THE ANCIENT EGYPTIANS THEIR MEDICINE AND SURGERY: THE ANCIENT EGYPTIANS THEIR MEDICINE AND SURGERY MR. S. SHANMUGAM RCJB/PUTERI SPECIALIST HOSPITAL PowerPoint Presentation: ALEXANDRIA GIZA SAKKARA ABYDOS KARNAK – VALLEY OF KINGS & QUEENS LUXOR-THEBES EDFU ABU SIMBEL NUBIA PowerPoint Presentation: IMHOTEP – EGYPTIAN FATHER OF MEDICINE RECEIVING THE MEDICAL SSROLLS FROM GOD THE LOUVRE (my visit 12/04/2006) PowerPoint Presentation: PHYSICIAN AND SCRIBE - SAKKARA HESI-RE BRITISH MUSEUM AN ADVANCED CIVILIZATION:
AN ADVANCED CIVILIZATION Medicine in ancient
was but one aspect of an advanced civilization. It was not practiced by witch doctors as in primitive tribes, with mixture of magic, herbal remedy, and superstitious beliefs. This was acknowledged by Homer in the Odyssey: ( Sameh M Arab MD ) “ In Egypt, the men are more skilled in Medicine than any of human kind ”.
HIGH DEGREE OF SPECIALIZATION !: HIGH DEGREE OF SPECIALIZATION ! “The practice of medicine is very specialized among them. Each physician treats just one disease. The country is full of physicians, some treat the eye, some the teeth, some of what belongs to the abdomen, and others internal diseases.” Herodotus, Histories 2,84 Sovereigns from foreign lands have frequently appealed to pharaohs to send them their physicians. A wall painting in a Thebean grave of the 18th dynasty (1400 BC) depicts “Nebamun”, scribe and physician of the king, receiving a Syrian prince paying him for his services in gifts. According to Herodotus, King Cyrus of Persia has requested Amasis (Ahmose II of the 26th dynasty, 560 BC) to send him the most skilful of all the Egyptian eye-doctors. : Sovereigns from foreign lands have frequently appealed to pharaohs to send them their physicians. A wall painting in a Thebean grave of the 18 th dynasty (1400 BC) depicts “ Nebamun ”, scribe and physician of the king, receiving a Syrian prince paying him for his services in gifts. According to Herodotus, King Cyrus of Persia has requested Amasis ( Ahmose II of the 26 th dynasty, 560 BC) to send him the most skilful of all the Egyptian eye-doctors. EGYPTIAN PHYSICIANS WERE IN DEMAND PowerPoint Presentation: NEBAMUN SCRIBE AND PHYSICIAN SYRIAN PRINCE PowerPoint Presentation: Montemhet , 4th prophet of Amen , put his faith in the god he served: I bow down to your (i.e. Amen's) name May it be my physician, May it drive pain away from me. MEDICINE BOTTLE WEB SEKHMET: EGYPTIAN PRIESTESS PHYSICIAN PowerPoint Presentation: Sekhmet , Priestess Physician PAPYRUS: PAPYRUS PowerPoint Presentation: The medical knowledge A few papyri have survived, from which we can learn about Egyptian medicine. 1. The Edwin Smith Papyrus describing surgical diagnosis and treatments, 2. The Ebers Papyrus on ophthalmology, diseases of the digestive system, the head, the skin and specific maladies like aAa , which some think may have been a precursor of aids and others, perhaps more reasonably, consider to have been a disease of the urinary tract, a compilation of earlier works that contains a large number of prescriptions and recipes, 3. The Kahun Gynaecological Papyrus , 4. The Berlin Medical Papyrus , 5. The London Medical Papyrus . 6. The Hearst medical papyrus repeats many of the recipes found in the Ebers papyrus. 7. The Demotic Magical Papyrus of London and Leiden contains a number of spells for treating physical ailments. MEDICAL PAPYRI: MEDICAL PAPYRI Some kind of medicine was already practiced in Egypt in the earliest prehistoric days, (the use of malachite as an eye paint in the Badarian age – around 4000 BC , and the same use of galena in predynastic times). The oldest yet discovered papyrus is the “ Kahun Gynecology Papyrus”, dating back to 1825 BC , during the reign of Amnemhat III. It describes methods of diagnosing pregnancy and the sex of the fetus, toothache during pregnancy, diseases of women, as well as feminine