Ancient Egyptian civilization is one of the oldest cultures in human history. Ancient Egyptians are well-known for pioneering the fields of art, medicine, and the documentation of discoveries as mythological tales.
The Egyptians mastered the integration of anatomy and mythology into artistic symbols and figures. The mythology of Isis, Osiris, and Horus is arguably one of the most recognized mythologies in ancient Egypt.
The Eye of Horus was used as a sign of prosperity and protection, derived from the myth of Isis and Osiris. This symbol has an astonishing connection between neuroanatomical structure and function.
Ancient Egyptians mastered the integration of anatomical knowledge and mythological stories into artistic symbols and figures. Artistically, the Eye is comprised of six different parts. Mythologically, each part is considered to be an individual symbol.
Anatomically, each part corresponds with the center of a particular human sensorium. For many years, the Eye of Horus was considered as a symbol of prosperity and protection by the ancient Egyptians, and its legacy continued into modern Egypt as well.
In Ancient Egypt, light and fire, which were closely related to the Sun God Ra, were the sources of life and well-being, while the dark meant danger and death. Similar to death, darkness drops on human beings in deep sleep and they enter a space inhabited by shadows.
Dreams were believed to reveal an unknown world, to give the sleeper a glimpse into the future. Vision attracts distant objects and their light, on the other hand, can hurt the eyes like a burning flame.
Eyes were the most important organ in Egyptian thought, as they allowed perception of the real world. Their importance has been immortalised in the myth of the Eye of Horus that explains the role of either eye.
One represents the moonlight, which disperses the darkness of the night, and the other represents the sunshine, which creates life, and both could also represents the power of human intellect. Blindness, in turn, congenital or disease-related, was considered a divine punishment.
A man, thus handicapped, would sink in a state of uncertainty and darkness. To protect the eyes from blindness, people used drops and ointments, which were believed to chase away all kinds of insects and demons that threatened with a variety of eye infections.
Egyptian eye doctors or physicians, carried a special kit that contained green chrysocolla and a black kohl makeup, highly appreciated as prophylaxis because they personified Osiris’ humours or body fluids. These products were offered to Gods to restore the brightness of divine glance and incite sun and moon to spread their beneficial light.
Mythology is a creation of the human consciousness that attempts to interpret events and observations that are beyond the scope of systematic scientific discourse.
Myths are those stories that have evolved in response to the great questions that concerned people in distant ages, when human thought was not able to verify objective truth.
For every people, mythology operates as the beginning of their history. Among the various mythologies created by different peoples, Greek mythology has surpassed many boundaries of time and space.
In addition to having been widely disseminated by the Romans, the Greek myths are universal and anthropocentric, with man at their center. The myths were created in a period when scientific dis-course played a minor role in the life of society, and theoral language used neither theoretical abstractions norrational concepts.
As such, the myths that contain the thoughts of the Greeks on life, the law, and natural and social paradoxes embody elements of important philosophical thinking at a time well before philosophy developed into a science. Moreover, they also contain important aspects of medical knowledge.
As an example, the myth of Prometheus hides an important medical observation. Prometheus stole fire from the gods and gave it to man. To punish him for this, Zeus left him chained to a rock on Mount Caucasus, suspended over a terrifying precipice. Every day, an eagle would come and eat away at his liver, and every night it would regenerate.
This immediately raises the question of why the eagle did not eat another organ—the lungs or kidneys, for instance—or indeed why not Prometheus’ flesh?
Might the choice of the liver in this myth indicatethat the ancients were aware that, unlike other organs, the liver regenerates? It is interesting to speculate under what circumstances they could have acquired this knowledge.
Greek myths contain a number of other medical references, including some related to ophthalmology.
The main ancient Greek sources containing material relating to mythology. Those sections relating to an understanding of vision, visual abilities, and the eye, including inherent andacquired abnormalities, blindness, injuries, and treatment, were identified.
In ancient Greek mythology, the physician–healer often had a divine status and was represented by Apollo himself, who was the first ophthalmologist. It was to Apollo that, much later, the Hippocratic physicians would swear their oath.
Medicine, as both a form of knowledge and a skill possessed by the god–healers, was taught to a succession of heroes and great physicians. Apollo was connected genealogically to a series of deified physicians, the first being his son Asclepius, whom Homer referred to as an excellent physician.
