Respectful Insolence

The Art of Medicine in Ancient Egypt

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgIt’s the week between Christmas and New Years, and, oddly enough, I’m feeling exceptionally lazy. For one thing, it’s a slow “news” time; nothing much is happening to blog about, at least nothing that’s motivated me to rouse myself from my declining food-induced coma to lay down some not-so-Respectful Insolence today. For another thing, I’m supposed to be on vacation! Well, sort of. I will be working on grants for part of today, and I’ve already answered a whole bunch of work-related e-mails, fool that I am. In any case, this post dates way, way back to November 2005. True, I did repost it once in December 2006 (during the very same period between Christmas and New Years, actually), but that still means that, if you haven’t been reading for at least four years, it’s new to you. I’ll probably be back tomorrow, though. I notice that Age of Autism is rolling out its yearly awards, as it does every year at this time, and there might be some blogging material there. There’s also still material from before Christmas floating around.

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.

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.

i-9bbb38c800c668aa87f0f3cd6a60c858-Recto-6-7.L.jpgActually, 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.”

i-66aeb7852e68e9646002dee97e100718-eg10.176.113.L.jpg

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…

Comments

  1. #1 daedalus2u
    December 28, 2010

    The ancient Egyptian treatment that I like is the one that relates to my nitric oxide research.

    http://www.digitalegypt.ucl.ac.uk/med/birthpapyrus.html

    If you look at remedy # 21. Column 3, 6

    “tm [..] Hs msH wgp Hr HsA awyt txb […]”

    “For preventing [..] crocodile dung, chopped over HsA and awyt-liquid, sprinkle […]”

    It describes the use of crocodile dung, as a pessary. Unfortunately, what was to be prevented is unknown because there is a hole in the papyrus. They have an image, so you can see for yourself.

    There have been multiple speculations as to what this treatment was actually for. It has been suggested it might work as a contraceptive because of low pH, or by fostering abstinence. ;) My own research suggests that it is a powerful sexual stimulant due to its nitric oxide releasing properties.

    Crocodiles are uricotelic organisms, they excrete uric acid in their urine which is what makes it white and semi-solid. In the soil nitrogen compounds are degraded to ammonia, and then oxidized to nitrite by ammonia oxidizing bacteria. Nitrite is a component of saliva, which I think is responsible for the therapeutic effects of the common folk remedy for male impotence and for female anorgasmia, application of saliva to the sexual organs. Nitric oxide is essential to activate the physiology of the male sexual response, and females also have erectile tissue that is activated by NO release.

    I didn’t have crocodile dung, so I used a crocodile dung simulant, Cockadoodle DOO.

    http://www.purebarnyard.com/cockadoodledoo/default.asp

    This is the aerobically composted dung of another uricotelic organism, Gallus gallus. When moistened with water, it releases a large and sustained bolus of nitric oxide, on the order of 1 nM/minute (that is a physiologically significant amount) for ~ an hour or so.

  2. #2 D. C. Sessions
    December 28, 2010

    Don’t totally write off the old treatments with olive oil and wine or vinegar, either. They at least keep the wound margins from drying, plus olive oil, turpentine, and wine have some moderately effective antibacterial properties.

    Honey, of course, is a fair antibacterial based on sugar osmosis.

    All in all, I greatly prefer the spiffy stuff we have now but if I were stuck three thousand years ago I wouldn’t turn up my nose at some of the stuff mentioned. (Some of the others, like the purported virtues of crocodile excrement, you’d have to catch me first.)

  3. #3 daedalus2u
    December 28, 2010

    DC, I posted on that very subject and it is held up in moderation. Crocodile dung is a great nitric oxide source and that NO would kill the Clostridia that is often found in honey ;) I think that is why it was used on umbilical cords too.

  4. #4 Alex Besogonov
    December 28, 2010

    daedalus2u: Is there anything that can’t be cured by a little bit of NO? :)

  5. #5 daedalus2u
    December 28, 2010

    Alex, yes, many things. I just don’t post about them ;)

    But don’t let me stop you from posting about them ;)

    But don’t worry, I’ve got your back. If you mistakenly post about something not being cured by NO when it is, I will try to gently correct you ;)

  6. #6 Denice Walter
    December 28, 2010

    “treatments often combined the practical and the magical”- I see that “integrative medicine” has been around for a *really* long time.( BTW woo-meisters still talk up honey for this).

    But more seriously : if you saw this exhibit at the Met, I hope that you did not miss the awesomely spectacular Temple of Dendur, compleat with reflecting pools and naturally skylit, with a view of Central Park.

