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Full text of "I-em-hotep and ancient Egyptian medicine. Prevention of valvular disease"

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THE HARVEIAN ORATION 



LONDON : 
C. J. CLAY AND SONS 

CAMBRIDGE UNIVERSITY PRESS WAREHOUSE, AVE MARIA LANE 
GLASGOW : 50 Wellington Street 




LEIPZIG : F. A. Brockhaus 

NEW YORK : The Macmillan Company 

BOMBAY ; Macmillan & Co., Limited 






I. I-EM-HOTEP AND Ancient Egyptian Medicine 
II. Prevention of Valvular Disease 



THE 

HARVEIAN ORATION 

DELIVERED BEFORE THE ROYAL COLLEGE OF 
PHYSICIANS ON JUNE 21, 190+ 



BY 

RICHARD CATON, M.D., F.R.C.P. 

EMERITUS PROFESSOR OF PHYSIOLOGY, UNIVERSITY OF LIVERPOOL ; 

CONSULTING PHYSICIAN, ROYAL INFIRMARY / (J 

,1 y 



l^f^ 




With Seven Illustrations 



PRINTED AT THE UNIVERSITY PRESS OF LIVERPOOL 

LONDON : C. J. CLAY AND SONS 
CAMBRIDGE UNIVERSITY PRESS WAREHOUSE, AVE MARIA LANE 

1904 

ALL RIGHTS RESERVED 



TO 

Sir WILLIAM SELBY CHURCH, Bart, K.C.B, M.D. 

THE PRESIDENT 
AND TO 

THE FELLOWS 
OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON 

THIS ORATION IS DEDICATED 
WITH MUCH RESPECT 



THE 

HARVEIAN ORATION 

1904 

MR. PRESIDENT and GENTLEMEN, 
The officials fellows and friends of this 
college assemble to-day, as we and our 
predecessors have assembled year by year for 
two-and-a-half centuries, to commemorate the 
services which William Harvey has rendered to 
mankind, and in order to keep alive in our own 
minds the wise counsels which he addressed to 
us, the memory of which he desired us ever to 
renew at the festival which he founded. We are 
to honour our great profession, to continue in 
mutual love and affection among ourselves, and to 
search and to study out the secrets of nature by 
way of experiment in order to prevent suffering 
and to ameliorate human life. 

In commencing the pleasing duty which the 
kindness of our President has placed in my hands 
it is needful to comply with the desire of our 
founder that we commemorate the names of 



2 THE HARVEIAN ORATION, 1904 

benefactors of this college. The lengthy and 
honourable roll was so fully dealt with by the 
learned orator of last year that I shall merely add 
to his recital the names of those who since that 
time have given of their substance for the advance- 
ment of medicine. Dr. Horace Dobell of Park- 
stone Heights, Dorset, gave the sum of >C5oo to 
encourage research into the ultimate origin, 
evolution, and life-history of bacilli and other 
pathogenic micro-organisms ; Dr. George Oliver, 
Fellow of this College, of Harrogate, and Farn- 
ham, Surrey, has given ^2,000 to found the 
Oliver-Sharpey lectureship or prize in memory 
of William Sharpey of University College, and 
to encourage the application of physiological 
knowledge for the prevention and cure of disease 
and for the prolongation of life ; and Lady Clark 
has presented to us a bust of our revered and 
lamented former president. Sir Andrew Clark. 

No student of the works of Harvey can fail 
to bear in mind the great loss we have sustained 
this year in the decease of Sir Edward Sieveking, 
who in his Harveian Oration drew special attention 
to the Prelectiones Anatomiae and in conjunction 
with Dr. George Johnson and other Fellows of 
this College arranged for the admirable autotype 
reproduction of Harvey's manuscript which we 
possess. 



THE HARVEIAN ORATION, 1904 3 

Desiring to render this address as little 
wearisome as may be I propose to divide it into 
two parts : the first archaeological, dealing with 
Egyptian medicine, the medicine god, and the 
earliest inquiries known to have been made con- 
cerning the circulation and circulatory diseases — 
viz., those of the physicians of ancient Egypt, a 
department of pre-Harveian work, and perhaps 
the only one, which has not been dealt with in 
this room. Secondly, I wish to speak with great 
brevity on the more practical subject of the pre- 
ventive treatment of certain forms of circulatory 
disease. 

