The Evolution of Modern Medicine: Chapter I - EGYPTIAN MEDICINE

The Evolution of Modern Medicine, by William Osler is part of HackerNoon’s Book Blog Post series. You can jump to any chapter in this book here.

EGYPTIAN MEDICINE

OUT of the ocean of oblivion, man emerges in history in a highly civilized state on the banks of the Nile, some sixty centuries ago. After millenniums of a gradual upward progress, which can be traced in the records of the stone age, civilization springs forth Minerva-like, complete, and highly developed, in the Nile Valley. In this sheltered, fertile spot, neolithic man first raised himself above his kindred races of the Mediterranean basin, and it is suggested that by the accidental discovery of copper Egypt "forged the instruments that raised civilization out of the slough of the Stone Age" (Elliot Smith). Of special interest to us is the fact that one of the best-known names of this earliest period is that of a physician—guide, philosopher and friend of the king—a man in a position of wide trust and importance. On leaving Cairo, to go up the Nile, one sees on the right in the desert behind Memphis a terraced pyramid 190 feet in height, "the first large structure of stone known in history." It is the royal tomb of Zoser, the first of a long series with which the Egyptian monarchy sought "to adorn the coming bulk of death." The design of this is attributed to Imhotep, the first figure of a physician to stand out clearly from the mists of antiquity. "In priestly wisdom, in magic, in the formulation of wise proverbs, in medicine and architecture, this remarkable figure of Zoser's reign left so notable a reputation that his name was never forgotten, and 2500 years after his death he had become a God of Medicine, in whom the Greeks, who called him Imouthes, recognized their own AEsculapius."(3) He became a popular god, not only healing men when alive, but taking good care of them in the journeys after death. The facts about this medicinae primus inventor, as he has been called, may be gathered from Kurt Sethe's study.(4) He seems to have corresponded very much to the Greek Asklepios. As a god he is met with comparatively late, between 700 and 332 B.C. Numerous bronze figures of him remain. The oldest memorial mentioning him is a statue of one of his priests, Amasis (No. 14765 in the British Museum). Ptolemy V dedicated to him a temple on the island of Philae. His cult increased much in later days, and a special temple was dedicated to him near Memphis Sethe suggests that the cult of Imhotep gave the inspiration to the Hermetic literature. The association of Imhotep with the famous temple at Edfu is of special interest.

Egypt became a centre from which civilization spread to the other peoples of the Mediterranean. For long centuries, to be learned in all the wisdom of the Egyptians meant the possession of all knowledge. We must come to the land of the Nile for the origin of many of man's most distinctive and highly cherished beliefs. Not only is there a magnificent material civilization, but in records so marvellously preserved in stone we may see, as in a glass, here clearly, there darkly, the picture of man's search after righteousness, the earliest impressions of his moral awakening, the beginnings of the strife in which he has always been engaged for social justice and for the recognition of the rights of the individual. But above all, earlier and more strongly than in any other people, was developed the faith that looked through death, to which, to this day, the noblest of their monuments bear an enduring testimony. With all this, it is not surprising to find a growth in the knowledge of practical medicine; but Egyptian civilization illustrates how crude and primitive may remain a knowledge of disease when conditioned by erroneous views of its nature. At first, the priest and physician were identified, and medicine never became fully dissociated from religion. Only in the later periods did a special group of physicians arise who were not members of priestly colleges.(6) Maspero states that the Egyptians believed that disease and death were not natural and inevitable, but caused by some malign influence which could use any agency, natural or invisible, and very often belonged to the invisible world. "Often, though, it belongs to the invisible world, and only reveals itself by the malignity of its attacks: it is a god, a spirit, the soul of a dead man, that has cunningly entered a living person, or that throws itself upon him with irresistible violence. Once in possession of the body, the evil influence breaks the bones, sucks out the marrow, drinks the blood, gnaws the intestines and the heart and devours the flesh. The invalid perishes according to the progress of this destructive work; and death speedily ensues, unless the evil genius can be driven out of it before it has committed irreparable damage. Whoever treats a sick person has therefore two equally important duties to perform. He must first discover the nature of the spirit in possession, and, if necessary, its name, and then attack it, drive it out, or even destroy it. He can only succeed by powerful magic, so he must be an expert in reciting incantations, and skilful in making amulets. He must then use medicine (drugs and diet) to contend with the disorders which the presence of the strange being has produced in the body."(6)

In this way it came about that diseases were believed to be due to hostile spirits, or caused by the anger of a god, so that medicines, no matter how powerful, could only be expected to assuage the pain; but magic alone, incantations, spells and prayers, could remove the disease. Experience brought much of the wisdom we call empirical, and the records, extending for thousands of years, show that the Egyptians employed emetics, purgatives, enemata, diuretics, diaphoretics and even bleeding. They had a rich pharmacopoeia derived from the animal, vegetable and mineral kingdoms. In the later periods, specialism reached a remarkable development, and Herodotus remarks that the country was full of physicians;—"One treats only the diseases of the eye, another those of the head, the teeth, the abdomen, or the internal organs."

