I may mention in passing that, although the medical papyri which have
come down to us are no doubt only an insignificant fraction of those
possessed by the Egyptians, we, nevertheless, find in them abundant
reference to medicine and surgery. In the Kahun papyrus obstetrics is
dealt with. Gynaecology, also ophthalmology, materia medica, diseases of
the ear, tongue, and nerves, also dentistry, are the subjects of others,
and even veterinary medicine was treated of in a papyrus, a fragment of
which was found by Professor Flinders Petrie.
According to Herodotus, Egyptian physicians specialized to a
considerable extent, ‘Each physician applies himself to one disease
only.’ ‘Some,’ he says, ‘are for the eyes alone, others for the head,
others for the teeth, others for diseases of the abdomen, others again
for special internal diseases.’[28] As to dentistry it may be remarked
that the ancient Egyptians were probably the first to stop decayed teeth
with gold. I may add that Ebers states that twenty distinct diseases of
the eye are referred to in the papyri, and Dr. Grant Bey asserts that
the operation for cataract was practised in ancient Egypt.[29]
As regards materia medica the Egyptians possessed the following
drugs:—lactuca, various salts of lead, such as the sulphate, with the
action of which in allaying local inflammation they were well
acquainted; pomegranate and acanthus pith as vermifuges; peppermint,
sulphate and acetate of copper, oxide of antimony, sulphide of mercury,
petroleum, nitrate of potash, castor oil, opium, coriander, absinthe,
juniper (much used as a diuretic), caraway, lotus, gentian, mustard,
ox-gall, aloes, garlic, and various bitter infusions; mandragora,
linseed, squills, saffron, resin, and various turpentine products;
cassia, certain species of cucumis, cedar-oil, yeast, colchicum,
nasturtium, myrrh, tamarisk, powdered lapis lazuli, vinegar, indigo; the
oasis onion, mastic and various gums, mint, fennel, hebanon or
hyoscyamus, magnesia, sebeste (a tonic and a cough medicine), lime,
soda, iron, and a great number of other agents, the names of which no
one can at present translate.
[Illustration: PLATE VI
Front of the temple of I-em-hotep, Island of Philae]
[Illustration: PLATE VII
Eastern wall of courtyard of temple of I-em-hotep, Philae; showing
door and apertures into narrow wall chamber]
In reading this very imperfect list one does not wonder that Homer
speaks of ‘the abundant herbs of Egypt, healing and baneful, used by men
more skilled in medicine than any of human kind.’[30] The Berlin Medical
papyrus alone mentions fifty medicines of vegetable origin. Some of the
prescriptions in Ebers’ papyrus are stated to have come from the great
medical temples of Sais and Heliopolis. The copy of Ebers’ papyrus has
evidently been in use by the priest physicians, for various notes have
been added on the margin by later hands in reference to the
prescriptions—‘Good,’ ‘Very good,’ ‘Try this,’ etc.
It is an interesting fact that upon the walls of some of the ancient
temples hieroglyphic records have been cut referring to medicine, and
containing, in some instances, prescriptions; in other cases
descriptions of various chemical processes; some of the temples seem to
have had laboratories attached to them. The hieroglyphic name for the
land of Egypt was Khami, whence are derived the words ‘Alchemy’ and
‘Chemistry.’[31]
Surgical instruments and the actual cautery were in use, also steam
inhalations, massage, ointments, plasters, poultices, suppositories,
injections, and emetics, and the importance of temperature in disease
was to some extent recognized.
Prescriptions were written out in due form and sometimes at great
length, fully equalling those of the most enthusiastic therapeutist of
our own day. Some hundreds of prescriptions have come down to us in
papyri. The longest prescription which I have read contained thirty-five
ingredients. To read it was a formidable task; to take it I should think
a much more formidable one. Some prescriptions are wise and rational, a
few strange and repulsive, and some are associated with charms and
spells.
Human nature is the same in all ages; hence one was not surprised to
meet with hair invigorators, hair dyes, cosmetics, pain killers, insect
powders, and a soothing syrup for small children containing opium in use
three thousand five hundred years ago. It was rather interesting to find
that the symbol for a half tenat often used in their prescriptions is
identical with that indicating a drachm with us, though the amounts are
not the same. I trust that the drachm will soon be as obsolete as the
tenat.