I 

Egypt and the Earliest Researches on the 

Circulation 

To all who love our venerable and beneficent 
profession the spectacle of our predecessors in early 
ages striving in darkness and difficulty to acquire 
that hidden knowledge to which we have partially 
attained is interesting and should awaken our 
sympathy. As was remarked by the learned 
Harveian Orator of 1 896 : ' The past is worth our 
study and ever more so the further we advance.'' 

The information which archaeological re- 
search has of late afforded, though in a fitful and 
partial manner, as to the earliest history of 
medicine, and particularly in regard to that de- 
partment in which our founder laboured, is not 
unworthy of our attention. 

I. Dr. Payne, Harveian Oration, p. 51 



4 THE HARVEIAN ORATION, 1904 

The first evidence of definite Inquiry, In any 
degree worthy to be called scientific by a body of 
men specially educated for, and devoting their 
lives to medical service, occurs in the early history 
of Egypt. The ability, learning, and artistic skill 
shown during the early dynasties, which all 
Egyptologists recognize, are paralleled by the 
remarkable interest then manifested in medicine. 
Works on anatomy and medicine are stated to have 
been written even by the early sovereigns of 
Egypt. Athothis, the son of Menes, who lived 
six thousand years ago,' is stated in the Berlin 
papyrus to have written a book on medicine, and 
I shall soon have to quote from the anatomical 
writings of the Pharaoh Usaphais, one of his 
successors ; Semti, the seventh m.onarch of the 
same dynasty, pursued similar investigations. It 
is clear that, like the Greeks, these men in the 
childhood of the world believed that vyialveiv txlv 
apicTTov ea-TiVj Sanitation was to them the first of the 
sciences. 

The Medicine God I-em-hotep 

During the third dynasty, about the year 
3,500 B.C. there lived a learned physician (pro- 
bably a priest of Ra, the sun-god) the founder of 
a cult, whose eminence was such that in course 
of ages he is deified and becomes for later genera- 
tions the special god of medicine. His temples 

I. In all estimations of date I have taken the lower limit, thus probably much 
understating the remoteness of the events recorded. 



PLATE I 




Ancient bronze figure of I-em-hotep, the Egyptian God of Medicine 

(By the kind permission ot the Committee and Curator of the 
Liverpool Museum) 



To face pttgt 4 



THE HARVEIAN ORATION, 1904 5 

were places of healing for the people. His name 
is I-em-hotep, meaning ' he who cometh in peace.' 
According to ancient inscriptions he was the son 
of a certain architect named Kanofer, but when 
raised in popular esteem to the rank of a demi-| 
god he is called the son of the supreme god Ptah, 
the Hephaistos of Egypt, and he becomes one of 
the great god-triad of Memphis. I-em-hotep is 
described as 'the good physician of gods and men, 
a kind and merciful god, assuaging the sufferings 
of those in pain, healing the diseases of men, 
giving peaceful sleep to the restless and suffering'; 
he is called 'the creative god who giveth life to all 
men, who comes unto them who call upon him 
in every place, and who gives sons to the child- 
less.'' He was great in magic and all learning. 
He and his followers had to do with the embalming 
of the body, and he protected the soul of the dead 
man from all spiritual enemies after it had left the 
body. In the ritual of embalmment the dead man 
was encouraged by these words, 'Thy soul uniteth 
itself to I-em-hotep ; while thou art in the funeral 
valley thy heart rejoiceth because thou dost not 
go into the dwelling of Sebek, but thou are like 
a son in the house of his father.'^ 

From the testimony of temple inscriptions 
and papyri, as well as from the writings of Man- 
etho, it is clear that the cult of the medicine-god 

