2,700 B.C.: Imhotep invents rational medicine

Imhotep was deified
1500 years after his death.
(10)

Natural medicine was an art that developed over hundreds, if not thousands, of years.  Yet it culminated in the 3rd millennium B.C. during the reign of king Djoser (pronounced Zoser).  Yet this time the pharaoh was not given credit, instead it went to a non-pharaoh who became known as Imhotep.

His birth name was Thosortes or Athotis, and he was the son of Ptah.  He was born to a family of priests, and therefore he was educated in the best schools in Egypt.  He was a man of brilliant mind, one that made him a famous for his architectural, engineering, and medicinal talents.  He was also a great scribe, and it was probably this skill that made him vizier (chief advisor) to King Djoser (2650-2575 B.C.) of the Third Egyptian Dynasty.

Since all wisdom came from the gods, legend had it that he developed a close relationship with the god Thoth, who was the god of arts and sciences, and secretary to the gods. It was from Thoth that Imhotep learned how to write, and from whom he learned about architecture, engineering and medicine.

Imhotep grew to a "position of wide trust and importance," said William Osler in his 1913 history of medicine. (9, page 10)

In fact, it was during Djoser's reign with Imhotep at his side that knowledge of architecture, engineering, and medicine came to a culmination. The man given credit for it all was Thosortes, who became known as Imhotep  (2650-2600), which means physician.

Prior to Imhotep (pronounced I-em-hetep), pyramids were build of mud brick and didn't last the test of time. Imhotep was the first to suggest using stone (or at least he's given credit), and he designed Pharaoh Djoser's step pyramid in Saqqara (Sakkara).  He also is said to have invented many of the tools used to make these pyramids and an irrigation system which supplied water from the Nile to fields.  (1)

He also impressed by his ability to heal, and it was from th

King Djoser was an Egyptian Pharaoh
during the 3rd Dynasty of the Old Kingdom

is talent that he earned the name Imhotep, although there are variations of this depending on who the author is, such as Imhotpu, Emeph, Eimoph, Imothph, and Imouthes.

He had other names too, such as "scribe of numbers."  Perhaps this was in reference to the knowledge of numbers required to understand the prescriptions that were recorded, and to have an understanding of the "great many remedies that they employed for diseases of various kinds and many methods of delivering them." (2)

He was paid well for his services, most often in the form of gifts from the Pharaoh. Gifts might have been something elaborate like a necklace or bracelet, or someting as large as a plot of land or even a boat.  A boat would have been useful for traveling down the Nile to visit the sick in their homes.  (5, pages 321-322)

This is Pharaoh Djoser's step pyramid at Saqquara.
At the time it was the largest man-made structure.
Many speculate it as designed by Imhotep. (10)

He also was paid handsomely in the form of great respect throughout the dynasty, and posterity for all time.  In fact, he was so well respected that his legend lived on for centuries after his death, to the point that he became the god Imhotep, a god of health and healing similar to Thoth, Isis, Sekhmet, Heka, Serket, and Ta-Bitjet..  (5, page 321, 322)

Legend has it that he recorded all the medical wisdom he learned from Thoth for all future students of medicine to learn from.  While these documents are lost to time, they were referred to by later physicians, including Claudius Galen in the 1st century A.D.  Since the ancient Greeks referred to Thoth as Hermes Trismegistus, these documents are referred to as the Hermetic texts.

During the 19th century, two large scrolls were discovered, perhaps between the legs of a mummy. (3) They were purchased from a native dealer by Edwin Smith.
The large of the two was sold to Georg Ebers, and became known as the Ebers Papyri.

When it was translated and discovered to be a series of books about internal diseases and recipes for how to treat them, Ebers speculated it was the last six of the 42 Hermetic texts.  While this inspired some early excitement, the document was  dated about 1500 B.C., or a thousand years after Imhotep had lived.   (5, page 305)

The Ebers Papyri is now thought to be an encyclopedia of random recipes from random scrolls.  Perhaps these were recipes one physician thought were important and wanted to remember.  Chances are pretty good this physician was not Imhotep.

