Education: How Old The New

by James J. Walsh

The first picture that we have of a physician in history is, indeed, one to make us proud of our profession. The first physician was I-em-Hetep, whose name means "the bringer of peace." He had two other titles according to tradition, one of which was "the master of secrets," evidently in reference to the fact that more or less necessarily many secrets must be entrusted to the physician, but also, doubtless, in connection with the knowledge of the secrets of therapeutics which he was supposed to possess. Another of his titles was that of "the scribe of numbers," by which, perhaps, reference is made to his prescriptions, which may have been lengthy, for there are many "calendar" prescriptions in the early days, but may only refer to the necessity of his knowing weights and measures and numbers very exactly for professional purposes. I-em-Hetep lived in the reign of King Tchser, a monarch of the third dynasty in Egypt, the date of which is somewhat uncertain, but is about 4500 B.C. How distinguished this first physician was in his time may be gathered from the fact that the well-known step pyramid at Sakkara, the old cemetery near Memphis, is attributed to him. So great was the honor paid to him that, after his death he was worshipped as a god, and so we have statues of him as a placid-looking man with a certain divine expression, seated with a [{358}] scroll on his knees and an air of benignant knowledge well suited to his profession.

I called attention in 1907 [Footnote 21] to the fact that the earliest pictures of surgical operations extant had recently been uncovered in the cemetery of Sakkara near Memphis in Egypt. These pictures show that surgery was probably an organized branch of medicine thus early, and the fact that they are found in a very important tomb shows how prominent a place in the community the surgeon held at that time. The oldest document after that which we have with regard to medicine is the "Ebers Papyrus," the writing of which was done probably about 1600 B.C. This, however, is only a copy of an older manuscript or series of manuscripts, and there seems to be no doubt that the text, which contains idioms of a much older period, or, indeed, several periods, probably represents accumulations of information made during 2,000 or even 3,000 years before the date of our manuscript. Indeed, it is not improbable that the oldest portions of the "Ebers Papyrus" owe their origin to men of the first Egyptian dynasties, nearly 5,000 years B.C. To be members of a profession that can thus trace its earliest written documents to a time nearly some 7,000 years ago, is an honor that may be readily appreciated and that may allow of some complacency.

[Footnote 21: Journal of the American Medical Association, November 8, 1907.]

There is a well-grounded tradition which shows [{359}] us that an Egyptian monarch with whose name even we are familiar, though we may not be able to pronounce it very well--he was Athothis, the son of Menes--wrote a work on anatomy. The exact date of this monarch's death is sometimes said to be 4157 b.c. We have traces of hospitals in existence at this time and something of the nature of a medical school. Indeed, one may fairly infer that medical education, which had been developing for some time, probably for some centuries, took a definite form at this time in connection with the temples of Saturn. Priests and physicians were the same, or at least physicians formed one of the orders of the clergy and the teachers of medicine particularly were clergymen. This tradition of close affiliation between religion and medicine continued down to the fifteenth century. How few of us there are who realize that until the fourteenth century the professors of medicine at the great universities were not married men, because members of the faculty, as is true at the present time of many members of the faculty in the English universities, were not allowed to marry. The old clerical tradition was still maintaining itself even with regard to the medical teachers.

Perhaps the most interesting thing about this early history of medicine in Egypt is that, with the very earliest dawn of medical history, we have traces of highly developed specialism in medicine. There were thirty-six departments of medicine, or [{360}] at least there were thirty-six medical divinities who presided over the particular parts of the human body. In the larger temples, at least, there was a special corps of priest physicians for each one of these departments. Herodotus, the Father of History, is particularly full in his details of Egyptian history, and though he wrote about 400 B.C., nearly 2,300 years ago, his attention was attracted by this highly developed specialism among the Egyptians. He tells us in quaint fashion, "Physicke is so studied and practised with the Egyptians that every disease hath his several physician, who striveth to excell in healing that one disease and not to be expert in curing many. Whereof it cometh that every corner of that country is full of physicians. Some for the eyes, others for the head, many for the teeth, not a few for the stomach and the inwards."