I. Hieroglyphic inscription on Temple of I-em-hotep at Philae. 
See Brugsch, Thaaurus, p. 783 

2, Maspero, La Mjthd. Egypt, p, 80 



6 THE HARVEIAN ORATION, 1904 

I-em-hotep was established first in early times at 
Memphis. In, or adjacent to, some temple — per- 
haps that of Ra — I-em-hotep and his assistant 
priests gave advice and medical aid to multitudes 
of the sick and ailing. It is evident that he gained 
great renow^n for his skill and learning. When 
at length he died he was buried in or near the 
temple. The priests whom he had taught 
continued there the work of healing, always in 
association with his name. Just as the Greeks 
came to Epidaurus to be healed by Asklepios, so 
did the Egyptians, many centuries earlier, visit 
Memphis to seek help from l-em-hotep. It seems 
probable that in course of time the temple 
formerly dedicated to some well-known Egyptian 
god ceased to be known by his name, and in 
popular speech became the house of I-em-hotep. 
There is the clearest evidence of the existence ot 
an important temple in later times dedicated to 
I-em-hotep at Memphis. 

A hieroglyphic inscription describes I-em- 
hotep appearing in a vision to the high priest of 
Memphis, and addressing him thus : — ' I desire 
that a great building be erected in the holy place 
at Anche-tewej (a part of Memphis), where my 
body is hidden, for building it I will give thee 
the reward of a son.'' We know this temple was 
built. Later again, similar temples were erected 
elsewhere ; doubtless priest physicians were 
transferred from Memphis to new centres, just as to 

I. Bnigsch, Thesaurus, V, 923 



THE HARVEIAN ORATION, 1904 7 

Greece and Magna Graecia Epidaurus sent forth 
trained priests to establish Asklepieia at Athens, 
Cos, or Pergamos. 

As the centuries and millenniums passed on 
the cult of I-em-hotep seems to have become 
more and more popular In later times, when 
Greek colonists appeared in Egypt, they gave him 
the name Imouthes, and applied to his temples 
the Greek term ' Asklepieia,' clearly regarding 
him as alike in kind to the Greek Asklepios and 
his temples as hospitals for the sick. The 
following phrase occurs in the Serapeum Greek 
papyrus : — 

^ TO 7r/)6? Mefx(piv n-eya 'AaKXtjTrieiov ' 

The great temple stood outside the eastern 
wall of Memphis close to the Serapeum. We 
may reasonably hope that a careful examination 
of the site may yet reveal to us traces of the 
temple and perhaps even the tomb and remains 
of I-em-hotep himself. Some of those who are 
present to-day when visiting the site of the temple 
of I-em-hotep have been impressed by the thought 
that on this spot, long before Asklepios, the source, 
or Hippocrates, commonly called the father of 
medicine, were born, probably before the Homeric 
poems were written, before the Israelites were in 
Egypt, before the Stone Age had passed, learned 
men here devoted themselves to the consideration 

I. Peyron, Acad. Sc. de Torino., Ser. II, Tom. Ill, 1841, p. 40 



8 THE HARVEIAN ORATION, 1904 

of the nature of human life, strove to prolong it, 
to assuage suffering, and to cure disease. They 
studied and treated many of the ailments familiar 
to us, such as tubercle, leprosy, plague, anaemia, - 
and other diseases prevalent in Egypt to-day. 
Near the site of this temple, securely sealed in an 
earthen vessel which had been hidden in the sand, 
was found one of the medical papyri from which 
I shall quote some passages ; doubtless it belonged 
to an early physician who sought, perhaps during 
the invasion of Ethiopian or other barbarians, to ' 
preserve for mankind the precious knowledge 
that seemed in danger of extinction. 

As we should naturally expect in the case of 
one so eminent, the Egyptian artists made many 
drawings and bronze figures of I-em-hotep ; they 
usually represent him as a man rather than as a' 
god, with few mystic or metaphorical emblems 
excepting those related to learning or human life. ■ 
He is represented in art as a bald-headed man, 
usually in a sitting posture, bearing on his knees 
an open papyrus scroll, and sometimes holding in 
his hand the symbol of life.' 

Testimonies as to I-em-hotep 

I-em-hotep rises before us as one of those 
intellectual giants who take all knowledge for their 
province. In his comprehensiveness he surpasses 
Leonardo da Vinci or our own Linacre ; he is 

" I. See Plate I , 



PLAIF. II 




.■ ,«>■ 1.;. ', I'S'-fikP 



I'LAIE IH 













If 'jJ 












I^;:' 







o 



o 
o 



O 



v:i 



Oh 

o 



CO rz 

^ s 



en 

O 

cu 

3 






THE HARVEIAN ORATION, 1904 9 

distinguished as a physician, a minister of the 
king, a priest, a writer, an architect, an alchemist, 
and an astronomer — great in all, but greatest in 
medicine ; so eminent that in the view of Egypt 
he is a god. 

