HistoricalPerspectives

Egyptian Contributions toCardiovascular Medicine

James T. Willerson, MDRebecca Teaff, MA

Ancient Egypt was one of the greatest civilizations to havearisen, becoming the cradle of scientific inquiry and so-cial development over 3 millennia.1

Ancient Egypt

Key words: Cardiovascularmedicine; Egypt; history ofmedicine, ancient

From: The Department ofCardiovascular Research,Texas Heart Institute; andthe Division of Cardiology,Department of InternalMedicine, The Universityof Texas Medical School-Houston; Houston, Texas77030

Presented at a joint meetingof the Texas Heart Instituteand the Egyptian CardiologySociety, Cairo, Egypt,October 1995

Address for reprints:James T Willerson, MD,Division of Adult Cardiology,Texas Heart Institute,1 101 Bates, Rm. P-335(Mail Code 1-102),Houston, TX 77030

M any concepts in cardiovascular medicine may be directly traced to prac-tices of ancient Egypt. With their discovery of papyrus, the Egyptiansmade possible the preservation of the written word; they also became

experts at embalming and preserving the human body. The Egyptians left us manyartifacts of historical importance-tombs, pottery, depictions, hieroglyphics, andmummies. Evidence from these artifacts, along with the writings of ancient histo-rians, reveals an educated society in early Egypt with an intense interest in thesciences, humanities, and medicine.

Records of Egyptian history begin with the Old Kingdom, around 3000 BC (TableI).I The great pyramids were probably constructed during this period. For the nextfew centuries (6th to 11th dynasties), there was a weakening of a strong centralgovernment in Egypt. It was partially reestablished during the 11th and 12th dy-nasties, which marked the Middle Kingdom (2035-1668 BC). This period has beencalled the "Classical Age" as an indication of its high intellectual emphasis, andmedicine apparently held a prominent place in the pursuit of learning.'Around the 13th century BC, Ramesses II, builder of the great temple of Abu

Simbel, was pharaoh. The Biblical story of the enslavement of the Hebrews prob-ably dates from this period. In succeeding centuries, Egypt fell under the rulingauthority of several countries, including Libya, Ethiopia, Assyria, and finally, Per-sia.2 In 323 BC, Alexander the Great, the Macedonian Greek conqueror, defeatedPersia and chose his general Ptolemy to take the throne as king of Egypt. There,Alexander founded the city of Alexandria, which became the medical and intel-lectual capital of the Mediterranean world.2

The Heart

In attempting to explain primordial medical systems, Henry Sigerist concludedthat "physiology began when man ... tried to correlate the action of food, air, andblood.'3 The Egyptians found the focal point of this correlation in the heart, whichthey regarded as the central organ in the body, essential to the living and thedead.4The hieroglyph that represented the heart was 1st drawn with vessels attached

to it, but after the 3rd Dynasty this symbol was considerably modified and ac-quired the traditional shape of a heart-shaped jar (Fig. 1). The heart was regardedas the organic motor of the body and the seat of intelligence, emotions, and de-sire; theologians even explained creation as being the making of "the heart thatconceives" and of "the tongue that commands."' The heart thus came to be heldresponsible for human emotions. Because the Egyptians regarded the heart as thebody's principal organ, absolutely essential to life, they failed to recognize its roleas a potential seat of disease.6

Medical Papyri

The word papyrus refers to a paper reed, Cyperus papyrus, which was a plantcultivated in ancient times in the Nile Delta region of Egypt (Fig. 2). With the

Egyptian Contributions to Cardiovascular Medicine 191Texas Heai-t Instititte.journal

TABLE 1. Dynasties of Ancient Egypt and EquivalentTime Periods

Dynasty Period Approx Date Bc

l-ll Archaic 3168-2705I-VI Old Kingdom 2705-2250

VII-X 1st Intermediate 2250-2035Xi-XI Middle Kingdom 2035-1668XIV-XVI 2nd Intermediate 1720-1550XVI I-XX New Kingdom 1550-1070XXI-XXXI Late Period 1070-332Ptolemaic Greek Period 332-30Emperors Roman Period 30 Bc-395AD

(Source: Sullivan R.' Reprinted from the Journal of the RoyalSociety of Medicine.)

invention of the alphabet and the conversion of thepapyrus into a vehicle for preserving the writtenword, the transmission of knowledge was greatlyaccelerated. The reliance on the oral passage of in-formation and its clay and stone substitutes wasabolished forever.IThe most enlightening sources describing the

Egyptians' knowledge of the cardiovascular systemare to be found in several papyri, named after theirdiscoverers: the (Edwin) Smith Surgical Papyrus, the(Georg) Ebers Papyrus, and the (Heinrich) BrugschPapyrus. These papyri form a representative sampleof the world's 1st body of medical literature.

