Monday, May 28, 2012

5000-50 B.C.: Egyptian priests/ physicians treat your asthma

So you are an Egyptian father of an Egyptian boy and you are convinced he is cursed by the god Isis.  You don't know what your son did, but he is outside leaning against a tree in order to breathe, and he's making loud wheezing sounds with each prolonged expiration.  You cannot bear to watch him suffer anymore, and so you send for help.  

It's possible that in the early days of Egypt you would have your child sit in the streets, and people who walked by would offer their medical advice; their diagnosis and medical treatment.  Some historians speculate this never actually occurred in Egypt, and others speculate it was an early transitional stage prior to the priest studying health at the temples, and maybe even prior to the transition of some priest into physicians.  (1, page 2)

Various temples were built where you could worship the various gods of Egypt, and specialized temples were built where you could worship the gods who specialized in health and healing.  These temples were places where the sick could sleep in the night, and a diagnosis and remedy would occur in the night, and in the morning a priest would interpret these dreams and visions. (1, page 2) (3, page 16)(8, page 19)

Patients who were too sick to leave their homes may send for a physician.  The president of the temple would determine the specialist best for the individual case, and that physician would be sent to the patient's home.  In this way, physicians made house calls.  (2, page 4) (4, page 17)

When he did so, he offered the following: (11, page 14)(12, page 13-15)
  • Magic
  • Draughts (potions)
  • Blisters
  • Poultices
  • Plasters
  • Powders
  • Clysters
  • Bleeding
  • Pills made of dough
  • Gargles
  • Salves
  • Inhalations
  • Fumigations
  • Supositories
  • Incantations
  • Amulets
  • Hope
  • Emetics
  • Purgatives
  • Diuretics
  • Diaphoretics
  • Cautery
  • Surgery
The various drugs used were from animals (worms, snakes, insects, elephant, camel, crocodile, hyena), plants (radishes, onion), minerals (sulfur, zinc) and even humans excrements (feces, semen, saliva).  These were formulated in a variety of recipes that were prepared by the priests/physicians.  (12, page 15)

They would also prescribe good hygiene and a proper diet. (12, page 15)  They encouraged regular baths and purgings, and perhaps this was where the old adage came from: "prevention is better than the cure." People early on in history must have learned that nary a drug cured anything, and sometimes the drugs used made the person worse, or even killed him.  So the emphasis was placed on good hygiene and healthy eating, with the goal of keeping you healthy, and preventing you from getting sick.

Proof of this can been found in the Bible, when God told Moses to tell the people to follow a the laws set forth to prevent the spread of disease.  Moses, who probably studied under the tutelage of Royal Egyptian priest/physicians, encouraged Israelites to avoid diseased people, and not to touch corpes, and to wash and have good behaviors in order to prevent sickness. 

Common diseases treated were osteoarthritis, tuberculosis, rickets, and syphilis. (12, page 15)  Modern evidence from mummies suggests they also treated atherosclerosis. Although their limited knowledge of anatomy prevented them from knowing about these diseases, they basically observed and treated the symptoms, which to them were caused by the gods, and, if not treated by the powerful magic of the priests/ physicians, would result in death.

The god Thoth communicated with an ancient priest, perhaps Imhotep, and Thoth provided Imhotep with all the wisdom of the gods.  The god invented all the arts and sciences, including a written language, medicine, and laws.  Thoth provided Imhotep with all this wisdom, and he carved them into pillars of stone, creating 42 books, the last six of which containing all the medical wisdom of the gods, and the laws regulating their practice.  (2, page 3)(3, page 14)

The ancient Greeks called Thoth Hermes Trismegistus, and therefore the books he wrote are often referred to as the Hermatic books.  A specialty of priests became the scribes, and they were among the wisest and most revered priests in all of Egypt.  Scribes transcribed the Hermatic books so they could be visible in all temples of the gods of health and healing, and so these temples became the places of learning among the priesthood.

Thoth ultimately taught the priesthood to make paper out of stalks of papyrus, and scribes were able to transcribe the Hermatic text onto large scrolls, and in this way every physicians could now have his own copy. When called upon to visit the sick, he must have taken his scroll with him, perhaps carrying it with him in his medical bag.

