[Transcribed from the History of Science by George Sarton
Edited and prepared by Prof. Hamed A. Ead at Heidelberg, Germany 10th, September 1998]
It is not necessary to emphasize the antiquity of Egyptian medicine; in every culture medicine develops very early, for the need of it is too universal and too pressing ever to be overlooked. We may be sure that some kind of medicine was already practiced in Egypt in the earliest prehistoric days, many millennia before Christ. To quote an example, the use of malachite as an eye paint and an eye salve goes back to the Badarian age; the use of galena for similar purposes was introduced later, though still in predynastic times. Circumcision is a rite of immemorial age; bodies exhumed from prehistoric graves (as early as, say, 4000 B.c.) show traces of it. A very clear representation of the operation was sculptured on the wall of a tomb of the Sixth Dynasty (c. 2625-2475).
The earliest physician whose name has been recorded, Imhotep,” was the wazir of Zoser, founder of the Third Dynasty, in the thirtieth century. Imhotep was a learned man, astronomer, physician, architect (he may have been the builder of the first pyramid, the step pyramid of Saqqara). In later times he was worshiped as a hero, as a blameless physician, and later still as the god of medicine, the prototype of Asclepios (even as the learned God Thoth was the prototype of Hermes and Mercury). We know precious little about Imhotep’s medical knowledge but his apotheosis is significant and we may well take him at the Egyptian valuation as the first great man in medicine. The people who speak of Hippocrates as the father of medicine should bear in mind that Hippocrates comes about half way between Imhotep and us. That would improve their perspective of ancient science.
Not only were there many physicians in the Pyramid Age, but there were very specialized ones. The skill of an early dentist is beautifully illustrated by a mandible found in a tomb of the Fourth Dynasty (2900-2750), in which an alveolar process was pierced to drain an abscess under the first molar. From the tombstone of Iry, chief physician to a pharaoh of the Sixth Dynasty (2625-2475), we learn that he was also “palace eye physician” and “palace stomach bowel physician” and bore the titles “one understanding the internal fluids” and “guardian of the anus.” ‘
The medical papyri that have come to us, seven or more, are relatively late. They date from the Twelfth Dynasty to the Twentieth (2000 to 1090), but most of them reflect professedly earlier knowledge, going back to the Old Kingdom, as far back as the Fourth Dynasty. The two earliest papyri, the Kahun and the Gardiner fragments (c. 2000), deal with diseases of women, children, and cattle. The two Most important ones, the so-called Smith and Ebers papyri, date from the seventeenth and sixteenth centuries B.C.. The Smith one is of the same age as the Rhind mathematical papyrus. Roughly speaking, we may say that the outstanding, mathematical and medical treatises that have come to us are of the same period, the the Middle Kingdom and the beginning of the NewKingdom just prior the imperial age, when Egypt dominated the world.
Smith and Ebers Papyri
Let us consider more carefully the two outstanding, the Smith and the Ebers, both of which are much larger than any others. On the basis of the figure given by Sarton, the seven medical papyri listed by him include 3746 lines, the Smith has 469 lines and the Ebers 2289, so that together they have 2758 lines, which is almost 74 percent of the total. As all the manuscripts are ultimately derived from similar Old Kingdom sources, we may safely assume that the study of the Ebers and the Smith papyri will give us a fair knowledge of ancient Egyptian medicine.
We shall begin with the younger one, the Ebers papyrus, because it is by far the largest (almost five times as large as the Smith) and was the best known until very recent times. The difference in age is small anyhow, about a century, and negligible if one bears in mind that both texts represent older traditions. We are sure that the Ebers papyrus was written somewhat later than the Smith one, but it would be unwise to conclude that the contents of the former are of later date than the contents of the latter.
The Ebers papyrus is a roll 20.23 m long and 30 cm high; the text is distributed in 108 columns of 20 to 22 lines each. It contains 877 recipes concerning a great variety of diseases or symptoms. Spells are recommended only in twelve cases and in other cases the therapeutics does not seem irrational, though we are seldom able to understand either the trouble or the remedy. The contents are arranged in the following order:
- Recitals before medical treatment, to increase the virtue of the remedy.
- Internal medical diseases. Diseases of the eye.
- Diseases of the skin (with an appendix of sundries).
