Monday, November 07, 2005

The Art of Medicine in Ancient Egypt

Over the weekend, I visited the Metropolitan Museum of Art. My wife and I were interested primarily in two exhibits: Vincent Van Gogh: The Drawings and The Art of Medicine in Ancient Egypt. As you might expect, my wife was more interested in the Van Gogh exhibit, and I was more interested in the Egyptian exhibit.

I will admit that the Van Gogh exhibit impressed me quite a bit. Art near-illiterate that I am, I had had no idea that Van Gogh, whom I had usually associated with imaginative and bright paintings, such as the famous Sunflowers or The Starry Night was also highly accomplished at drawing. Yet, gallery after gallery of Van Gogh's drawings showed me how little I knew about this master. The drawings included in the exhibit, some of which were paired with paintings derived from the drawings, were a revelation, and even the self-important woman who tried to lecture my wife on the exhibit could not mar the experience. If you live near New York or will be in New York before December 31, I highly recommend that you check this exhibit out.

The Egyptian exhibit was far more modest in scale, being contained in one relatively small gallery. However, to me, it was probably more interesting because of the centerpiece of the exhibit, the Edwin Smith Papyrus. This papyrus was named after the American Egyptologist who purchased it in Luxor in 1862 and brought it back to the U.S. The papyrus dates to approximately 1600 B.C. and appears to be a copy of a document that dates back 200-300 years earlier still. What fascinated me is that this papyrus was a practical guide to the treatment of various ailments and embodied the medical thinking of Egyptian physicians of the time. Even more fascinating is that the knowledge contained in the scroll was presented as several cases. Most of the cases were, as might be expected, how to deal with traumatic wounds. There are also included eight magic spells purported to protect against airborne disease, but there is also one for preventing harm from an accidentally swallowed fly. Showing that some things never change, there were also two prescription for cosmetic purposes, one of which was for an ointment to combat a head cold, as well as for "rejuvenation of the skin and repelling of wrinkles, any age spots, any sign of old age, and any fever that may be in the body."

And you wonder where alties got their ideas from.

Actually, reading the translations for some of the remedies filled me with wonder. Remember: The ancient Egyptians had no idea what caused most diseases (which is probably why a lot of this papyrus dealt with trauma, which had a mechanical cause and mostly mechanical treatments). They had no concept of bacteria, only a very rudimentary idea of the circulatory system, knowing only that it originated in the heart, but having no real idea what its purpose was. Diseases were ascribed to the malign influence of various gods and magic, and physicians were often also priests, usually Sekhmet or Imhotep (Greeks equated Imhotep with their own god of medicine, Asklepios). Because Egyptian physicians were both medical doctors and priests, their treatments often combined the practical and the magical.

However, reading some of these cases was quite instructive. The papyrus presents the cases in terms of diagnosis and practical treatment, dividing the conditions into three categories: "An ailment I will handle" (meaning there was a practical treatment available); "an ailment I will fight with" (for ailments for which the treatment and outcome was less certain); and "an ailment for which nothing is done" (for ailments for which no treatment is known). For ailments falling in the first two categories, the papyrus provides a description of the recommended treatment. Take these two cases, one of a head wound with skull damage (case 3) or a head wound with damage to the plates of the skull (case 4):
Case 3. A head wound with skull damage.

Title: Practices for a gaping wound in his head which has penetrated to the bone and violated his skull.

Examination and prognosis: If you treat a man for a gaping wound in his head, which has penetrated to the bone and violated his skull, you have to probe his wound. Should you find him uunable to look at his arms and his chest and suffering from stiffness in his neck, then you say about him: "One who has a gaping wound in the head, which has penetrated to the bone and violated his skull, who suffers from stiffness in his neck: an ailment I will handle."

Treatment: After you stitch him, you have to put fresh meat the first day on his wound. You should not bandage him. He is to be put down on his bead until th etime of his injury passes, and you should treat him afterward with an oil and honey dressing eery day until he gets well.
This sounds like a description of a serious gaping scalp laceration without an underlying skull fracture, and the treatment here is not all that different than what we'd do today (the raw meat and oil and honey dressings excepted, of course). Contrast this to s more serious head wound:
Case 4. A head wound with damage to the plates of the skull.

Title: Practices for a gaping would in his head, which has penetrated to the bone and split his skull.

