Monday, March 18, 2013

5000-50 B.C.: Asthma in Ancien Egypt: the Ebers Papyri

Facsimiles from the Ebers Papyrus in Egyptian Hieratic characters,
the upper containing three, the lower eleven dental prescriptions.
From Walter Libby's 1922 book on the history of medicine (12, page 6)
In the early 19th century an old scroll was discovered between the legs of a mummy in Assasif, which is in the necropolis of Thebes on the west bank of the Nile River in Egypt. It was soon noted to be one of the longest medical papyri known to history, and it is very well preserved, and even includes the notes of the owner in the margins.  (1, page 1517)  It is from this ancient text we find our first known description of asthma-like symptoms, and our first asthma remedy.

This old Egyptian scroll was purchased in Luxor in 1862 by Edwin Smith, who also purchased another famous scroll, the Edwin Smith Papyrus, at about the same time. It is unknown to history by whom Smith purchased it from.  It's also a mystery what tomb it came from considering the person who found it had passed away before it was learned the significance of it.  However, it's believed to be from the tomb of a doctor, and some speculate it came from the same tomb as the Smith Papyrus (3, page 30)(10)

The scroll was purchased by Egyptologist George Ebers in 1873.  When he came into possession of it, "it consisted of a single, tightly rolled piece of the finest yellow-brown papyrus. The width of the document was 30 centimeters, and the length of the written part 20.23 meters. No other papyrus known to Egyptologists is better preserved." (10)  He had it translated and published, and from here on out it has been referred to as the Georg Ebers Papyrus. (3, page 30)  Ebers gave the original scroll to the University of Leipsic "for safe keeping," and where it an be observed by anyone who visits the museum.    (10) It remains there to this day (at least as of 3/17/13).

The 20.32 meter long scroll consists of 108 neatly organized columns of 20-22 lines written in hieratic*. This text is printed in black ink.  Each column is numbered (the rubrics) and printed in red ink (that contained red lead).  (4, page 49)(5, page 311)(10)

Unlike other ancient Egyptian texts which were only fragments of larger texts, the Ebers Papyrus is believed to be a complete text.  (4, page 49)(5, page 311)  Fielding Hudson Garrison, in his 1922 book, "An introduction to the history of medicine," explains that the  papyrus appears to be written "edition de luxe, as it is prepared for some great temple." (4, page 49)

Yet by the time it was translated and determined to be the most important ancient medical texts of all time, (2, page 17) the person who found it was dead. Even the person who sold it to Edwin Smith remained a mystery, so where the document was actually found may never be known.  (3, page 30)

Translating the text proved to be complicated, as many of the Egyptian descriptions of ailments and remedies proved hard to translate into modern languages.  Dr. Joachim translated it into German in 1890, and this was translated into English in 1930 by Dr. Cyril Bryan.  Later, in 1937, Dr. Ebbell attempted another English translation and he appeared to be bolder in his translation, and it is from here that we come to our belief that this great document describes symptoms of modern diseases such as diabetes, angina, jaundice and asthma.  Other experts have criticized Ebbell for overly using his imagination in his interpretations. (3, page 30)

Some passages in the text refer to past Egyptian Pharaohs going all the way back to the First Dynasty of around 3400 B.C., wrote Dr. Elliot Smith in his introduction to Bryan's translation.  Although, he says, the mentioning of such names is unreliable in dating because tying script with known names was common among ancient societies in order to garnish credibility.  The document was ultimately dated thanks to experts who were adept at dating the methods of Egyptian writings. (9, page xii, xv)

So the document is dated to about 1550 B.C.  Considering there is a description on the back side of the scroll of Amenhotep I, (1, page 1517)  who lived around 1500 to 1526 B.C., these dates are also frequently noted.  

Either way, due to passages that date back to the First Dynasty, it is clear that the content dates farther back than when the scroll was written.  It was this observation, perhaps, that inspired the imagination of Georg Eber to speculate that the document might have been a copy of the last six of the Hermetic texts, which are thought to contain medical wisdom from the god Thoth (referred to as Hermes by the ancient Greeks).