- Diseases of the extremities. Miscellinea (especially diseases of the head, for example, of the tongue, teeth, nose, and ears, and cosmetics).
- Diseases of women (and matters concerning housekeeping).
- Information of an anatomic, physiologic, and pathologic nature, and explanation of words.
- Surgical diseases.
That order is open to many objections, but the author’s intention is clear enough. He wanted to put together as well as possible all the information that a physician might need; he wrote a medical treatise, one of the earliest ever written (thirty-six centuries ago!).
The Smith papyrus is much shorter. It is 33 cm high and was probably 5 m long, but the beginning has been lost and it now measures 4.70 m. lt is a copy of a much older text, dating back to the Pyramid Age, perhaps even early in that age, let us say the thirtieth century. After it had circulated for some generations it was found that its terms were antiquated.
Toward the end of the Old Kingdom, say in the twenty-sixth century, a learned physician had the idea of rejuvenating it by the addition of glosses (69 in all), explaining obsolete terms and discussing dubious matters. (N.B. the Papyrus Ebers has also some glosses, 26 in all, but they have been badly messed up). These glosses constitute the most valuable part of the papyrus.
The text as we have it now comprises two very distinct parts – 17 columns (377 lines) on the front and 4.5 columns (92 lines) on the back. The latter part contains only recipes and incantations and need not detain us. The main part is a surgical treatise, informed by a scientific spirit far superior to that of the Ebers papyrus.
To be sure, the field of surgery is much less likely than that of internal medicine to be contaminated by irrational ideas, for in most surgical cases dealt with by ancient physicians the cause of the injury was too obvious to require the insertion of magical antecedents. On the contrary, an internal disease is always mysterious and likely to breed superstitious ideas in the patient’s mind, even in the physician’s mind. The Smith papyrus consists not of recipes but of definite cases. It was planned to deal with the ailments in the order of the bodily parts from head to foot, but unfortunately it stops a little below the shoulders, whether because the scribe was interrupted or because the end of the manuscript got 1ost. That order – eis podas ec cephales, a capite ad calces -remained the one throughout the Middle Ages, but it was so natural, as a first approximation, that we should not assume it was determined by the Egyptian example.
The forty-eight cases dealt with in the papyrus, as it has come to us, are classified as follows:
The discussion begins with the head and skull, proceeding thence downward by way of the nose, face and ears, to the neck, clavicle, humerus, thorax, shoulders and spinal column, where the text is discontinued, leaving the document incomplete. Without any external indication of the arrangement of the text, the content of the treatise is nevertheless carefully disposed in groups of cases, each group being concerned with a certain region. These groups are as follows:
A. Head (27 cases, the first incomplete): Skull, overlying soft tissue and brain, Cases 1-10. Nose, Cases 11-14. Maxillary region, Cases 15-17. Temporal region, Cases 18-22. Ears, mandible, lips and chin, Cases 23-27.
B. Throat and neck (cervical vertebrae), Cases 28-33
C. Clavicle, Cases 34-35.
D. Humerus, Cases 36-38
E. Sternum, overlying soft tissue, and trueribs, Cases 39-46.
F. Shoulders, Case 47.
G. Spinal Column, Case 48.
The incompleteness of Case 48 confirms our suspicion that the rest of the treatise is lost. The discussion of each case is done systematically in the following way:
4. Treatment (unless a fatal case, considered untreatable).
5. Glosses (a little dictionary of obscure terms, if any, employed in the discussion of the case
The title of Case 4 reads, “Instructions concerning a gaping wound in his head, penetrating to the bone, and splitting his skull”; that of Case 6, “Instructions concerning a gaping wound in his head, penetrating to the bone, smashing his skull, and rending open the brain of his skull.”
The examination regularly begins thus-. “If thou examinest a man having . . .”
The form adopted is that of a teacher instructing a pupil that he shall do so and so. The methods of observation expressly stipulated or implied are answers elicited from the patient, ocular, olfactory, and tactile observations, movements of parts of the body by the patient as directed by the surgeon. Strange to say, eight out of eleven surgical operations are classified with the examination rather than with the treatment. This would suggest that the surgical work was considered a preparation to the medical treatment, independent of it.
