The History of Otolaryngology From Ancient to Modern Times EMMANUEL S. HELIDONIS, MD, FACS The history of medicine is the history of and (7) the modern period (19th and 20th cen- man himself. Prehistoric man was prone to turies) . regard disease as an evil spirit or the work of such a spirit. It is impossible to know how the THE FOLKLORE OF OTOLARYNGOLOGY man of the Neolithic period (10,000to 4000 A great number of fascinating references BC) faced different diseases. However by with regard to ear, nose, and throat diseases studying discovered bones, it was found that are found among different people. Folklore he knew how to immobilize fractured bones. remedies which have been used since ancient In all primitive societies priest, magician, times are in use even today. Vegetables, fruits, and physician were one and the same, and the juices of plants and snails, and the urine of medicine was practiced in a way we call today bulls and humans have been used for treating folk medicine.’ Scientific medicine devel- numerous disorders of the head and neck oped from this folk and magic medicine. area. In northern Greece in remote villages, Medicine as a scientific system began as a acute otitis media is still treated by dropping Mediterranean phenomenon, whereas the de- human urine into the ear canal, and in west- velopment of a rational, scientific concept of ern Bohemia nasal catarrh is treated by having disease not as a demon or something inside the patient inhale a child’s warm urine. For the body, but as altered physiology, is essen- treating diseases of the throat, folklore reme- tially modern. This turn of mind is believed to dies include the use of the juice of crabs, the date from the middle of the 16th century with ashes of a burnt swallow, cabbage, nettles, gar- Claude Bernard. lic, sorrel, and injection of butter boiled with Otolaryngology followed closely the path of honey. In Morocco on the 25th of March rain medicine. The oldest traces of information re- water is collected to be used for curing dis- garding ear, nose, and throat diseases are to be eases of the ear and nose. For treating epistax- found in folk medicine, which is probably the is several remedies have been also used oldest form of medical practice and was per- among different people, including cold water petuated by speech rather than by writing.’ and vinegar or salt applied to the forehead of The history of otolaryngology can be classi- hands and feet,’ various prayers, the use of fied into the following periods: (1) what has the patient’s own blood to write the words come down to us through the ages by way of “consummatum est” on his forehead,3 frying legends and folk medicine; (2) information one’s own blood and applying it a snuff ,4 and from the prehistoric age (before 4000 BC); (3) various plant and animal products. the Egyptian, Minoan, and Chinese periods; The ear as an organ of reproduction is found (4) the Greek and Hindu periods; (51 the Ro- in Indian, Mongolian, and Persian legends man, Byzantine, and Arabic periods; (6) the and also in the writings of Rabelais and Mo- Middle Ages and the Renaissance periods; liere.’ The size and shape of the ear was sup- posed to determine the character of the indi- viduals Small ears denoted high mental abil- From the Department of Otolaryngology, University of Crete, Heraklion, Crete, Greece. ity and large ears indicated dullness. Also, Address reprint requests to Emmanual S. Helidonis, large noses were connected with the sexual MD, FACS, Department of Otolaryngology, University of organs and there was thought to be a relation- Crete, PO Box 1218, Heraklion 71110, Crete, Greece. Copyright 0 1993 by W.B. Saunders Company ship between the size of the nose and the size 0198-0709193/1408-0002$5.00/O of the penis.5 382 American Journal of Otolaryngology, Vol 14, No 8 (November-December), 1993: pp 382-393 HISTORY OF OTOLARYNGOLOGY FROM ANCIENT TIMES 383 EGYPTIAN, CHINESE, AND crushing injuries of the neck, deafness and the MINOAN OTOLARYNGOLOGY loss of speech is mentioned. Hyperacusis also is described, which accompanies fractures of The oldest historic phase of medicine the temporal bone. In Smith’s papyrus frac- known to us is that of ancient Egypt. Egypt ture of the nasal septum is presented as the came second only to Mesopotamia in achiev- cause of disfigurement and epistaxis, which is ing civilization, around 2700 BC.~ Our main prevented by nasal packing. Besides trauma, sources of knowledge of Egyptian otolaryngol- infections are also discussed along with their ogy are the medical papyri, the well-splinted treatment. fractures of the Fifth Dynasty (2750-2625 BC), Emery described two tablets dating from the and certain pictures engraved on the door- beginning of the dynastic period, one belong- posts of a tomb in the burial ground near ing to Aha and the other to Djer.’ They show Memphis (2500 BC).~ Egyptian medicine is re- a person sitting and directing a sharp instru- flected in the papyri of Ebers, Kahoun, Hearst, ment towards the neck of a kneeling person. and others, and it is a mixture of magic and Vikentieff believes that this was a magical cer- important elements of pharmacology and emony tracheotomy meant to insufflate life anatomy. into the aged king9 (Fig 1). Egyptian medicine A considerable number of names and biog- also developed fields of specialization. Hero- raphies of ancient Egyptian physicians are dotus, in regard to the practice of medicine in known. The earliest physician was Sekhet’ Egypt, writes, “Each physician is a (specialist) enanch who lived about 3500 BC and of whom in one illness and in no more . some are set it is said that “he healed the king’s nos- as Ophthalmologists other as (physicians) of trils.“‘v3 The most famous is Imhotep who the middle body cavities, and other of Internal lived around 2800 BC. He was the prime min- illnesses.“” ister of the Pharaoh Djeser of the Third Mem- Egyptians seemed to understand well the phite Dynasty (before the ancient empire). He anatomy of the nose and its relationship to the was later adored and believed to be a descen- bases of the skull and brain. Herodotus de- dant of the god Ptah himself. scribes in detail the technique for mummifi- In Eb (854~) it is written that the deaf man cation practiced by the Egyptians: “As much cannot open his mouth, and in Eb (418) nasal as possible of the brain is extracted through cattarh is mentioned. For its treatment, the the nostrils with an iron hook, and what the milk of a woman who has a male child is hook cannot reach is rinsed out with drugs. mixed with an odiferous glue and this mixture The drawback lays in the fact, that the nasal is then inserted into the nose for the treatment septum, was destroyed which resulted in a of rhinorrhea. Surgery of the ears is also dis- slight flattening of the nose.“” cussed and several recipes are described During almost the same period as ancient many times in other undeciphered languages. Egypt the island of Crete made more rapid One of them, Eb (422), is a magig formula progress towards civilization. It is through the which is pronounced in the ancient language well-documented contacts with Egyptian his- of Kjtj, spoken by the people from the island of Crete. The Ebers papyrus, with extensive sections on the ear,7 was obtained by George Ebers at Thebes in 1872, and is dated to about 1550 BC. However the most valuable medical papyrus is that acquired by Edwin Smith (1722-1906) at Thebes in 1862. rm In Edwin Smith’s papyrus (1600 BC) are written 48 cases of clinical surgery covering, among others, injuries to the head, nose, and 7-mI temporal bone. Deafness is mentioned as re- Fig 1. Plaque illustrating a tracheotomy? (Courtesy of Cairo lated to fracture of the temporal bone. In Museum.) ?T 384 EMMANUEL S. HELIDONIS tory that the cultural sequence of Crete can be so closely dated. Crete is indeed first men- tioned in records of the middle kingdom un- der the name of Keftiu, biblical Caphtor.’ Egyptian and Cretan culture no doubt evolved at approximately the same time and attained great heights. But their ideas did not cross- fertilize. Both countries were completely sep- arated and only in later times were some trade relations established.ll The 300 years preceding 1450 BC marked the zenith of Minoan civilization. Crete was densely populated. It was Homer’s rich and Fig 2. Kidney-shaped ceramic resembling an emesis basin of lovely land, boasting ninety cities.” The unknown use. (Courtesy of Heraklion Museum.) records of the Minoan civilization show that health matters were of the utmost importance. Minoans believed in two goddesses who were her attention to the healing of the particular directly related to medicine: the curing god- anatomic structure or to express gratitude for dess or “Poppy Goddess” (Sakelarakis),13 and her help in hea1ing.l” the fertility goddess who was worshiped in The following interesting items relating to the caves of Lithia and Inattos. Knowledge of otolaryngologic diseases are found in the Her- Minoan medicine comes mainly from study- aklion Museum (Crete]: an ivory idol sugges- ing frescoes, idols, sculpture, instruments, tive of hemilateral facial paralysis (2500-2000 and various written documents. Doro Levi, an BC; Fig 31, an idol showing a left lateral neck Italian archeologist, says the following about the anatomic details of Minoan sculpture. “On the harvester’s vase the profile of the fig- ures is pictured.