The Origin of Medicine
Ancient Egyptian Medicine
CAIRO, APRIL 2008: Ancient Egyptian civilization has contributed significant developments to all kinds of human knowledge, and medicine is not an exception. Ancient Egyptians used to call a doctor a “physician” referring to an active, a professional and a wise person. A physician was able to deal with what might happen during daily practice as competently as a countryside general practitioner would do today. The physician’s job was not only to attend sick people and to recommend a treatment but also a physician would prepare and dispense medication. The physician was usually a priest and perhaps with good knowledge of other arts.
Ancient Egyptians were the first known people to have had a detailed study of medicine and to leave written records to describe the healing practices. The oldest Egyptian medical texts date back nearly to 2000 B.C. These texts were reasonably free of the magician approach to treat illness.
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The earliest known physician in history was Hesyre, who was the “Chief dentist and Physician” of King Djoser in the 27th Century BC. The earliest known female physician was also an Egyptian. Peseshet practiced medicine during the period of the fourth dynasty (2600 B.C). Her title was “Lady Overseer of the Lady Physicians”. As well as practicing medicine, Peseshet had a supervisory position and graduated many midwives at the ancient medical school in Sais (Sa el-Hagar today).
Conception of the human body:
Ancient Egyptians tried to rationalize and understand the physiology of the human body. Given how important River Nile was for life, Ancient Egyptians would suppose likeness to the flow of the mighty river and to how it irrigated the fields. They assumed the human body, by analogy, had channels that flowed with blood, breathed air and water. People would fall sick if a blockage to these channels happened. For example, they believed that bad food would produce gases, which in turn would block these channels. They, therefore, assumed that most of the diseases were because of improperly digested food.
Notions of physiology and disease focused on the heart as the center of the human. The heart was one’s partner; it spoke to a person in his or her solitude. It was at the same time the engine of all the bodily work, not only circulation. From the heart, continued channels (Metu) linked all parts of the body together. Metu did not refer only to blood vessels, but also to the respiratory tube, ducts of various glands, spermatic duct, the muscles, tendons and ligaments.
The Goddess of medicine (Sekhmet):
Sekhmet was originally the warrior Goddess of Upper Egypt. Ancient Egyptians figured her as a lioness, the fiercest hunter known to them. They believed that her pant created the arid region beyond the Nile banks, and considered Sekhmet the protector of all Pharaohs.
The name Sekhmet became synonymous to the Goddess of Medicine during the Middle Kingdom. Therefore, physicians, dentists and veterinary practitioners were the “Priests of Sekhmet”. The head of lioness symbolized power and the supreme deity of healing. The priests of Sekhmet were the specialists in medicine and surgery.
Students learned the medical profession at schools called the “Houses of Life”. The tutors had given them some applied experience, but mainly the students had to learn from the written papyri full of knowledge and experience. The medical texts were not only a fount of professional knowledge but also a safeguard against possible failure.
Categories of Ancient Egyptian Physicians:
The social class of Egyptian Physicians existed since the days of the Old Kingdom. Medical specialization also existed. Writing of travels to Egypt, Herodotus (484-425 BC) noted, “The practice of medicine based on a plan of separation. Each specialist physician treated a single disorder and not more. Thus, Egypt was full of medical practitioners, some undertaking to cure diseases of the eye, others of the head and others of the intestines. Specialist physicians did not necessarily settle in the villages and towns they practiced the art of healing” (Herodotus: The Persian Wars. P. 155).
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Many physicians were priests and some were scribes as shown in titles like “Chief physician and scribe of the word of God”. Physician ranks were an ordinary physician (like a general practitioner of today), a senior physician, an inspector, an overseer and a “Master” of medicine. The Chief Physicians of the South and North were like ministers of health. Royal and palace physicians had special ranks and titles.
A practicing physician had to learn the science of drug preparation and medicinal plants. Ancient Egyptians held treating physicians in so much high esteem that they raised Imhotep (the great physician, 2700 BC) after death to a sacred status of the God of Medicine.
Ancient Egyptian cures:
Because of old notions of physiology and disease, laxatives had a significant place in Egyptian cures. Ingredients included fresh carob, castor oil and colocynth. Bulk laxatives of bran, figs and fresh fruits were also in use.
Physicians used calcium carbonate and figs as antacids. They also used soured milk and honey to help digestion. They mixed aggressive purgatives with “anticholinergics” such as hyoscyamus (atropine) or carminatives as cumin, coriander and mint. Carob (powder tasted like chocolate made from pods of a certain tree) and gypsum (calcium sulfate powder) were effective antidiarrheal cures.
Egyptian physicians treated heart conditions not as efficient, because the Egyptian physicians had difficulty distinguishing heart and stomach symptoms. They recommended aloe, mustard, willow, hyoscyamus and pomegranate (containing glycosides or useful vasodilators). Diuretics included celery, beer, carob and powdered dates.
