While I am on vacation, I’m reprinting a number of “Classic Insolence” posts to keep the blog active while I’m gone. (It also has the salutory effect of allowing me to move some of my favorite posts from the old blog over to the new blog, and I’m guessing that quite a few of my readers have probably never seen many of these old posts, most of which are more than a year old.) These posts will be interspersed with occasional fresh material. This post originally appeared on November 7, 2005. As for this particular post, it occurs to me: Geez, why haven’t I continued this series past part 2?
Over the weekend, I visited the Metropolitan Museum of Art. My wife and I were interested primarily in two exhibits: Vincent Van Gogh: The Drawings and The Art of Medicine in Ancient Egypt. As you might expect, my wife was more interested in the Van Gogh exhibit, and I was more interested in the Egyptian exhibit.
I will admit that the Van Gogh exhibit impressed me quite a bit. Art near-illiterate that I am, I had had no idea that Van Gogh, whom I had usually associated with imaginative and bright paintings, such as the famous Sunflowers or The Starry Night was also highly accomplished at drawing. Yet, gallery after gallery of Van Gogh’s drawings showed me how little I knew about this master. The drawings included in the exhibit, some of which were paired with paintings derived from the drawings, were a revelation, and even the self-important woman who tried to lecture my wife on the exhibit could not mar the experience. If you live near New York or will be in New York before December 31, I highly recommend that you check this exhibit out.
The Egyptian exhibit was far more modest in scale, being contained in one relatively small gallery. However, to me, it was probably more interesting because of the centerpiece of the exhibit, the Edwin Smith Papyrus. This papyrus was named after the American Egyptologist who purchased it in Luxor in 1862 and brought it back to the U.S. The papyrus dates to approximately 1600 B.C. and appears to be a copy of a document that dates back 200-300 years earlier still. What fascinated me is that this papyrus was a practical guide to the treatment of various ailments and embodied the medical thinking of Egyptian physicians of the time. Even more fascinating is that the knowledge contained in the scroll was presented as several cases. Most of the cases were, as might be expected, how to deal with traumatic wounds. There are also included eight magic spells purported to protect against airborne disease, but there is also one for preventing harm from an accidentally swallowed fly. Showing that some things never change, there were also two prescription for cosmetic purposes, one of which was for an ointment to combat a head cold, as well as for “rejuvenation of the skin and repelling of wrinkles, any age spots, any sign of old age, and any fever that may be in the body.”
And you wonder where alties got their ideas from.
Actually, reading the translations for some of the remedies filled me with wonder. Remember: The ancient Egyptians had no idea what caused most diseases (which is probably why a lot of this papyrus dealt with trauma, which had a mechanical cause and mostly mechanical treatments). They had no concept of bacteria, only a very rudimentary idea of the circulatory system, knowing only that it originated in the heart, but having no real idea what its purpose was. Diseases were ascribed to the malign influence of various gods and magic, and physicians were often also priests, usually Sekhmet or Imhotep (Greeks equated Imhotep with their own god of medicine, Asklepios). Because Egyptian physicians were both medical doctors and priests, their treatments often combined the practical and the magical.
However, reading some of these cases was quite instructive. The papyrus presents the cases in terms of diagnosis and practical treatment, dividing the conditions into three categories: “An ailment I will handle” (meaning there was a practical treatment available); “an ailment I will fight with” (for ailments for which the treatment and outcome was less certain); and “an ailment for which nothing is done” (for ailments for which no treatment is known). For ailments falling in the first two categories, the papyrus provides a description of the recommended treatment. Take these two cases, one of a head wound with skull damage (case 3) or a head wound with damage to the plates of the skull (case 4):
Case 3. A head wound with skull damage.
Practices for a gaping wound in his head which has penetrated to the bone and violated his skull.
Examination and prognosis: If you treat a man for a gaping wound in his head, which has penetrated to the bone and violated his skull, you have to probe his wound. Should you find him uunable to look at his arms and his chest and suffering from stiffness in his neck, then you say about him: “One who has a gaping wound in the head, which has penetrated to the bone and violated his skull, who suffers from stiffness in his neck: an ailment I will handle.”
Treatment: After you stitch him, you have to put fresh meat the first day on his wound. You should not bandage him. He is to be put down on his bead until th etime of his injury passes, and you should treat him afterward with an oil and honey dressing eery day until he gets well.
This sounds like a description of a serious gaping scalp laceration without an underlying skull fracture, and the treatment here is not all that different than what we’d do today (the raw meat and oil and honey dressings excepted, of course). Contrast this to s more serious head wound:
Case 4. A head wound with damage to the plates of the skull.
Title: Practices for a gaping would in his head, which has penetrated to the bone and split his skull.
If you treat a man for a gaping wound in his head, which has penetrated to the bone and split his skull, you have to probe the wound. Should you find something hter uneven under your fingers, should he be very much in pain at it, and should the swelling that is on it be high, while he bleeds from his nostrils and his ears, suffers stiffness in his neck, and is unable to look at his arms and chest, then you say about him: “One who has a gaping wound in his head, which has penetrated to the bone and split his skull, while he bleeds from his notsrilsa nd his ehars and suffers stiffness in the neck: an ailment I will fight with.”
Treatment: Since you find that man with his skull split, you should not bandage him. He is to be put down on his bead until the time of his injury passes. Sitting is his treatment, with two supports of brick made for him, until you learn that he arrives at a turning point. ou have to put oil on his head and soften his neck and shoulders with it. You should do likewise for any man you find with his skull split.
Explanations: As for “which has split his skull,” it is the pushing away of one plate of his skull from the other, while the pieces stayin in the flesh of his head and do not fall down. As for “the swelling on it is high,” it means that the bloating that is on the split is great and lifted upward.” As for “you learn that he arrives at a turning point, ” it is to say that you learn that he will die or until he has revived, since it is an “ailment I will fight with.”
This is a startlingly good description of a head injury with a skull fracture (probably a basilar skull fracture, given the bleeding from the ears), and the examination is not too different from what is done in the trauma bay today: Probe the wound and see if you can feel any fractures. Also surprisingly accurate is the observation that “sitting is his treatment.” Elevated intracranial pressure can occur with fractures of this sort, and keeping the head elevated is one way to minimize the rise in intracranial pressure. Indeed, even today, we often keep head-injured patients in a partial sitting position to try to minimize the tendency to intracranial pressure to rise. Of course, we now have CT scans and MRIs to delineate the full extent of the injury and intracranial pressure monitors to determine the extent of the brain selling. We also have hyperventilation and mannitol as adjuncts to try to lower intracranial pressure, and, if they fail, there is always the last resort of the phenobarbital-induced coma. However, given the primitive resources available to ancient Egyptian doctors, it is impressive indeed that they were able to figure out that sitting the patient upright would be helpful for this sort of injury.
I just love this sort of exhibit, as it lets me indulge my interest in both medicine and history. You know, since I happened to have purchased the exhibit book, which contains the complete translations of all the cases in the papyrus, I might have to make this a recurring series, in which I discuss some of the more interesting cases. Maybe later this week…