The smaller of the two scrolls was kept by Edwin Smith and is referred to as the Edwin Smith Papyri.  It continued to be thought to be the works of Imhotep even after the other document was proved not to be, although this, too, was later learned to be untrue.  It was learned to be fragments, or copies, of older surgical texts. (5, page 304)

Sigerist said that while some believe the Smith Papyri was the"work of a surgeon.  There is good internal evidence, however, that the book was a manual of a war surgery or rather that the experience it reflects was gained to a large extent from war injuries." (5, page 310)

While the idea that Imhotep wrote this document caused a great deal of excitement, later scholars proved this not to be the case.  Sigerist added: "It is not very probable that the vizier of a great Pharaoh would have acted as an army surgeon."

The scrolls may have been texts at one of the Egyptian schools, although they may have been owned by an Egyptian priest as a reference.  When a sick person approached the physician complaining of certain symptoms, the scrolls would have been used to find the medicinal remedy and the incantation to coincide with it.

However, Imhotep's legacy lived on even beyond the era of Egyptian supremacy. During the time when the Greeks ruled over Egypt, around 500 B.C, Imhotep was worshiped as a deity for good health and healing.  Temples in Memphis, Thebes and Pilae were built in his honor, as well as many statues.  (4)

In fact, he was so well respected by the ancient Greeks that he was often associated with the god Asclepius.  (1)  In the end, Imhotep, the great physician, became the most famous non pharaoh in all of ancient Egypt.

Further reading:

• 5000-50 B.C.: Egyptian gods educate physicians
• 5000-50 B.C.: The role of the Bible in medicine
• 5000-50 B.C.: The Ebers Papyrus: the first asthma remedy? 
• 800 B.C.- 800 A.D.: Asclepius will heal your asthma

References:

1. "Imhotep," Egyptpast.com, http://www.egyptpast.com/pyramids/imhotep.html, reviewed May, 26, 2012
2. "The First Physician," Journal of the American Medical Association, August 19, 2009, 302 (7), page 807
3. Dunn, Jimmy, "Egypt: Imhotep, Doctor, Architect, High Priest, Scribe and Vizier to King Djoser," touregypt.net, http://www.touregypt.net/featurestories/imhotep.htm, referenced May 26, 2012
4. Lambert, Tim, "A brief history of medicine," localhistories.org, http://www.localhistories.org/medicine.html, observed May 26, 2012
5. Sigerist, Henry E "A History of Medicine," vol I, "Primitive and Archaic Medicine," 1951, New York, Oxford university Press
6. Withington, Edward Theodore, "Medical History From the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press, page 14-15 (Chapter IV: Medicine in Ancient Egypt)
7. Wilder, Aleander, "History of Medicine," 1901, Maine, New England eclectic Publishing
8. Sozinskey, Thomas S., "Medical Symbolism in connection with historical studies in the arts of healing and hygiene," 1891, Philadelphia and London, F.A. Davis Publisher
9. Osler, William, "Evolution of Modern Medicine: a series of lectures at Yale University to the Silliman Foundation in April 1913, 1921", New haven, Yale University Press
10. "Stepping toward a true pyramid," nationalgeographic.com, http://www.nationalgeographic.com/pyramids/djoser.html, accessed 6/5/14

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2600 B.C.: Hermetic Books allow medicine to flourish in Egypt

The Hermetic Books, mainly the last six of them, or the Embre, were memorized by every priest/ physician in Egypt.  These contained all the medical wisdom of the gods, and the laws regulating their practice. (1, page 3)(4, page 14)  Memorizing the texts, and sticking to them when practicing, protected physicians from any malpractice, allowing the profession to flourish in Egypt.

The Embre are broken down as follows: (7, page 4)

• Book 37: Anatomy
• Book 38: Diseases
• Book 39: Surgery
• Book 40: Remedies
• Book 41: Disease of the Eye
• Book 42: Disease of Women

Deviating from these texts made the physician liable for any assumptions regarding their medical treatment. For instance, if it was assumed that a patient became sicker or died as a result of a physicians black magic, the physician could be held responsible.  So memorizing the texts was deemed essential.  

Of course a disadvantage of this is that it prevented experimentation, which ultimately prevented any physician from inventing a new potion that might have healed patients better or faster.  