The diagnosis is always introduced by the words: “Thou should say concerning him [the patient] . . .” and ends with one of three statements:
1. An ailment which I will treat.
2. An ailment with which I will contend.
3. An ailment not to be treated.
Three diagnoses consist of this final hopeless verdict and nothing more; but in forty-nine diagnoses in our treatise the three verdicts are preceded by other observations on the case. In thirty-six of these forty-nine diagnoses the other observations are nothing more than a repetition of the title of the case, or of observations already made in the examination; but in the remaining thirteen, the diagnosis adds one or more conclusions based on the facts determined in the examination. These are the earliest surviving examples of observation and conclusion, the oldest known evidences of an inductive process in the history of the human mind.’ Parallel with the systematic use of these three verdicts is a similar series of temporal clauses bearing more directly on the condition of the Patient although not so regularly employed, and placed at the end of the treatment. These read:
A. “Until he recovers.”
B. “Until the period of his injury passes by.”
C. “Until thou knowest that he has reached decisive point.”
The matter-of-factness and soberness of those early medical texts is very impressive. The doctor who wrote them down was not only an experienced man but a wise one, whose general point of view sometimes adumbrates that of the Hippocratic writings. For example, he recommends an expectant attitude, trusting in the healing power of nature, or he recommends waiting “until thou knowest that he [the patient] has reached a decisive point”; this reminds us of the Hippocratic notion of crisis.
Did the Egyptians study Anatomy?
There is no reason to believe that the ancient Egyptians had studied anatomy, by means of deliberate dissections, but they had taken advantage of the accidental experiments falling under their eyes and had accumulated much knowledge. Of course, the mummification of dead bodies of men and animals, which had been practiced from time immemorial, might have taught them many things, but I am rather skeptical about that; the embalmers were too much concerned about their own difficult art to pay attention to irrelevant anatomic details. lt is possible that the practice of mummification made it easier later, much later, in Ptolemaic times, for Greek scientists to undertake systematic dissections, but that is another story. As far as ancient Egypt is concerned there is no evidence of the influence of mummification on anatomic knowledge.
The author whose work is recorded in the Smith papyrus had meditated on anatomic and physiologic questions. He was aware of the importance of the pulse, and of a connection between pulse and heart. He had some vague idea of a cardiac system, though not of course of a circulation, which nobody clearly understood before Harvey (and before him the Muslim physiacin Ibn Al-Nafis). His knowledge of the vascular system was made hopelessly difficult by his inability to distinguish between blood vessels, tendons, and nerves. Yet consider these astounding observations of the brain : “If thou examines a man having a gaping wound in his head penetrating to the bone, smashing his skull, and rending open the brain of his skull, thou shouldst palpate his wound. Shouldst thou find that smash which in his skull like those corrugations which form in molten copper, and something therein throbbing and fluttering under thy fingers, like the weak place of an infant’s crown before it becomes whole- when it has happened there is no throbbing and fluttering under thy fingers until the brain of his [the patient’s] skull is rent open and he discharges blood from both his nostrils, and he suffers with stiffness in his neck.”
He had observed the meninges, the cerebrospinal fluid, and the convolutions of the brain (compared in the previous quotation to the rippling surface of metallic slag). Moreover, he had realized that the brain was the seat of the control of the body, and that special kinds of control were localized in special parts of the brain.
To conclude, the Smith papyrus, and to a lesser extent the Ebers one, give us a very favorable idea of the medicine, anatomy, and physiology of the Egyptians, and of the scientific outlook that they obtained at least two thousand years before Hippocrates.
Mummification in Ancient Egypt
Preservation of human bodies after death is usually designated by two expressions, namely, “embalming” and “mummification”. To embalm literally means “to place in balsam or resin”. which is actually one of the last steps of the whole process of the preservation of the body. The word “mummification” is derived from the Latin word (perhaps of Persian origin) “mumia” which was mentioned by Dioscorides (first century A.D.) as a black bitumen found oozing from the earth in certain places. This word was applied at a late date to the embalmed bodies in Egypt, probably due to the fact that from the Twenty-sixth Dynasty onwards, bituminous materials were largely used in the presevation of the body.
Mummification is undoubtedly the most distinctive technique or art which developed in Ancient Egypt. It greatly affected the habits and customs of the ancient Egyptians and, through it, much knowledge was gained in anatomy, chemistry, and many arts and industries.