Reliance on the writings of Greek and Romancommentators, such as Homer, Herodotus, andHippocrates, was necessary for knowledge of an-cient Egyptian medicine until the discovery of theRosetta Stone in 1799 during Napoleon's conquestof Egypt. Though the writings of the Egyptians wereabundant in historic ruins, they had been virtuallyundecipherable until this discovery provided thekeys essential for translation.

KACA1 S Dynasty

I'b heart

-Classical period

Peribsen2nd Dynasty

Fig. 1 Various ways of depicting the heart at different epochs.

(Source: IskandarAZ A catalogue of Arabic manuscripts on

medicine and science in the Wellcome Historical MedicalLibrary. London: Wellcome Historical Medical Library, 1967.Original drawing adapted by Melissa J. Mayo, Texas HeartInstitute.)

The Smith PapyrusThe Smith Surgical Papyrus (ca. 17th century BC)provides important insights into the state of surgicalknowledge in ancient Egypt. Discovered at Thebesin 1862 and purchased by Edwin Smith, an Ameri-can Egyptologist, the document remained obscureuntil 1920, when Smith's daughter bequeathed it tothe New York Historical Society. Although it wasdated at 1600 BC, the Smith Papyrus is believed tohave been copied from a much older document,originally written around 2500 BC. (Some historianshave dated it as far back as 3000 Bc.) Published in1930 with a translation and commentary by JamesHenry Breasted, the original is now housed in theNew York Academy of Medicine.

The Smith Papyrus contains descriptions of 48mostly traumatic surgical cases. It follows a logicalpattern, starting at the head and working down, butthe text abruptly stops at mid-chest. The format hasbeen likened to a series of clinical presentationsrather than a "how to" text.8 Each surgical case isgiven a title, followed by a description of the methodof examination. On the basis of the examination,which includes interrogation, inspection, palpation,and the observation of movements performed at thedirection of the "surgeon," a diagnosis is reached.9The diagnosis is preceded by 1 of 3 assessments: 'anailment which I will treat"; 'an ailment with which Iwill contend"; or "an ailment not to be treated." "'

192 Egyptian Contributions to Cardiovascular Medicine Iblume,43-vitinber-3, 1996

Fig. 2 Cyperus papyrus, from which papyrus is derived.

(Source: Manniche L. An ancient Egyptian herbal. Austin.University of Texas Press, 1989.)

the 1st description of the circulation of the blood,preceding the Greek Democritus's crucle descriptionof the circulation in his treatise Onz Nuittrition1' byover 2 millennia.' In addition, the documiient con-tains a glossary. explaining some of the terminologyfrom the Oldl Kingdom.9

The initial wvords of the Smith Papyrus show- theEgyptians belief in a direct correlation betw-een thepulse and the heiart: 12

The counting of anything with the fingers (isdone) to recognize the way the heart goes.There are v-essels in it leading to every part ofthe body. Vhen a Sekhmet priest, any sin aldoctor puts his fingers to the head tothe two hands, to the place of the heart .itspeaks in every vessel. every part of thebody.

In actual practice, the pulse -was counted with theaid of an earthenw-are vessel that acted as a clock(Fig. 4). This v-essel had a tiny hole in the bottomfrom which water escaped, drop by drop. The pulserate was determined by correlating the heats w-iththe drops of w-ater.

The 1st type of ailment is considered curable. Forthe 2nd, therapy is instituted, even though the ssur-geon may hav-e doubts about the potential for cure.The 3rd verdict is serious: in such a case, the ssur-geon refrains from immediate therapy and restrictshimself to w-atching, waiting, and thoroughly observ-ing the patient.9 Treatments are limited to the follow-ing choices: 1) mechanical or surgical treatment, 2)a combination of surgical treatment and externalmedicines, and 3) external medicines only.