In the reign of Tosorthros, of the third 
dynasty, five or six thousand years ago, we meet 
with the wise I-em-hotep in an inscription refer- 
ring to the seven years of famine which befell 
Egypt in consequence of a succession of low Niles. 
He is there the adviser of Pharaoh ; to him the 
king applies in his trouble for counsel and help.' In 
the inscriptions in the temple of Edfu^ he is des- 
cribed at length as the great priest I-em-hotep, 
the son of Ptah, who speaks or lectures.^ Perhaps 
his discourses or lectures were on medicine. Else- 
where he is described as the writer of the divine 
books. It may here be remarked that probably 
Eber's papyrus was one of the six divine books 
attributed to Thoth ceremonially, but not 
improbably in large part the work of I-em-hotep. 
Manetho, while speaking of his eminence as, a 
physician, refers to him also as an architect, the 
first to build with hewn stone. '^ Not improbably 
he built the step pyramid of Sakkara, the tomb 
of his patron Tosorthros.5 Manetho also suggests 
that I-em-hotep improved and completed the 

I. Maspero, His. Arte, de P Orient, I, 240 

2. See Plate II 

3. De Rouge, Insc. du Temps. d'Edfou, II, 89 

4. Eusebius on Manetho ; Lauth, Manetho und der Turiner Konigspapyrus, 144 

Sec Plate III 



lo THE HARVEIAN ORATION, 1904 

hieroglyphic script of Egypt. In the Hermetic 
literature he is famed for his knowledge of 
astronomy or astrology ; the Westcar papyrus 
describes him further as an alchemist and magi- 
cian.' These powers were always associated with 
medicine, and even to-day in the popular view 
they are not entirely dissociated from it. What 
share I-em-hotep may have had in those early 
discoveries of the movement of the blood, to which 
I am about to advert, we do not know. It does, 
however, seem clear that either through the 
labours of I-em-hotep or of other priest physicians, 
the Egyptians had discovered certain elementary 
facts and knew as much as the Greeks, as much 
as we find in the Hippocratic writings, or in those 
of Aristotle and the later Alexandrian school, and 
the hypothesis seems a natural one that the know- 
ledge possessed by the Greeks was acquired from 
Egypt. 

Necropsies made by the Egyptian Priests 

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 

I. Erman, Die Marchen dti Papyrut fVatcar, I, S 22 



THE HARVEIAN ORATION, 1904 11 

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. » 
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 ;i 
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 

I. Pliny, Nat. Hist., xix, 5 



12 THE HARVEIAN ORATION, 1904 

a good medium for the clear and definite state- 
ment 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 
Ihave 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, Pro- 
fessor FHnders Petrie, Mr. Percy E. Newberry, 
and others, for help orally, or from their writings, 
without which, in my ignorance, I should have 



THE HARVEIAN ORATION, 1904 13 

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 
Eber's papyrus' : ' Man hath twelve vessels pro- 
ceeding 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 Eber's 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.^ The 
extracts which I am about to read commence 
thus : ' From the secret book of the physician, 

1. Fo. 103 

2, Fo. 99 



14 THE HARVEIAN ORATION, 1904 

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 
leart 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's papyrus' — ' 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, con- 
veying fluid and air ; these may be the seat of 

I. Fo. 99 



THE HARVEIAN ORATION, 1904 15 

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.'' These vessels here de- 
scribed 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 putre- 
factive 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. . . .^ When the disease affects the basic 



