Monday, August 15, 2011

5000 to 50 B.C.: Asthma in Ancient Egypt

Eber Papyrus showing treatment of asthma
It's a blessing to be alive during a time when there are many options to help us asthmatics.  We have rescue medicine like Albuterol to cure an attack, and asthma controller medicines to prevent asthma altogether.

 
Yet could you imagine living 5,000 years ago?  How would you treat your asthma in the ancient world?  Thankfully there were a few unknown writers we can thank for preserving ancient wisdom.  Plus we have the Bible. 

 
The Bible has perhaps the first recorded evidence that physicians existed in Egypt about 1,700  years before the birth of Christ.  Whe Jacob died, "Joseph commanded his servants, the physicians, to embalm him; and the physicians embalmed Israel, and forty days were fulfilled for him, for so are fulfilled the days of those that are embalmed." (1)

 
Moses was rescued from the river by one of the daughters of the pharaoh, and he was raised as a son of pharaoh and educated "in all the knowledge of the Egyptian priesthood, in which he became proficient," according to Pierre Victor Renouard in his 1856 book, "History of Medicine: From the origin to the 19th century," (2)

 
Renouard explains that it was this wisdom, particularly the esoteric medical wisdom he obtained, that allowed Moses to lead the Hebrews to the promised land.  He preached good hygeine, and he made sure his followers ate only the purest of foods, such as the rabit and hog, even though these animals were considered impure in Egypt.  Perhaps, Renouard proclaims, this is evidence that Moses held "his own views other than those ascribed to him." 

 
The ultimate goal being to keep people clean, especially while traveling to foreign lands, and when touching strangers, and handling dead bodies.  This was a technique of keeping people "pure" in order to avoid sickness. For an example Renouard refers us readers to the Bible, Numbers Chapter XV

 
It is also beleived by many historians that Moses helped to carry knowledge, including medical knowledge from the Egyptians, to the Hebrews, and later to other people who came into contact with the Hebrews.  In this way Moses was a very important historical figure not just in Biblical terms, but also for the the spread of medical wisdom, writes Renouard. 

 
He explains the Egyptians were perhaps the first society to record what medicine worked for what disease.  They also took care of the sick in public so anyone in attendance could share any knowledge they had that might help the sick.  (3)

 
By the time Alexandria was a flourishing city, Egypt was the leading nation when it came to medical knowledge.  Many physicians went to Egypt to learn medicine, and it is believed that even Hippocrates, who later became known as the father of medicine, traveled to Egypt to hone his medical skills. 

 
Egyptians physicians/ priest who did the embalming were surely familiar with human anatomy, according  Renouard.  He writes:
When Pliny (the elder) assures us that the kings of Egypt permitted the opening of the corpse, for the purpose of discovering the causes of diseases, he always means the Ptolomies, under whose reign anatomy was carried to a very high degree of perfection." (4)
I write about Pliny the Elder here, so I won't delve into his career in this post.  Yet Ptolomy (90-168 A.D.) was a Greco-Roman who lived in Egypt and was one of the seven bodyguards who served Alexander the Great.  After Alexander's death Ptolomy was declared Governor of Egypt and he declared himself King Ptolomy.  He was accepted as the ruler, and so future members of his family essentially replaced the pharoah as rulers of Egypt.  So these are the kings Pliny was referring to, or so we should assume by Pliny's writings.

 
So at least some knowledge of anatomy must have been known by the Egyptians.  Through their writings they made recollections, as did cave men through their cave drawings, of where the best place to shoot prey.  Physicians likewise had knowledge to internal organs, although their understanding of them was primitive and speculative at best. 

 
The Eber Papyri describes various vessels of the body, and by "feeling the pulse you feel the heart that 'speaks out of the vessels of every limb,' the text then proceeds to list 46 vessels."  (5, 349-351)

 
As a random example, consider the following from one transclation:
There are 2 vessels in him to the back of the head.
There are 2 vessels in him to hi forehead.
There are 2 vessels in him to his eyes.
There are 2 vessels in him to his eyebrows.
There are 2 vessels in him to his nose.
There are 2 vessels in him to his right ear; the breath of life enters into them.
There are 2 vessels in him to his left ear; the breath of death enters into them.
Renouard describes Egypt as being divided into six orders:  kings and princes, priests, soldiers, shephards, laborers and artisans.  Your priests were also your physicians, and they were the "most respected and the most powerful; it was a depot of the laws, science and religion."  They shared their wisdom by their writings, and they took great care to make sure their writings were esoteric only to the priesthood. 

 
In 1862 a 110 page scroll was discovered between the legs of  a mummy in Thebes.  We have no idea who wrote it, nor if it was written by one scribe or many.  Ancient texts like this were hand written, and copies were often made of copies.  (5) 

 
This means that the texts that we now have access to may have been added to many times.  If you're a physician you have your own scroll, and you scrible some of your own formulas in the margins.  When it's recopied these scribbles may end up in the text, making it difficult for historians to know what text was original and what was added to it. 

