11 May

Unfortunately, except for a few fragmentary medical papyri,  the texts used for teaching  the art  of medicine in the Houses  of Life have been lost. The eight surviving medical papyri were composed  between about 1900 and 1100 B.C.E., but they are probably  compilations and copies of older medical texts. In modern translations, the surviving medical papyri constitute  only about  two hundred  printed  pages.

Remedies  and  case  histories  taken  from  the  Ebers,  Smith,  and Kahun  papyri  provide  the most significant  insights into ancient  Egyp- tian ideas about health and disease, anatomy  and physiology, and magic and  medicine. The other  medical texts include collections of remedies, aphrodisiacs, incantations against  disease, descriptions  of fertility tests, and spells for the safety of pregnant  women and infants.

The Ebers papyrus,  which was probably  written about  1500 B.C.E., is the longest, most complete, and most famous  of the medical papyri. Named  after Georg Ebers, who obtained  the papyrus  in 1873 and pub- lished a facsimile and partial translation two years later, it is an encyclo- pedic collection  of prescriptions, incantations and  extracts  of medical texts on diseases and  surgery  taken  from  at  least forty  older  sources. The  Ebers  papyrus  was apparently planned  as a  guide  for  the  three kinds  of healers: those who dealt  with internal  and  external  remedies, surgeons  who treated  wounds  and fractures,  and sorcerers or exorcists who wrestled with the demons of disease.

Although  the ancients did not see any reason for a strict separation between  natural and  supernatural diseases,  there  was a  tendency  for what  might  be called ‘‘realistic’’ prescriptions to  be grouped  together with diseases that  could be treated  with a reasonable  chance of success. Incurable  disorders are generally clustered together with more magically oriented  practices. Healers were warned against  causing additional suf- fering by undertaking useless treatments. In hopeless cases, ointments and incantations were preferable  to the knife.

Many  recipes,  at  least  in translation, call for  incomprehensible, exotic, or seemingly impossible ingredients, like Thot’s Feather  and Heaven’s Eye, which may have been cryptic or picturesque  names  for ordinary  medicinal herbs. No doubt  Egyptian  pharmacists  would have ridiculed prescriptions calling for ‘‘fox’s gloves’’ (digitalis), ‘‘pretty lady’’ (belladonna), or ‘‘male duck’’ (mandrake).

About seven hundred drugs, combined in a variety of ways to create more  than  eight  hundred  formulas,  are  found  in the  Ebers  papyrus. Drugs  were  administered as  pills,  ointments,   poultices,  fumigations, inhalations, snuffs, gargles, suppositories, enemas, and so forth.  Physi- cians  apparently relied  on  specialized  assistants  and  drug  collectors, but sometimes they prepared their own remedies. In contrast to Mesopo- tamian  custom,  Egyptian  prescriptions were precise about  quantities.

Although  components  were usually measured by volume rather  than by weight,  the  instruments   used  in  the  preparation  of  drugs  included balances, as well as mortars,  mills, and sieves.

Remedies fortified by spells were said to open and close the bowels, induce  vomiting,  expel worms  and  demons,  cure  fevers, rheumatism, cough, bloody urine, dysentery, and a plethora of other diseases. Hemorrhages,  wounds,  and  crocodile  bites  could  be  dressed  with  a mixture of oil, honey, and roasted  barley, and covered with fresh meat. Other  prescriptions called  for  crocodile  dung,  human   urine,  myrrh, beans,  dates,  and  ostrich  eggs. Gold,  silver, and  precious  stones  were identified  with  the  flesh  and  limbs  of  gods;  thus,  they  were  used  in amulets and talismans to ward off disease. Less exotic minerals, such as sulfur,  natron, and  heavy metal  salts, were commonly  associated  with skin diseases, but one interesting  ointment  called for burnt  frog in oil. Minerals  were used either in their  native form  or as powders  recycled from broken  pottery,  bricks, or millstones.

Diseases of the eye were apparently as much a problem  in ancient Egypt as they are today  in many parts  of the Middle East,  India,  and Africa.  Blindness  was not  uncommon, as indicated  by various  docu- ments and paintings.  For  a disorder  that  was probably  night blindness (a common  sign of vitamin  A deficiency), roasted  ox liver was enthusi- astically recommended.  Another  remedy for impaired eyesight consisted of honey,  red  ochre,  and  the  humor  of a pig’s eye, which  the  healer poured  into the patient’s  ear.

