Respectful Insolence

The Art of Medicine in Ancient Egypt, Part 2

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. I also wonder why I never took this series past part 2.

Last week, I wrote about my visit to the Metropolitan Museum of Art’s exhibit The Art of Medicine in Ancient Egypt, where I enjoyed examining the Edwin Smith Papyrus. This papyrus, as you may recall, is one of the earliest surviving medical texts, and what is remarkable about it is that the knowledge is presented as a series of case reports not all that much unlike the way we sometimes present cases today. What I discussed last time was mostly the management of head wounds, and I picked a couple of cases from the papyrus to illustrate that the practical management of these head wounds is not all that different today in some ways. I also rather like the way that the Egyptian physicians divided diseases and wounds into “an ailment I will handle” (a problem for which there was a treatment), “an ailment I will fight with” (a problem for which the treatment was less certain), or “an ailment for which nothing is done.”

i-a7466d1a684246cc07f9f40b813a0796-57-(33.2.1).R.jpgI had been planning on moving on to a different type of injury for the second part of my series, but then I looked at the very first case again and noticed something that perhaps I should have talked about last week. So, hopefully it won’t perturb anyone if I revisit the ancient Egyptian method of treating head injuries. I’ll get to different injuries and illnesses in the next installment. For the moment, I’d like to revisit the head injuries. Bear with me, and I think you’ll see why. So, here is the first case on the Edwin Smith papyrus, a rather straightforward scalp laceration (note that this part of the papyrus is fragmentary, leaving gaps):

Case 1. A Flesh Wound in the Head

TITLE: Practices for a man who suffers from a wound in his head, which has reached to the bone of his skull without gaping.

EXAMINATION AND PROGNOSIS: If you treat a man with a wound in his head whose wound’s lips are closed and not gaping, and […], and then you say about him: “One who has a wound in his head: an ailment I will handle.”

TREATMENT: You have to bandage him with fresh meat the first day and treat him afterward with oil and honey dressing every day until he gets well.

EXPLANATIONS: As for “you treat a man,” it is taking account of someone like taking account of things with a grain measure, treating one takes account of whatever things with a grain measure or takes account of something with the fingers in order to […] them. As for measuring things with a grain measure […], suffering is taking account of in the same way.

Measuring a man’s suffering in order to […]. As for the heart, there are vessels from it to [every] limb. As for that on which any lay-priest of Seihment and physician puts his hands or fingers–[on the head, on the back of the] head, on the hands, on the pulse, on the legs–he measures the heart. For it is the case that its vessles are in the back of the head and in the pulse, and it is the case that it speaks to every vessel and every limb, revealing the measurement of his […]–on the vessels of the head, of the back of his head, of his legs. […] his heart in order to learn the knowledge that comes from it, for [it] reveals its measurement to one who ould learn what has happened there.

As for “who suffers from […] his wound,” it is to say his would is small [not wide] without gaping from one side to the other.

As for “which has reached [to the bone of his skull without] gaping,” it is to say there has been gaping by the flishe , while that which […] on the bone of his skull has no aping and is small, not wide.

What’s interesting about this passage is that it is one of the very earliest writings describing the cardiovascular system and apparently describing how to monitor the pulse as a means of monitoring the patient. It’s not clear to me why the scribe chose to include this information for what in essence sounds like a relatively minor scalp laceration, but I can speculate. This is the very first case presented on the papyrus. Perhaps the scribe wanted to emphasize this information early, to be used for the 47 additional cases that were to follow as a general principle. It’s hard to say, and the papyrus is rather fragmented around this case, hence the missing text.

i-a833260aec2537007d288de5661c6a6c-eg19.2.16-17.L.jpg

What is most interesting about this case is that it suggests that the Egyptians understood the rudiments of how the cardiovascular system works. They appear to have understood that the heart was at the center of the cardiovascular system and that it pumped blood to the rest of the body (“to every vessel and every limb”). Of course, these ancient physicians had no idea what the purpose of pumping the blood to the rest of the body was or what the blood was carrying. Even so, they also appeared to have understood that monitoring the pulse would help them in the assessment of how badly injured the patient was. It is also important to remember that the process of mummification involved removing the internal organs, giving Egyptian physicians of this time period (1,600 B. C.) the opportunity to examine gross pathology of organs in a way that few civilizations would for more than 3,000 years. Although the heart was usually left in place during mummification, it would be difficult not to note the large tubular structures (arteries and veins) entering and proceeding from the heart.