Examination and prognosis: If you treat a man for a gaping wound in his head, which has penetrated to the bone and split his skull, you have to probe the wound. Should you find something hter uneven under your fingers, should he be very much in pain at it, and should the swelling that is on it be high, while he bleeds from his nostrils and his ears, suffers stiffness in his neck, and is unable to look at his arms and chest, then you say about him: "One who has a gaping wound in his head, which has penetrated to the bone and split his skull, while he bleeds from his notsrilsa nd his ehars and suffers stiffness in the neck: an ailment I will fight with."

Treatment: Since you find that man with his skull split, you should not bandage him. He is to be put down on his bead until the time of his injury passes. Sitting is his treatment, with two supports of brick made for him, until you learn that he arrives at a turning point. ou have to put oil on his head and soften his neck and shoulders with it. You should do likewise for any man you find with his skull split.

Explanations: As for "which has split his skull," it is the pushing away of one plate of his skull from the other, while the pieces stayin in the flesh of his head and do not fall down. As for "the swelling on it is high," it means that the bloating that is on the split is great and lifted upward." As for "you learn that he arrives at a turning point, " it is to say that you learn that he will die or until he has revived, since it is an "ailment I will fight with."
This is a startlingly good description of a head injury with a skull fracture (probably a basilar skull fracture, given the bleeding from the ears), and the examination is not too different from what is done in the trauma bay today: Probe the wound and see if you can feel any fractures. Also surprisingly accurate is the observation that "sitting is his treatment." Elevated intracranial pressure can occur with fractures of this sort, and keeping the head elevated is one way to minimize the rise in intracranial pressure. Indeed, even today, we often keep head-injured patients in a partial sitting position to try to minimize the tendency to intracranial pressure to rise. Of course, we now have CT scans and MRIs to delineate the full extent of the injury and intracranial pressure monitors to determine the extent of the brain selling. We also have hyperventilation and mannitol as adjuncts to try to lower intracranial pressure, and, if they fail, there is always the last resort of the phenobarbital-induced coma. However, given the primitive resources available to ancient Egyptian doctors, it is impressive indeed that they were able to figure out that sitting the patient upright would be helpful for this sort of injury.

I just love this sort of exhibit, as it lets me indulge my interest in both medicine and history. You know, since I happened to have purchased the exhibit book, which contains the complete translations of all the cases in the papyrus, I might have to make this a recurring series, in which I discuss some of the more interesting cases. Maybe later this week...

19 example(s) of insolence returned:


At 11/07/2005 8:17 AM, Blogger M said...

I love the history of medicine. There are a lot of parallels between humoral theory and some branches of 'altie' thinking.

 

At 11/07/2005 8:29 AM, Anonymous Matt Wigdahl said...

The raw meat treatment for a head laceration seems to mirror "maggot therapy", which was a staple in early medicine and is making a comeback even these days.

As I understand it, maggots in open wounds can greatly assist in debridement and removal of necrotic tissue and would probably have reduced death from infection significantly.

 

At 11/07/2005 8:32 AM, Blogger OutEast said...

I recently visited a rather macabre ossuary with my neurosurgeon father-in-law. Among the skulls on display were a number showing arrow wounds - and my father-in-law was intrigued to discover two where the bone around the injuries showed that the victims had survived for at least a few years.

 

At 11/07/2005 9:47 AM, Blogger Greg P said...

I think the main thing that meat on the wound would accomplish would be to maintain moisture so that passive drainage from the site could continue, rather than the wound crust over and seal off. If the meat remained in place, there would be relative protection from bacterial contamination. Meat from a freshly slaughtered animal would probably be one of the cleaner things that could be put on the wound.

 

At 11/07/2005 9:58 AM, Blogger bushpigeon said...

Fascinating post. As for the honey dressing, manuka honey is being clinically trialed for efficacy in treating wounds: http://www.ctru.auckland.ac.nz/research/halt/

 

At 11/07/2005 10:55 AM, Anonymous Dave Harmon said...

About the case and comments thereon:

1) "After you stitch him, you have to put fresh meat the first day on his wound."

Unless he *left* that same piece of meat there, scratch maggot therapy; it would take days for flies to hatch, let alone move from the obviously-dead meat to the mostly-living wound. Admittedly, there could be a translation issue with the idea of "fresh" meat.

2) "Meat from a freshly slaughtered animal would probably be one of the cleaner things that could be put on the wound."

