Tuesday, October 16, 2012

2,700 B.C.: Imhotep invents rational medicine

Imhotep
If you lived with asthma in ancient Egypt you had the option of seeking a physician or a magician or priest for help.  You had a choice between seeking actual medicine or an incantation, or perhaps both. 

Similar to medicine today, physicains in Ancient Egypt were specialized. If you had asthma you'd seek out a different doctor as opposed to if you fell off your horse and broke your pelvis and leg.  You receive breathing relief from your physician, and the person you thank is the great Imhotep. 

Imhotep (Imhotpu, Emeph, Eimoph, Imothph, Imouthes) lived about 2,650 or 2,600 years before the birth of Christ.  He is known by historians as the most famous non Pharaoh to have lived in Ancient Egypt.  He is also considered as the man who invented medicine, and this why he was called Imhotep, which means "physician."

His birth name was Thosortes or Athotis, and he was the son of Ptah, and was later referred to by the Greeks as the Aesclepius of the Egyptians. An inscription on a shrine devoted to him at "Aesculapius, who is Imuthes, son of Vulcan."  The Egyptians new him as the first priest who became a physician.  He is usually represented with a cap on his head and book on his knee. (8, page 102)

Chances are Imhotep didn't actually invent medicine, and he also wasn't the first priest/ physician.  Many scribes of this era attached what they wrote with a Pharaoh or other significant figure to give such works credibility.  So while the actual scribes may go unknown to history, the writings are credited to such figures, with many medical texts being attributed to Imhotep.

He may, however, have invented medicine for the ancient Greeks, at least the type of medical system that was used by the Greeks.  Yet even to say this is mere speculation. Yet to speculate sort of fits right in with the ancient Egyptian era, where medicine was mainly based on myth (although some of their remedies proved useful to a future generation of physicians).

Proof that he wasn't the first physician when a small tomb was discovered amid the pyramids a Sakkarah believed to be that of Sekhet' enanch, the chief physician of Pharaoh Sahura of the 5th dynasty sometime around 5,000 and 5,333 B.C. (6)

Inscriptions in the tomb describe how he "healed the king's nostrils." What Sekhet' enanch did to King Sahura's nostrils, or what was wrong with them, historians don't know. (4)  Yet inscriptions inside the tomb show the physician was greatly rewarded for his actions, making him the first known physician in the world. (6)

Chances are many people invented medicine.  Some even speculate medicine was invented by his father, and since Imhotep was the Chief Priest at the time of its culmination, he was given credit.   Regardless, Imhotep is considered by many as the inventor of medicine. The true inventor, or inventors, may never be known.

Who is Imhotep?

Imhotep (I-em-hetep) became known as a famous Egyptian physician even before Egyptologists had actual evidence of his existence.  He was a man of a brilliant mind, and he was a great architect, medical man, among posessing many other talents.  It was probably due to his brilliant mind that he became vizier (chief advisor), physician and friend of King Djoser (Zoser) of the Third Egyptian Dynasty. Imhotep grew to a "position of wide trust and importance," according to William Osler in his history of medicine. (9, page 10)

Prior to Imhotep, pyramids were build of mud brick and didn't last the test of time.  Imhotep was the first to suggest using stone (or at least he's given credit), and he designed Pharoh Djoser's step pyramid in Saqqara (Sakkara).  He also is said to have invented many of the tools used to make such pyramids and an irrigation system which supplied water from the Nile to fields.  (1)

Thus is was Imhotep who invented the technology -- or at least he is given credit -- that made it possible for the Ancient Egyptians to build the great pyramids that still stand, and are still awed upon, to this day.  For this he is often considered the first known architect.(3)

So while he impressed Egyptians by his architectural skills, he likewise impressed them with his ability to heal.  During his life he had many names, one of which was "Scribe of numbers."  Perhaps this is in reference to the knowledge of numbers required to understand the prescriptions that were recorded, and to have an understanding of the "great many remedies that they employed for diseases of various kinds and many methods of delivering them." (2)

He thus became a very famous physician.  He was also knowledgeable of the Egyptian literature and had the ability to write.  Back then this took special talent, and a person with such an ability was payed well for his services.  The Egyptians didn't have a money system, and so Imhotep must have been paid with gifts from the king.

As a physician he would also have been paid well, both for caring for the king, the wealthy and the poor.  The king would have provided him with boat so he could travel wherever he was needed.  Yet he would also receive gifts from others he treated.  Although it was still rather likely a sick person would have sought out a magician/priest instead of a physician.  (5, page 321, 322)

Among his other writings, Imhotep is known for recording his medical knowledge.  Most may have been intended to share medical wisdom with other physicians, yet some may have been used for teaching those who wished to enter into the medical field.  While these original documents are lost to time, they are referred to by other ancient physicians, such as Galen. So historians are sure of their existence. 

As I will relate many times in my history of asthma, when a scribe such as Imhotep writes down what he knows about a subject, he is writing things that he learned from his parents and teachers by word of mouth.  He is writing down knowledge of illness and remedies to cure them that have been handed down from generation to generation.

Then each physician will want his own copy of Imhotep's wisdom, so they will make a copy of the original by hand.  Then each physician will write in the margins his own experience, his own remedies, and when his text is recopied, perhaps by his children (children were often forced to follow in their parent's steps), the transcriber may add what was in the margins into the texts.  In this way what is handed through time is a copy of a copy of a copy. It is quite a daunting task for historians, I have read, to separate the original works with additions.

While there are no known original texts handed down to us from Imhotep, many believe the contents of a scroll discovered in the 19th century were originally written by Imhotep himself.