And, indeed, there may have been significant contact between embalmers and physicians, as indicated in Case 9, which describes a “forehead wound with skull fracture.” The examination and treatment state:

If you treat a man for a wound in the front of his face, which has fractured the shell of his skull, you have to make him the egg of an ostrich, ground with oil, and put it in the mouth of the wound. Afterward, you have to make him the egg of an ostrich, grownd and made into a powder: that is what dries the wound. You have to put for him a cloth of a physician’s outfit on it.

Besides the rather strange use of ostrich eggs, an important comment is made in the explanation:

As for “a cloth of a physician’s outfit,” it is the strip of cloth that is used by the bandager.

And who is this bandager?

It’s the embalmer, the professional whose charge it was to make mummies. This passage therefore suggests that there may have been contact and exchanging of knowledge between these two professional groups, suggesting the possibility of physicians learning from the removal of organs during the preparation of corpses for burial.

Despite all this knowledge, however, we should not forget that much of the treatments in ancient Egypt were based on magic. For example, before using the ostrich egg concoction, the papyrus instructs:

What is said as magic over this prescription: “The enemy in the wound has been driven off; the conspiracy in the blood has been made to tremble; the fulbure of every side has been given to the mouth of the effective goddess. This temple will not deterioriate; there is no crocodile or poison therein. For I am in the effective goddess’s protection: Osiris’s son is rescued.”

For all the surprising level of knowledge about disease for such an ancient time, Egyptian physicians were primarily priests. Many of the treatments they used were based on magic and superstition. Even so, through observation, they managed to understand more than you might think.

Comments

  1. #1 Birger Johansson
    December 29, 2010

    And they knew quite a bit of chemistry; the ancient Greeks learned their stuff from them. Therefore, chemistry was called “The Egyptian art” (The Egyptians’ own name for their country was “Kham”, hence “chemistry”).

  2. #2 Shane
    December 29, 2010

    A minor quibble – Egypt was called “Kemet” (“The Black Land”); although known to the Arabs as al-Misr, the term al-Keme(t) was also used in some contexts, which made its way via the Ottoman empire to Europe as the word “alchemy”, and “chemistry” derives from that.

    Or so I have been told :-)

    The digression on the pulse is fascinating – these explanations or glosses are thought to have originally been marginalia that subsequently got incorportated into the main text.

    -Shane

  3. #3 islami sohbet
    December 29, 2010

    Otobüsün içini kısa sürede dumanlar sararken, sürücü Halim Getir, otobüsü yol kenarında durdurarak yolcuların inmesini sağladı. Panik halinde otobüsü terk eden yolcular, eşyalarını kurtarmaya vakit bulamadı.
    İçerisinde 37 yolcu bulunan otobüs tamamen yanarken, olay yerine gelen Düzce Belediyesi İtfaiye ekipleri, yangını uzun uğraşlar sonucunda söndürebildi.

  4. #4 Yojimbo
    December 29, 2010

    Interesting. I didn’t quite follow @3’s comment, so I ran it through Google iTranslate. Couldn’t get a translation except in Azerbaijani:

    “Otobüsün dumanlar sararken inside as soon as possible, drive Get Mr. Halim, bus stop at the way the passengers inmesini sağladı. The passengers leave the bus in panic, things kurtarmaya bulamadı time.
    37 passenger bus is completely within the bulunan yanarken, from the Duzce event instead of the Municipality Fire Brigade teams, fire as a result of a long uğraşlar söndürebildi.”