Maybe, though of course the animal could also be carrying something nasty. This might also provoke a touch of xenorejection, which could help discourage opportunistic infections.

3) As far as (I paraphrase) "how clever they were to make him sit up" -- remember that even the 3rd dynasty in Egypt, c. 27th century BC, is still near the tail end of a few *hundred* milennia of human existence. Medical procedures might *often* have been arbitrary or even wrong, but over that sort of time, even preliterate tribes learn something from experience!

 

At 11/07/2005 11:25 AM, Anonymous Anonymous said...

Fascinating! Thanks for sharing. :)

-Ali

 

At 11/07/2005 12:35 PM, Blogger Pierce Wetter said...

I seem to remember that honey is mildly aniseptic.

Much of the materia medica we use today came from Western historical medical lore like this. It's important to remember that even though the ancients didn't have chemistry and molecular biology, they still had the power of observation.

That's especially important for modern skeptics to remember when considering herbal medicine, especially Eastern varieties that were unknown to the creators of Western medicine, so missed the rationalization boat...

 

At 11/07/2005 2:28 PM, Blogger Kyle said...

I would very much enjoy if this were a running series. Thanks for taking the time to post it.

 

At 11/07/2005 4:41 PM, Anonymous HCN said...

For those who need to do some online browsing on this subject, may I suggest:
http://www.nlm.nih.gov/onlineexhibitions.html

 

At 11/07/2005 5:31 PM, Blogger The Probe said...

I was in NYC over the weekend and did not see you there....

We have a free pass to MOMA and I plan to see this exhibit over Thanksgiving.

Thanks for the tip.

 

At 11/07/2005 10:25 PM, Blogger Acad Ronin said...

Cool. I hope you continue.

We can't make too much of our analyses of the treatments though. Sure, some make sense given what we know now, but many still don;t, and both those we can understand and those we can't were equally valif to our Egyptian physician.

 

At 11/08/2005 1:40 AM, Blogger bonni said...

Interesting! I enjoyed this, I'd love to see a series on this topic, including at least one entry on some of the weirder recommendations (I'm sure there had to be some).

 

At 11/08/2005 6:36 AM, Blogger Kristjan Wager said...

More posts on the subject would certainly be welcome, at least by me. Very interesting.

 

At 11/08/2005 11:34 AM, Blogger Qalmlea said...

Awesome post. I will add my vote that this be a continuing series. And I will add that I (also) have heard that honey has antiseptic properties, which makes sense. It's a food source for the bees, and if it made a good host for bacteria, etc., it wouldn't last very long.

 

At 11/08/2005 3:29 PM, Anonymous Anonymous said...

The language is somewhat confusing: for example, I would understand "violated his skull" to mean "penetrated into the cranial cavity", whereas here it seems to mean "bone on view but not broken". Otherwise a good presentation, and keep it up.

 

At 11/08/2005 4:42 PM, Anonymous Stephanie said...

Let me chime in to request more of these posts-that was fascinating.

 

At 11/09/2005 6:35 PM, Blogger Scott said...

I realize that I am coming very late to this discussion, but hope that I can contribute something. I always appreciate a modern medical perspective on historical medicine. Thanks for pointing out that there is a catalog for the exhibit that reproduces the entire Smith papyrus. I look forward to getting a copy myself and reading more of your comments on the translations.

An interesting book which includes commentary on the Smith papyrus is _The Healing Hand: Man and Wound in the Ancient World_ by Guido Majno, MD. (Who is currently in the Dept. of Pathology at UMass) He mentions the use of meat and states that "muscle can act as a clotting agent, crushed tissue in general works very well". (pg 106). However, hs also notes that the Egyptians were unlikely to realize this.

He continues with a fascinating discussion of oil and honey and the antiseptic properties of honey. He even conducted a few experiments of mixing up animal grease ("oil") and honey as seemed prescribed in the papyrus and injected the mixture with staphylococci and E.coli and found they were killed in a matter of a few days.

Thankfully, he's also rigourous about documenting where he gets his information so the footnotes are a rich source of specific research papers.

 

At 11/15/2005 12:05 AM, Anonymous BramptonBryan said...

"I always appreciate a modern medical perspective on historical medicine."

Let us hope that modernmindedness does not infect your work on early modern surgery to as destructive an extent as it contaminated the thinking of Guido Majno. Retrospective thinking is one of the perennial temptations of medical historians.

 

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