  7. #7 Roadstergal
    December 28, 2010

    “an ailment for which nothing is done”

    According to The Emperor of All Maladies (which someone here recommended, and thank you for that!), breast cancer fell under that category…

  8. #8 seattle chiropractor
    December 28, 2010

    For most of my life, I’ve been an exceptionally healthy person. Then, ten months ago, everything changed and I began to have some serious health problems that turned my life upside down. My body was telling me that things were out of balance and I was diagnosed with PRP, a rare skin disease characterized by scaly lesions over my entire body and thickening of the palms of my hands and soles of my feet. I was shedding so much skin that my home and office resembled a snow storm. In addition, my energy was totally depleted, severely limiting my ability to live life normally.
    The cause of PRP is unknown and there is no known cure. In most patients, the disease burns itself out after 3-7 years, though medical doctors insist on treating the disease from the medical paradigm of suppressing symptoms with steroids, which have dangerous side-effects. Going through PRP feels like limbo. You can’t get on with your life, there’s fear of the unknown, and there are the day-to-day limitations of chronic illness. All of it can be overwhelming and depressing.
    My solution? I walked away from conventional medicine after three weeks–no more follow-up appointments, no more tests. I needed to change my mindset before PRP became too much a part of my identity and purpose each day. I knew this health issue was brought on by stressful events in my life over the last year and that it was largely up to me to manage it.
    I sought the help of Rosita Arvigo, a naprapathic physician, herbalist, international lecturer, author and teacher of Maya medicine. Rosita’s husband, Dr. Gregory Shropshire, dismissed the autoimmune supposition altogether and treated me with herbal infusions made from plants. A dramatic improvement in my condition began almost immediately and I was able to go from barely being able to walk at all to going on a two-mile bike ride within two weeks after beginning Dr. Gregory’s regimen.
    I’m not saying that this type of treatment is right for everyone. We all need to decide on the course that’s right for us, and different circumstances might dictate very different actions. There are times when we need to pursue the tests and stay the course, as is the case with cancer. For me, this was the right choice.

  9. #9 Lexi
    December 28, 2010

    Honey can help slow the growth of bacteria in wounds; maybe this is what’s referred to in the discussion of the treatment of a scalp laceration.

  10. #10 Heliopolitan
    December 29, 2010

    Not sure comment#8 is on-thread, or that a tale of spontaneous remission of a disease that typically spontaneously remits has much to say about the medicine practised in Ancient Egypt, or about the healing powers of “naprapaths” or whatever. Maybe it’s an ad for “Dr Gregory”? (Is this a US thing? In the UK, to be called “Dr Joe” is just incredibly naff. It’s “Dr Bloggs”, dear sir. I insist. Anyway…)

    With regard to Ancient Egyptian medicine, a striking feature is the commonality with modern practice of the concept of history/examination/investigations/differential diagnosis/prognosis structure. Although there seem to be some very weird things going on, and although the pharmacopoeia is hugely underspecified, if one were to be trying to recreate some of the treatments, you can see why the Hippocratic school of medicine attributed some of their best stuff to their Egyptian forebears.

    However, it’s pretty evident that although the medical papyri give us some insight, we have lost a heck of a lot about what it would have been like in an actual Egyptian swnw‘s clinic. Many of the papyri (not the Smith) are clearly copies several generations removed from the original, and have been copied by scribes, not the actual medical practitioners. It seems at least probable that there were certain standard “medical meanings” of things like “crocodile dung”, eg. a standardised way of preparing the stuff, rather than simply usage from what you gathered up by the Nile.

    I did my Certificate of Egyptology dissertation on the medical treatment of children in Ancient Egypt – the data are actually rather sparse, and I think a great deal was simply passed on by word of mouth from doctor to apprentice, without ever being written down. But clearly they were regarded as good, since the kings of the ancient Near East used to beg for Egyptian doctors to come and tend their families.

    I also particularly like the triage concept, into relatively minor disorders which don’t pose a challenge, significant disorders which need some intervention and a dollop of good luck, and disorders where it’s game over. Very similar again to modern triage.

    There was a huge amount of magic also, often based on the sorts of erroneous thinking that we see in altie and folk medicine to this day – lettuce (because it’s firm and crunchy) as an aphrodisiac, for example. It probably comes back to the philosophical fallacy of “qualia”, where properties like “dogness” and “tableness” exist as attributes that can sometimes be transferred to other objects or people. The Elephant Man’s mother was startled by an elephant, so some of the elephant essence was transferred to her fetus – that sort of bollocks.

    I rather think Imhotep would have been delighted with the rise of medical science that has consigned a lot of the magical nonsense to the midden pits…

  11. #11 wfjag
    December 29, 2010

    @Besogonov: “daedalus2u: Is there anything that can’t be cured by a little bit of NO? :)”

    Hey, Alex. NO was declared “Molecule of the Year” in 1992. http://www.sciencemag.org/content/258/5090/1862 Get it to wear a blonde wig and CNN will probably give it the 8:00 PM (EST) time slot (it would have to be better than Parker-Spitzer).

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