ANCIENT EGYPT CLINICAL EXAMINATION

The first treatise in the book of the heart at the Ebers papyrus is entitled “Beginning of the secret of the physician”. Probably the examination of the pulse was one of the secret teachings they refrained from passing to Greek visitors later, and hence has not developed in our modern medicine.

The process of examination follows in the same steps we follow in our modern medical practice. Interrogation of the patient as a first step was shown in the Edwin Smith Papyrus

“If thou ask of him concerning his malady and he speaks not to thee”.

This is followed by our classical steps, inspection, palpation the percussion of the body and diseased organs.

“Thou shouldst inspect his wound”, and “his eyebrows are drown, while his face is as if he wept”.

Inspection also included the body discharges as urine, stools, sputum and blood.

Equally to palpation of the pulse, were those of the abdomen, fractures (for crepitus) and tumors.

“You should put your finger on it, you should then palpate his belly”.

Tumors were well differentiated. An aneurysm was described as a hemispherical tumor of the vessel, which increases in volume beneath the fingers at each pulsation. It ceases to throb if one exerts pressure with the finger in the direction of the “current”. A skill practiced nowadays by physicians.

An inguinal hernia was described as a tumor above the genitalia, which appears on coughing, and could be restored by heat application.

“If thou examinst a swelling of the covering of his belly’s horns above his pudenda (sex organs) then thou shalt place thy finger on it and examine his belly and knock on the fingers (percuss) if thou examinst his that has come out and has arisen by his cough. Then thou shalt say concerning it: it is a swelling of the covering of his belly. It is a disease which I will treat”.

That impulse on cough is the first manifestation of a hernia in modern surgical teachings. Heat application is one of the methods to reduce a strangulated hernia. The mummy of Meren-Ptah (19th dynasty) shows a sign of an open wound resulting from surgical interference.

The ancient physician also knew percussion, as the third step in examination modern physicians practice.

“and examine his belly, and knock on the finger” and “place thy hand on the patient and tap”.

Following diagnosis, the decision was in one of three forms: “An ailment which I will treat”, “An ailment which I contend” or “An ailment not to be treated”. In only 3 out of 49 cases discussed in the Smith Papyrus was the verdict hopeless.

Simple bed-side diagnostic tests were then performed:

“Say to the patient: ‘Look at thy shoulder, then thy breast, then look upwards and downwards’. If he is not able to do this, he is suffering from a dislocation of the vertebrae of the neck”.