History of Medicine: Ancient Mesopotamia and Egypt

(Updated this early post from 6/11/2013)

I stumbled upon “Disease and Medicine in World History” by Sheldon Watts in the library and realized I couldn’t pass up the chance to learn about such an interesting topic. My dad also gave me another book, “the Healers: The Doctor, Then and Now” by Kurt Pollack and E. Ashworth Underwood. I also used “the Medical Book” by Clifford Pickover at some parts.

I like Watt’s stance, in which he rejects the glorification of European roots in biomedicine. He’s trying to show a global history of medicine, touching upon the influence of ancient civilizations.

He begins with describing the basic evolution of disease. How did disease even come to be? Watts states that proximity to domesticated animals led to disease. Smallpox came from its bovine form of cowpox. Measles came from fowls, like chickens (measles was absent in areas where there were few chickens, such as ancient Egypt).

The New World apparently did not have any major diseases prior to the arrival of the Europeans. He says that when people crossed into the Americas, they slaughtered animals for food. Such animals included the horse and camels, which could have been domesticated animals. So New Worlders did not live side by side with animals and were protected from disease.

ANCIENT MESOPOTAMIA

In all ancient civilizations, medicine went hand in hand with magic. Physicians acted as healers and priests. I really love this quote by Robert Adler that I found in the Pickover book

“It is in the powerful figures of shamans and sorcerers that we find the predecessors of our white-coated physicians…whom we, like our ancestors, imbue with great power.”

According to Pollak and Underwood, Mesopotamians had different kinds of healers. There was the Baru, or soothsayer, who diagnosed the spiritual cause of  disease, and the Ashipu, the exorcist of evil spirits. The Asu was also a priest, but he could also use non-magical remedies, such as drugs or surgery. Note: As I’m reading about ancient physicians from different countries and their emergence from their priestly origins, it’s hard to see the divisions between who are the physicians, priests and both. No doubt there must have been overlap, but distinctions are not clear. The main idea though, is that physicians used magic and religion for the healing process.

Demons were the root of illness. If someone committed a sin, he lost protection from the gods. Physician-priests would then use magical charms or religious chants, praying to the gods (like Marduk, the main god of Babylon) to free the person of demonic presence. If it was difficult to ascertain a reason for sickness, they searched for omens in things like the color of the flame, the formation of oil globules in water, or the appearance of sacrificed animals (the sheep was popular — if the liver was long, then the patient would have a long life).

“Ashakku caused fever in the head and also phthisis [pulmonary tuberculosis]; Namtaru threatened to bring plague; Utukku afflicted the neck, Alu the breast, Gallu the hand, Rabisu the skin.” Pollack and Underwood pg 15

The doctor-priests were not without some use of rational empiricism. Coloration played a role in allowing for one to determine the severity or cause of a disease. For instance, if the eye was yellow, the doctors knew that it was a bile disease and not an eye disease.

Assurbanipal hunting lions

Most of what historians know about medicine in Mesopotamia (Assyrian, Babylonian etc.) came from cuneiform tablets, which were discovered in the mid 1800s in Iraq, near the ruins of the ancient city of Ninevah. The Library of Assurbanipal (who was King of Assyria 668-626 BC) contained 22,000 cuneiform tablets, 800 devoted to medical information, which is where historians got most of their information on medicine in the region.

Another document that sheds some light of doctors of the time was the Code of Hammurabi (Hammurabi was Babylonian king 1728-1686 BC), one of the oldest pieces of law in history. Out of its 282 paragraphs, 9 were related to the physician’s fee charges. These were based on the status of the patient, with those of higher status having to pay more.

(whole section from Pollack and Underwood)

meso

Code of Hammurabi’s physician fees. From The Healers

ANCIENT EGYPT

Like in Mesopotamia, religion and medicine in Egypt were one. Demons and gods caused diseases, and gods brought healing. Doctors played the role of priest as well as physician (Watts). Pollack and Underwood states “Every general statement on Egyptian medicine or on Egyptian doctors is inevitably a simplification of the many-coloured picture. All that we can say with certainty is that all the sciences, including medicine, bore a strongly religious character and the priests were the educated class.”

Physician-priests were highly regarded and very important for the ruling class. Watts says that because of this, peasants who were distant from the imperial courts could not easily access doctors. Workers just made do by praying. Thus while doctors were important figures in the high classes, low classes did not benefit as much.

