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Medicine
Medical Concepts
Egyptian medicine was a mixture of magical and rational treatments. Both methods were considered equally valid; where the cause of the affliction was visible, objective and scientific treatments were used, and where the cause was hidden (and often attributed to the vengeance of the dead, punishment by the gods, and the ill wishes of enemies), magic was employed. The rational treatments were based on observation of patients and a good knowledge of anatomy (the result of mummification practices). Magic involved the use of spells or incantations accompained by a ritual in which the practitioner performed acts or gestures over the patient. (In the patient’s absence, these were imitated on a figurine.) The sick were always treated well, and no disease was considered untouchable; however, doctors did identify cases as curable, incurable, or of uncertain outcome. There were high standards of ethical behavior, and doctors were forbidden to divulge their patients’ confidences or to look at the women in the households they visited. Patients were examined and questioned, and if possible the sickness was diagnosed and treatment was prescribed. If this were not immediately possible, the patient was confined to bed and reexamined later. Probably because the internal organs were never examined during life but only postmortem as part of the process of mummification, the Egyptians had some erroneous ideas about body systems and functions. A concept that dominated their medicine was the belief that there was a system of conduits (the metw) that carried blood, tears, and all bodily fluids around the body. All vessels, ducts, and nerves were metw, and the center of this network was the heart, regarded as the seat of the intellect and emotions. Thus, according to this theory, sorrow felt in the heart would have the physical effect of sending tears to the tear ducts. Obstructions in the metw caused “floods” or “droughts,” with their accompanying symptoms, in different parts of the body. The Egyptians’ idea of physical functions within the body was probably directly based on their picture of Egypt as a country fed by canals. . Medical Sources There are several sources for our knowledge of Egyptian medicine, although none provides a complete account: tomb scenes and statuary showing persons with diseases or afflictions; stelae (tomb stones) of physicians that provide their titles and give some indication of various categories and career progression; and surgical instruments (although only from the Greco- Roman Period) and a wall scene in the Temple of Kom Ombo that may represent a panel of surgical instruments. The mummies themselves provide information about a variety of diseases; scientific techniques including radiology, histopathology, immunology, dental studies, and DNA and genetic identifications continue to provide researchers with new knowledge of disease and disease patterns. One very important source is the ten major medical papyri that have been identified to date. Most date from c.1550 BC onward, but are probably copies of earlier works. They presumably represent only a very small proportion of the medical documents that once existed but are now either lost or awaiting discovery and identification. The papyri seem to include handbooks for surgeons’ daily use, outlines for medical lectures, and lecture notes and clinical notebooks that doctors used when they were students and subsequently retained to help them practice their profession. Each papyrus is not a book with any unity of composition and subject but contains information on a variety of subjects. In most papyri scientific or rational treatments are written alongside magical formulas, although the proportion of each varies from text to text. The inscriptions are usually written in hieratic (although some are in hieroglyphs) and present case studies with details of symptoms and recommended treatments. The papyri reveal the great complexity that existed in the structure of pharaonic medicine. The Edwin Smith Papyrus is famous as the world’s first treatise on surgery, while the Kahun Papyrus supplies the earliest known record of gynecological treatments. . Doctors The earliest medical practitioners were the chieftains of villages who extended their role as local leader to act as priest and magician (healer) for the community. As Egypt became a kingdom, the pharaoh (as supreme chieftain) also acquired power as the country’s religious leader who possessed medical wisdom and healing ability. Indeed, the first pharaoh was credited by a later historian with the authorship of a treatise on anatomy and dissection. Medical practice and religion were therefore always closely associated, and the king’s powers in both these areas were gradually delegated to the priest-doctors. Doctors were specialized priests who had originally acted as religious mediators between the god and the patient, but over the centuries, they acquired detailed medical knowledge and experience. Even as early as the Old Kingdom, the medical profession appears to have been highly organized and incorporated rational as well as magical treatment of patients. Little is known of the medical training and whether it was entirely practical or whether the students had to pass examinations. The temples appear to have played an important part both in medical training and the healing of patients. The “House of Life” was an area of the temple that, as a center of documentation where sacred papyri were written or copied, may also have been used as a teaching center for medical students. At the highest level, doctors (who often specialized in particular areas of medicine) were called wabau, meaning that they were ritually pure and thus able to be in the god’s presence. They were priests of the goddess Sekhmet and spent part of each year in the temple; for the rest of the time they practiced medicine in the community. There were also swnw who were general practitioners employed by the state and appointed to the building sites, the army, burial grounds, or royal palaces. In addition, there were the sau who specialized in the use of magic and probably filled an important role in local communities. Nurses, masseurs, and bandagers assisted the doctors, and there were specialist midwives who were trained in the temple of Sais. One doctor of paramount importance in Egypt was Imhotep, the vizier of King Djoser. The historian Manetho credits him with the invention of building in stone, and he was the architect of the Step Pyramid at Saqqara (the world’s first monumental stone building). However, the Egyptians revered him as a great physician and the founder of medical science. In the Late Period he was worshiped as a god of healing and medicine, and