Hieroglyphic characters in the Smith Papyrus rep-resent the lst wvritten observations of the heartbeat(Fig. 3). This document also presents what may be

Fig. 3 Counting or measurement of the pulse as depicted byhieroglyphic characters in the Smith Papyrus. The symbol onthe right represents seeds being emptied from the container.

(Photo source: University of Central Florida. Literary source:Breasted JH. The Edwin Smith Surgical Papyrus. Chicago:University of Chicago Press. Original drawing adapted byMelissa J. Mayo, Texas Heart Institute.)

The Ebers PapyrusThe Ebers Papyrus (ca. 1555 BC), at more than 100pages the longest intact papyvrus, contains the great-est amount of material relating to internal medicine.including a treatise on the heart and Xvessels (Fig. 5).The heart is again described in this papyrus as be-ing the center of a system of v-essels ssupplying thebody.

Fig. 4 Egyptian clock.

(Photo source: National Library of Medicine. Literary source.Brewer LA. Sphygmology through the centuries. historicalnotes. Am J Surg 1983; 145.696-701. Used with permission.)

Egyptian Contributions to Cardiovascular Medicine 19.Texas fleai-t Institute.fournal

The Ebers Papyrus was written approximately1500 years after the Smith Papyrus, but it lacks thecoherence and careful organization found in the lat-ter. The best known translation is by B. Ebbell in1937.The unknown physician who recorded his obser-

vations in what came to be known as the Ebers Pa-pyrus uised the phrase, "to measure the heart inorder to recognize its indications." Most Egyptolo-gists agree that 'to measure the heart" refers tocounting the pulse. Recognition of a direct correla-tion between the pulse and the heart can be foundin this papyrus:'3

From the heart arise the vessels which go tothe whole body . .. if the physician lay his fin-ger on the head, on the neck, on the hand, onthe epigastrium, on the arm or the leg, every-where the motion of the heart touches him,couLrsing through the vessels to all the mem-bers.... When the heart is diseased, its workis imperfectly performed; the vessels proceed-ing from the heart become inactive so that youcannot feel them.... If the heart trembles, haslittle power and sinks, the disease is advanc-ing.

Fig. 5 Ebers Papyrus.

(Photo source: National Library of Medicine. Literary source:Wreszinski W Atlas zur Altaegyptischen Kulturgeschichte.Leipzig: JC Henrichs Buchhandlung, 1914-1946. Used withpermission.)

Though ventricular fibrillation, as we know it to-day, was probably 1st described by J.E. Erichsen in1842,'4 the latter part of the preceding passage-according to medical historians-may also be a de-scription of ventricular fibrillation. The keys here arethe trembling of the heart and the lack of pulsation:important features of ventricular fibrillation.

Also contained in the Ebers Papyrus are instruc-tions regarding the diagnosis of tumors and descrip-tions of a type of "vessel-tumor," which may nothave been a blood vessel. Tumors are described ascoming from the wound of a vessel. The writer rec-ommends that surgical removal of a tulmor be doneby use of a knife that has been heatecl in a fire, inorder to reduce the amount of bleeding. So it ap-pears that the actions of cutting and cauterizing weredone simultaneously.'2 The papyrus also contains adescription of 'serpentine windings," which wereprobably varicose veins.

The Brugsch PapyrusThe Brugsch Papyrus, which is also known as theGreater Berlin Papyrus, contains a description of theheart similar to that found in the Ebers Papyrus; italso presents a superficial description of the ana-tomy of the veins. Heinrich Brugsch discovered thisdocument in a jar dluring excavations at Saqqaraearly in the 20th century.'5,"6 It is dated between 1350and 1200 BC. Translated and published by WalterWreszinski in 1909, it is now housed in the BerlinMuseum.'2 Some historians believe that this papyrusis referenced in the writings of Galen.f

The Evolution of MedicalPractice and Teaching

Gods of HealingIn early times, the ruling kings of Egypt were re-

garded as gods, but they retained human qualities,as did the cosmic gods.2 Although all the deitieswere associated with some aspect of health or ill-ness, no god was devoted only to medicine untillater in Egyptian history (Fig. 6). Then, each special-ization in medicine had a patron god or goddess.and the physicians worked directly under the aus-

pices of their own particular deity.The 2 most important healing divinities were

Thoth, who became a patron god of physicians (asthe source of medical knowledge) and of scribes (asthe inventor of writing), and Imhotep, whom SirWilliam Osler called "the first figure of a physicianto stand out clearly from the mists of antiquity.""'