While temples to the gods were places of worship and healing, many were also were also the centerpieces of places that acted like our modern universities, complete with schools, libraries, laboratories, papyrus/paper factory and boarding houses.  These were places of instruction for not just priests and physicians, but astronomers, mathematicians, and a variety of other professions. Some of the original and most famous temples/ universities were situated at Memphis, Thebes and Heliopolis, Sais, and Chennu. (3, page 16)(8, page 19)(11, page 9)

The higher class of priests at these schools studied the first 36 books, and others the last six*.  Perhaps it was at such schools where Egyptian priests/ physicians developed such beliefs as life "should be indefinitely prolonged, unless someone or something caused death, such as a spirit, or the soul of a dead man, which cunningly entered a dead person," according to Sandwich. (1, page 2)(9, page 25)

Perhaps it was at these temples that a greater understanding of diseases was speculated upon, and the realization was made that many diseases were associated with dirtiness, and that some diseases were spread from person to person.  It's for this reason, perhaps, that people contaminated with certain diseases, such as the lepers, were cast from society and you were warned to stay away from them.

The priesthood, then, learned the importance of cleanliness in maintaining good health, and it's from here where circumcision became standard practice, along with regularly scheduled bathing, the wearing of clean clothing, and similar such rituals.  It is also from here that diet and drugs were incorporated into the medical regime "to counteract the disorders which the strange being had produced in the body," according to Fleming Sandwich in his 1905 book. (1, page 2)

Such cleanliness must have been rather successful at keeping the Egyptians healthy.  William Hudson Garrison, in his 1922 history of medicine, quotes Aristotle from his Politics, as saying: "They purge themselves every month, three days in succession, seeking to improve health by emetics and clysters; for they suppose that all diseases to which men are subject proceed from the food they use. And, indeed, in other respect, the Egyptians, next to the Libyans, are the most healthy people in the world, as they, on account of the seasons, because they are not liable to change." (5, page 51)

Likewise, Plinio Prioreschi,  in his 1991 history of medicine, explains that Egyptian medicine gained a "great reputation" as noted by the following passage from Homer's Odyssey: (10, page 257)
...for there (in Egypt) the earth, the giver of grain, bears the greatest store of drugs, many that are healing when mixed, and many that are baneful; there every man is a physician, wise above human kind... 
Alexander Wilder, in his 1901 history of medicine, says that "the skill and learning of physicians of Egypt made them famous in the neighboring countries."   In one example, "the Prince Bakhtan (Bashan) sent an embasy to Ramases XII for medical aid for his queen's sister."  Ultimately "the pastaphori and physicians bearing a receptacle of the divinity... the mission was successful; the princess speedily recovered, and the god received the glory." (11, page 15)
-------------------------
By the height of Egyptian civilization, society evolved into six orders:  (4, page 32)
  • Kings and princes 
  • Priests
  • Soldiers
  • Shepherds
  • Laborers
  • Artisans.  
Of these six orders, only the kings and princes were privy to their own physicians.  

Most of these orders were divided into various castes, with various of the priesthood being chosen to specialize in the various wounds and diseases and these became the caste of physicians. Members of this caste becoming "the most respected and the most powerful" members of the society. The caste "was a depot of the laws, science and religion."  (2, page 32)

 Of these physicians, the great Greek historian Herodotus (484-425 B.C.) once wrote: (5, page 50-51):
"The art of medicine is divided among them: each physician applies himself to one disease only, and not more. All places abound in physicians; some physicians are for the eyes, others for the head, others for the teeth, others for the intestines, and others for internal disorders."
Each physicians specialized in one disorder, such as:
  • Disorders of the head
  • Disorders of the eyes
  • Disorders of the rectum/ anus
  • Disorders of the teeth
  • Disorders of women
  • Experts in child bearing
  • Experts in surgery (surgeons)
  • Internal medicine (treat asthma-like symptoms, cancer, upset stomach, etc.)
Homer even notes the following regarding Egyptians:
...in the land where the fruitful soil bore abundance of herbs potent for good or evil, nearly everyone was, so to speak, a doctor or a descendant of Paeon and learned among the men. (8, page 18)
Paeon (Paean) was the physician to the gods.  By Homer's reference, historians surmise that as medical knowledge was specialized, many of the commoners became knowledgeable in medicine, each becoming a pseudo-physician.  As our modern day homes, many people had their own medicine chests, and had the ability to treat basic cuts and scrapes, and ailments like the common cold.