The writings of Dr. Grant Bey contain the information that during the
Hyksos period a law was enacted to the effect that if any physician
adopted a method of treatment not authorized by the sacred books and in
case the patient died under that treatment, the life of the physician
should also be forfeited. It is to be hoped that a principle so
absolutely fatal to all progress was not permitted long to remain in
operation.[32]
II
A Suggestion in Regard to Preventive Treatment of Valvular Disease
I have referred to certain facts, mostly of recent discovery, bearing on
the existence of our profession in the remote past and in reference to
the partial knowledge to which the priests of I-em-hotep attained as to
the circulation of the blood, a subject not without a certain interest,
but the advances of that knowledge made subsequently, which have on more
than one occasion been dealt with in this room, those now making, and
those yet to be made in the future are of more practical importance to
us.
The genius and the marvellous industry of Harvey first clearly unfolded
the great secret of the course of the circulation, thus opening a wide
door for the work of others, physiological and therapeutic. A
recognition of the principles of blood pressure, and of the action of
vasomotor nerves, and other advances have followed. We have attained to
a larger, though I believe as yet only to a partial and provisional,
hold of truth in these matters. As such we shall regard our knowledge if
we are wise. The great mistake in all times has been that of believing
that the truth already attained is the whole and that nothing remained
behind.
Our Egyptian and our Greek predecessors seem to have believed that they
had attained to absolute and final knowledge on these subjects. While we
smile at their error, let us be humble in estimating our own position
and ever remember that we ourselves may be yet barely on the threshold.
Our father, Harvey, has exhorted us ever to search and to study out the
secrets of nature by the way of experiment. Will you pardon me if I
devote the remainder of this paper to an account of a humble attempt to
carry out his mandate, if I narrate briefly an experiment dealing with a
yet unsolved problem in the pathology of the circulation, to which I
have devoted twenty-five years of my life?
I may plead the usage of speakers and writers who follow a tale or
narrative by a moral or practical application, and perhaps I may also be
allowed to say that the discovery that ancient Egyptian physicians
advocated rest in certain forms of heart disease suggested to me the
propriety of supporting this doctrine by a brief narration of my own
experience in the same direction.
As the Egyptians were probably ignorant as to the action of the valves
of the heart, they can only have known the fact that rest was
beneficial, but not the reason.
Valvular defect is one of the most important and perhaps the most common
of circulatory diseases. It is one which probably we shall never be able
to cure, and is thus likely to remain one of the opprobia of medicine.
Is it possible to treat it by prevention? This is the problem upon which
I wish to speak a few words. I am the more encouraged to do this because
I know that various Fellows and Members of this College hold similar
views to those which I desire to unfold.
Joints recover: Why does the Endocardium fail to do so?
There are in this audience many who have treated cases of acute
rheumatism and cases of valvular disease in hundreds of instances. We
are all aware that in acute rheumatism, however severe the joint lesion
may be, however great the swelling, the pain, the local pyrexia, and the
effusion, in the large majority of cases, after the usual treatment all
these grave symptoms subside, or if they linger in any joint many of us
know how certainly they will vanish if we stimulate the trophic and
vasomotor nerves by small blisters applied to the adjacent skin, the
final issue in most cases being the restoration of every joint to a
normal condition. But, alas, we also know that when the endocardium
covering the mitral or aortic valve cusps is in like manner attacked, a
like restoration does not take place spontaneously excepting in few and
rare instances. When regurgitation through the valve, shown by an apex
bruit with accentuation of the second pulmonary sound, has occurred in
acute rheumatism, if after treating the rheumatism we leave the affected
heart to its own course, and the patient to his, persistent bruit,
persistent pulmonary accentuation, hypertrophy, dilatation—in fact,
life-long heart disease and its train of attendant evils follow in a
large majority of cases, and mar or shorten life. Why should the
rheumatic heart be so much more intractable than the rheumatic joint?