It is of some interest to note that these priests of I-em-hotep, themselves learned men, not only saw and prescribed daily for vast numbers of sick persons but also performed innumerable necropsies. They removed the heart, large blood-vessels, viscera, and brain from the bodies of deceased persons, also from the bodies of sacred animals, prior to embalmment; the heart was placed in a separate jar by itself and the remainder of the viscera in a larger vessel. We are told by Pliny that in later times an examination of the body was made after death in order to ascertain the nature of the disease which was the cause of death.[14] Thus these men had an opportunity of learning something of anatomy and pathology. They may have gained some insight into the intricate problem of the action of the heart, the movement of the blood, and the changes of heart and vessels produced by disease; no nation of antiquity had such opportunities. Did they discover anything? I think I can demonstrate to you that they did obtain a partial knowledge of the circulation; they did not solve the problem, but they approached it as nearly as did the Greeks, and probably from them the Greeks obtained such knowledge as they possessed in early times.
References to the Circulation in the Medical Papyri
Certain of the contents of the medical papyri are at present almost incomprehensible, partly on account of the difficulty of translating technical terms; these parts I shall not refer to at all; those portions which are more easily understood still present difficulties, and translations must necessarily be free and at times vague. It must be remembered that the hieratic script was not a good medium for the clear and definite statement of facts, also that the modes of thought and forms of expression of the time were far removed from our own, even far remote from those of the Hellenes. We enter a different world when we try to comprehend the beliefs and conceptions of the ancient Egyptian, the platform of thought on which he built is imperfectly known to us. Furthermore, the philosophic conceptions which the Greeks gave to mankind and their lucidity of expression had not then come into existence.
In addition to these negative aspects of difference there are positive ones. The Egyptian believed himself to dwell in a universe peopled by spirits and demons, good and evil, whose influence must be propitiated or averted by charms and spells. It will, therefore, be understood that a hieratic papyrus is vastly more difficult to interpret than a Greek manuscript.
The references in various papyri to the circulation, though somewhat vague, are not without interest. Where the sense is important I have had the help of one or two learned living Egyptologists, and here I must express my acknowledgments to Dr. Budge, Professor Kurt Sethe, Dr. Brugsch, Dr. Joachim, Dr. Leemans, Dr. Withington, Dr. Grant Bey, Dr. Sandwich, Mr. Garstang, Professor Carrington Bolton, Professor Flinders Petrie, Mr. Percy E. Newberry, and others, for help orally, or from their writings, without which, in my ignorance, I should have done little. I am especially indebted to Professor Kurt Sethe’s work on ‘Imhotep’ and to Dr. H. Joachim’s ‘Papyros Ebers.’
Let me read you one or two extracts from the work of the Pharaoh Usaphais quoted in Ebers’ papyrus[15]: ‘Man hath twelve vessels proceeding from his heart which extend to his body and limbs; two vessels go to the contents of his chest, two vessels go to each leg, two to each arm, two vessels go to the back of the head, two to the front of the head, two branches go to the eyes, two to the nose, two vessels go to the right ear, the breath of life goes through them, two go to the left ear, and through them passes the breath of death; they all proceed from the heart.’ The concluding sentence is the earliest example I know of the ancient superstition that the left side of the body is sinister and evil. This is very early anatomy, professing to be at least six thousand years old; we must not expect it to be quite accurate.
Turning to a comparatively recent period, I shall quote from other parts of Ebers’ papyrus; the only existing copy of this papyrus (found in a tomb at Thebes) was written in or before the sixteenth century B.C. No doubt most, if not all, its contents are much older than that date.[16] The extracts which I am about to read commence thus: ‘From the secret book of the physician, a description of the action of the heart and of the heart itself. From the heart arise the vessels which go to the whole body ... if the physician lays his finger on the head, on the neck, on the hand, on the epigastrium, on the arm or the leg, everywhere the motion of the heart touches him, coursing through the vessels to all the members’ [the reference is clearly to the pulse]; ‘thus the heart is known as the centre of all the vessels. Four vessels go to the nasal chambers, of which two convey mucus and two convey blood. There are four vessels within the temples or skull, from these the eyes obtain their blood.... The four vessels divide inside the head and spread towards the hinder part.’ The Berlin papyrus speaks of the division into thirty-two vessels within the skull, and implies that air traverses, at any rate, some of them.
