Wednesday, March 27, 2013

2700 B.C.: The Hermetic Books

All human wisdom was believed to come from the gods, and before writing this wisdom was passed on from one generation to the next by word of mouth, and, according to Egyptians, supposedly came from Thoth, a friend of Osiris, and the  secretary of the gods.

Thoth was the inventor of all the arts and sciences, and this included language, writing, and medicine.  Sometime around 2,700 years before the birth of Christ. Thoth communicated with a priest, and many suspect this priest was Imhotep.  (1, page 6)(2, page 19)(3) (4, page 14)

Thoth taught this priest how to write, and he instructed him how to carve words onto pillars of stone, and he told him all the wisdom of the gods. In this way, Thoth gave Egyptians all their laws, and he taught them how to perform religious ceremonies (5, page 24)

The priest (of whom some speculate was Imhotep, although more than likely was a variety of priests/physicians) then sat down and carved  all this information into "pillars of stone" (4, page 14), compiling a collection of 42 books.  The pillars of stone were recopied in each village or city, and was available only to priests.  Ultimately Thoth taught a priest to make paper out of stalks of papyrus.  So now, instead of medical wisdom being available one specific temple, scribes made copies, and each physicians had his own medical scroll.

Yet there are other theories regarding Thoth and the "Sacred Books" carved into pillars of stone.  Some speculate he himself wrote these books, which may signify that he was a real person at one time, and a famous physician who became a legend long after his death, and ultimately a god (which was not uncommon in the ancient world). (1, page 6)

While he was worshiped by the Egyptians, Thoth was also worshiped by the Greeks, and the Greeks referred to him as Hermes Trismegistus, and for this reason the books became known to history as the Hermetic books.

In 1856 Pierce Victor Renouard says that most physicians who refer to the Hermetic texts write of it in past tense, as though it exists yet they have not seen it.  By all accounts, the books are lost to history. Along the same lines, the number of books varies from 42 volumes to twenty thousand.

The first 36 books contained basic wisdom of the gods, such as knowledge of astronomy, mandates of religion, church ceremonies, administering justice, philosophy, the art of writing, geography, cosmography, and the knowledge of weights and measures, medicine, etc.  These are often referred to as the Sacred Books. (5, page 24)(8, page 19)

The last six books are also referred to as Embre, Ambre or Scientia Causalitatis. (5, page 24)(8, page 19) (6, page 60)(4, page 4) The name comes from the original passages of these medical texts: "Here begins the book of the preparation of drugs for all parts of the human body."  The Embre, according to Johann Baas, in his 1889 history of medicine, "served as a source of, and a mask for, the vagaries of magic, and the extravagances and frauds of the alchemists." (4, page 4)

This "mask" was necessary due to the bad name sorcerers, physicians, and their potions gained early in Egyptian history.  The only way to learn whether a potion worked, or how much to give, was to try it on the sick, and sometimes this made the patient worse, and sometimes it resulted in death.  Sometimes these remedies were used implicitly for their poisonous qualities to kill unwanted people.  So a bad reputation ensued among the medical profession.

Fielding Hudson Garrison in his 1922 history of medicine explains that alchemy, pharmacology, or "chemistry" comes from references to Egypt by it's ancient name: "The Black Land." He writes how Homer mentioned how the Egyptians were adept as making various drugs by use of the "Black Art." So while Egyptians physicians were not pharmacists per se, they were indeed involved in the "Black Art" as they usually concocted their own potions. (9, page 53) In the older days of Egypt, probably before the Sacred Books were written, physicians accused of practicing the "black art" were sentenced to death (4, page 23)

So the Embre, therefore, was a necessary cover to allow the priests/physicians to do their work, thus allaying some of the fears of the populace.  This must have worked, because medicine in ancient Egypt grew to be a proficient and abounding profession.