Watt states that there is evidence that Egypt changed medical practice from science to magic, not magic to science as other researcher had speculated. It seems that pre-dynastic Egypt and the Old Kingdom (3100 – 2181 BCE) was based more on empirical evidence (physical symptoms), while the New Kingdom and the time of Persian rule, were on the side of magic. Physicians became well regarded not really because of their curing abilities, but because of their knowledge on the ancient religious rituals.

Imhotep  was the Pharoah Zoser’s counselor during the Third Dynasty (circa 2600 BC). Imhotep (who was the inspiration for the evil guy in The Mummy) was a polymath, being a scribe, priest, teacher, architect, and physician amongst others. It’s not completely clear what exactly he did (though he’s credited with founding a medical school in Memphis). But he is seen as one of the first physicians. He was deified later as a healing god. People went to his temple for miracles and healing (Pollack and Underwood). Watts however, has another perspective, stating that Imhotep didn’t have anything to do with medicine. It wasn’t until hundreds of years later when he was raised in status by the Egyptians. Note: Need to research more on this.

The four essential organs of the Egyptians were the liver, lungs, stomach and intestines. They were placed into jars with a mummy, as they were needed for the next life. The heart was the most important organ, as it was the seat of the soul or ba. The brain was not important. It was taken out of the dead body through a tube going up the nose (Watts).

Other points: Herodotus states that Egyptian doctors were specialized, one for a particular part of the body. Egyptians also believed in cleanliness to make the gods happy. They were conscious of what they ate, thinking it was the an important route for disease. Emetics were used for vomiting. (Pollack and Underwood).

“Their remedies by which they prevent diseases are enemas, fasting and vomitting. These are at times applied daily, at others they are suspended for three or four days. They claim that of every food the main part is superfluous after digestion and that the diseases are born from this; therefore they served the preservation of health best” Diodorus Siculus

It seems that before the coming of Alexander the Great, there were no epidemics of major diseases such as cholera or malaria. So what were the causes of death? Staple foods were wheat, barley and rye. When they were ground up for making bread, little stones were released from the rolling stone and got into the bread. These stones wore away the teeth enamel, exposing vessels and nerves at the center of the tooth. Infections from this led to deaths. Since Egyptians did not eat much sweets until the Persians arrived, sugar was not a string possible cause of tooth decay. Other causes of death included neck and spinal injuries from carrying heavy loads on head. If the Nile failed to rise, there was famine and starvation. There were also deadly/poisonous animals such as crocodiles and snakes (Watts).

In 1862, an American named Edwin Smith bought an ancient roll of papyrus from a local. It was around 1906, when he died, when his daughter gave it to the New York Historical Society. Egyptologist James Breasted was given the job of translating, which he did in 1922. The Edwin Smith Papyrus as it is known, is thus far, the oldest work of surgery ever. The papyrus is a copy written around 1600 BC of an original that was probably written around 3000 BC. The papyrus describes 48 surgical cases (the 48th was not finished). The authorship is unknown, though Breasted thought it could be Imhotep. The papyrus reveals that the Egyptians did not know much about the interior of the body. Wound treatment was using living animal flesh (Pollack and Underwood). Of the 48 cases, 27 deal with head trauma. Also mentioned are cranial sutures (natural fibers that attach pieces of the skull together), surface of brain, and cerebrospinal fluid (Pickover). Six cases describe suturing a wound. Physicians also noted that cases had to be labeled on realistic results: could be cured, healed, or death.

the Edwin Smith Papyrus

Edwin Smith had another papyrus, which he sold to German Egyptologist Georg Ebers in 1876. A couple years later, Ebers published it. It contains 876 remedies, with more than 500 substances coming from minerals, plants, animals, and “disgusting things” like feces, fat etc. There was also magical therapy, which was more prominent here than in the Edwin Smith Papyrus.

While all of this information is based on the few records that have been excavated,  it gives an idea of the status and function of medicine thousands of years ago. Pretty cool!

Questions:

1. Why do some diseases not occur? I don’t understand how malaria was not prominent, because I’d think the Nile would have had mosquitoes.

Note to self: Look up

History and Pathology of Malaria

Imhotep’s significance

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