When wounds were severe, or as diagnosis and treatment reached beyond the commoners scope of knowledge, only then would the greater expertise of a priest or physician be sought.

The classes of priest/ physicians were divided this way:  (3, page 16-17)(2, page 3-4)(7, page 13-14)
  1. Chief Priests:  Also referred to as Sages, Soothsayers, Image Bearers, Magi, sorcerers, wise men or magicians.  These were the wisest of the priests/ physicians, and they were privileged to all the knowledge of the gods, and hence were responsible for reading the first 36 books of the Hermetic books. They were physicians of the "higher sciences."  These priests/physicians were responsible for "conjurations, dissolving the charms of the gods by prayer, interpretations of the revelations received by the sick during incubation in the temples."  (3, page 16-17) They were more like the medicine men of the primitive world, "disolving the charms of the gods by prayer... magic and divination."  (2, page 4)  They were even mentioned by Moses "in the 7th and 8th chapters of Exodus, under the names of wise men, the sorcerers, and magicians, of Egypt, whom Pharaoh called in to rival the miracles performed by Moses." (7, page 13)
  2. Pastaphori: The lower class of priests were responsible for studying the last six of the Hermetic books, and were responsible for visiting the sick and treating them.  They were your prototypical physicians, or ordinary physicians devoted specifically to medicine and the art of healing. Each of these physicians/ priests specialized in a certain ailment, such as internal medicine, dentistry, rectum, etc. They treated "anatomy, pathology, pharmacology, opthalmology, and gynecology." This profession probably morphed from the need of physicians to leave the temples, especially as medicine (particularly rational/civilized) evolved. 
  3. Military physicians:  They essentially were Pastaphori who followed the military, and mainly were experts in treating battle wounds with salves, casts, splints, incantations, etc. Each of these also specialized.
  4. Veterinary:  They specialized in health and healing of animals.  They specialized as well, as your cattle doctors, fowl doctors, etc. 
According to William Hamilton in his 1831 history of medicine, only certain priests were privileged to become physicians, and "the office of these priests was hereditary and their privileges were exclusive; as the son trod with unvarying servility in the footsteps of his father."  (7, page 13)

Physicians were free from the bondage of taxes, were paid by the collective, and profits belonged to the temple. The only obligation of the patient was to provide gifts, which sometimes included models of the organ fixed or operated on (such as an arm or leg), and these were kept at the temples as mementos, perhaps, of the healing powers of the gods. Likewise, "during war, or in the case of anyone falling ill upon a journey, the doctors were bound to render help gratis," (4, page 17) (9, page 25)(11, page 10)

Hamilton says that "Improvement to medical knowledge was effectually arrested by the penal discouragement of every attempt to deviate from the canons of practice laid down in the volumes ascribed to Thouth (Thoth); and the interests of the priests led to the perpetuation of the popular delusion respecting the cause of disease, (7, pages 13 and 14)

According to the Diodorus, diseases were diagnosed by the position of the patient in bed, (6, page 25), and treatment was standard, or based on your symptoms, as noted by Bradford: (1, page 6)
The Egyptians paid strict attention to dietetic rules; they thought that the majority of diseases were caused by indigestion, and excess in eating. They practiced abstinence and used emetics. They had a considerable knowledge of Materia Medica (the pharmacopoeia) and used many drugs in the cure of the sick. They were somewhat skilled in operative surgery. They practiced castration, lithotomy and amputations
So Egypt had a plethora of physicians who specialized in the various wounds and ailments that plagued Egyptian society.  Such specialization was both bad and good.  It was bad when you were sent a specialist who didn't specialize in what plagued you, such as if a physician who specialized in disorders of the rectum was sent to treat your son's dyspnea.

It was good when your specialist had knowledge of internal disorders, and had access to remedies that contained opium or belladonna that had magical abilities to sedate him so he can better deal with his agony.