1. Fo. 100 

2, Fo. 101 



i6 THE HARVEIAN OR.\TIOX, 1904 

region or lower mass of the heart there i< short- 
ness ot breath, the heart is displaced on account 
of the volume of blood tirom the abdomen ' 
[probably the old idea of the rush of blood enter- 
ing the heart from the Hver]. ' There mav be 
tever 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 ad^'ice from the ancient Egvptians, 
advice the importance of which we have scarcelv 
as yet recognized, and which we mav to-dav 
follow \s-ith 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 accompir.iei bv dropsv 
:hc:e is a lessening' [in strength jr.riMv] 'in 
the ventricle or cavit\'. . . . When the weak- 
ness of the heart is due to old age there is dropsv. 
^^ hen there is raising or increase of the heart it 
presses towards the left side, it is increased bv its 
own fat, and is displaced ; there mav be much 
fat contained within its covering or pericardium. 
If in a suppurative disease the heart is pushed 
lorward it floats or sinks in the fluid and is dis- 
rliced.' Here we surely have a reference to 
zt:::}.:i:i'. t~ision. . . . * If the heart trembles 
or palpitates, has Httle power, and sinks down- 
wards, the disease is advancing. When there is 
much beating at the irir. :rdia, with a feeling of 
weight, when the rr.iuih is hot and languid, and 



THE HAR^TIAN ORATION, 1904 17 

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 papvrus the word translated circulate 
can only have a vague meaning, implying move- 
ment to and fro, iust like the expression ' -repiooos 
difiaT(K' in the Hippocratic writings, which seems 
to imply the circuit of the blood, but in realit}^ 
has only a similar indefinite meaning. It is 
evident that the Eg\'ptians 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 Levden 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.^ 

The Passalaqua papyrus is rather interesting. 
It was found in an earthen jar at Thebes, and 
deals largely with leprosy (which prevailed greatly 

I. Lerman, Mdcs. i-gfpt d» Mxiu. d'Artiq. LddgUf is 39 



1 8 THE HARVEIAN ORATION, 1904 

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 forages. It was rediscovered 
in the reign of a later monarch, and recopied on 
to a new roll of papyrus.' 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. '^ In earlier times these prayers are much 
more common than during the later dynasties, 
when the physician seems to have relied more 
upon treatment. 

The various papyri from which I quote deal 
of course with practical medicine and not with 
physiology ; no distinct definition as to structure 
or function is to be looked for in them ; only as 
associated with diagnosis, prognosis, or treatment 
do we get statements as to the nature of the heart, 
the vessels, and the movement of the blood. 

I. Brugsch, Recueil dt la Mon. Egypt, I 
2. Birch, Zeitichr.fiir Mgypt Sfr, and Alrert/tum, 1871, S. 61-64 



THE HARVEIAN ORATION, 1904 19 

Importance of the Medicine and Sanitation of 

Ancient Egypt 

It is clear from the study of these medical 
papyri that medicine advanced considerably 
amongst the Egyptians, and from them medical 
and sanitary knowledge has descended to us by 
two channels — namely, by the Greeks and through 
the Jewish race, while probably much of it was 
lost irrecoverably. Joseph us quotes from Manetho 
a statement that Osarsiph, who Josephus says 
was the great Hebrew leader Moses, was a priest 
at Heliopolis, where medicine was taught.' It 
is highly probable that the sanitary laws of the 
Jews were derived from the Egyptians. Just as 
the Jews remembered the diseases of Egypt 
(Deut. xxviii, 60) so they also remembered the 
sanitary and remedial measures they had learnt 
there. Those of us who have seen in the later 
excavations at Knossos the evidences of sanitary 
knowledge of a somewhat high type, possessed 
by the Cretans at a remote period, exemplified 
among other things by drainage pipes, scarcely 
excelled by our own to-day, knowing as we do 
the close connexion between Crete and Egypt, 
may well believe that here we have an example 
of sanitation derived from Egyptian sources. 

In England we have overlooked the im- 
portance of Egypt as a primary source of the 
science and art of medicine. If we regard with 
reverence the dim traditional form of Asklepios 

|, Josephus C. Apionem I, z6 



20 THE HARVEIAN ORATION, 1904 

as a founder of our art, and the Asklepiela where 
throughout Greece and Magna Graecia medicine 
was practised and taught, in greater degree 
should we reverence the much more venerable 
I-em-hotep and view with interest the primaeval 
medicine temples and hospitals of Egypt. The 
evidence of this priority from Egyptian sources is 
absolutely conclusive, but in addition we have 
corroborative evidence from European authorities. 