 
The scroll is 20.32 meters long and consists of 108 columns of 20-22 lines.  Unlike other ancient Egyptian texts which are only fragments of larger texts, the Eber Papyrus is believed to be a complete text.  (6, page 311) It is believed to have been found in a a tomb in the necropolis in Thebes with another papyri -- the Edwin Smith Papyri, and purchased by Egyptologist Edwin Smith in 1862. (6, page 303)

 
German Egyptologist Georg Eber purchased the papyri from Smith in 1870 and it was transcribed, published,  and ultimately referred to as the Georg Eber Papyri.  (6, page 310) It then became the most important medical papyri of all Ancient Egypt, and the oldest preserved medical document of all time.
The Eber Papyrus is believed to have been written about 1500 B.C. and copied from earlier texts dating as far back as 3400 B.C.  Prior to such writing the formulas were relayed from parent to child, or physician to apprentice, by word of mouth.  By writing the formulas it gave physicians the ability to share wisdom more easily.  It also made it so medicine could become more complex. 
Once transcribed it was learned the scroll contained over 700 magical formulas and remedies for the most common ailments of that time, including asthma. Diseases back then were believed to be caused by an imbalance of phlegm or humors in the body, and remedies were an attempt to balance these humors.

 
While the word asthma was not used in the papyri, asthma-like symptoms were described.  Physicians were unable to differentiate between different causes of shortness of breath and cough, so these symptoms were generally grouped as one malady, and the recommended treatment was uniform regardless of the actual cause. 

 
If you consulted a physican he may first assess you to make sure you were worth treating.  If there was no hope of saving you he may decide to let you die.  Yet if there was hope, he would have a variety of options to help you.  He may then recommend you eat a balanced diet, bathe yourself, or even shave your body hair.

 
He may have access to real remedies, such as herbs and minerals drunk in wine or beer, or rolled up in dough -- the first pills -- and swallowed, or placing a salve with honey in it over wounds (while they may not have known it, honey really does firght against infection). (7)
He may also recommend:    
Another remedy was to place herbs on heated bricks or stone so those with breathing difficulties could inhale the medicine -- the first inhalers.  The columns your physician would seek are as follows:
Thou shalt fetch 7 stones and heat them by the fire, thou shalt take one therof and place (a little) of these remedies on it and cover it with a new vessel whose bottom is perforated and place a stalk of a reed in this hole; thou shalt put thy mouth to this stalk, so that thou inhalest the smoke of it.  Likewise wit all stones.  Thereafter thou shalt eat something fat, of fat meat or oil." (8)
  • Enemas (the stomach was believed to be a cause of breathing problems)
  • Animal excreta (including crocodile and camel)
  • Herbs such as squill and henbane
  • Fumes of burned sundried and crushed Belladonna leaves and roots (heated on brick)
  • Eating foods such as figs , grapes, frankincense, cumin and juniper fruit
  • Drinking wine and sweet beer

Belladonna plant

Surely the best remedy was the belladonna plant, which was the mother of modern medicines like Atrovent and Spiriva.  It's a mild bronchodilator.  Yet if you're like me, you know neither of these does much to allay an attack of asthma.

 
Belladonna had many other  uses, one of which was as a cosmetic.  Young ladies placed drops in their eyes to dilate their pupils.  This made their eyes pretty and attractive to young men.  Italians later referred to it as bella-donna, which means pretty lady.

 
Once he's done treating you he may perform religious ceremonies, marriages, embalming, and funeral services.  Your physician was a busy man, one who was paid well for his services.  Yet you may not have to pay him, as his services would be taken care of by the king, the wealthy, with healthcare to all others provided for free.  Although you may reimburse him with a small offering.

 
If his healing methods didn't work for you a priest/ magician might be summoned.  He would first diagnose you.  He'd then give you an amulet to wear and an incantation to say each morning. Or he might place his gentle palm over your throat or chest and chant an incantation to induce healing and scare away the evil demons that were causing you to breathe heavy.  

 
One can only imagine how hard it would have been for asthmatics back then.  They were most likely treated as burdens on society, and therefore the best treatment might be to keep your mouth shut and simply tough it out.  Could you imagine?

 

 
References:
  1. Renouard, Pierce Victor, "History of Medicine: From it's origin to the 19th century," 1856, Cincinnati, Moore, Wistach, Keys and Co., page 26, chapter 1, "Medicine of the Antique Nation."
  2. Renouard, ibid, page 83
  3. Renouard, ibid, page 30
  4. Renouard, ibid, page 31
  5. I will get this up soon. 
  6. Sigerist, Henry E, "A History of Medicine," vol II, "Primitive and Archaic Medicine," 1951, New York, Oxford University Press, pages 303, 310-11
  7. Lambert, Tim, "A brief history of medicine," localhistories.org, http://www.localhistories.org/medicine.html, observed May 26, 2012
  8. Jackson, Mark, "Asthma: A biography," 2009, New York, Oxford University Press, page 39.  From a translation of the Ebery Papyrus by B. Ebbell (B. Ebbell, "The Papyrus Ebers: The Greatest Egyptian Medical Document," 1937, Copenhagan, page 67)

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