Thoth was the moon god, and he had a significant role in medicine (similar to Apollo in ancient Greece).  It is believed he talked to an Egyptian priest (or priests) during the early ages of Egypt, and this priest wrote down the wisdom he learned from the god.  There are various references to these documents by various physicians, although the original texts have long disappeared.  (2page 19)(4, page 49)

However, this theory, and others like it, were ultimately believed to be untrue, as experts now figure the document to be an encyclopedia of sorts of medical wisdom from various ancient documents. Smith Quotes Warren R. Dawson from his 1929 book "Magician and Leech" as saying the Ebers Papyrus is basically a compilation of recipes for the various ailments of that time taken from various other books that are "many centuries older."  Dawson says the Ebers Papyrus "is not a book in the proper sense of the word: it is a miscellaneous collection of extracts and jottings collected from at least forty different sources. It consists mainly of a large collection of prescriptions for a number of named ailments, specifying the names of the drugs, the quantities of each, and the method of administration."  And, as noted above, a few sections deal with diagnosis, symptoms and anatomy. (9, page xv)

This theory may be supported by the fact the papyrus has scribbles in the margins, such as  "this is a genuine remedy," or "Excellent.  I have often made it, and also proved it," according to Withington.  (2, page 17)  Perhaps notes similar to these were scribbled next to our description of our first inhaler:
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." (6, page 9
It is unclear exactly what herbal preparations were used, although its' probable that they used stramonium, belladona, henbane, and bitumen to "alleviate catarrh and coughs, and ease breathing," according to Mark Jackson in his article, "'Divine Stramonium': The Rise and Fall of Smoking for Asthma." (14, page 174)

One major difficulty with interpreting these old documents, or so the experts say, is that it can sometimes be difficult to translate Egyptian writing into our modern language. This in mind, I think, therefore, I can honestly say there is scanty evidence this Egyptian "inhaler" was used for anything more than a priest-physicians's trick to fool a patient into thinking something was being done, perhaps by the magic of the gods.

Henry Sigerist, in his 1951 book "A History of Medicine: Primitive and Archaic Medicine," notes that "Fumigations were not infrequently used in the treatment of anus and vagina and a recipe of the Berlin Papyrus (and Ebers Papyrus) tells us what the technique was.  Seven bricks were heated, and the cold drug was poured over one after another while the patient was held over the developing fumes."

My point here is we must be careful in thinking any inhalers or fumigation used by the ancient Egyptians was anything more than just something that was not' understood being used for an ailment that was not understood.  According to Mark Jackson, in his 2009 book "Asthma: A Biography:"
While Ebell's specific interpretation has been challenged by other translators, the papyrus certainly appears to list remedies to remove phlegm, alleviate catarrh, coryza, and coughs, and to ease breathing.  Significantly, Egyptian treatments for respiratory conditions included not only the oral consumption of a variety of concocted vegetable, mineral, and animal products but also the delivery of active substances directly to the lungs by inhalation."  (13, page 38)
So, as you can see, we could easily use our imaginations here as it comes to the treatment of asthma in ancient Egypt.  You are short of breath, you call for a physician, and a specialist comes to your house.  You hope he's an Internist who specializes in diseases of the chest, and you hope he has knowledge to this primitive inhaler, and that he also has a medicine called Belladonna that he tosses on those heated bricks.  Belladonna would take the edge of by easing both your breathing and your mind.

According to Sigerist the teeth where food enters and the anus where food exits were highly regarded by the ancient Egyptians.  Sigerist even notes various references to "the holy anus," and "shepherd of the Anus."  These shepherds were probably physicians who specialized in ailments of the anus, such as "hemorrhoids, prolapsus recti, inflammation and pruritus of the anus."  The pharaoh had his very own anal physician to take care of it, and perhaps this physician recommended this inhaler for hemorrhoids, a remedy we might think of as purely irrational, although to the Egyptians it was most surely rational.  (Sigerist, page 317, 335)

We must realize that Egyptian physicians had scanty knowledge of anatomy, and this is true despite the fact they prepared animals for food and sacrifice, and humans for mummification.  They knew about the inner organs, and they knew about vessels and blood, but they didn't know about the relationship with these and ailments of the body.  They did not make that connection.

So they would have no idea about diseases like asthma, nor other diseases that would make a person short of breath.  Basically, all physicians could do was note the symptoms -- chest pain, short of breath, wheezing -- and what remedies seemed to work.  And, according to

Likewise, it must be understood here that Egyptian medicine was based on myth, and ailments were caused by the wrath of gods, particularly the god Isis.  So remedies, in a sense, were believed to be gifts from the gods of health and healing, such as Thoth.  They worked by magical means.  So while these remedies may seem irrational to the modern reader, they were quite rational given the medical wisdom of the time.

Once translated, the Ebers Papyrus scroll was learned to contain over 700 magical formulas as remedies for the most common ailments of that time, with various incantations randomly assorted through the text.  Some of the remedies included pills in the form of dough, herbs and minerals that were put into beer and wine, salves and oils to rub onto the skin and wounds, a salve made from honey was put over wounds, and gargles and inhalations.

If you had complained of an ailment, a physicians would be summoned.  Egyptian physicians specialized in particular symptoms, so you would see a physician who specialized in treating your symptoms. If your specialist was an internist, perhaps you would be provided with the remedy above, which may actually contain breathing relief, considering Belladonna was later proven to contain a mild bronchodilator component.