Imhotep was a multi-talented individual-scribe,poet, architect, and chief physician of the PharaohDjoser (3rd Dynasty). During the Greek period, hewas deified and identified with Asklepios, the Greekgod of healing, and with the Roman counterpart,

194 Egyptian Contributions to Cardiovascular Medicine

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It7

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Fig. 6 Nineteenth-dynasty physician lwty shown seatedwith scroll on lap in pose reminiscent of representationsof Imhotep, the god of medicine.

(Photo source: Rijks Museum van Oudheden, Leiden. Literarysource: Lyons AS, Petrucelli RJ II. Ancient Egypt. In: Medi-cine: an illustrated history. New York: Harry N Abrams, 1978.Used with permission.)

Aesculapius. Imhotep apparently wrote about botharchitecture and medicine; although none of hiswritings has survived, some historians believe thathe is the author of the material on which the SmithPapyrus is based. The greatest architectural legacyattributed to Imhotep is the building of the great steppyramid at Saqqara (ca. 2650 BC). This necropoliswas the 1st pyramid built in Egypt, and it is also be-lieved to be the oldest large-scale stone building inthe world.

The Medical HierarchyOrganized medical care began with the Egyptians atthe time of Imhotep. The medical hierarchy startedwith the sunv (ordinary doctor),* imyrswnu. (over-seer of doctors), wr swnw (chief of doctors), smsw

*Su.,nu,I is probably pronounced something like sounou.

swnw (eldest of doctors), and sbd su'nu' (inspectorof doctors).'8

There is also evidence of women physicians: 1 re-lief describes Pereshet as imy-rt-suwny, lady directorof lady physicians. However, this is the only knownreference to suggest that women held medical posts.

In 425 BC, the Greek physician Herodotus de-scribed the practice of medicine among the Egyp-tians in terms of specialization:'9

The practice of medicine they split into sepa-rate parts, each doctor being responsible forthe treatment of only one disease. There are,in consequence, innumerable doctors, somespecializing in diseases of the eye, others of thehead, others of the stomach, and so on; whileothers, again, deal with the sort of troubleswhich cannot be exactly localized.

Although, according to the Egyptian scholar J.Worth Estes,20 it is unlikely that the Egyptian physi-cians actually were divided in terms of specializa-tion, some may have earned reputations for treatingspecific conditions, such as inflammation around theeye. Specialization in terms of internal organs wouldhave been unlikely, since the suwnu, assumed thatalmost all types of illnesses arose from 1 underlyingcause.

Taking an accurate history of the patient was anessential component of Egyptian medicine eventhough the questioning was somewhat limited bya lack of knowledge of anatomy and physiology.Symptoms such as palpitation, dyspnea, and painwere commonly pursued. William Heberden theelder is traditionally given credit for 1st describingangina pectoris, but the Egyptians anticipated himby 4,000 years with a classic and dramatic descrip-tion of coronary ischemia:21

If thou examinest a man for illness in his car-dia and he has pains in his arms, and in hisbreast and in one side of his cardia it isdeath threatening him.

Cyanosis, one of the more important clinical signsof congenital heart disease, was also described bythe ancient Egyptians (Fig. 7). The earliest illustra-tion of a blue-skinned person was taken from thetomb of Osiris, dating from about 2000 Bc. The SmithPapyrus presents convincing evidence (Fig. 8) thatcyanosis was observed even earlier than this illus-tration indicates.

Medical TeachingAfter the golden age of the papyri, no record ofEgyptian medical practice exists for more than athousand years. Several explanations have been

Egyptian Contributions to Cardiovascular Medicine 195Texas Heart Instititte.journal

given for this void, one being the repeated havoc ofwars and invasions.5 Another is that the teaching and

Fig. 7 Earliest illustration of a blue-skinned person.