Rheumatism is the diagnosis suggested by descriptions  of chronic aches and pains in the neck, limbs, and joints. Treatment for this pain- ful condition  included massages with clay or mud and  ointments  con- taining  herbs,  animal  fat,  ox spleen,  honey,  wine dregs,  natron, and various  obscure  materials.  The recommendation that  certain  remedies be applied  to  the big toe suggests that  gout  was one of these painful disorders.

Not all prescriptions in the medical papyri were for life-threatening conditions.  The medical texts also contain recipes for cosmetics and hair restoratives,  such as a mixture of burnt  hedgehog quills mixed with oil. Another  ingenious  recipe  could  be  applied  to  the  head  of  a  woman one hated in order to make her hair fall out. Cosmetics generally reflect only  vanity  and  the  tyranny  of fashion,  but  cleansing  unguents,  per- fumes, and  pigments  probably  had  valuable  astringent  and  antiseptic properties.

Another  example  of  the  lighter  side of  ancient  medicine  comes from  the  study  of  masticatories or  quids,  materials  that  are  chewed but not  swallowed. The masticatory favored  by the Egyptians  was the stem of the papyrus  plant.  The Greeks  thought the Egyptian  habit  of chewing papyrus  stems and spitting  out  the residue was ludicrous  and squalid, until they too took up the custom. Resin-based pellets and balls of  natron and  frankincense   were  chewed  to  purify  and  sweeten  the breath.  Other  masticatories were said to prevent  disorders  of the teeth and gums.

The  Kahun  papyrus,  which was probably  composed  about  1900 B.C.E., consists of fragments dealing with gynecology and veterinary medicine,  including  methods  for  detecting  pregnancy,  predicting  the sex of the fetus, and preventing  conception.  One of the contraceptives was basically a pessary (vaginal suppository)  containing  crocodile dung. Other  prescriptions call for a plug (rather  like a contraceptive sponge) made  with  honey  and  natron, an  extract  of  the  acacia  plant,  and  a gum-like  material.  Later  contraceptive prescriptions kept  the spirit  of the Egyptian recipe, but substituted elephant dung for that of the croco- dile. Greek  observers  noted  that  the Egyptians  seemed to regulate  the size of their  families without  infanticide.  This  suggests  that  even the most  noxious  and  bizarre  pessaries  might  work  if they  functioned  as mechanical  barriers,  or spermicides,  or caused  a total  lack of interest in sexual intercourse.  Prolonged  lactation,  which tends to suppress ovu- lation, and a three-year interval between births were considered essential for the health  of mother  and child.

Although  midwives were probably  the main childbirth  attendants, physicians were acquainted with various gynecological conditions, including  prolapse  of the  uterus,  cancer,  leucorrhoea,  dysmenorrhea, amenorrhea, and  menopause.  Because the uterus  was thought to be a mobile organ  that  could cause mischief by wandering  about  the body, doctors  prescribed  special fumigants  to lure it back to its proper  posi- tion. Complex and noxious mixtures were recommended  for wandering uterus, abnormal delivery, and miscarriage. Such remedies were said to warm the breasts,  cool the womb, regulate  menstruation, and increase milk production. Generally,  these medicines were taken  as fumigants, douches,  or  suppositories,  but  in  some  cases,  the  woman  simply  sat on the remedy. Fertility  tests were based on the assumption that  in fer- tile women free passages existed between the genital tract and the rest of the body. Therefore,  when the woman  sat on a test substance,  such as date  flour  mixed  with  beer,  vomiting  proved  that  conception   could occur and the number  of vomits corresponded to the number  of future children.  Once  pregnancy  was  established,  the  physician  studied  the effect of the patient’s  urine  on the germination and  growth  of wheat and barley seedlings in order  to predict the sex of the child. Of course, such tests had at least a fifty–fifty chance of being correct.

Ancient  texts indicate  that  women  gave birth  while squatting  on so-called magical bricks decorated  with religious symbols and images of the gods that protected  the health of mothers and infants. A remarkable example of these birth bricks was discovered by archaeologists excavating the ruins of Abydos, an ancient city in southern  Egypt. A painted  brick found  among  the artifacts  in a 3,700-year-old house depicted a mother with her newborn baby, female assistants,  and Hathor, the cow goddess associated with birth and motherhood. An image of the sun god and his guardians  presumably  invoked magical protection for the fragile life of the newborn babe.