In the ancient writings of the pseudo- 
Apuleius Hermes is described as speaking to the 
youthful Asklepios as follows' : — 'Thine an- 
cestor, the first discoverer of medicine, hath a 
temple consecrated to him in the Libyan mount- 
ains near the Nile, where his body lies, while his 
better part, the spiritual essence, hath returned 
to the heavens, whence he still by his divine 
power helps feeble men as he formerly on earth 
succoured them by his art as a physician.' 

In the Cairo Museum probably many of 
the present audience have seen the sepulchral 
stele of Shemkhetnankh, a great physician of the 
fifth dynasty, who was contemporary with King 
Sahura, and who is described in the stele as the 
principal physician of the Royal Hospital. His 
name, which is doubtless a title given to him by 
the monarch, means ' He who possesses the 
things that give life.' It is interesting to find 
that five thousand years ago a hospital should 
exist associated with, and under the patronage 

J, Pseudo-Apul., Asklepios C, 37 



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THE HARVEIAN ORATION, 1904 21 

of, the Pharaoh and having its own staff of 
physicians. And it is manifest that our calHng 
held a distinguished position at the time when 
art and learning in Egypt were at their zenith. 

Few of the temples of I-em-hotep remain. 
When viewing the ruins of Heliopolis, the ' On' 
of the Bible, the visitor naturally wonders in what 
part of the wide area the great halls were situated 
in which Horus was healed after being wounded 
by Typhon, those halls which, as Ebers tells us, 
had from mythical times been used for clinical 
purposes by the celebrated faculty of medicine 
of Heliopolis. A small temple of I-em-hotep 
still exists at Philae, with certain adjacent court- 
yards, which were probably employed for 
medical purposes. I subjoin a ground plan and 
three photographs of these remains at Philae. 

This temple is contemporary with the earlier 
Ptolomies ; the hieroglyphics are of the date of 
Ptolomy IV, but the inscription in Greek on the 
cornice of the southern door (see Plate VI) is 
later, dating from the reign of Ptolemy Epiphanes, 
two centuries before the Christian era.' The 
colonnade (Plate V) and also the courtyard in 
front of the temple appear to be still later additions. 
Since the Coptic houses and much accumulated 
rubbish have been cleared away, and certain 
necessary restorations made by Captain Lyons, on 
behalf of the Public Works Department of Egypt, 
all details of the temple can be examined with ease. 

I. Budge, Godi of the Egyptiansy p. 523 



22 THE HARVEIAN ORATION, 1904 

From the colonnade a door marked e on 
the plan (Plate IV) leads into a square courtyard, 
the north side of which, marked ad in the plan, 
is formed by the fa9ade of the temple proper. 
Here some of the hieroglyphs refer to I-em-hotep 
and his work (Plate VI). In the centre of this 
fafade a door marked / leads into the larger 
anterior chamber of the temple. From this the 
door g communicates with the inner sanctuary. 
The eastern wall of the courtyard has a curious 
elongated recess, many yards in length but only 
a foot-and-a-half in depth, marked ac in the plan, 
a narrow door, b^ gives access to it. Between 
a and b a small aperture in the wall marked x 
communicates with this curious recess, and the 
remains of a second aperture exist further to the 
left. It is difficult to understand the purpose of 
this structure.' Plate VII represents the wall ac 
with the doorway and apertures referred to. A 
door marked h leads into a larger courtyard which 
again communicates by three doors on its western 
side with the colonnade. 

Whether this further courtyard was a portion 
of the purlieus of the temple is uncertain, no doubt 
a considerable space would be required for the 
medical work of the priest physicians. 

Plate V represents the west wall of the temple 
(shewing a mediaeval Coptic doorway broken 
through into the sanctuary), also a part of the 

I. I3 it possible this was a drug store or dispensary ; the prescription being 
passed in at the one aperture and the medicine given out from the other ? 



THE HARVEIAN ORATION, 1904 23 

colonnade. To the left is a portion of the great 
pylon of the temple of Isis. 

I am indebted to the courtesy of the Egyptian 
Public Works Department and to Captain Lyons 
for the privilege of reproducing these views ot the 
temple of I-em-hotep at Philae.' 