the Greeks in Egypt later identified him with Asklepios, their own god of medicine. Buildings within various temples were dedicated to him, and there is a chapel built in his honor on the island of Philae. . Temples as Centers of Healing Some temples had a special reputation for healing the sick. Cripples from all over Egypt visited Imhotep’s chapel at Saqqara (the Asklepieion) in search of a cure, and the upper terrace of the Temple of Deir el-Bahri became a resort for invalids in the Greco-Roman Period. From the graffiti left there on the walls, it is evident that foreigners as well as Egyptians sought help. Although such healing centers are best known from the Greek tradition, it is evident that temples in Egypt had been used for healing since much earlier times. Those at Sais and Heliopolis were famous in the Middle Kingdom (c.1900 BC), and a document relates that the Persian king Darius reorganized the medical school at Sais during the Persian occupation of Egypt. There was probably always a healing role and tradition associated with temples in Egypt. One particularly interesting building has been discovered and excavated in the precincts of the Temple of Hathor at Denderah. This has been identified as a “sanatorium” or “hotel” where the mentally ill were accommodated and underwent preparation for the “Therapeutic Dream.” The building was arranged around a corridor and central area; the corridor was lined with healing statues, and there were sanitary installations with a drainage system so that the sacred water that had passed over the statues was directed into a series of cubicles where the sick were bathed. Hathor (Isis) was the goddess attributed with the invention of most healing remedies. At Denderah the sanatorium was of a late date, but there is evidence for the Therapeutic Dream (incubation) method in Egypt from at least the Middle Kingdom. Using isolation, silence, lamps, and possibly narcotics, the patient spent one or more nights at the center in a state of deep sleep when, it was believed, he could enter Nun, the dwelling of the dead. Here, the soul could act and travel and attempt to contact the gods, thus gaining knowledge of the future and of any dangers or evil spells that threatened him as well as achieving a cure for his ailments. During this sleep, Isis appeared to the patient, held him, and treated him for his illness. Because she herself had attained immortality, she could help humans and restore their health even when cure by rational means had failed. Texts in papyri indicate that songs played an important part in the healing process, particularly in driving out mental illness. The earliest reference to the value of such songs occurs in the First Intermediate Period (c.2200 BC). Sometimes, the goddess gave direct healing to the patient through song, but in other instances this was achieved through the wise interpretation of the priests who prescribed treatment for the patient. The center for incubation was always close to the temple, either in a separate building or perhaps in a special chamber of the temple. It was essential to have a plain dark room in order to obtain this sleep, which was assisted by burning four pieces of sweet-smelling wood. . Gods of Healing There was no one god of medicine or healing. Imhotep, the human founder of medical science, was deified and worshiped in the later periods. The lioness goddess Sekhmet, believed to be the destroyer and bringer of epidemics, was worshiped to placate her wrath, and the most senior doctors held priesthoods of Sekhmet. Her consort, Seth, was also regarded as a source of sickness and epidemics and received prayers. Thoth, patron god of scribes, was credited with the invention of the healing formulas, and Isis/Hathor was the patroness of magicians and regarded as the inventor of many healing treatments. Some deities played special roles: Horus and Amun were in charge of cures for eye diseases, and Tauert (the hippopotamus goddess) controlled all aspects of fecundity and childbirth. . Medical Treatment The Egyptians used surgical and pharmaceutical procedures. Surgery was mainly employed for the superficial treatment of wounds, dislocations and fractures, and the excision of some tumors. There is also evidence, however, that they practiced trepanning and male circumcision. Anesthetics were available in the form of drugs derived from plants. One area of medicine that attracted particular attention was gynecology. In the medical papyri many entries are devoted to fertility and pregnancy tests, contraceptive measures, the treatment of women’s ailments, and problems associated with childbirth. As far as we are aware there were no specialized dentists, and there is no conclusive evidence of cosmetic dentistry. Although there are relatively few examples of caries (tooth decay) in the mummies of the Pharaonic Period, virtually everyone suffered from attrition (wear of the cusps) due to the gritty composition of the bread. Pharmaceutical treatments included medicines to be taken orally or by fumigation and ointments to be applied externally. These incorporated substances from mineral, animal, and vegetable sources: Pulverized precious metals or stones and aromatic oils were included to attract good deities to the patient, thus improving his condition, whereas unpleasant or disagreeable ingredients (fat and blood of various animals, as well as their horns, hides, hooves, and bones, or excrement and urine) were thought to expel evil spirits from the sick person. Unpleasant medicines were taken in water, wine, milk, or beer or were disguised with honey. For the treatment of some ailments, including the common cold, magical spells were used. . Contribution to Medical History The Egyptians made the first strides in developing medical science. They were the first to make observations in human and animal anatomy; conduct experiments in surgery and pharmacy; use splints, bandages, and compresses; and devise medical and anatomical terms. Because mummification familiarized them with the concept of autopsying the human body, there were no religious or popular objections to the process. In the later times Greeks came to Alexandria to practice systematic dissection, which was forbidden in their own country. Despite its many advances, however, Egyptian medicine retained the use of magical formulas alongside rational, scientific treatments, and some remedies were valueless. Most concepts of medicine in Europe and the Near East owe their origin to ancient Egypt. This knowledge was passed down through medical practice and through literature from the Greek sources into medieval texts in Europe and through Arabic literature. .
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Medicine
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