Egyptian  physicians  were remarkably specialized, but  there  is no mention of pediatrics, a field based on the age of the patient  rather than specific parts  of the body,  as a separate  area  of specialization.  There were, however, remedies and spells for the health of infants and prescriptions for obscure  childhood  diseases, bed-wetting,  retention  of urine,  cough,  and  teething.  For  example,  chewing  on  a  fried  mouse was recommended  to  ease the pain  of cutting  teeth  and  an  old letter boiled in oil was said to cure retention  of urine. Since the child was com- monly breast-fed for three years, remedies could be given to the mother or wet nurse.

Since the Egyptians  made mummies of humans and other animals, they  had  the  opportunity to  study  comparative  anatomy.  Archaeolo- gists have discovered the skeletons or mummies of lions, baboons,  ibis, fish, cats, dogs, and crocodiles in tombs and special cemeteries. Never- theless, despite  centuries  of experience with  mummification, Egyptian anatomical  concepts   remained   rudimentary.  The   embalmers,   who belonged to a special guild of craftsmen,  were not practicing physicians or disinterested scientists. Even the embalmers seem to have been ambivalent about the task of opening the body. As part of the ritual that preceded this act, a man called the scribe drew a mark along the flank. The man who actually made the incision was symbolically abused  and driven away with stones and curses.

Haruspicy,  divination  through  the study of animal organs, offered another  source of anatomical information. Since the structure,  size, and shape  of organs  used for divination  were important omens,  haruspicy probably  provided a greater impetus to anatomical study than mummi- fication.  Support  for this hypothesis  is found  in the animal-like  hiero- glyphic  signs used  for  human  organs.  Egyptologists  have  catalogued names for over a hundred  anatomical signs; many names apply to parts of the all-important alimentary  canal. The nerves, arteries, and veins, in contrast, were poorly  understood and essentially undifferentiated.

Physiological and pathological  phenomena were explained in terms of the movement of fluids in a system of channels that brought  nourish- ment to the body just as the flooding of the Nile brought  nourishment to the land. A complicated  system of vessels carried blood,  mucus, water, air,  semen,  urine,  and  tears.  The  heart,  the  ‘‘seat of the  mind,’’ was clearly regarded  as a major  gathering  place for  the  vessels, but  there was another  confluence of channels in the vicinity of the anus. Because the rectum  and anus  were associated  with dangerous  decaying matter, the arrangement of the vessels exposed  the entire  system to  contami- nation  with the products  of internal  decay.

As a sign of its special significance, the heart  was left in the body during mummification. ‘‘Weighing the heart’’ was an important step in the judgment of the dead by the gods. Afraid that their hearts might not measure  up, the Egyptians  carefully fortified  their tombs  with magical amulets designed to secure successful judgments.  By weighing the heart of the dead, the gods could measure their moral worth. In the living, the physician  measured  health  by placing  his fingers on the pulses of the head,  neck, stomach,  and  limbs, because  the heart  spoke out  through the vessels of the body.  Indeed,  knowledge of the heart  and  its move- ments  was  called  the  ‘‘physician’s secret.’’ The  physician  knew  that fainting  occurred  when the  heart  could  no  longer  speak.  If the  heart and its vessels became contaminated with decaying matter  or heat from the rectum, the patient  would experience illness, debility, and ultimately loss of consciousness.

In 1862, Edwin  Smith  (1822–1906), a pioneer  Egyptologist,  pur-chased  a papyrus  scroll that  had  been  found  in a grave  near  Luxor. Smith’s attempts  to  decipher  the  document  were not  very successful. But when James Henry Breasted (1865–1935) completed  his translation of the scroll in 1930, he revolutionized  ideas about the relative weight of magic,  empiricism,  and  surgery  in Egyptian  medicine.  Breasted  envi- sioned the Smith papyrus  as a document  in a class by itself, because it was a systematic  collection  of case histories  that  offered the physician important anatomical and  physiological  information. Sections  of the Smith  papyrus  were copied from  texts so ancient  that  the idioms and concepts  in the  originals  had  already  become  virtually  incomprehen- sible. Therefore,  the scribe who compiled the document  had to include explanations that  would  make  the  text  useful  to  his contemporaries, thus providing  valuable information for modern  Egyptologists.

The 48 cases preserved in the Smith papyrus were arranged  system- atically  from  head  to  foot  in order  of severity. Each  case consists  of a title,  instructions  to  the physician,  the probable  prognosis,  and  the proper  treatment. Ailments  were divided  into  three  categories:  those that   were  almost   definitely  curable,   those  that   were  treatable,   but uncertain,  and  incurable  disorders  for  which  no  treatment should  be attempted.