Methods Employed by the Egyptian Physicians 

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 w^as 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.'^ As to dentistry it may be 
remarked that the ancient Egyptians were probably 

I. A Report on the Island and Temples of PMilae, by Capt. G. H. Lyons, R.E., 
Public Works Department, Egypt. 

2. Euterpe^ 84 



24 THE HARVEIAN ORATION, 1904 

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.' 

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, garhc, and various bitter infusions ; man- 
dragora, linseed, squills, saffron, resin, and various 
turpentine products ; cassia, certain species of 
cucumis, cedar-oil, yeast, colchicum, nasturtium, 
myrrh, tamarisk, powdered lapis lazuh, 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. 

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 

I. Dr. Grant Bey, Ancient Egyptian Medicine. A paper prepared for Internst. 
Med. Congress, 1894. 



PLATE VI 




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PLATE VII 




THE HARVEIAN ORATION, 1904 25 

kind.'' The Berlin Medical papyrus alone men- 
tions 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 pro- 
cesses ; 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 ' Chemis- 
try.'^ 

Surgical instruments and the actual cautery 
were in use, also steam inhalations, massage, oint- 
ments, 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 prcscrip- 

I. Odyssey, IV, 227 
2. Dr. Grant Bey, Loc. Cit, 



26 THE HARVEIAN ORATION, 1904 

tion 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 asso- 
ciated with charms and spells. 

Human nature is the same in all ages ; hence 
one was not surprised to meet with hair in- 
vigorators, 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 efi-ect'^ 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 Hfe 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.' 



I. Dr. Grant Bey, Loc. Cit. 



THE HARVEIAN ORATION, 1904 27 



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 sub- 
sequently, 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 andthat nothing 
remained behind. 



28 THE HARVEIAN ORATION, 1904 

Our Egyptian and our Greek predecessors 
seem to have believed that they had attained 
to absolute and final knowledge on these subjects. 
While wt smile at their error, let us be humble 
in estimating our ow^n 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 pro- 
priety 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. 



THE HARVEIAN ORATION, 1904 29 

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 



30 THE HARVEIAN ORATION, 1904 

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 rheum- 
atism, 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 .? 

The Rheumatic Joint rests, but not the 
Rheumatic Heart 

No doubt the reason is that the joint can 
rest. The merciful influence of pain in the part 
affected insures repose for each affected joint. 
Suppose it were otherwise. Imagine pain absent 
and conceive for a moment that we could flex and 
extend an acutely rheumatic knee or elbow sixty 
or eighty times per minute continuously, what 
would be the fate of the joint ? Is there any 
probabiHty that restoration to the normal condition 
would follow .? Few of us, I think, would expect 
it, for it is a physiological law that repair in a 
diseased organ cannot coincide with full functional 
activity. When the endocardium and valve 
cusps are inflamed pain does not give the signal 
for rest, for, indeed, pain or no pain, the toiling 
heart cannot intermit its labours. 



THE HARVEIAN ORATION, 1904 31 
Disastrous results of Valvulitis if not specially 

TREATED 

During my thirty-five years of experience as 
a hospital physician and in private I have w^atchcd 
with special interest the fate of the numerous 
cases of endocarditis which came under my charge, 
endeavouring as far as possible to trace the later 
history of such cases for a lengthened period. 
During the earlier years I merely treated the 
rheumatism, believing, as I had been taught, that 
little or nothing could be done to prevent disaster 
to the heart. I had the pain of discovering that 
many, indeed most, of these cases merged into 
permanent valvular disease. This distressing 
experience induced me to experiment on various 
methods of preventive treatment. Of these, one 
has proved successful and has been constantly 
employed by me for twenty years. 