Our knowledge of Egyptian medicine is derived largely from the remarkable papyri dealing specially with this subject. Of these, six or seven are of the first importance. The most famous is that discovered by Ebers, dating from about 1500 B.C. A superb document, one of the great treasures of the Leipzig Library, it is 20.23 metres long and 30 centimetres high and in a state of wonderful preservation. Others are the Kahun, Berlin, Hearst and British Museum papyri. All these have now been published—the last three quite recently, edited by Wreszinski.(7) I show here a reproduction from which an idea may be had of these remarkable documents. They are motley collections, filled with incantations, charms, magical formulae, symbols, prayers and prescriptions for all sorts of ailments. One is impressed by the richness of the pharmacopoeia, and the high development which the art of pharmacy must have attained. There were gargles, salves, snuffs, inhalations, suppositories, fumigations, enemata, poultices and plasters; and they knew the use of opium, hemlock, the copper salts, squills and castor oil. Surgery was not very highly developed, but the knife and actual cautery were freely used. Ophthalmic surgery was practiced by specialists, and there are many prescriptions in the papyri for ophthalmia.

One department of Egyptian medicine reached a high stage of development, vis., hygiene. Cleanliness of the dwellings, of the cities and of the person was regulated by law, and the priests set a splendid example in their frequent ablutions, shaving of the entire body, and the spotless cleanliness of their clothing. As Diodorus remarks, so evenly ordered was their whole manner of life that it was as if arranged by a learned physician rather than by a lawgiver.

Two world-wide modes of practice found their earliest illustration in ancient Egypt. Magic, the first of these, represented the attitude of primitive man to nature, and really was his religion. He had no idea of immutable laws, but regarded the world about him as changeable and fickle like himself, and "to make life go as he wished, he must be able to please and propitiate or to coerce these forces outside himself."(8)

The point of interest to us is that in the Pyramid Texts—"the oldest chapter in human thinking preserved to us, the remotest reach in the intellectual history of man which we are now able to discern"(9)—one of their six-fold contents relates to the practice of magic. A deep belief existed as to its efficacy, particularly in guiding the dead, who were said to be glorious by reason of mouths equipped with the charms, prayers and ritual of the Pyramid Texts, armed with which alone could the soul escape the innumerable dangers and ordeals of the passage through another world. Man has never lost his belief in the efficacy of magic, in the widest sense of the term. Only a very few of the most intellectual nations have escaped from its shackles. Nobody else has so clearly expressed the origins and relations of magic as Pliny in his "Natural History."(10) "Now, if a man consider the thing well, no marvaile it is that it hath continued thus in so great request and authoritie; for it is the onely Science which seemeth to comprise in itselfe three possessions besides, which have the command and rule of mans mind above any other whatsoever. For to begin withall, no man doubteth but that Magicke tooke root first, and proceeded from Physicke, under the presence of maintaining health, curing, and preventing diseases: things plausible to the world, crept and insinuated farther into the heart of man, with a deepe conceit of some high and divine matter therein more than ordinarie, and in comparison whereof, all other Physicke was but basely accounted. And having thus made way and entrance, the better to fortifie it selfe, and to give a goodly colour and lustre to those fair and flattering promises of things, which our nature is most given to hearken after, on goeth the habite also and cloake of religion: a point, I may tell you, that even in these daies holdeth captivate the spirit of man, and draweth away with it a greater part of the world, and nothing so much. But not content with this successe and good proceeding, to gather more strength and win a greater name, shee entermingled with medicinable receipts and religious ceremonies, the skill of Astrologie and arts Mathematicall; presuming upon this, That all men by nature are very curious and desirous to know their future fortunes, and what shall betide them hereafter, persuading themselves, that all such foreknowledge dependeth upon the course and influence of the starres, which give the truest and most certain light of things to come. Being thus wholly possessed of men, and having their senses and understanding by this meanes fast ynough bound with three sure chains, no marvell if this art grew in processe of time to such an head, that it was and is at this day reputed by most nations of the earth for the paragon and cheefe of all sciences: insomuch as the mightie kings and monarchs of the Levant are altogether ruled and governed thereby."