(Photo source: National Library of Medicine. Literary source:Rashkind WJ. Historic aspects of congenital heart disease.Birth defects. Original Article Series, 1972:8 [Fig. 5]. Usedwith permission.)

practice of medicine were conveyed largely throughan oral, rather than a written, tradition.

In the 6th century isc, the great temples of Egyptwere destroyed. Then reconstruction began, andHouses of Life were built. In Sais, the House of Lifewas reconstructed and attached to the temple. Here,priest-physicians were trained in rational medicine,in addition to mysticism. Their education was largelysecret, and orally conveyed. Some scholars believethat these Houses of Life were forerunners of medi-cal departments in our modern universities.By the 3rd quarter of the 4th century AD, hospitals

had been established as independent institutions forthe care and treatment of the sick. According to VanMinnen,22 the birth of the hospital was the 1 medicalrevolution to occur in late antiquity. Egyptian docu-ments reveal a multitude of hospitals that werefounded by private individuals and were indepen-dent of ecclesiastical institutions. Apparently, thehospital as a singular institution also helped to re-solve major tensions between medical, ecclesiastical,and religious orders of ancient times.22

A

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Fig. 8 In this hieroglyph from the Smith Papyrus, "B" describes a color that is reddish, while "C" indicates a color that is bluish.Some Egyptologists believe that the intended color was based on the medical practitioners' description of cyanosis. It is a mix-ture of red and blue.

(Photo source: National Library of Medicine. Literary source: Rashkind WJ. Historic aspects of congenital heart disease. Birthdefects. Original Article Series, 1972:8 [Fig. 8. Original drawing adapted by Melissa J. Mayo, Texas Heart Institute. Used withpermisslon.)

196 Egyptian Contributions to Cardiovascular Medicine

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Medical ScholarsSome 300 years after the rebuilding of the temples,only 40 miles from Sais, Alexander built Alexandria.After his death, the Ptolemies started a grand tradi-tion, making their city an international emporiumof trade and ideas that attracted the finest scholarsin the world. Two of these exceptional scholars,Herophilus and Erasistratus, distinguished the arter-ies from the veins, differentiated arterial from venousblood, and nearly discovered the circulation.5 It isdifficult to determine their exact influences, butthese 2 Greek scientists may have been inspired bythe papyri kept in the vast libraries of Alexandria andMemphis, for according to Galen, Greek physiciansstill studied there in the 2nd century AD. After theseimportant discoveries, nearly 13 centuries passed,dominated by the figure of Galen.

Then, in 13th-century Cairo, Ibn al-Nafis wrote aCommentary on theAnatomy ofAvicenna, in whichhe flatly refuted the ideas of both Galen and the Arabphilosopher and physician Avicenna. The Egyptianscholar Paul Ghalioungui has examined the contri-butions of al-Nafis, which are summarized as fol-lows:5

* He claimed that the blood runs from the rightto the left ventricle through the lungs and notthrough the septal pores as Galen had imag-ined.

* He denied the existence of 3 ventricles, as as-serted by Aristotle and Avicenna.

* Importantly, he opposed the view that theheart is nourished by a sediment left by theblood in the right ventricle-that the heartobtains its nourishment from the blood thatruns in its substance. This was actually the 1stdescription of the coronary circulation, and itwas written long before the work of WilliamHarvey, who is commonly thought to be theauthor of this discovery.

* He stated that the walls of the pulmonary veinsare thin in order to facilitate the receptionof what comes out of the pulmonary arterythrough perceptible pores between the 2. Thisperception was the nearest he could get to thecapillary circulation before the invention of themicroscope and the description of the capil-lary circulation by Malpighi. It completed histheory of the lesser circulation.

According to Ghalioungui, there is now proof thatfrom the death of Ibn al-Nafis in 1288 until the 17thcentury, when Harvey's De motu cordis was pub-lished, the views of Ibn al-Nafis were widely publi-cized in several well-known Arabic treatises. Onecan be found in the Paris Bibliotheque Nationale.Ghalioungui is convinced that some connection be-

tween Ibn al-Nafis and Harvey exists-at least thatHarvey owed something to this important predeces-sor.