    I dunno – that seems a tad off topic to me…

  5. #5 Yojimbo
    December 29, 2010

    Actually, its Turkish – but still off topic :)

  6. #6 Jim
    December 29, 2010

    It’s similar to a lot of spammy stuff I’ve scene in SciBlogs in the last few days – appears to be ads for tourism services or something, according to another poster.

  7. #7 daedalus4u
    December 29, 2010

    I wonder if the use of fresh meat as a bandage was to ward off infection of the wound by flesh eating parasites?

  8. #8 JacobV
    December 29, 2010

    Who knew Lady Gaga was receiving her medical care from an ancient Egyptian priest.

  9. #9 Old Rockin' Dave
    December 29, 2010

    The Turkish translation engine at Babylon.com gives it this way: “The Halim brings a driver becomes your bus smokes up her inside at the short period,, her bus provided the travelers to get off while stopping at an road edge. Panic empty the bus abandonment the travelers who do, rescue your furnitures she did not besmear time. Inside 37 travelers the bus which exists yanarken completely and her fairly smooth municipality whose to place the event comes could make fire department teams and addicted burn and at the long occupations result.”
    My hypothesis is that the comment is the Turkish translation of the ancient Egyptian EMS protocol for fires on diesel buses if the driver is named Halim, and is therefore on topic.

  10. #10 SoulmanZ
    December 29, 2010

    The honey makes sense. The meat could makes sense. The ostrich egg?

    Anyone know if an emulsion of ostrich eggshell powder in oil becomes bone cement?

  11. #11 daedalus4u
    December 29, 2010

    What I like about ancient Egyptian medicine is that they seemed to know their limits. There were things for which they said there was no treatment. That is where any treatment will cause more harm than it will help. That is the essence of the Hippocratic oath, “first do no harm”.

    Practitioners of CAM don’t have that mindset. They are all too willing to apply treatments with no benefits but with real harms, like the Gonzalez protocol.

  12. #12 Ken Keenan
    December 29, 2010

    @SoulmanZ: Bob Briers’ book, “The Murder of Tutankhamen” (a theory since discredited by the most recent CAT scans!) suggests that this was likely to be a kind of sympathetic magic. By applying eggshells to a skull fracture, the Egyptian physicians probably hoped that the skull would become whole again, like an egg.

  13. #13 starskeptic
    December 29, 2010

    “My hypothesis is that the comment is the Turkish translation of the ancient Egyptian EMS protocol for fires on diesel buses if the driver is named Halim, and is therefore on topic.”

    way too funny Dave…

  14. #14 Andy King
    December 30, 2010

    Dressing with oil and honey is OK. I can not digest the bandage with meat. There might be bacterial infection with meat bandage.

  15. #15 daedalus4u
    December 30, 2010

    “Fresh” meat to an ancient Egyptian, was likely less than a few hours old, perhaps even freshly killed. If there is no refrigeration, it has to be very fresh. If the meat being mentioned is skeletal muscle, that takes a while to die when it is taken out of the organism. Skeletal muscle a couple of hours old is mostly still alive. The immune cells are going to be alive, they are pretty resistant to hypoxia.

    The usual practice in butchering meat is to have the animals very unstressed. This is to maximize the glycogen reserves in skeletal muscle. After the animal is killed, that glycogen is converted to lactate by the still living muscle cells, lowering the pH.

    Depending on the nitrate/nitrite status of the animal, the meat could be a source of NO. When tissues are subjected to hypoxia, they do generate lots of NO from nitrite. Myoglobin is a good nitrite reductase.

    Immune cells migrate toward a high temperature region. The remaining immune cells in the meat might migrate toward the wound where it is warmer. The honey might provide glucose to sustain those immune cells longer. Honey also has glucose oxidase which generates H2O2 when the osmotic pressure is reduced.