The WORK of the Rheumatic Heart must for 

A TIME BE MINIMISED 

The method is very simple ; it is merely to 
give the heart the same advantages, the same 
opportunities for repair, so far as we can, that the 
joints enjoy ; in other words, by every means in 
our power we lessen the work to be done by the 
heart. The most absolute quiet is enjoined, the 
patient lies with his head at a low level, pain and 
fever are subdued, no excitement is permitted, 
the patient is made as comfortable as we can make 



32 THE HARVEIAN ORATION, 1904 

him, and sleep is encouraged — in fact, we seek to 
attain physiological rest. We follow the precept 
of our ancient Egyptian brother, declared so many 
thousand years ago : we give the ailing heart the 
nearest approach to rest that is practicable. In 
addition we administer sodium or potassium 
iodide, partly to help in the absorption of morbid 
exudations but chiefly to lower vascular tension, 
just as we give these drugs in cases of internal 
aneurism. Lastly, we endeavour to influence the 
cardiac vasomotor and trophic nerves reflexly by 
gentle and almost painless stimulation of those 
cutaneous nerves which we know from physio- 
logical data, and from the evidence of the referred 
pains of angina to be in close relation with the 
heart — viz., the first four dorsal nerves. 

I believe, however, that by far the most 
important factor in the abortive treatment of 
endocarditis is rest, rest for many weeks, the 
slowing of the heart, the lengthening of the 
diastole, which is the only rest-time possible, the 
careful avoidance of high blood pressures, which 
the weakened and softened valve cusps cannot 
sustain without peril, and the diminution of the 
volume of the blood to be moved. 

Only then, when functional activity is 
minimised, can we hope for repair of mischief, 
re-formation of destroyed endothelia and absorp- 
tion of effusion in the valve cusps. Moreover, 
repair is only possible during the early stages 
of endocarditis ; later the mischief is permanent, 



THE HARVEIAN ORATION, 1904 33 

unalterable by any form of treatment. The 
method fails if from any reason it is found 
impracticable to slowdown the heart, for example, 
if asthma, bronchitis, or pneumonia, or great 
nervous excitability co-exist. 

I submit that these measures are rational, 
their objects being by affording rest to give 
opportunity for the exercise of the vis medicatrix 
naturae which is our sheet anchor, nay, indeed, 
to stimulate that natural reparative process which 
alone can effect restoration. 



Two Objections to the Proposed Method 

It may be objected that there are two 
difficulties in our path. First, in regard to 
diagnosis, how are we to distinguish the signs ot 
commencing endocarditis from those of mere 
dilatation t In the great majority of instances 
in which marked and continuing bruit occurs, 
endocarditis is present and not mere dilatation, 
but I admit that in some cases discrimination is 
difficult. The wisest course is, if in doubt, to 
treat as endocarditis. Secondly, some physicians 
complain, as those at the Johns Hopkins Hospital 
have recently done, that they find difficulty in 
inducing private and hospital patients to submit 
to a sufficiently long period of rest. Occasionally 
that is so in the case of foolish or thoughtless 
persons, but in general, if the danger to which 
the heart is exposed be calmly and plainly stated 



34 THE HARVEIAN ORATION, 1904 

to the patient, and also if the hope of perfect 
recovery be held out to him through the agency 
of prolonged rest, he will agree to give this 
method a fair trial. Such, at least, has been my 
experience. 

Successful Results obtained 

For twenty years continuously this method 
has been carried out. The results have been 
striking. The comparative absence of permanent 
heart disease after endocarditis has been in marked 
contrast to its frequency prior to the adoption of 
the treatment by rest. So striking indeed is the 
change that I confess it now seems to me that it 
would be an immoral act on my part to omit 
these measures in any recent case of endocardial 
disease. 

If we make it a rule to watch carefully for 
incipient valvulitis and if, when we find it, we 
secure for the heart prolonged rest, I believe that 
it is in our power to diminish, in a most material 
degree, the frequency of chronic valvular disease 
of the heart. 



PRINTED BY DONALD ERASER, 37 HANOVER STREET, LIVERPOOL 



BY THE SAME AUTHOR 



THE 

TEMPLES AND RITUAL OF 
ASKLEPIOS 

TWO LECTURES DELIVERED AT THE ROYAL INSTITUTION OF 

GREAT BRITAIN 

WITH THIRTY-FOUR ILLUSTRATIONS 

SECOND EDITION 



ALSO 

THE PREVENTION OF VALVULAR 
DISEASE OF THE HEART 



WITH SIX ILLUSTRATIONS 



BOTH PUBLISHED BY 

C. J. CLAY AND SONS 

CAMBRIDGE UNIVERSITY PRESS, AVE MARIA LANE 

LONDON 



41 4