Mummification

Arterial degenerative disease was not uncommon inancient times, as noted from the extensive examina-tions of Egyptian mummies (Fig. 9). The EgyptianMuseum in Cairo houses one of the largest collec-tions of mummies in the world, and the only collec-tion of royal mummies.23The swnw probably learned nothing of medical

value from the mummification process because, forclimatic and religious reasons, anatomic investiga-tions were not carried out on cadavers.20 In addition,the embalmers had a low rank in society, which pre-cluded their participation in "scholarly activities"with those in more learned professions.20 Thoughthere is some evidence that physicians themselvesperformed autopsies, the descriptions of the heartand vessels in the papyri were based more on specu-lation than on pure observation.Modern diagnostic techniques, including radiog-

raphy, computed tomography, electron and lightmicroscopy, serology, and endoscopy, have all beenapplied to the study of ancient Egyptian remains.Although mummification involved practically com-plete removal of the intrathoracic and intra-abdomi-nal organs, the heart was well preserved. This wasdue to religious beliefs at the time, which mandatedthat the heart remain with the dead to safeguardthem in the afterlife. Remnants of the aorta and itsmajor branches were thus preserved for study byfuture pathologists.

D).s Afmz.s.

I

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Fig. 9 Embalming: Egyptian mummies, corpse, pyramids, andthe embalming process.

(Photo source: National Library of Medicine. Literary source:Pomet. Histoire generale des drogues, Paris, 1694. Used withpermission.)

Egyptian Contributions to Cardiovascular Medicine 197Texas Heart Institittejoiirnal

Proof that atherosclerosis was present among theearly Egyptians was supplied by Sir Marc ArmandRuffer in Cairo in 191124 and S.G. Shattock25 in Lon-don during the same period. Interestingly, their ob-servations were independent of each other. Rufferwas a member of the medical faculty at Cairo whenhe published his incredible findings involving an ex-tensive macroscopic and microscopic study of thearterial lesions of Egyptian mummies.24

Most of the intrathoracic and intra-abdominal ar-teries were destroyed during the almost completeevisceration of the body undergoing mummification.However, there were enough remnants, both thereand in the limbs, for Ruffer to describe the lesions ofatherosclerosis in various stages of development andappearance. His observations included the soft ath-eromatous lesions, the calcified plaques, the ulcers,and even the type of sclerosis that Monckeberg de-scribed so well in 1903.

Ruffer was also able to demonstrate that the scle-rotic changes were not the exclusive prerogative ofthe elderly. He used Aristotle's method of estimatingage to determine the degree of hardening of thecartilaginous tissues. Thus he was able to roughly as-sess the age of the mummies under study, and there-by note atherosclerotic lesions even in youngerpeople. Ruffer's work was closely aligned in timewith Shattock's description of atherosclerotic lesionsin the mummy of Menephtah, who was a pharaohin Biblical times. When examined, Menephtah'smummy revealed that he had died in old age, withan obese abdomen and arteriosclerosis of the aorta.2Observation of the head showed tortuous, calcifiedtemporal arteries.26 The father of Menephtah, thePharaoh Ramesses II, lived uintil he was more than90 years old (Fig. 10).

Arteriosclerosis is sometimes associated with obe-sity, and this was true in ancient times as shown bythe skin folds of certain mummies, such as the pha-raohs Amenophis III and Ramesses III. Althoughthese men were extremely overweight, their obesitywas not generally depicted in their portraits, mostlikely for reasons of etiquette.2"

Since the discoveries of Ruffer, numerous othermummies, whose ages at death ranged from the 4thto the 8th decades, have shown similar vascularchanges. According to 1 observation published byLong in 193127 regarding the mummy of Lady Teye(21st Dynasty), there was evidence of atheromatousdisease of the aorta with calcification of the coro-nary artery and mitral valve. She also had arte-riosclerosis of the kidney, which wouldl havecontributed to a serious rise in blood pressure. Shewas estimated to have been about 50 years old at thetime of her death. By the 1960s, modern histologicmethods were lsed to examine and photograph thearteries of mummies28 (Fig. 11).

Fig. 10 Radiograph showing anterior aspect of the knees ofRamesses II. Note the calcification of the popliteal arteries attheir bifurcation (arrows).