Analgesics were few and restricted to carminatives or antispasmodics. Ancient physicians used effective antipyretics as salt, alum and willow. However, no evidence exists to the use of narcotics or other sedatives until the Roman period (30 BC).
Treatment of musculoskeletal disorder was topical with warm bandages, poultices or rubefacients (medicines to redden and warm the skin, known today as counter- irritants) like mustard, turpentine, juniper and frankincense. The Egyptians used celery for painful joints (it is still in use today as antirheumatic drug). They used saffron to treat backache.
Physicians and midwives used gynecological medications to stimulate labor, control conception or infection. They used absinthe (a bitter taste plant) for menstrual disorders and pessaries of crocodile dung to serve as contraceptive (the acidity is spermicidal). They recommended insertion of juniper oil to stimulate labor (now known to increase uterine contraction and launch labor).
Ancient Egyptians have known parasitic infestations; however, they did not recognize that schistosomiasis (Bilharzias) caused the hematuria (blood in urine) they described. Antihelminthic dugs based on pomegranate, absinthe, thyme and antimony, followed by a purgative, controlled round worms and tapeworms infestations.
Antiseptics and germicides were effective. Egyptian physicians used phenols as thyme (basil) and bitumen; alcohols were beer and fermented grapes juice. They also used minerals as zinc, antimony and copper as astringents mixed in a medium for even distribution.
For cough, they recommended mixtures of honey, acacia and antimony with aromatic inhalation. Egyptian physicians used ammi visnaga (containing a bronchodilator khellin) to treat asthma.
Egyptian physicians treated eye infections with antiseptic of copper and honey, placed on the eyelids or in the eye. They used acacia, carob and milk as demulcents for ophthalmic cures.
Skin demulcents as acacia gum and plant mucilage were popular. Physicians used Balanites oil, castor oil and goose fat to control skin infections. They mixed these ingredients with salt, malachite or ocher and used the mixture for bandages. Ladanum treated dandruff. For baldness, they used fats, oils and, symbolically, hedgehog quills. For burns, they applied an antibacterial mixture of turpentine, copper, oils and honey. To promote healing, they used Aloe vera.
Pharmacy in Ancient Egypt:
Pharmacy did not exist as an independent profession in Ancient Egypt, but a compelling evidence exists of the Egyptians had professional protocols and standards. The based the treatments conceptually, restricted by limited knowledge of physiology. The basis of most medicines was herbs and vegetables. Physicians used drugs in the form of pills, ointments and drops. They also used dressings and deodorant preparations.
Ancient Egyptian physicians did not have a pharmacopeia (book of standard drugs). Instead, the medical papyri fulfilled the task of a formulary. Medications were proper and effective that BPC (British Pharmacopeia) 1911 included 25 percent of the available drug substances stemmed from Ancient Egyptian medications.
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Recommendation of a cure, preparation and dosage pointed to awareness of potential benefits and dangers, without evidence of available formal regard to toxicity or contraindication to the medications used. An Egyptian physician could only deviate from a given treatment after four days, suggesting remarkable protocol standards.
The argument that placebo of Ancient Egyptian medication was greater than the therapeutic value appears untrue. What we grasp from Ancient Egyptian history marks a society aware of the need for healthcare and treatment. Physicians used a diverse range of plant, animal and mineral ingredients to this end. It is true that religion influenced Ancient Egyptians daily life and so had to be intrinsic to medical practice, yet as written in the medical papyri, documented rational treatment predominated that supported by prayers.
Some cures from famous vegetables and herbs:
- Garlic: Believed to give vitality, sooth flatulence and help digestion. Egyptian physicians used garlic as a mild laxative and shrink hemorrhoids (piles). During building the pyramids, supervisors delivered garlic daily to workers to give them vitality and strength needed to carry on and perform well.
- Onion: Physicians used onions to prevent colds, bring about perspiration, sooth sciatica and as a diuretic. Priests did not have onions as neither food nor medicine.
- Cumin: It is widely available in Egypt; physicians used it to increase the intestinal motion and to treat flatulence. Physicians who were treating joint aches mixed cumin with wheat flour, coriander and water to apply as a poultice on the aching joint.
- Parsley and sesame: Physicians used any as a good diuretic.
- Mustard: The uses of mustard were to provoke vomiting and to relieve chest aches.
- Coriander: The uses of coriander were many. It helped with loss of appetite, absent menstruation (not because of pregnancy), a laxative and aphrodisiac. Ancient Egyptians believed that coriander has antifungal properties and deters insects. This is the cause of finding in Tutankhamen’s Tomb.