It is interesting to realize that the same state of affairs upon which you young graduates will come now that you are going out to find an opportunity to practise for yourselves at the end of the first decade of the twentieth century, is not very different from that which the great Father of History chronicles as the state of affairs among the Egyptians between 600 and 1,000 before Christ,--let us say about 3,000 years ago. You, too, will find that every corner is full of physicians, some for the eyes, others for the head, many for the teeth, not a few for the stomach and everything else under the sun quite as in [{361}] ancient Egypt. After a time you will probably find that some little corner has been left for you, and you will work hard enough to get into it first, and then to fill it afterward. The story of how young physicians have got on in their first few years has probably been interesting at all times in the world's history. I think that I know about it at five different periods, and in every one of these there seemed to be no possible room, and yet somehow room was eventually found, though only after there had been a struggle, in the midst of which a certain number of the young physicians found another sphere of activity besides medicine.

Of course it is easy to think that these specialties did not amount to much, but any such thought is the merest assumption. A single instance will show you how completely at fault this assumption is. Dentistry is presumed to be a very modern profession. As a matter of fact mummies were found in the cemetery of Thebes whose bodies probably come from before 3000 B.C., who have in their teeth the remains of gold fillings that were well put in, and show good workmanship, nearly 5,000 years ago. [Footnote 22] After dentistry, the specialty that we would be sure could not have had any significant existence so long ago would be that of ophthalmology. As a matter of fact, it is with regard to the knowledge of eye diseases displayed by these early teachers of [{362}] medicine that the "Ebers Papyrus" is most startling. It is especially full in diagnosis and contained many valuable hints for treatment. As for laryngology and rhinology, one of the earliest medical records that we have, is the rewarding by one of the kings of Egypt of an early dynasty (nearly 4000 B.C.), of a physician who had cured him of a trouble of the nose of long standing, that seems to have interfered with his breathing.

[Footnote 22: Burdett: "History of Hospitals.">[

It is easy to think in spite of all this, that the Egyptians did not know much medicine; but only one who knows nothing about it thinks so. According to Dr. Carl von Klein, who discussed the "Medical Features of the Ebers Papyrus" in the Journal of the American Medical Association about five years ago, over 700 different substances are mentioned as of remedial value in this old-time medical work. There is scarcely a disease of any important organ with which we are familiar in the modern time that is not mentioned here. While the significance of diseases of such organs as the spleen, the ductless glands, and the appendix was, of course, missed, nearly every other pathological condition was either expressly named or at least hinted at. The papyrus insists very much on the value of history-taking in medicine, and hints that the reason why physicians fail to cure is often because they have not studied their cases sufficiently. While the treatment was mainly symptomatic, it was not more so than is a great deal of therapeutics [{363}] at the present time, even in the regular school of medicine. The number and variety of their remedies and of their modes of administering them is so marvellous, that I prefer to quote Dr. von Klein's enumeration of them for you:

"In this papyrus are mentioned over 700 different substances from the animal, vegetable and mineral kingdoms which act as stimulants, sedatives, motor excitants, motor depressants, narcotics, hypnotics, analgesics, anodynes, antispasmodics, mydriatics, myotics, expectorants, tonics, dentifrices, sialogogues, antisialics, refrigerants, emetics, antiemetics, carminatives, cathartics, purgatives, astringents, cholagogues, anthelmintics, restoratives, haematics, alteratives, antipyretics, antiphlogistics, antiperiodics, diuretics, diluents, diaphoretics, sudorifics, anhydrotics, emmenagogues, oxytocics, caustics, ecbolics, galactagogues, irritants, escharotics, caustics, styptics, haemostatics, emollients, demulcents, protectives, antizymotics, disinfectants, deodorants, parasiticides, antidotes and antagonists."