    The combination of nitrite, H2O2, and lactate is synergistically antimicrobial.

    Immune cells from cattle, are probably not that bad to use as a topical anti-microbial agent. They won’t be able to survive long term, and won’t persist in a human host. Better than Clostridia.

  16. #16 mic
    January 2, 2011

    Orac – Your amazement at the fact that people other than the current medical fraternity actually knew something about the human body really does highlight your insolence and ignorance…

    Your entire blog also seems to indicate you feel there will be no more “bottom falling out of the pail” complete scientific re-thinks, which have occurred regularly since the time of the Egyptians…Do you think we are close approaching a complete understanding of the magnificence of the human being?? Your attitude is reminiscent of that when for so many years, the medical community could not accept Harvey’s discovery that the blood circulates. Oh and do you consider that cancer and most of our modern problems didn’t really exist for the Egyptians? what’s up there? – surely nutrition and modern lifestyle doesn’t have anything to do with it. All genetics hey…lets neglect the fact that we had the same genetics then as now, its a little inconvenient…

    We truly do not have much more of an advanced understanding of what it is to be a healthy or human, we just have some fancy textbooks, drugs and a few extraordinarily rich companies… The Hippocratic oath is busted at every turn, nowadays its first do harm then take another drug/have another op to fix it then oh wait we don’t really even know whats wrong, but this new drug promises to fix it.

    Personally I don’t like to think of science and medicine as being in the same basket, one is way too polluted with vested interests. All science has is models, even research that can be taken as ‘fact’ today is nothing more than a transient model. There are never facts…things move, change adapt, most truly groundbreaking advances in science and medicine are initially met with hostility and ‘overly critical thinking’. Fundamental quacks and fundamental skeptics should be thrown in the same basket. Hopefully you will all cancel each other out and the few left can get on with some open-minded research and play… Both extremes are pretty easy to send into a rant-frenzy i say… poke, step back and watch! (oh and of course ensure you have the right balance between knowledge and openness, to not get thrown in a basket.)

  17. #17 Chris
    January 2, 2011

    mic:

    Oh and do you consider that cancer and most of our modern problems didn’t really exist for the Egyptians?

    Where does Orac mention cancer and the Egyptians?

  18. #18 mic
    January 2, 2011

    @Chris
    True my wording would suggest he did mention this when clearly he does not.. Indeed most of my comment isn’t truly relevant as a blog post, I accept this. I happened across the blog running broad searches for something entirely different, but I guess holiday boredom/free time got the better of me and I felt it necessary to chime in. Bringing it up was alluding to my humble opinion that Orac appears to display the common egotistical/I know lots because i’m a glorified butcher attitude… I know that i am not entitled to question a blogger on their own blog (heaven forbid), I just bet that there’s lots this person would never/could never consider.

  19. #19 Chris
    January 2, 2011

    Here is an idea, actually read the blog article before commenting.

  20. #20 mic
    January 2, 2011

    Here’s another idea…write something constructive, or leave your pettiness out thanks. I did read it, thrice, as I do most articles I read. I see you have less to say about the arrticle than myself, you have more to say about my comments, seems a touch backwards.

  21. #21 Scottynuke
    January 2, 2011

    Such a total site- and self-comprehension FAIL, mic. Try looking through the archives, compare the posts and comments to your less-than-constructive comment and try again.

    Kthnxbai.

  22. #22 T. Bruce McNeely
    January 2, 2011

    Bringing it up was alluding to my humble opinion

    Humble opinion? You crack me up!

    Of course, it isn’t really your opinion, it’s the same old shit we’ve been hearing from Alties for years. It’s old, busted and false.

    Here’s another idea…write something constructive, or leave your pettiness out thanks.

    Here’s yet another idea – follow your own advice.

  23. #23 Chris
    January 2, 2011

    Meh. I just noticed that what “mic” wrote had very little to do with the above article, especially with the last sentence. It looked like he was just pontificating his “humble opinion” without regard to what was really written.