The word ophthalmos, from which the term ophthal-mology is derived, appears often in Homer’s epic poetry:“Athena aimed the arrow towards the nose, near the oph-thalmos [eye] and pierced the white teeth”.
Asclepius was taught the healing art by the centaur Chiron, a mythical being with the head and torso of a manattached to the body of a horse.
His presence as a teacher of the art of medicine is connected with the knowledge anduse of the medicinal herbs of the Greek earth. Asclepiusthen taught medicine to his sons Machaon and Podalirius, the most prominent physicians in the Homeric epics.
In accounts of external eye diseases, the descriptionsgiven of “knyzosis” are particularly interesting. With the term “knyzosis,” Homer refers to an eye condition that Athena inflicted on Odysseus.
This gave his eyes an unpleasant appearance, although without decreasing their vision, and was accompanied by an itchy feeling. The goddess inflicted this illness on Odysseus to change his appearance temporarily so he would not be recognized once he returned to Ithaca. Homer characterizes the person without the sense of light as “blind”.
There are many references to transient or permanent amaurosis in Homer. Achilles experienced a transient loss of vision during his battle with Aeneas, which is attributedto an intervention by Poseidon.
After Diomedes had been injured by a perforating wound to hisright shoulder while fighting at Troy, Athena had lifted the mist from his eyes so he could fight on. Among the myths that refer to the centaur Chiron isone about his treatment of the blind Phoenix, who had accompanied Achilles to Troy.
“This Phoenix had been blinded by his father on the strength of a false accusation of seduction preferred against him by his father’s concu-bine Phthia. But Peleus brought him to Chiron, who restored his sight, and there upon Peleus made him king of the Dolopians”.
Ocular trauma is one of the most frequently mentioned eye conditions described by Homer, perhaps because such injuries involve relatively easily understood pathologies. We have descriptions of globe rupture, such as when Menelaus struck Peisandros with his sword.
The blow was on the forehead, above the bridge of the nose; the bones were broken and both eyes fell down into thedust at Peisandros’ feet.
A similar wound was inflicted by Patroclus on Hector’s charioteer, Cebriones, whom he struck with a stone on the fore-head, across both eyebrows. The frontal bone broke andboth Cebriones’s eyes fell into the dust.
In Greek mythology, we can discern well-documented references to the transmission of medical knowledge, starting from the centaur Chiron, who is represented in mythology as a polymath.
This is reflected in the necessary range of knowledge that a physician should have and in his all-around education, which required that he learn medicine as part of his general knowledge and skills.
Chiron was a true teacher, teaching his students about the body and the soul. The transmission of medical knowl-edge, which originated in the gods and was then transmitted from father to son, influenced the Pythagorean philosophers and ultimately found expression in the Hippocratic oath.
The Homeric epics incorporated very ancient Greek myths, and they contain identifiable descriptions of illnesses and wounds, many of which relate to the eye and itsfunctions. The knowledge of anatomy evident in Homer’s writing implies advanced observations made during injury, clinical practice, external postmortem examinations, and certainly during dissection of animals.
It is only to be expected, however, that knowledge of physiology would be limited to the major and clearly obvious functions. The myth of Panoptes with eyes over all his body suggests the possibility that the ancient Greeks understood the concept of the visual field of the human eye.
The visual field is the space that one eye can see while remaining fixed. Panoptes was able to comprehend the space that surrounded him to its full extent. The literal placement of eyes all over Panoptes’ body, rather than the use of a metaphorical expression such as “eyes in the back of his head”, reflects an understanding of the limited visual field of two eyes alone.
In the case of Panoptes, the idea of visual field may also have been connected with visual acuity. Visual acuity refers to the eye’s ability to see an in-focus image and resolve fine details at a standardized distance.
Panoptes acuity in discerning fine detail made him an excellent guard. The myth about Odysseus’ eye condition described as “knyzosis” infers an eye disease, the symptoms of which were well known.
The differential diagnosis involves conditions such as severe ocular trauma, extensive central leukomas of the cornea, strabismus, and madarosis. The absence of decreased vision and the presence of itchiness, however, exclude traumas and leukomas.
In the case of strabismus, vision can be unaffected (e.g., alternating tropias) yet it is not accompanied by itchiness. Consequently, madarosis is considered to have been the most likely diagnosis for Odysseus’ eye condition.