(Source: Whitehouse WM. Radiologic findings in the royalmummies. In: Harris JE, Wente EFl editors. An x-ray atlas ofthe royal mummies. Chicago: University of Chicago Press,1980. Used with permission.)

Fig. 11 Carotid artery of a male mummy showing fibrosis.Verhoeff-van Gieson stain.

(Source: Sandison AT Diseases in ancient Egypt. In: CockburnA, Cockburn E, editors. Mummies, disease, and ancientcultures. Cambridge: Cambridge University Press, 1980.Used with permission.)

Pharmacopeia

The early Egyptian physicians were aware of a vari-ety of abnormal cardiac conditions, including ar-rhythmia, aneurysm, congestive heart failure, anclvenous insufficiency. Therapeutic remedies derivedfrom plants have been an important element ofpharmacopeias throLughout the ages (Fig. 12).29 Sincenearly 700 drugs filled the ancient Egyptian phar-macopeia, some must have had specific applicationsto cardiovascular conditions, but those treatments

198 Egyptian Contributions to Cardiovascular Medicine l'ohime 213, Nuinber,3, 1996

humlian heing dulring life. At the timile of judgment,the heart was weig(hed on a scale ag.ainst a feather(Fig. 13). A -irttuous heart wvould prove lighlt wsin-ning its possessor etei-nal salvation w-hile a sinfulheart would prove heavy and be cast to the croco-diles of the Nile, forever dcamning its owxner.3'

J*r-Th _ _S _F

L~ ~~

Fig. 13 Scene from the 19th Dynasty f1307-1196 Bc Book

of the Dead papyrus of Hunefer (London, Bri'tish Museum)showing the deceased led in by Anubls, and hiS heart

wei'ghed agai'nst a feather A 2nd figure of Anubi'S checks

the balance, while the "Eater" stands ready and Thoth

records the result. In the small register above, Hunefer(the deceased) adores a group of deities.

(Source: Baines J, Malek J. Atlas of ancient Egypt. New York:Facts on file, 1982.)

Fig. 12 Girl holding clusters of dates. Dates had manymedicinal applications in ancient times, including treatmentfor certain heart ailments.

(Source: Manniche L. An ancient Egyptian herbal. Austin:University of Texas Press, 1989.)

remain unknown.2' Mention of the oldest knowncardiac glycoside-containing plant. squill. is to befouLnd in the Ebers Papyrus. Neither the actuLal chem-ical composition nor its action on the heart wasknow-n at the time: it was Llsed as an ingredient inthe preparation of antidotes to poison.

Mysticism, Magic,and Medicine

Altholuglh the earliest roots of WVestern medicinelie in Mesopotamia. the Egyptians nuLrtured and ex-pandecd the art of healing with great national fervorand pricle. Egyptian physicians were respected anclconsulted throuLghouLt the ancient world. In Greece.it w-as sacid that to have studied meclicine in Egyptawas the highest creclential a physician could pre-sent.2'

Physicians in ancient Egypt faced liimlitecl thera-peultic options. buLt the papyri suLggest that they prac-ticecl in an extremely caring and suLpportiv-e fashion.Patients ancd their disorders were not to be ridicuLled.ancl cdN-ing patients were to be treated wxith greatcompassion. The ultimate admonition was empha-sized through frequent repetition: "Do not abandon

11i1l. '' 3IThoug1(h it was often Imlixecl with mythologv. mvs-

ticisIml. and theology. the science of the early Egyp-tians represented a major step from suLperstition tothe scientific fouLndations of Greek ancl Rom.an mecli-cine. ancl beyond. It is uLncdeniable that the earlyEgyptian physicians cleveloped skills of observation.physical examination. clinical diagnosis. and sUr-gerv. that foreshado-wed imiany- clevelo)piments inmocdern imieclicine.

Egyptian Contributions to Cardiovascular Medicine 199

In the ancient wo-orldl, religion. magic, ancl imlecdicinewere intertw-inecl. The heart was thoughlt capablle ofrecording all the goocl and ev-il acts performecl by a

Knws Heeli-t Iiislillilc, Journal

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the action of the heart. Med Gazette, n.s. 1842;30:561.15. Willius, p. 18.16. Passalacqua: 1826. Catalogue raisonne et historique, no. 1,

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