While preparing the ingredients, he may he might site the following incantation: (3, page 23)
"May Isis heal me, as she healed Horns of all the ills inflicted upon him when Set slew his father, Osiris. 0 Isis, thou great enchantress, free me, deliver me from all evil, bad and horrible things, from the god and goddess of evil, from the cod and goddess of sickness, and from the unclean demon who presses upon me, as thou didst loose and free thy son Horus" 
As you can see, the medical profession among "the ancient Egyptians hold the honor of being the first people to cultivate medicine as a science," and that this "medicine was closely associated with the mythology of Egypt."  (2, page 1)

Surely we might look at Egyptian medicine, as well as medicine of any ancient society, and think to ourselves:  this is quackery.  Yet these ancient societies probably benefited more from the magic of incantations and  prayers, or by the gentle touch of a palm on the shoulder, than from any other form of medicine.  As noted by Henry Sigerist in his 1951 book, "A History of Medicine: Primitive and Archaic Medicine: (13, page 280-1)
The oral rite was all important.  The correct choice of words to frighten a spirit, to enlist the help of the gods, the intonation probably also in which a spell was recited or sung, this all must have had a profound effect upon the patient.  We know the power of suggestion and know how highly responsive religious individuals are to such rites.  I should not be astonished if the sorcerer with his spells had had as better results in many cases than the physician with his drugs.  Magician and priest were able to put the sick in a frame of mind in which the healing power of the organism could do its work under the best conditions.  They gave him peace and confidence and helped him to readjust to the world from which disease had torn him.(13, page 280)
Sigerist also writes the following:
The manual rites performed in the course of an incantation appear in infinite variety from teh simplest to the most elaborate and complicated.  the rite may have consisted of nothing but putting one's hand on the patient, the classical gesture of protection so familiar to us from the Bible.  After having exorcised a demon the magician said: 'My hands are on this child, and the hands of Isis are on him, as she puts her hands on her son Horus.'  Or the magician held his seal over the child and such as seal was obviously a powerful fetish: 'My hand is on thee and my seal is thy protection'  (13, page 281)
There may have come a day when "drugs were prepared and given without incantation and this was the moment when magic and medicine separated, when physicians and magician-priest became different individuals." (13, page 280  Yet the priest of the ancient world, whether using magic words or herbal remedies, would have known of the power of suggestion, and perhaps, just perhaps, never ceased to use the power of magical words, amulets, talismans and gesticulations.

So your son continues to struggle with his breathing, and you decide you need to seek help for him.  You summon a priest, and within a few hours a priest/physician is humming incantations while your son is inhaling fumes from herbs tossed on the fire. Perhaps by the doctor's appearance alone your boy is able to relax, allowing nature to heal him over time.

*Along with physicians, judges, mathematicians, astronomers, etc., were also educated at such schools. (8, page 19)

Further reading:
 References:
  1. Sandwich, Fleming Mant, "The medical diseases of Egypt, part I," 1905, London
  2. Bradford, Thomas Lindsley, "Quiz questions on the history of medicine: form the lectures of Thomas Lindsley Bradford, M.D," 1898, Philadelphia
  3. Baas, Johann Herman, author, Henry Ebenezer Sanderson, translator, "Outlines of the history of medicine and the medical profession," 1889, New York
  4. 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."
  5. Garrison, Fielding Hudon, "An introduction to the history of medicine," 1922, Philadelphia and London, W.B. Saunders Company
  6. Dunglison, Robley, author, Richard James Dunglison, editor,  "History of Medicine from the earliest ages to the commencement of the nineteenth century," 1872, Philadelphia, Lindsay and Blakiston
  7. Hamilton, William, "The history of medicine, surgery, and anatomy, from the creation of the world to the commencement of the nineteenth century," 1831, volume I, London, Henry Colburn and Richard Bentley
  8. Puschmann, Theodor, translated by Evan H. Hare, "A history of medical education from teh most remote to the most recdent times," 1891, London, H.K. Lewis
  9. Puschman, Theodor, translated by Evan H. Hare, "A history of medical education from the most remote to the most recent times," 1891, London, H.K. Lewis
  10. Prioreschi, Plinio, "A History of Medicine," Volume 1: Primitive and Ancient Medicine," 1991, Edwin Mellen Press, Chapter IV: Egyhptian Medicine, page 257.  Reference noted by author is as follows:  Homer, "Ocyssey, IV, 229-232, Translation by A.T. Murray.
  11. Wilder, Aleander, "History of Medicine," 1901, Maine, New England eclectic Publishing
  12. Osler, William, "Evolution of Modern Medicine: a series of lectures at Yale University to the Silliman Foundation in April 1913, 1921", New haven, Yale University Press
  13. Sigerist, Henry E, "A History of Medicine: Primitive and Archaic Medicine," volume I, 1951, New York, Oxford University Press

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