In his 1872 history of medicine, Robley Dunglison said the script forced physicians to diagnose by the position of the patient, which must be observed as "a mode of discrimination, as may readily be conceived, at once nugatory and absurd." (8, page 25)

Dunglison said:

The blind adherence to the opinions and rules of their predecessors, and the criminality, as it was considered, of all innovation— whilst they continued—effectually prevented any improvement in the science, or as it might, at that time, be more properly styled, the art of medicine. (8, page 25) 

In his 1831 history of medicine, William Hamilton said that "Improvement to medical knowledge was effectually arrested by the penal discouragement of every attempt to deviate from the canons of practice laid down in the volumes ascribed to Thouth (Thoth); and the interests of the priests led to the perpetuation of the popular delusion respecting the cause of disease." (10, pages 13 and 14)

Hamilton added:

While the door of salutary competition was effectually closed by the exclusion of all but the initiated few, and no opportunities afforded for the display of superior talent, or the exercise of superior skill; it cannot be a matter of surprise that medical knowledge should have remained so long stationary, and should have become almost retrogressive, or that the conquest of disease should have been effected rather by the efforts of nature counteracting the operations of art, or by the fortunate by unpremeditated concurrence of circumstances, than by any combination of skill, or exertion of judgement. (10, pages 13-14)

So from around 2,700 B.C. to the opening of the school of Alexandria in 331 B.C., it was considered as "offensive to the Gods as the violation even of those bodies which they had slain without compunction in the fields, much more the dissection of those who had died from natural causes in their beds," said Hamilton. (10, page 8)

This pretty much made physicians slaves to their own profession.  Not only were they not able to experiment, they were also not able to learn by their own investigations.  In fact, Theodor Puschmn, in his 1891 history of medicine, said that even "embalming exercised thus no beneficial influence upon the development of anatomical knowledge."  (11, page 23)

While physicians did understand that the heart was the "seat of origin of the blood vessels," they were prevented from, even discouraged, from deviating from the traditional means of mummification.  (11, page 23)  In other words, priest/ physicians were forbidden from inspecting the bodies of dead people for scientific gain.

"Hence," Hamilton said, "it was that men, being destitute of the means of acquiring a just knowledge of the structure, functions, and relative positions, of the human viscera, were unable to form a correct judgement as to the seat or causes of disease, or to adopt a rational method of cure." (10, pages 8-9)

Garrison said that Aristotle wrote a century later, in his Politics, that, if after the fourth day the patient was not cured, a physician was allowed to deviate from script, and this allowed for some experimentation to take place. (9, page 49)(10, page 15)

But this was certainly not enough to advance the profession. While Egyptians, partially due to the Hermetic Texts, are often credited for giving rise to rational medicine, the art did not grow into a full and flourishing tree until the philosophical days of ancient Greece.

References:

1. Bradford, Thomas Lindsley, "Quiz questions on the history of medicine: form the lectures of Thomas Lindsley Bradford, M.D," 1898, Philadelphia
2. Withington, Edward theodore, "medical history from the earliest times: a popular history of the art of healing," 1894, London, The Scientific Press
3. 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.  
4. Baas, Johann Herman, author, Henry Ebenezer Sanderson, translator, "Outlines of the history of medicine and the medical profession," 1889, New York
5. Dunglison, Robley, author, Richard James Dunglison, editor,  "History of Medicine from the earliest ages to the commencement of the nineteenth century," 1872, Philadelphia, Lindsay and Blakiston
6. Renouard, Pierce Victor, "History of Medicine: From it's origin to the 19th century," 1856, Cincinnati, Moore, Wistach, Keys and Co., page 26, chapter 1, "Medicine of the Antique Nation."
7. Bryan, Cyril P., translator, "The Papyrus Ebers," 1930, London, Garden City Press
8. Dunglison, Robley, author, Richard James Dunglison, editor,  "History of Medicine from the earliest ages to the commencement of the nineteenth 
9. Garrison, Fielding Hudon, "An introduction to the history of medicine," 1922, Philadelphia and London, W.B. Saunders Company, page 49
10. Hamilton, William, "The history of medicine, surgery, and anatomy, from the creation of the world to the commencement of the nineteenth century," 1831, volume I, London, Henry Colburn and Richard Bentley
11. Puschman, Theodor, translated by Evan H. Hare, "A history of medical education from the most remote to the most recent times," 1891, London, H.K. Lewis
12. Wilder, Aleander, "History of Medicine," 1901, Maine, New England eclectic Publishing
13. Sandwich, Fleming Mant, "The medical diseases of Egypt, part I," 1905, London
14. Puschman, Theodor, translated by Evan H. Hare, "A history of medical education from the most remote to the most recent times," 1891, London, H.K. Lewis

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