drugs, pastes and vaginal applications. PowerPoint Presentation: Examination of a woman aching in her legs and her calves after walking You should say of it 'it is discharges of the womb'. You should treat it with a massage of her legs and calves with mud until she is well. Kahun Medical Papy ru s EDWIN SMITH PAPYRUS: The Edwin Smith Papyrus is 5 meters long, and is chiefly concerned with surgery. It described 48 surgical cases of wounds of the head, neck, shoulders, breast and chest. Unfortunately, the scribe who copied it did not proceed further from the thorax, and it ended abruptly in the middle of a sentence. The papyrus listed the manifestations, followed by prescriptions to every individual case. It included a vast experience in fractures that can only be acquired at a site where accidents were extremely numerous, as during the building of the pyramids. The Ebers Papyrus is a huge roll of more than 20 meters long and 30 cm wide. It is chiefly an internal medicine reference, as well as diseases of the eye, skin, extremities, gynecology and some surgical diseases. Anatomical and physiological terminology are also included. For treatment of those diseases, 877 recipes and 400 drugs were described. EDWIN SMITH PAPYRUS EDWIN SMITH PAPYRUS: EDWIN SMITH PAPYRUS The most famous and elaborate papyri are the “Edwin Smith Papyrus” (1600 BC) and the “ Ebers papyrus”, which refers to King Den (1 st dynasty, 3000 BC), suggesting a much earlier origin . EDWIN SMITH PAPYRUS: EDWIN SMITH PAPYRUS EBERS PAPYRUS: EBERS PAPYRUS THE DISEASES: THE DISEASES 1.Bilharziasis 2.Malaria 3.Trachoma 4. Bubonic plague 5. Tuberculosis 6. Elephantiasis 7. Trichinae (Worms) 8. Small pox 9. Polio etc…………… PowerPoint Presentation: POLIO NOTE: THE WASTED LEG OF PRIEST REMI AND NOTE THE CRUTCH FERTILITY DIAGNOSIS: FERTILITY DIAGNOSIS Fertility was diagnosed by placing garlic in the vagina for one night. If the next day the woman can taste or smell it in her mouth, she is fertile. This is based upon the connection between the genital parts and interior of the body. Such connection would be lost in a case of obstructed Fallopian tubes. In modern medicine, phenolphthalein injected in the uterus would appear in urine based upon the same principle. A test known to gynecologists as “Speck’s test”. PREGNANCY TEST: PREGNANCY TEST Diagnosis of pregnancy and sex determination of the future child was based on the fact that pregnant urine germinates cereals more rapid then non-pregnant one. If the child was a male, the urine would germinate wheat, and if a female, it would geminate barley. The same tests have been used in Europe up till the Middle Ages. DELIVERY AND CONTRACEPTION: DELIVERY AND CONTRACEPTION Delivery was performed in the squatting position, with the woman supporting her arms on knees and sitting on two bricks. Difficult labors were aided by burning resin, or massaging the abdomen by saffron powder and beer. Abortions were done by introduction of warm oil and fat in the vagina. Contraception was also performed by the insertion of crocodile oil, gum acacia or honey consperge and natron into the vagina. Gum acacia when dissolved produces lactic acid, a very effective known spermicidal. The Ebers papyrus says: “ To cause a woman to stop being pregnant, be it one, two or three years: part of acacia, colocynth, dates, finely ground in a hin of honey, fibers are moistened therewith, introduced into her vagina ”. PowerPoint Presentation: DELIVERY CHAIR PowerPoint Presentation: KUM OMBO WALL RELIEF AT HOUSE OF ‘MAMMISI ‘ PowerPoint Presentation: GODDESS RITHO DELIVERING THE GOD RA “ Houses of birth” or “ Mammisi ” were annexed to temples. They were visited by pregnant women seeking divine help, rather than being a birth place. BREAST FEEDING: BREAST FEEDING 1.Infants were breast fed for three years, and this was encouraged: “ Nothing is more lawful than one’s mother milk ”. 