The Journey of Discovering Skull Base Anatomy in Ancient Egypt and the Special Influence of Alexandria

Ali M. Elhadi, M.D.; Samuel Kalb, M.D.; Luis Perez-Orribo, M.D.; Andrew S. Little, M.D.; Robert F. Spetzler, M.D.; Mark C. Preul, M.D.

Disclosures

Neurosurg Focus. 2012;33(2):e2 

In This Article

Rise of the Greek Empire in Ancient Egypt

Egyptian civilization began to weaken by the end of the 26th dynasty (685–525 BC) as the Egyptians struggled with the Persians. Finally, in 332 BC Alexander the Great conquered Egypt as part of his conquest of the Persian Empire. During this period, the father of medicine, Hippocrates (460–370 BC), accumulated considerable anatomical knowledge of the brain as mentioned in his collections Corpus Hippocraticum, which includes about 70 medical works. For example, one description of the brain from the corpus is as follows: "The brain of man, as in all other animals, is double, and a thin membrane divides it through the middle."[24] Another example states that "the same thing applies to the membrane which surrounds the brain: for when, by sawing the bone, and removing it from the meninx, you lay the latter bare, you must make it clean and dry as quickly as possible, lest being in a moist state for a considerable time, it become soaked therewith and swelled; for when these things occur, there is danger of its mortifying."[23] Whether Hippocrates himself wrote the corpus remains a mystery. The volumes may have been produced by his students and followers who practiced medicine and dissections in Egypt.

Compared with the earlier papyri, the Hippocratic writings exhibit an improved understanding of brain function and anatomy.[30,34] The corpus attributed primary control of the body's function to the brain, which was likely based on direct observations of injuries or maladies affecting the head: "For this reason I consider the brain to be the most powerful organ of the man's body for when it is healthy it is our interpreter of the impressions produced by the air; now, the air gives intelligence. The eyes, the ears, the tongue, the hand the feet, act according to the brain's understanding; in fact, the whole body participates in the intelligence in proportion to its participation in the air; now, the brain is the messenger for the intelligence."[23] The Hippocratic writings also tracked the arterial supply of the brain to the carotids arteries: "The remaining part of it rises upward across the clavicle to the right side of the neck, and is superficial so as to be seen; near the ear it is concealed, and there it divides its thickest, largest, and most hollow part ends in the brain."[23]

In 332 BC, Alexander the Great conquered Egypt as part of his conquest of the Persian Empire. Including the entire Persian Empire, Alexander's dominion was composed of Anatolia, Syria, Phoenicia, Judea, Gaza, Egypt, Bactria, and Mesopotamia and extended as far as Punjab and India. His conquests opened communication and the exchange of culture and knowledge over a vast region previously composed of largely hostile neighbors. The Egyptians welcomed Alexander as a man who would free them from Persian rule. Once he entered the capital Memphis, he declared himself as the legitimate successor of the pharaohs. Nonetheless, he seemed to have allowed the resident cultures to flourish.[13]

Alexander stayed in Egypt for about a year and founded the city that bears his name, Alexandria. For a time, because of its library and museum, this city harbored the greatest concentration of the world's recorded knowledge, not only in holdings of writings, but also in attracting philosophers, teachers, and those who can be called early scientists. Alexander founded this city on a site that was well known to the Greeks, as described by Homer in The Odyssey: "There is an island called Pharos in the rolling seas off the mouth of the Nile, a day's sail out for a well-found vessel with a roaring wind astern. In this island is a sheltered cove where sailors come to draw their water from a well and can launch their boats on an even keel into the deep sea."[25]

Alexandria is where the systematic study of anatomy appears to have begun, and in those efforts we find evidence of investigation of the cranium. The Musaeum, or Mouseion at Alexandria, which included the Royal Library of Alexandria, was founded by Ptolemy I Soter (323–283 BC) or by Ptolemy II Philadelphus (283–246 BC)[13] and was continuously supported by the Ptolemaic royal family (Ptolemy III is credited with founding a smaller library nearby).[3] The Library, at one time holding perhaps as many as 700,000 texts, was a part of the Mouseion. Rather than being simply a museum, it was an institution for the best scholars of the Hellenistic world. Archimedes, Aristarchus of Samos, Callimachus, Euclid, Herophilus, Erasistratus, Pappus, Hero, and others performed what appear to be well-organized scientific investigations and active education. They were supported with meals, rooms, and servants, and the facility was overseen by an administrative priest of the pharaoh.[6]

Mouseion facilities were located in several parts of Alexandria, including theaters, lecture halls, gardens, roofed walkways, residential quarters, a communal dining room, and several private study rooms where scholars shared ideas, studied, conducted research, and were supported by servants, staff, and scholars (perhaps as many as 1000 lived in the campus-like facility), as noted by Bagnall (Fig. 6).[3,6] We can infer that there was at least some space specifically devoted to the study of anatomy, where the first documented and detailed human and animal dissections, including those of the brain and skull base, were performed.[22] "Doubtless the Egyptian of the period considered the work of the Ptolemaic anatomists an unspeakable profanation, and, indeed, it was nothing less than revolutionary—so revolutionary that it could not be sustained in subsequent generations… . [T]he great Galen, at Rome, five centuries after the time of Herophilus, was prohibited from dissecting the human subject."[22]

Figure 6.

Left: A map of Alexandria by M. Bonamy, which is the oldest known reconstruction of the city, originally from a presentation of August 31, 1731. Note the Bruchion area and the designation of the Museum, which is probably accurate, although other sites, such as the Serapaeum, are not. Image available in Bonamy M: Description de la Ville d'Alexandrie, telle qu'elle estoit du temps de Strabon, in Histoire de l'Académie Royale des Inscriptions et Belles Lettres 9:416–432, 1736. Right: Artist's conception of the Royal Library of Alexandria. Image available in Castaigne JA: In the time of the Ptolemies: The Alexandrian Library, in Harper's Weekly. New York: Harper Brothers, 1908.

The Mouseion and Library flourished until about the time of the Roman conquest of Egypt in 30 BC or perhaps later in AD 272, when, under the orders of Aurelian, a section of Alexandria (the Bruchion, or palace quarter, along the beautiful coastline) was burned.[18] Destruction of the Mouseion and library appears to have occurred over centuries and at the impetus of various people or groups.[18] As with most ancient locations in cities, stones and blocks of the destroyed Mouseion and library were used to construct other buildings that now reside over the ancient structures. Today, it is difficult if not impossible to exactly locate the original structures. Visiting the beautiful coastline of Alexandria today, one can only imagine the grandeur and revolutionary exploratory spirit that must have pervaded the area.

Of significant impetus to the study of anatomy was the establishment of a medical school in Alexandria around the end of the 3rd century BC.[37] The medical school was probably integrated into studies at the Mouseion and may have even been part of it. It is in Alexandria that Aristotle's notions on biology were first challenged. We can trace systematic anatomical studies of the cranium, even of the skull base, and the beginnings of definitions of the origins of cerebral arteries and nerves to several key figures who performed their work in Alexandria at the medical school and the Mouseion.

The next sections of this article review the work of Herophilus, Erasistratus, Rufus, and Galen with regard to cranial anatomy and their significant tenures in Alexandria. No other ancient center had as much influence on the knowledge of medicine and anatomy as Alexandria.

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