Tuesday, August 29, 2006

Secrets of the Pharaohs' Physicians Revealed

HealthDay News) -- A doctor is called to the house of a young man with a severe wound on his cheek. The flesh is split open, red and inflamed.
After assessing the damage, the doctor applies a special enzymatic cleanser to the affected area, then covers it in a bandage soaked in an antibacterial compound, to reduce the risk of infection. Chances are, the man will make a complete recovery.
While this course of treatment may sound modern, the doctor in question lived and practiced almost 4,000 years ago, in an ancient Egypt where skilled medicine worked hand-in-hand with magic potions and incantations to the lion-headed goddess Sekhmet.
The anonymous physician in question -- practicing in the Middle Kingdom period of about 1900 B.C. -- passed on his knowledge about the diagnosis and treatment of 48 serious injuries in a document now known as the Edwin Smith Papyrus.
The papyrus -- itself a copy set down about 1600 B.C. -- is comprised of 11 hieroglyphic panels spanning 15 feet.
It is the oldest surgical text yet discovered. And along with a host of artifacts, it will be the centerpiece of The Art of Medicine in Ancient Egypt, a major exhibit set to open Sept. 13 at New York City's Metropolitan Museum of Art.
Because it was made in a period of Egypt's history when factions from the North and South Nile were fighting for dominance, "it's tempting to speculate that this papyrus was written down for use by a surgeon treating battle wounds," said James Allen, curator of Egyptian Art at the museum.
Whatever its function, the papyrus, which is owned by the New York Academy of Medicine, highlights just how advanced these ancient practitioners were.
"When you see these things, you really have to marvel at the ingenuity of these people," said Dr. David Mininberg, a New York City physician who also holds a master's degree in Middle Eastern Studies and who is volunteering as a consultant to the exhibit.
"They were meticulous recorders of what they observed," he added, noting that the papyrus shows that the practice of medicine was already a respected science 600 years before the reign of King Tutankhamen.
The papyrus, which is of unknown origin and was bought in 1862 in Egypt by an American, Edwin Smith, begins with an assurance to would-be doctors that diagnosis is a simple act of measurement and observation, to be undertaken like any other important task in the then-largely agricultural society.
"As for measuring things with a grain measure ... suffering is to be taken account of in the same way," the anonymous physician wrote.
Measurements of symptoms and bodily health are equally matter-of-fact. Middle Kingdom doctors -- most of whom were also priests of Sekhmet, the lion-headed goddess of unforeseen calamity -- had a keen understanding of the circulatory system, the external surface of the brain and how to interpret the pulse. They could also easily distinguish between bone sprains and bone breaks and abscesses as opposed to tumors.
Many doctors were specialists -- according to Allen, other papyri focus solely on gynecologic or dental problems. Some physicians even gained great fame -- among the exhibits at the museum is a limestone statue of Yuny (ca. 1290 B.C.), one of a father-son pair of doctors. The two became so renowned that a shrine was erected to them after their deaths, to which pilgrims came for healing.
The ancient Egyptian physician's knowledge of internal anatomy was probably based on examinations of animals, not man, experts believe.
"Remember, they wanted to preserve the body -- as a mummy, a place the soul could go to, so invasion of the body was considered a bad thing," Mininberg said. Indeed, the hieroglyphics for various organs usually resemble those of animals, not humans.
Given those restrictions, the average Middle Kingdom doctor understood his power and his limitations. After careful observation and diagnosis of the patient in question, the dozens of injuries listed in the papyrus are divided into three categories: "an ailment I will handle," "an ailment I will fight with," and "an ailment for which nothing is done."
"In light of today's practices, in my opinion, it's an incredibly enlightened view," Mininberg said. "In other words, in the first case he says, 'I know what this is, I can treat it and I'm expecting a good outcome.' In the second category, he hedges his bets a little bit. And the third category is what I think is most impressive: not to treat. In other words, rather than undertake end-of-life, heroic measures with no chance of success, he simply gives supportive care."
In the case of the split cheek injury, the physician decides this is "an ailment I will handle." He then instructs budding doctors that "you have to bandage [the patient] with fresh meat the first day. His treatment is to sit in order to reduce his swelling. You should treat him afterward with an oil-and-honey dressing every day until he gets well."
This protocol makes sense to Mininberg. Fresh meat contains enzymes that essentially help clean wounds and reduce inflammation, for example. "They also put honey on wounds; with our technology we've learned that honey has got antibacterial properties," Mininberg said.
Of course, the ancient Egyptians didn't know bacteria caused disease, but through trial and error they discovered what worked.
"If you think about it, that's not too much different from a modern drug trial," Mininberg said. "You say, 'Hey, this ought to work -- if it does, we'll keep doing it.' "
Other remedies displayed in the exhibition include pomegranate (used as an astringent) and lotus root (which contains morphine-like analgesics). The papyrus also reveals that Middle Kingdom physicians knew how to suture and cauterize.
The physician was only one part of a larger healing team, however. The papyrus contains recipes for magic potions as well as supplications to important deities.
For example, patients fighting snakebite had an ally in Isis, "mistress of magic," who assured supplicants that "every biting serpent-mouth listens to me."
And while the average ancient Egyptian had no knowledge of the infectious organisms that cause epidemics, an incantation written on the reverse side of the papyrus is "for barring air of the bitterness of the night-demons, those of smallness, Sekhmet's messengers. Retreat, night-demons!"
According to the papyrus, the man who recites this while circling his house "cannot die because of a disease year." Other spells and potions offer protection against menstrual cramps, mental problems, and even "rejuvenating the face."
Allen believes all of this reflects a rational response to events of unknown origin.
"The ancient Egyptians basically approached medicine the way we do -- trying to understand, then to cure," he said. "Of course, they had a lot less knowledge to work with. So when anyone got sick or went blind from bacteria, the only way they could explain it was through some kind of supernatural force. And what you used in that case, of course, was magic. It was a really very practical approach."

More information
For more on ancient Egyptian medicine, visit the Metropolitan Museum of Art.

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