2. Milk stimulants were resorted to, as mentioned in Ebers Papyrus: “ To bring forth the milk of a nurse who feeds subject who must feed a child: Spine of Nile-perch, fried in oil/fat, her spine is anointed therewith ”. 3.Only when the mother failed to feed her infant, they resorted to cow milk. SOME REMEDIES: SOME REMEDIES For the evacuation of the belly: Cow's milk, 1; .grains, 1; honey 1; mash, sift, cook; take in four portions. To remedy the bowels: Melilot (?), 1; dates, 1; cook in oil; anoint sick part. To refresh an aching head: Flour, 1; incense, 1; wood of wa , 1; waneb plant, 1; mint (?), 1; horn of a stag, 1; sycamore (?) seeds, 1; seeds of [ (?)], 1; mason's plaster (?), 1; seeds of zart , 1; water, 1; mash, apply to the head . EBERS PAPYRUS DIETARY DEFICIENCIES: DIETARY DEFICIENCIES A restricted diet caused or aggravated a number of ailments, some with fatal outcome. There were times when malnutrition was widespread. Prehistoric dental records suggest that health was poor during much of that period, and improved with the increasing adoption of agriculture. Bad nutrition caused many other diseases as well. Because of vitamin and other deficiencies,dental abrasion, and bad mouth hygiene, caries and abscesses were the lot of many ancient Egyptians. HERBAL MEDICINE: HERBAL MEDICINE Herbs played a major part in Egyptian medicine. The plant medicines mentioned in the Ebers papyrus for instance include opium, cannabis, myrrh, frankincense, fennel, cassia, senna , thyme, henna, juniper, aloe, linseed and castor oil. Egyptians thought garlic and onions aided endurance, and consumed large quantities of them. Raw garlic was routinely given to asthmatics and to those suffering with bronchial-pulmonary complaints. Onions helped against problems of the digestive system. (e.g. pEbers 192 ) MALACHITE: MALACHITE Malachite used as an eye-liner also had therapeutic value. In a country where eye infections were endemic, the effects of its germicidal qualities were appreciated even if the reasons for its effectiveness were not understood. SURGERY: SURGERY PERFORMANCE OF SURGERY IS SEEN ON THE WALLS OF MANY TEMPLES. AT SAQQARA THERE IS THE TOMB OF ANKH-MAHOR, KNOWN AS THE TOMB OF THE PHYSICIAN . WALL RELIEFS SHOW AMPUTEES AND TREATMENT TO THE STUMPS TREPHANATION WAS PRACTISED TOO PowerPoint Presentation: The Edwin Smith Papyrus shows the suturing of non-infected wounds with a needle and thread. Raw meat was applied on the first day, subsequently replaced by dressing of astringent herbs, honey and butter or bread. Raw meat is known to be an efficient way to prevent bleeding. Honey is a potent hygroscopic material (absorbs water) and stimulates the secretion of white blood cells, the natural first body defense mechanism. The application of sour or moldy bread was practiced in European medicine until the Renaissance. In AD 1928, Alexander Fleming extracted Penicillin from moulds, and 17 years later was awarded the Nobel Prize of Medicine. SUTURING CANCER: CANCER At least 39 mummies with cancer have been identified. Cancer of the uterus has been described in the Ebers papyrus. “ Another for one in whom there is eating on her uterus in whose vagina ulcers have appeared ”. BREAST CANCER: BREAST CANCER Breast cancer was also described, but was non-curable . “If thou examinst a man having bulging tumors on his breast, and if thou puttst thy hand upon his breast upon these tumors, and thou findst them very cool, there being no fever at all when thy hand touches him, they have no granulation, they form no fluid, they do not generate secretions of fluid, and they are bulging to thy hand. Thou shouldst say concerning him: One having bulging tumors. An ailment with which I will not contend ”. SURGERY: SURGERY Two sculptured slabs from the 1 st dynasty (3150 – 2925 BC) dating to kings Aha and Djer (2 nd and 3 rd kings) show a seated person directing