The  section  called  the  ‘‘Book of  Wounds’’  describes  treatments for fractures,  dislocations,  bites, tumors,  ulcers, and abscesses. Broken bones were set in splints made from ox bones,  supported by bandages soaked in quick-setting  resin. Recognizing  the poor prognosis for com- pound or open fractures (fractures in which the broken ends of the bone have pierced the skin), the doctor  who was prepared  to ‘‘contend with’’ simple  or  closed  fractures   considered   an  open  fracture   an  ailment beyond  treatment. Plasters  or  adhesive  bandages  were generally  used to  close wounds,  but  some  injuries  called  for  sutures.  The  Egyptian surgeon  used a variety  of bandages,  adhesive plasters,  splints,  braces, drains,  plugs,  cleansers,  and  cauteries,  as well as bronze  implements, including  scalpels  and  needles.  Excavations   at  the  tomb  of  a  Fifth Dynasty physician revealed many bronze surgical implements, as well as statues  of gods and goddesses.

Although  the Egyptians  were familiar  with the sedative effects of opium  and henbane,  there is no direct evidence of their use as surgical anesthetics.  A scene depicting male circumcision accompanied  by a text that  states: ‘‘This is to render it agreeable,’’ has been interpreted as evi- dence of anesthesia.  However, the inscription  that  accompanies  a simi- lar depiction of this operation says: ‘‘Hold him so that he does not fall.’’ Since circumcision was a religious ritual, it fell within the province of the priest  and  would  not  be discussed in a medical  treatise.  The  surgical tools  used in circumcision  are  shown  in some Egyptian  temples.  One illustration seems to  represent  an  initiation  ritual,  but  there  is debate about  whether a priest is being circumcised or doing a circumcision.

Although  Amenhotep  II and  III  were circumcised,  the mummies presumed  to be those of their predecessors,  Amenhotep  I and Ahmose I,  were uncircumcised.  Studies  of  early  male  mummies  indicate  that male  circumcision  was not  uncommon in the  Old  Kingdom,  but  the practice was probably  more common among priests and royalty in later periods.  Although  there  are  panels  depicting  the  male  operation, no such pictures  of female circumcision,  now generally  known  as female genital  mutilation, are  known.  Even  today  there  is a similar  pattern; the circumcision  of a boy is a public  celebration,  but  that  of a girl is conducted  privately,  without  celebration.

Female  circumcision,  which  consists  of  excising the  clitoris  and other external female genitalia, persists in the region today. Infibulation, the most extreme form of female genital mutilation involves removing the  entire  clitoris,  the  labia  minora,  and  parts  of  the  labia  majora. The  Greek   geographer   Strabo,   who  visited  Egypt  about   25  B.C.E., reported  that it was customary  among the Egyptians  to circumcise male children  and  excise females.  The  operation was generally  done  when children were about  14 and almost  ready for adult  roles.

Unfortunately, the ‘‘Books of Wounds’’ is incomplete.  The scribe apparently stopped  writing  in the middle of an interesting  account  of afflictions  of the  spine and  left the  rest  of that  ‘‘page’’ blank.  When he resumed  work,  he apparently turned  to another  source and  copied out  recipes  to  ‘‘transform  an  old  man  into  a  youth  of  twenty’’ and incantations against  ‘‘the wind  of the  pest  of the  year.’’ This  abrupt transition may be symptomatic of the gradual  transformation of prior- ities in Egyptian  culture  over the millennia,  during  which engineering, astronomy,  science,  and  medicine  stagnated,  while  superstition   and magic flourished.

In 322 B.C.E.  Alexander the Great  (356–323 B.C.E.) conquered  Egypt and  brought  it into  the  sphere  of Hellenistic  culture.  How  much  the Greeks learned from the Egyptians  and how much they taught  them is difficult to determine. By this late stage, much of the esoteric knowledge of ancient  Egypt had been forgotten, although  medicine, mathematics, and  technology  would flourish  once again,  at least for a brief time, in the great city of Alexandria  in Egypt. Under  the Roman  Empire, Egypt played an important role in the network of maritime and overland trade routes  that  linked Rome  to Arabia  and India,  as well as Egypt.  Trade items included ivory, tortoise shells, drugs, slaves, peppercorns, frankin- cense, and myrrh.  Port  cities along the Egyptian  shore of the Red Sea supported maritime  trade  routes  that  rivaled  the Silk Road,  but  they were eventually abandoned, buried  by desert sands, and forgotten.

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