The second world-wide practice which finds its earliest record among the Egyptians is the use secretions and parts of the animal body as medicine. The practice was one of great antiquity with primitive man, but the papyri already mentioned contain the earliest known records. Saliva, urine, bile, faeces, various parts of the body, dried and powdered, worms, insects, snakes were important ingredients in the pharmacopoeia. The practice became very widespread throughout the ancient world. Its extent and importance may be best gathered from chapters VII and VIII in the 28th book of Pliny's "Natural History." Several remedies are mentioned as derived from man; others from the elephant, lion, camel, crocodile, and some seventy-nine are prepared from the hyaena. The practice was widely prevalent throughout the Middle Ages, and the pharmacopoeia of the seventeenth and even of the eighteenth century contains many extraordinary ingredients. "The Royal Pharmacopoeia" of Moses Charras (London ed., 1678), the most scientific work of the day, is full of organotherapy and directions for the preparation of medicines from the most loathsome excretions. A curious thing is that with the discoveries of the mummies a belief arose as to the great efficacy of powdered mummy in various maladies. As Sir Thomas Browne remarks in his "Urn Burial": "Mummy has become merchandize. Mizraim cures wounds, and Pharaoh is sold for balsams."

One formula in everyday use has come to us in a curious way from the Egyptians. In the Osiris myth, the youthful Horus loses an eye in his battle with Set. This eye, the symbol of sacrifice, became, next to the sacred beetle, the most common talisman of the country, and all museums are rich in models of the Horus eye in glass or stone.

"When alchemy or chemistry, which had its cradle in Egypt, and derived its name from Khami, an old title for this country, passed to the hands of the Greeks, and later of the Arabs, this sign passed with it. It was also adopted to some extent by the Gnostics of the early Christian church in Egypt. In a cursive form it is found in mediaeval translations of the works of Ptolemy the astrologer, as the sign of the planet Jupiter. As such it was placed upon horoscopes and upon formula containing drugs made for administration to the body, so that the harmful properties of these drugs might be removed under the influence of the lucky planet. At present, in a slightly modified form, it still figures at the top of prescriptions written daily in Great Britain (Rx)."(11)

For centuries Egyptian physicians had a great reputation, and in the Odyssey (Bk. IV), Polydamna, the wife of Thonis, gives medicinal plants to Helen in Egypt—"a country producing an infinite number of drugs . . . where each physician possesses knowledge above all other men." Jeremiah (xlvi, 11) refers to the virgin daughter of Egypt, who should in vain use many medicines. Herodotus tells that Darius had at his court certain Egyptians, whom he reckoned the best skilled physicians in all the world, and he makes the interesting statement that: "Medicine is practiced among them on a plan of separation; each physician treats a single disorder, and no more: thus the country swarms with medical practitioners, some under taking to cure diseases of the eye, others of the head, others again of the teeth, others of the intestines, and some those which are not local."(12)

A remarkable statement is made by Pliny, in the discussion upon the use of radishes, which are said to cure a "Phthisicke," or ulcer of the lungs—"proofe whereof was found and seen in AEgypt by occasion that the KK. there, caused dead bodies to be cut up, and anatomies to be made, for to search out the maladies whereof men died."(13)

The study of the anatomy of mummies has thrown a very interesting light upon the diseases of the ancient Egyptians, one of the most prevalent of which appears to have been osteo-arthritis. This has been studied by Elliot Smith, Wood Jones, Ruffer and Rietti. The majority of the lesions appear to have been the common osteo-arthritis, which involved not only the men, but many of the pet animals kept in the temples. In a much higher proportion apparently than in modern days, the spinal column was involved. It is interesting to note that the "determinative" of old age in hieroglyphic writing is the picture of a man afflicted with arthritis deformans. Evidences of tuberculosis, rickets and syphilis, according to these authors, have not been found.

A study of the internal organs has been made by Ruffer, who has shown that arterio-sclerosis with calcification was a common disease 8500 years ago; and he holds that it could not have been associated with hard work or alcohol, for the ancient Egyptians did not drink spirits, and they had practically the same hours of work as modern Egyptians, with every seventh day free.

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Osler, William. 2006. The Evolution of Modern Medicine. Urbana, Illinois: Project Gutenberg. Retrieved April 2022 from https://www.gutenberg.org/files/1566/1566-h/1566-h.htm#link2H_4_0007

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