st cent. BC and 1st cent AD), dedicated to the gods Sobek and Haroeris.
The back corridor bears quite a big table of surgical instruments, divided into four horizontal rows. From top to bottom, we can see : knife blades, a seesaw, spoons, spatulas, forceps, pincers, perhaps to remove a strange element from the body, or for dental care ; small bags for drugs and a small scale used for measuring drugs (pharmacology was very precise) ; specula for dilating entrances to body cavities ; in the bottom register, two round forms may represent vases for bloodletting ; next to them is a papyrus scroll, two packages for needles or small instruments, a strange oval object which may be a cushion for holding needles, needles and cleaning tools for the womb after miscarriage.
III - SNAKE AND SCORPION BITES
Therapeutic bleeding is not mentioned in medical texts, although the papyri note that snake and scorpion bites can be cured by sucking blood from the wound and applying a tourniquet around the affected limb.
IV – BILHARZIASIS
This very frequent infectious disease was known in Egypt in early history and down toto present times. It is caused by a parasite which reproduces itself on the banks of the Nile and of the channels. It enters through the skin and brings infection to the viscera, especially the liver and kidneys. It was very common in rural population who used to walk in still waters. Physician Egyptologists identified the mention of the symptoms of this disease in the document of Pharaonic Egypt, where it is mentioned numerous times in the papyri of Berlin, Hearst, London and Ebers. The treatment they discovered depended mainly on antimony sulfide.
V - OPHTALMOLOGY
Ophthalmology was a very important and necessary branch of medicine, for plain reasons : the bright light of Egypt, the hot climate, the dust, the insects and, more than all, the flies. The eye had a very high symbolical value in Ancient Egyptian religion : the eye of Horus, divided by Seth into 64 fragments, became the eye ouadjat.
About ten Papyri deal with ophthalmology ; although they were composed in the form we have in the Late Period, their receipts are probably to be traced back to the Middle and Old Kingdoms. Papyrus Ebers and Papyrus Edwin Smith are very important as far as ophthalmology is concerned. The Edwin Smith papyrus is the more important for clinical treatment. Some hints at ophthalmology are also to be found in the Papyri of Leiden, Harris and Chassinet.
Few specialists of the eyes are mentioned : one of them is Niankh-Douaou from the 5th dynasty (Old Kingdom); another one is Khouy, Chief Priest of Heliopolis who invented some eye drops; he was also a specialist of viscera and teeth.
Papyrus Ebers mentions eye drops (collyre)for the eyes and gives its receipt (n 4/19). Some samples of eye drops tubes are housed in the Louvre Museum ; they bear hieroglyphic inscriptions : Msdmt nfw, excellent collyre, black of Galene, good for clear eye sight, push the blood (relieves congestion), push away the pain. Other Museums, like the Berlin Museum, hold other objects for eye care.
Medicine In Ancient Egypt - Selected Bibliography
Professor Ashraf Sadek