a pointed instrument to the throat of another who was kneeling. Some Egyptologists believe it was a tracheotomy (opening the airways to maintain breathing) procedure. The surgical treatment of abscesses or cysts was described in the Ebers Papyrus. “Instructions for a swelling of pus …. A disease that I treat with knife-treatment. If anything remains in pocket, it recurs ”. Surgeons today are aware that complete excision of a swelling capsule is mandatory to avoid its recurrence. Piles and rectal prolapse were treated by medication, suppositories, laxatives and enema. For burns , a mixture of milk of a woman who has borne a male child, gum, and, ram’s hair was applied. Urethral strictures were dilated using reeds. This was the earliest non-surgical intervention ever applied in history. In modern medicine, the first intervention was reported in the AD 1880’s by catgut balloons. Mild antiseptics , as frankincense, date-wine, turpentine and acacia gum were used. Hot fire-drill was employed in cauterization. SURGICAL INSTRUMENTS: SURGICAL INSTRUMENTS Cairo museum has a collection of surgical instruments, including scalpels, scissors, copper needles, forceps, spoons, lancets, hooks, probes and pincers. A collection of 37 instruments is engraved on a wall in the temple of Kom-Ombo (2 nd century BC) , which was one of the houses of life. The Ebers Papyrus states. “ thou shalt perform an operation for it, the same being split with a knife and sized with a …(? forceps) ”. The Edwin Smith Papyrus contains a list of instruments, including lint, swabs, bandage, adhesive plaster (x-formed), support, surgical stitches and cauterization. PowerPoint Presentation: NILE CRUISE BOAT PowerPoint Presentation: KOM OMBO TEMPLE TO HORUS AND SOBEK: TEMPLE TO HORUS AND SOBEK In the temple of Sobek there are reliefs of medical instruments: bone saws, suction cups, knives and scalpels, retractors, scales, lances, chisels and dental tools. Trepanation, practiced in many early cultures for a number of reasons, is not mentioned in any of the medical papyri, but seems to have been performed occasionally using mallet and chisel. Just 14 skulls, some healed or partially healed, have been found.Limb amputations were also performed. SURGICAL INSTRUMENTS: SURGICAL INSTRUM ENTS ONE OF THE BEST DEPICTIONS OF SURGICAL INSTRUMENTS IS ON THE WALLS OF THE TEMPLE IN KOM OMBO – THE TEMPLE TO HORUS SURGICAL INSTRUMENTS: SURGICAL INSTRUMENTS The knives used had stone blades. Flint or obsidian have edges sharper than modern surgical steel. It is small wonder that physicians would hesitate to replace sharp flint blades with comparatively dull metal ones, made first of bronze and later of iron. When metal instruments were finally used to any extent, the act of cauterizing accompanied it. In some procedures, the blade was heated until it glowed red, and then used to make incisions. It cut as well as sealed up the blood vessels, limiting bleeding [ 10 ] . PowerPoint Presentation: THE MOST FAMOUS WALL RELIEF OF SURGICAL INSTRUMENTS IN THE WORLD AT KOM OMBU PowerPoint Presentation: NOTE: WEIGHING SCALE SCISSORS PROBES AND DILATORS LITHOTOMY PROBES SAW GALLIPOTS PowerPoint Presentation: There is a large hall with pillars to the north of the first room and here is also the rests of five square pillars. On the southern wall are mourners depicted; though the reliefs here are badly kept, one can still see the beauty of the motifs. On the eastern wall women dancing are to be seen. In the doorway to the pillared hall are the famous medical scenes. Here are surgical operations and also the well-known circumcision scene, done on a priest. This particular theme can also be seen much later on a wall in the Mut temple at Karnak . There is also depictions of a foot being operated, which has led refexologists to think that their practice also was present in Ancient Egypt, which one could seriously doubt. AT SAQQARA – TOMB OF ANKH-MAHOR PowerPoint Presentation: THE PYRAMID OF ZOSER – THE OLDEST IN THE WORLD PowerPoint Presentation: MASTABA OF ANKHMAHOR - THE PHYSICIAN’S TOMB SURGERY: 1 . CIRCUMCISION WAS PRACTISED AS FAR BACK AS 5,000 BC. 2. RESERVED FOR ROYALTY AND THE PRIESTS MOSTLY? 