A famous Ancient Medical Text:

The Edwin Smith Papyri
During the 19th century two large scrolls were discovered, perhaps between the legs of a mummy  (3), probably in a tomb in the necropolis of Thebes, and ended in the hands of a native dealer.  The dealer sold the scrolls in 1862 to an Egyptologist named Edwin Smith. This native probably had no idea of their historical value. (5, page 304)

The smaller of the two documents was about 4.68 meters long with 21.5 columns of hieroglyphics.  It's believed to be a fragment of an even larger text (or a variety of ancient texts).  It became known as the Edwin Smith Papyri.  A majority of this papyri is a collection of "description of 48 cases, injuries, wounds, fractures, dislocations, tumors, in other words the kind of troubles that fall into the realm of the surgeon," according to Henry E. Sigerist in his 1951 book, "A history of Medicine." (5, page 304)  The document was published in 1930 by James H. Breasted. 

The other papyri was originally purchased by Smith (probably at the same time he purchased the Edwin Smith Papyri), yet it was advertised as a historical document of great historical value, and purchased by Egyptologist Georg Ebers.  This document became known as the Georg Ebers Papyri.  The Eber Papyri is considerably longer, 20.23 meters with 108 columns.  It's basically a series of books about internal diseases and recipes for how to treat them.  You can read about the significance of the Ebers Papyrus to our asthma history by using the links provided below.

Both these documents are believed to have been written around 1,500 B.C. and contain knowledge that goes back as far as 4,500 B.C.  Most of the Edwin Smith Papyri is written by one hand, and it ends abruptly in the middle of a description of the spine.  (5, page 305) Considering it was written around the time of Imhotep, some have speculated that Imhotep himself was the author.  (5, 304)

Many historians once speculated that Imhotep had the privilege of hearing the wisdom of the god Thoth, who is said to be the inventor of the arts and sciences, including medicine.  Imhotep took this wisdom and it is such that allowed him to become so famous.  Among the writings of Imhotep, many historians speculated he was the author of 42 books of the Hermetic texts, and the Eber Smith and Georg Ebers Papyrus were copies, or fragments, from the last six of these books, which included the medical wisdom. However, later historians refuted these claims.

Regardless, these papyri, or others similar to them, would have been used by physicians as a guide for learning about and treating diseases. If you summoned such a physician he would assess you and determine whether there was hope of success. If the physician thought there was no hope for you he might decide to let you die. If this was the case you could still recourse to the magician/priest for an incantation for hope, similar to what we might do today when modern medicine isn't enough to cure us. 

Yet if he decided there was hope for you, he might refer to scrolls such as the Eber Papyrus and treat you by tossing some herbs on a heated brick for you to inhale.  In this way, it is believed that the Egyptian physicians were the first physicians as we would describe them:  people who treat by reason as opposed to by incantation to the gods. (Yet we must recognize that to the ancient Egyptians mythology was reasonable them, as they believed these gods were ubiquitous).

While it makes for a good story that Imhotep wrote the Smith Papyri, or that he wrote the Ebers Papyri, or that he wrote the Hermatic texts, most historians do not believe this is true.  Sigerist explains that the Smith Papyri was a "work of a surgeon.  There is good internal evidence, however, that the book was a manual of a war surgery or rather that the experience it reflects was gained to a large extent from war injuries," Sigerest explains.  "It is not very probable that the vizier of a great Pharaoh would have acted as an army surgeon." (5, 310)

Other experts speculate the Ebers Papyrus was not a book in itself, but an encyclopedia of random recipes from random scrolls.  The chances it was written by Imhotep are also highly unlikely.

The legacy of Imhtep:

Regardless of who the first physician really was, Imhotep is given credit by many historians, and Hollywood, as the first physician, and he's often labeled as such.  He was so famous, and such a great healer during his life, that after his death he became a legend.  And in the ancient world, many legends become gods in and among themselves.

In fact, many must have believed that he was so good at whatever he did that he must have had more than human knowledge (some speculated he communicated with the god Thoth), and so they worshiped him as the god Imhotep.  He was, therefore, worshiped as one of the health and healing god, along with Thoth, Isis, Sekhmet, Heka, Serket, Ta-Bitjet.

During the time when the Greeks ruled over Egypt, around 500 B.C, he was worshiped as a deity for good health and healing.  Temples in Memphis, Thebes and Pilae were built in his honor, as well as many statues.  (4)

He was so famous he was often "associated with the Greek God of healing, Asclepius," according to Egyptpast.com (1)  If you were sick, if you're asthma acted up, the first things recommended for you might be to worship Imhotep in the hopes that he will cure you. Check out the links below for more on how asthma may have been treated in ancient Egypt.

Further reading:
References:
  1. "Imhotep," Egyptpast.com, http://www.egyptpast.com/pyramids/imhotep.html, reviewed May, 26, 2012
  2. "The First Physician," Journal of the American Medical Association, August 19, 2009, 302 (7), page 807
  3. Dunn, Jimmy, "Egypt: Imhotep, Doctor, Architect, High Priest, Scribe and Vizier to King Djoser," touregypt.net, http://www.touregypt.net/featurestories/imhotep.htm, referenced May 26, 2012
  4. Lambert, Tim, "A brief history of medicine," localhistories.org, http://www.localhistories.org/medicine.html, observed May 26, 2012
  5. Sigerist, Henry E "A History of Medicine," vol I, "Primitive and Archaic Medicine," 1951, New York, Oxford university Press
  6. Withington, Edward Theodore, "Medical History From the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press, page 14-15 (Chapter IV: Medicine in Ancient Egypt)
  7. Wilder, Aleander, "History of Medicine," 1901, Maine, New England eclectic Publishing
  8. Sozinskey, Thomas S., "Medical Symbolism in connection with historical studies in the arts of healing and hygiene," 1891, Philadelphia and London, F.A. Davis Publisher
  9. 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

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