The medical texts are broken down as follows: (7, page 4)
  • Book 37: Anatomy
  • Book 38: Diseases
  • Book 39: Surgery
  • Book 40: Remedies
  • Book 41: Disease of the Eye
  • Book 42: Disease of Women
These medical text were memorized and followed to a tee by physicians, as deviating from them made the physician liable if the patient died. Robley Dunglison, in his 1872 history of medicine, says that the script forced physicians to diagnose by the position of the patient, which must be observed as "a mode of discrimination, as may readily be conceived, at once nugatory and absurd." (8, page 25)

Dunglison says:
The blind adherence to the opinions and rules of their predecessors, and the criminality, as it was considered, of all innovation— whilst they continued—effectually prevented any improvement in the science, or as it might, at that time, be more properly styled, the art of medicine.  (8, page 25)
William Hamilton, in his 1831 history of medicine, wrote along similar lines: (10, pages 13-14)
While the door of salutary competition was effectually closed by the exclusion of all but the initiated few, and no opportunities afforded for the display of superior talent, or the exercise of superior skill; it cannot be a matter of surprise that medical knowledge should have remained so long stationary, and should have become almost retrogressive, or that the conquest of disease should have been effected rather by the efforts of nature counteracting the operations of art, or by the fortunate by unpremeditated concurrence of circumstances, than by any combination of skill, or exertion of judgement. (10, pages 13-14)
So from around 2,700 B.C. to the opening of the school of Alexandria in 331 B.C., it was considered as "offensive to the Gods as the the violation even of those bodies which they had slain without compunction in the fields, much more the dissection of those who had died from natural causes in their beds," says William Hamilton in his 1831 history of medicine.   (10, page 8)

Theodor Puschman, in his 1891 history of medicine, explains that even "embalming of corpses exercised thus no beneficial influence upon the development of anatomical knowledge."  While physicians did understand that the heart was the "seat of origin of the blood vessels," they were prevented from, even discouraged, from deviating from the traditional means of mummification.  (11, page 23)

"Hence," Hamilton adds, "it was that men, being destitute of the means of acquiring a just knowledge of the structure, functions, and relative positions, of the human viscera, were unable to form a correct judgement as to the seat or causes of disease, or to adopt a rational method of cure." (10, pages 8-9)

Fielding Hudson Garrison, however, notes in his 1922 history of medicine that Aristotle wrote a century later, in his Politics, that, if after the fourth day the patient was not cured, a physician was allowed to deviate from script, and this allowed for some experimentation to take place. (9, page 49)(10, page 15)

While future generations should be thankful to the Egyptians for the beginning of medicine, we must wait until the this medical knowledge morphed into Greek philosophy for medical wisdom to grow into a flourishing tree.

References:
  1. Bradford, Thomas Lindsley, "Quiz questions on the history of medicine: form the lectures of Thomas Lindsley Bradford, M.D," 1898, Philadelphia
  2. Withington, Edward theodore, "medical history from the earliest times: a popular history of the art of healing," 1894, London, The Scientific Press
  3. Von Klein, Carl H., "The Medical Features of the Papyrus Ebers," The Journal of the American Medical Association, December 23, 1905, Volume 45, page 1928, George H. Simmons, editor, volume XLV, July - December, 1905, Chicago, American Medical Association Press.  This article provides a fuller story of how the document ended up in the hands of Georg Ebers, how it came to existence, etc.  
  4. Baas, Johann Herman, author, Henry Ebenezer Sanderson, translator, "Outlines of the history of medicine and the medical profession," 1889, New York
  5. 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
  6. 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."
  7. Bryan, Cyril P., translator, "The Papyrus Ebers," 1930, London, Garden City Press
  8. Dunglison, Robley, author, Richard James Dunglison, editor,  "History of Medicine from the earliest ages to the commencement of the nineteenth 
  9. Garrison, Fielding Hudon, "An introduction to the history of medicine," 1922, Philadelphia and London, W.B. Saunders Company, page 49
  10. 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
  11. 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

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