Yet, more than likely, your treatment would be a general treatment, treated the same way as any other ailment.  Since the Egyptians were among the first society to attribute sickness to good health, he might suggest something simple to cleanse your body, which may involve any of the following::
  • Enemas (the stomach was believed to be a cause of most diseases breathing problems)
  • Emetics (to vomit out the poisons)
  • Animal excreta (including crocodile and camel)
  • Herbs such as squill and henbane
  • Fumes of burned sundried and crushed Belladonna leaves and roots (as noted above)
  • Eating foods such as figs , grapes, frankincense, cumin and juniper fruit
  • Drinking wine and sweet beer 
Along with the above treatments, the following were considered routine in order to keep your body clean: (11, page 18, 23)
  • Daily baths
  • Abstinence from certain foods (like cow flesh, pigs, flatulent beans, etc.)**
  • Gymnastics
  • Linen clothing worn for cleanliness
  • Purgatives and emetics every three months to cleans body***
  • Friction and inunction of the body (basically involves rubbing certain parts of the body)
  • Fumigations (usually during epidemics to "purify the air."  
  • Inhaling steam from inhalations 
  • Careful system of nurturing from childhood
  • Incantations (magic words)
  • Amulets (to wear or keep close to you and or your home to ward off spirits and for healing)
Or, if your asthma was diagnosed as being caused by witchcraft, the following remedy may be used:
"Against all kinds of witchcraft -- a large beetle; cut off his head and wings, boil him, put him in oil, and apply to the part. Then cook his head and wings, put them in serpent's fat, warm it, let the patient drink it." (2, page 18)
If your physician didn't heal you you might consult a priest or magician who would provide you with an amulet or 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.  Perhaps the good feeling of hope by this method was more healing to you than what your physician might recommend.

Another neat thing to note here is that by dating the Ebers Papyrus to around 1500 or 1550 B.C., this would place it as being written about the time of the Exodus.  That means it was probably written around the time Moses walked the earth, and the wisdom it contained was available to him.  So the Bible may provide us with another good source for learning what life was like for Asthmatics in Ancient Egypt. (see link below)

Further reading:
*Hieratic is a form of Egyptian cursive, and was used "chiefly on sacred and medical papyri and on wooden coffins... the characters are written from right to left... about 300 A.D. all knowledge of the meaning of the characters had died out, and it was not until the discovery in 1799 of the Rosetta stone (by Boussard, a French artillery officer) that any real progress was made in the decipherment." (10)

** Note that the upper classes of Egypt did not eat pig, and despite this, historians note a high incidence of hardened arteries.  One study of Egyptian mummies found hardened arteries in three fourth of the mummies studied.  While this was a recent study, some historians noted this as far back as the 1930s. You can read more about this here. Also see the comments to this post for reference. 

***While many historians noted the Egyptians to drink to excess, more modern historians think the beer and wine drank with most meals was more watered down and less potent than those of which we drink today. 

 References: 
  1. Selin, H., "Encyclopedia of the History of Science, Technology and Medicine in Western Cultures," 2nd edition, 2008, Springer
  2. Withington, Edward Theodor, "Medical History from its earliest times," 1894, London, Aberdeen University Press
  3. Nunn, John F, "Ancient Egyptian Medicine," 1996, University of Oklahoma Press
  4. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia and London, W.B. Saunders Company
  5. Sigerist, Henry E, "A History of Medicine," vol II, "Primitive and Archaic Medicine," 1951, New York, Oxford University Press
  6. Ebell, B.,  translator, "The Papyrus Ebers: The Grea)test Egyptian Medical Document," 1937, Copenhagan, page 67.  I found references to this passage by Mark Jackson (Asthma: A biography," 2009, New York, Oxford University Press, page 39), and Henry E. Sigerist (see reference immediadely above, page 339).  Sigerist says that a similar passage can also be found in the Berlin Papyrus.  
  7. Reference Pending
  8. Osler, William Henry, "The evolution of modern medicine," 1921, New Haven, Yale University Press
  9. Smith, G. Elliot, introduction to Cyril, Bryan,s book, "The Papyrus Ebers," 1930, London, The Garden City Press, Bryan's book was an English translation of the German translation of the papyrus. 
  10. 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.  
  11. Baas, Johann Herman, author, Henry Ebenezer Sanderson, translator, "Outlines of the history of medicine and the medical profession," 1889, New York
  12. Libby, Walter, "The history of medicine in its salient features," 1922, Boston and New York, Houghton Mifflin Commpany
  13. Jackson, Mark, Asthma: A biography," 2009, New York, Oxford University Press
  14. Jackson, Mark, "'Divine Stramonium': The Rise and Fall of Smoking for Asthma," Medical History, 2010, 54: 171-194

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