The oldest medical textbooks:
The Ancient Egyptians recorded the medical information we are aware of in 12 papyri written in hieratic script. They show the relative sophistication of medicine in Ancient Egypt, consistency of practice and longevity of cures. The most important papyri from the viewpoint of the detailed description of illnesses and treatment are:
The Ebers Medical Papyrus:
This papyrus is 23 pages long and is mostly an internal medicine reference. It includes anatomical and physiological references as well. It describes 876 recipes and 400 different drugs. The Ebers Papyrus consists of a list of recommendations for aliments such as wounds, stomach complaints, gynecological problems and skin irritations.
The scribe calculated the amounts of ingredients for a medicine according to fractions based on parts of Horus eye. Until today, the RX symbol on each prescription refers to the Eye of Horus. For some unknown reason the scribe who wrote it did not finish the papyrus, and ended in midsentence.
The Edwin Smith Medical Papyrus:
This papyrus is, perhaps, the work of a doctor associated with a pyramid-building workforce. This five meters papyrus deals mainly with problems such as broken bones, dislocations and crushing. The physician divided the 48 cases documented into categories: "An ailment which I will treat", "An ailment with which I will contend" and "An ailment not to treat".
It described symptoms of each of the documented cases, recommending possible cures. The Physician who wrote the papyrus was aware of blood circulation throughout the body. The scribe clearly recognized that patient’s pulse reflects the condition of the heart. This papyrus includes a vast experience in bone injuries that can occur only during building of the pyramids.
Similar to Edwin Smith papyrus, few paragraphs had titles. However, all paragraphs included the phrase: "If you examine a patient with a…," a characteristic, which marks how close it is to the Edwin Smith Papyrus. This suggests that ancient Egyptian physicians recognized that examination is essential to identify the illness. Yet, the scribe in both papyri did not mention the prospects of the diseases.
The Kahun medical papyrus1900 BC
The oldest yet discovered, dating from the era of Amenemhat II. The Kahun Medical Papyrus describes methods of diagnosing pregnancy and the sex of the unborn. It also describes toothache during pregnancy, diseases and various ailments of females, and concerned with the womb and determination of fertility. The gynecological text lies in thirty-four paragraphs, of which the first seventeen have a common format. They start with a title followed by a brief description of the symptoms, usually, of a problem of the reproductive organs. The second section begins on the third page, and includes eight paragraphs, which, because of both the state of the existing copy and the language, are almost unintelligible. The third section (paragraphs 26-32) dealt with the testing for pregnancy. The fourth and final section contains two paragraphs, which do not fall into any of the previous categories. The first describes treatment for toothaches during pregnancy. The second describes what sounds like a fistula of the bladder to the vagina with incontinence of urine".
It also described methods of contraception. It described prescriptions for urinary, abdomen and kidney problems, aching limbs and aches in the sockets of the eyes.
Did Ancient Egyptians recognize forensic medicine?
Ancient Egyptians used to examine bodies of the dead to understand the cause of death. This should not look strange for such people traditionally familiar, as they were, to careful pursuit of knowledge. According to the American historian James H. Breasted (an authority on ancient Egyptian history-University of Chicago, 1930), part of the skill of the ancient Egyptian surgeons was because of what they learned from examining the dead bodies. Surgeons treated clean wounds were by stitching and adhesive bandages. They treated other wounds by getting the edges close on the first day, and afterwards treating them with honey and astringent herbs. Egyptian surgeon performed amputations and even more made prosthesis.
The influence of Ancient Egyptian Medicine on the rest of the world:
The Ancient Egyptians were the first people in the world to have based knowledge on careful and astute observations, as well as trial and error. By careful observation, early physicians began healing practices that they have taught to many. They had a medical practice that developed over three thousand years and gave much toward advancing medical science worldwide. Egyptian physicians were famous in the Ancient World. Ramses II had sent physicians to the king of Hatti and the Persian king Achaemenids.
Greeks gained medical traditions and basis of knowledge from the medical schools of Egypt (Hamilton: The History of Medicine, Surgery and Anatomy. P. 35). Therefore, Egyptian theories and practices influenced the Greeks, who educated many of the physicians in the Roman Empire, who in turn influenced Arab and European medical thinking for centuries to come. One can clearly notice the legacy of Egyptian medicine in few fundamentals of the Greek scheme (Breasted 1930). Greek medicine developed during the sixth to seventh centuries B.C. The first Greek physician learned the art at Alexandria during the Ptolemaic period (305-330 B.C.). The Egyptian idea of decay [wekhedu] may have resurfaced in the [perittoma](pathogenic digestive residues) of the Alexandrine Greeks. Other features adopted by the Greeks from the Egyptians included several medicinal plants, how to write drug prescriptions, the practice of prenatal and gynecological fumigations, and the healing value of temple sleep.