Returning to Ebers’ papyrus[17]—‘When the breath enters the nostrils it penetrates to the heart and to the internal organs, and supplies the whole body abundantly.’ This idea that certain of the vessels convey air, you will observe, is identical with the Greek conception and probably was its source. ‘Three vessels traverse the arms and extend to the fingers, three vessels also pass down the leg and are distributed to the sole of the foot, a vessel goes to each testis and one to each kidney. Four vessels enter the liver, conveying fluid and air; these may be the seat of various diseases as they are mixed with the blood; four vessels convey fluid and air to the intestine and spleen; two go to the bladder and from them the renal secretion is produced. Four vessels convey fluid and air to the lower abdomen, going to the right and left sides; from them is formed the alvine excretion.’[18] These vessels here described are clearly the iliac arteries and veins. ‘When the heart is diseased its work is imperfectly performed: the vessels proceeding from the heart become inactive, so that you cannot feel them’ [no doubt this is a reference to changes in the pulse], ‘they become full of air and water.... When the heart is dilated the vessels from it contain effete matter. If a suppurative or putrefactive disease occur in the body’ [abscess, I imagine, for which various sites are suggested] ‘then the heart causes it’ [it being probably purulent or septic material] ‘to traverse the vessels, fever or inflammation of various kinds occur in the body, the heart is in a morbid state while the fever continues.’ [It may be noted in passing that the septic infection is asserted to enter the body by the left eye]. ‘In heart disease there is either disturbance of the action of the heart or the heart is congested or overfilled with blood, the heart is moved downwards, comes nearer the praecordia, and weakness and nausea occur....[19] When the disease affects the basic region or lower mass of the heart there is shortness of breath, the heart is displaced on account of the volume of blood from the abdomen’ [probably the old idea of the rush of blood entering the heart from the liver]. ‘There may be fever or inflammation of the heart.’ At this point comes a passage of some therapeutic interest. ‘The heart during such disease must be made to rest to some extent if it be possible.’ Here we have wise advice from the ancient Egyptians, advice the importance of which we have scarcely as yet recognized, and which we may to-day follow with advantage. ‘If the heart is atrophied (or wastes itself) there will be an accumulation of blood within it. When the disease of the substance of the heart is accompanied by dropsy there is a lessening’ [in strength probably] ‘in the ventricle or cavity.... When the weakness of the heart is due to old age there is dropsy. When there is raising or increase of the heart it presses towards the left side, it is increased by its own fat, and is displaced; there may be much fat contained within its covering or pericardium. If in a suppurative disease the heart is pushed forward it floats or sinks in the fluid and is displaced.’ Here we surely have a reference to pericardial effusion.... ‘If the heart trembles or palpitates, has little power, and sinks downwards, the disease is advancing. When there is much beating at the praecordia, with a feeling of weight, when the mouth is hot and languid, and the heart is exhausted the disease is a fever or inflammation.’ In another place (folio 102) the heart is spoken of as being full of blood which comes or flows from it again. In folio 39, after a description of symptoms, follows a statement to the effect that the heart is distended, the sick man is short of breath because the blood has stagnated and does not circulate. This is an interesting expression, but judging from other parts of the papyrus the word translated circulate can only have a vague meaning, implying movement to and fro, just like the expression ‘περίοδος αἴματος’ in the Hippocratic writings, which seems to imply the circuit of the blood, but in reality has only a similar indefinite meaning. It is evident that the Egyptians knew that blood flowed from the heart, but, like the Greeks, they never seem to have realized that the heart is a pump, nor did they recognize valves.
The Leyden medical papyrus speaks of a paralysis or disturbance of some sort in the blood-vessels of the head, causing blindness and disorder in the body and in the limbs; this seems to be a description of the results of cerebral haemorrhage. Remedies are suggested to subdue the vascular activity occurring in certain diseases.[20]
The Passalaqua papyrus is rather interesting. It was found in an earthen jar at Thebes, and deals largely with leprosy (which prevailed greatly in ancient Egypt). This papyrus appears to date from the time of Mencheres of the fourth dynasty, and for many centuries was enclosed in a case or box beneath the feet of the figure of the god Anubis, and forgotten for ages. It was rediscovered in the reign of a later monarch, and recopied on to a new roll of papyrus.[21] The British Museum papyrus dates back, as regards the major part of its contents, to the time of Khufu or Cheops the pyramid builder. It bears some evidence of Semitic influence. In the section on the treatment of wounds it contains the following prayer:—‘Oh Ra, creator of the gods, pass ye me along, renew ye me, avert from me all evil things, all evil maladies, all wounds in the flesh of these limbs.’[22] In earlier times these prayers are much more common than during the later dynasties, when the physician seems to have relied more upon treatment.