Imhotep: The Physician/Architect Who Led Us From Magic to Medicine (2655-2600 BC)

Primary Care Blog

“The first figure of a physician to stand out clearly from the mists of antiquity” – Sir William Osler

We must look at many historical figures in order to better understand what it means to be a healer and how to best practice the art of caring. Sir William Osler recommended that we “must come to the land of the Nile for the origin of many of man’s most distinctive and highly cherished beliefs.” Osler urges us to pay attention to the contributions of Imhotep—and so I am.

Imhotep, who lived in the 27th century BC, was an Egyptian polymath considered to be the first architect, engineer, and physician in recorded history. He was also revered as a philosopher and one of only a few commoners ever to be acknowledged by the Egyptian people as having divine status after his death. Imhotep was also deified by the Greeks as Asclepius, the god of healing.

Imhotep stood out from the mists of antiquity in part because his practices were unlike others of his era. They were devoid of magical thinking. The Egyptians of his time thought that most illnesses (aside from trauma) were expressions of hostility by a higher power, e.g., an adversary, a spirit, or a dead person. The Papyrus Ebers, not felt to be authored by Imhotep, but reflective of the type of medicine practiced in Ancient Egypt contained primarily magical remedies to help with suffering. An Egyptian may have sought out a magician or a priest as readily as a physician for a cure.  “The border between magic and medicine is a modern invention; such distinction did not exist for ancient healers,” noted Dr. Axel Karenberg, a medical historian and Dr. C. Leitz, an Egyptologist, both of the University of Cologne, Germany.

According to Egyptologist Bob Brier in his book Ancient Egyptian Magic, “Some evidence exists that the kind of illness determined the method of treatment. If the cause was known, as in the case of broken bones and such perils as crocodile bites, then the treatment tended to be nonmagical. For instance, for a crocodile bite, a practical suggestion was to sew the wound closed and place raw meat on it. If however the illness was something such as a fever, where the cause would be unknown to the Egyptians, then it might be attributed to demons or malicious magic.”

There are no known writings of Imhotep. The Edwin Smith Surgical Papyrus, one of the most important documents describing medicine in the ancient Nile Valley, has been attributed to Imhotep. The Edwin Smith Papyrus, which was written around 1700 BC, described wounds, and how to treat them. This 17-page papyrus is unique among the remaining Papyri of the time (Ebers Papyrus and London-Leiden Medical Papyrus) because of its rational and scientific approach. The other papyri were medical texts based on magic.

Imhotep, who was the architect of the step pyramid at Saqqara, would have been on the scene and seen many cases of broken bones and men injuring themselves by falling while building this large structure. The Edwin Smith Surgical Papyrus while dealing largely with trauma and surgery was highly descriptive. Forty eight specific cases are documented. The cases began with a descriptor describing what was to follow, such as: “Instructions Concerning a Wound on the Top of His Eyebrow”.  After which may be found details on the examination of the patient, followed by diagnosis. Bob Brier also notes “Here the physician is told to state the injury and then whether or not he can treat it. Actually, there were three things he could say: (1) “An ailment which I will treat”; (2) ”An ailment with which I will contend”; and (3) “An ailment not to be treated.” In these writings we see the concept of prognosis as well as treatment. Egyptian physicians also described diseases which were beyond treatment “An affection for which nothing can be done”. The Greeks would later write about the wisdom of knowing when to not measure things.

Details on closing wounds with sutures, preventing and curing infection with honey, and recommendations to immobilize those with head and spinal cord injury as well as other lower body fractures are described. Physicians used bandages, splints, plaster, tape, and sutures. They also advised suppositories, herbal dressings, enemas, and castor oil. Gold was used to bind teeth and facial abscesses were incised and drained. Aloe vera was used for skin disease.

The first translation of the Edwin Smith Surgical Papyrus was by James Henry Breasted. This translation revealed that rational, scientific practices were based on careful observation, and examination. For example, the surgical portion was the first of its kind revealing a methodical identification of an ailment starting from the top of the head and working downward. The development of methods would be a theme encouraged by Sir William Osler centuries later. While many of the treatments used in Ancient Egypt are now considered to be of little benefit, some approaches set the bar for the art of medicine as we know it today. Imhotep’s work formed a basis for how to care for the patient. Hippocrates and Galen, both of whom studied Egyptian works would later acknowledge his contribution.

Richard Colgan, MD, is an Associate Professor and Vice Chair of Medical Student Education and Clinical Operations in the Department of Family and Community Medicine at the University of Maryland School of Medicine in Baltimore, Maryland. He is the author of Advice to the Young Physician: On the Art of Medicine by Springer. For more information go to: www.advicetotheyoungphysician.com

The above is printed with permission by Springer from: Advice to the Healer: On the Art of Caring, to be released in November, 2012 by Springer.