  24. #24 Militant Agnostic
    January 2, 2011

    It is my understanding that the ancient Egyptians were unaware of the function of the brain. They thought it’s sole purpose was to drip mucus into the nose and the embalmers discarded the brain instead of preserving it with the other internal organs. In the case of mic they would have been correct.

  25. #25 mic
    January 2, 2011

    Hehe thanks guys you all made me laugh:) Put a poorly written cat amongst some ego hungry pigeons and watch in awe…

    @scottynuke – Ofcourse I read a lot of the archive I’m not the uninformed effing moron you all think I am! I assume by constructive, you mean constructive ‘in agreeing with the author’, as it appears anything other is not just cut down, but cops a whole lot of spite/personal character attacks. Point taken though there are a lot more thought out posts than mine! oh and ‘btw’ wish you had used EPICfail, so much more dramatic.

    @Millitantagnostic (interesting name) – your understanding seems a little misguided, not that I claim to be an expert. (however if we play Oracs game of ‘if I did it at uni/school x years ago then I must be able to critique it’, i’m aptly able to discuss a lot of topics). Its my understanding that the Egyptians knew the rudimentary function of the brain, just in their belief system, the heart of a man was much more important than the big thinking machine on top that ran things, especially for their concept of ‘afterlife’. We are only just starting to realize the important roles of the heart (and I mean in terms of physiology/immunology/communication, not this ‘woo’ you refer to.) – interesting, credible mainstream research. You must have some amazing ‘woo’ gift of knowing the size of someones intellect from reading one small half-arsed comment, thanks for the insight into myself!

    and to T Bruce McNeely – glad I could provide some light humour, you serious ones need it, glad to be of service;) They are ‘my opinions’ as, and I’m so sorry to disappoint, im not one of these ‘alties’ you refer to. Infact I dont really know much of their opinion at all. Here, some ‘complimentary’ therapies are covered by healthcare and are sometimes used in tandem with medicine to help patients feel better, whilst they seek medical care. Seems an alright system to me but I’ve never really considered it much. I don’t believe its the same old shit you been hearing (if you actually read my crap)… I believe you feel that anyone with thoughts that don’t match this blog should be thrown in that ‘altie’ basket! (small minded us-and-them mentality?). Perhaps with my background, If anything you can throw me in the preventative medicine basket. Medicine has developed so many great techniques, but we should be empowered to reduce our need for it, to ensure its always available for when we really need it…

    True and great scientists are always humble. Orac, you should not call yourself a scientist, you are a surgeon, most probably good at what you do, and a medical researcher by the sounds. I would like to see you look at and critique (not demolish as seems your style), some basic science that sits on the fringe eg in biophysics, where it appears that the standard model of nerve transmission is incomplete. A lot more interesting than just going after the most absurd ideas and cutting them down… Or just look up at the night sky and realise how small we all really are. I would also like to read your publications if you didn’t feel the need to hide your identity. I like the ‘demolish everything but don’t leave yourself open to it’, smart cookie.

    Now I shall ‘take my own advice’ and leave the unrelated and fairly un-constructive comments at that. Orac I really do apologise for leaving a bit of drivel here and there but hey, I’m entitled to leave comment, I’m sure even you can respect that. I’m not just going to let people berate me like that and just run off, for I, as you, still cling strong to the left brain/ego. Take a few steps down from that very-high-horse of yours, and find the time to broaden your horizons a little, by reading some real, inspiring an potentially revolutionary literature that’s out there. Oh and never again complain of not getting grant money, your in cancer research! sheesh grants are never easy but you sure as heck do have a lot more chance at it than in most other fields… good place to start with humility:)

    ‘Humble’ Regards,
    Michaela PhD.
    motor control,neurophysiology, and exercise researcher (and shit stirrer/observer of human reactivity)

  26. #26 T. Bruce McNeely
    January 2, 2011

    ‘Humble’ Regards,
    Michaela PhD.
    motor control,neurophysiology, and exercise researcher (and shit stirrer/observer of human reactivity)

    PhD?