3. SIGN TO DISTINGUISH IN TIMES OF WAR! 4. “ The ointment is used to make it acceptable ” ? USE OF ANAESTHETIC; USE OF POPPY SURGERY PowerPoint Presentation: Ankhmahor's tomb at Saqqara was decorated with scenes of people undergoing medical treatment. This scene, representing a circumcision, is one of the most famous scenes from this tomb. A PRIEST BEING CIRCUMCISED: A PRIEST BEING CIRCUMCISED PowerPoint Presentation: ART OF BANDAGING HIEROGLYPHICS MENTION ? USE OF LOCAL ANAESTHETIC INSTRUMENT USED APPEARS TO BE KNIFE! PowerPoint Presentation: FOOT MASSAGE ? REFLEXOLOGY PowerPoint Presentation: Fracture forearm with splint, from a mummy of the 5th dynasty, showing signs of healing. An inscription in the tomb of Ipujy , an architect of the 19 th dynasty (1300 BC) shows the physician – or sunu – reducing a dislocated joint. The procedure is exactly similar to the modern “Kocher’s technique” orthopedics use today. PowerPoint Presentation: SPLINTS AND PROSTHESIS ANGINA PECTORIS: ANGINA PECTORIS A good description of angina pectoris (heart attack) is demonstrated in the Ebers Papyrus: “ shouldst though examine a patient with stomach disease suffering from pain in the arms, in the breast, and on one side of the stomach, say: “Death threatens’ ” and “ If thou examinst a man for illness in his cardia , and he has pains in his arm, in his breast, and in side of his cardia , and it is said of him: it is w3d illness, then thou shalt say thereof: it is due to something entering the mouth it is death that threatens him. Thou shalt prepare for him: stimulating herbal remedies …. “. In our modern practice of cardiology nowadays, physicians are aware of the radiation of this type of pain, and its frequent mimic to stomach pain. PowerPoint Presentation: TWO FUNNEL INHALATIONAL BOTTLE ARTIFICIAL TOE: ARTIFICIAL TOE PowerPoint Presentation: WOOD AND LEATHER PROSTHESIS DENTISTRY: DENTISTRY AMENHOTEP SALVES: SALVES The pots containing medicines were (at least occasionally) labeled, stating the remedy's composition and how to use it. A certain little pink pot bears the following hieratic inscription: which, read from right to left, means: Saw dust, acacia leaves, galena, goose fat. Bandage with it. THE ERECT PENIS AND FERTILITY: THE ERECT PENIS AND FERTILITY THE LIFE GIVING SPERM COMING SOON: MYSTERIES OF THE PYRAMIDS!: COMING SOON: MYSTERIES OF THE PYRAMIDS! PowerPoint Presentation: GODS OF EGYPT COMING TO THIS SCREEN SOON THE EYE OF HORUS: THE EYE OF HORUS Rx PowerPoint Presentation: The legend of Osiris and Isis PowerPoint Presentation: NUBIAN HOUSE PETS: CROCODILE IN EGYPTIAN MEDICINE IN CONCLUSION: IN CONCLUSION Much of the ancient Egyptian pharmacopoeia and many medical practices were ineffective, if not downright deleterious: e.g. excrement used in medicines will only in the rarest of cases prove to be wholesome, and if applied as wound dressing may well cause tetanus poisoning, yet dung continued to be used in Europe until the Middle Ages. The reliance on magic and faith may well have retarded the development of more rational views of the causes of diseases and their cures. On the other hand, the strong belief of the patient in the divine origins of the cure may well have been a large part in its effectiveness, and in the absence of anything better often the only support a physician could give the natural healing processes. Egyptian theories and practices influenced the Greeks, who furnished many of the physicians in the Roman Empire, and through them Arab and European medical thinking for centuries to come. PowerPoint Presentation: A PPT BY MR. SHAN