    You should be ashamed of yourself.

  27. #27 mic
    January 2, 2011

    Ahah i see you didn’t get the errr shit stirrer part. Just playing your ego trip game!
    Not sure if you are insinuating that a)I should be ashamed that I chose to study for a PhD rather than go down the easy and well funded path of medicine, that b)I should be ashamed that I would be so egotistical as to stick it at the end of my name or that c)Ashamed that I should waste my time on such blogs when I clearly have more exciting research to be doing. hmmm ?? (or maybe you just diss my field?)

    Never ashamed of myself buddy and i’m pretty sure my colleagues aren’t either. We are a different bunch over here, intelligent and with a sense of humour! If I wasnt on the other side of the world I’d be a bit worried about a witchhunt!

  28. #28 Militant Agnostic
    January 2, 2011

    Orac has a PhD you arrogant twerp.

  29. #29 T. Bruce McNeely
    January 2, 2011

    I said that you should be ashamed of yourself because you are smart enough to have earned a PhD, yet your comment is arrogant unoriginal drivel that was beaten to death long ago. Also, your writing, spelling and punctuation would be a disgrace in a high school class.

    I wouldn’t worry about a witchhunt. Start worrying when someone talks about shooting boars. That could be misinterpreted to your disadvantage.

  30. #30 Mic(arrogant twerp)
    January 3, 2011

    Arrogant twerp, hmmm might make that my new screen name, cheers! Please direct me to where my arguments have been made before, exciting considering I am not a fan of alternative medicine, nor a fan of medicine particularly… (though I do go to the Doc when I need). Excuse the writing – it’s short hand lazy internet writing not really an indication of much, I take a little more care when engaged in serious discussion. I’ll be sure to mind my little boar rear should I venture too far west, thanks for the heads up.

    Truly Arrogant people cant laugh at themselves, and that is something I can do…

  31. #31 Chris
    January 3, 2011

    Militant Agnostic:

    Orac has a PhD you arrogant twerp.

    That is in addition to the MD.

    Michaela, no one knows who you are on the Internet… you are actually more judged by what you write. I was baffled at your comment on this article because it seemed to not coincide with its content, and you responded that “Indeed most of my comment isn’t truly relevant as a blog post,” which I took to mean you did not read it (it was originally posted in five years ago). For that I was accused of being petty.

    Whatever. You seem to be offended by a description of a museum exhibit by a surgeon and cancer researcher who teaches at a medical school. I don’t know why, since it is mostly a description of the exhibit with a bit of admiration for the knowledge they did possess (which could be contrasted that to the medical knowledge of Medieval Europe where dissection of humans was prohibited, which I learned about from reading Mary Roach’s Stiff and a book I bought for my daughter, Karen Cushman’s Matilda Bone).

    You also seemed to have passed the GRE before the written essay part was required, because you would have failed. That was the part I sucked at but did pass, but then again — I am just a lowly engineer (though I kicked butt with the reading and math parts, so I am actually a part time grad student).

    Yes, we know this is only a blog comment. But lurk around a bit, you will see that most of us communicate with full punctuation and spelling, though typos do happen. Commentators here are judged by their literacy and rhetoric. Deal with it.

    Word of warning: Orac will also have typos in his very long articles, but never ever, but NEVER! call him out on that. Corrections of major errors are okay, but not pedantic ones involving typos.

  32. #32 Emily
    January 3, 2011

    Nice one, f=very funny, made me laugh http://thehealthymonk.com

  33. Even if the Egyptian doctor of old was thinking of eggs and sympathetic magic, I wonder if putting ground eggshell into a skull fracture might not help create a calcium scaffold for healing. It might even have been a result of cultural selection for success, e.g. thinking of coconuts and using ground coconut wouldn’t work as well.

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