Madarosis is present in a variety of local (infectious ble-pharitis, seborrheic blepharitis, eyelid malignancies), skin(psoriasis, generalized alopecia, rosacea, atopic or contactdermatitis), and systemic disorders (myxoedema, sys-temic lupus erythematosus, syphilis, leprosy), as well astrichotillomania.
Of the many clinical entities that arerelated to madarosis, particular deformation of the eyelids can be caused by blepharitis due to Phthirus pubis.
Achilles’ case of transient amaurosis could be attributed, given the military context of the epics, to nonorganic visualloss (conversion reaction).
Patients with a conversion reaction, previously called hysterical blindness, react to environ-mental stress. A conversion reaction of hysterical blindnesson the battlefield is a reported expression of battle fatigue.
Diomedes experienced transient bilateral blurred vision, possibly due to hemorrhaging, as blood loss from his battle wound could have reduced vision by two different mechanisms;
First, in primary or secondary vasospastic syndrome, patients respond with spasm to stimuli such as cold or emotional stress. Secondary vasospasm can occur in a number of clinical entities, including hemorrhage.
The eyes are frequently involved in the vasospastic syndrome, and ocular manifestations of vasospasm includealteration of conjunctival vessels, corneal edema, retinal arterial and venous occlusions, choroidal ischemia, amau-rosis fugax, transient sudden visual loss, anterior ischemicoptic neuropathy, and glaucoma.
Second, it is possible that there was a pre-existing case of mild vertebrobasilarartery insufficiency, which, as a result of the reduced arterial pressure due to the significant hemorrhaging, was clinically manifested as transient bilateral blurred vision.
Our exploration of the mythological references impels usto seek the logical causes of Phoenix’s intentional blinding by his own father. The story contains only limited data, but these suggest an acquired and treatable condition for which there are several possible explanations.
Reduced vision could occur from corneal edema after thermal or mild chemical burns. Another hypothesis is the use of atropinelocally on Phoenix’s eyes, which could cause paralysis of accommodation (cycloplegia) for a period of up to two weeks. Atropine is an alkaloid obtained from the plant Atropa belladonna, or deadly nightshade.
Vision is signifi-cantly blurred and it is impossible to focus at close dis-tances. Finally, blindness could be caused by methyl alcoholintoxication. Methyl alcohol was produced by pyrolysis of wood and is used in methylated spirits and surgical spirits.
While methanol itself is only mildly intoxicating, it is con-verted to highly toxic metabolites (formic acid) responsiblefor acidosis, blindness, and potentially death. Similar reasonable questions can be asked of Homer’s references to ocular congenital abnormalities.
Holoprosencephaly is a congenital malformation of the fore brain and mid-face. Holoprosencephaly can be caused by disturbances early in embryogenesis, before or during gastrulation, that result in a complex anomaly involving not only the eyes but also the anterior part of the brain and the mesodermal structures.
It is surprisingly frequent during early embryogenesis, but since mostaffected fetuses are stillborn due to anomalous develop-ment of the brain, holoprosencephaly is rare in live births.
The anatomical structures of the two eyes may be either completely (cyclopia) or partially (synoph-thalmia) fused to form an apparently single eye within a single orbit in the middle of the forehead. This appearance could well underlie the ancient legend of the Cyclopes.
From the descriptions of injuries, especially those mentioned earlier, we can deduce cases of evisceration. In the cases of Peisandros and Cebriones, the phrase used in the Iliad, “the eye fell down in the dust beside his feet,” implies rupture of the eyeball with preservation of the sclera and extraocular muscles.
The description of the blinding of Polyphemus employs the term “rizai” namely the “roots” of the eye, which may have been used to denote the optic nerve. Other ancient Greek writings similarly liken the optic nerve to roots; for example, in Galen we find “the nerves of the eyes appear to be some kind of roots”.
In the treatment regimes described by Homer, we notice a correlation between the myth on one hand and the empirical methods and practices regularly applied on the other. The case of the “licking” treatment and the story of Melampus is characteristic, and a medical explanation can be put forward.
For bacterial keratitis to become established, micro organisms must bind either to a defect in the continuity of the corneal epithelium or toexposed corneal stroma. In any case of bacterial keratitis, treatment is directed toward stopping the proliferation of bacteria, minimizing inflammation and pain, and encour-aging corneal healing.
As such, treatment by licking appears to have been effective because it mechanically removed bacteria from the points where they had bound to the cornea and the necrotic stroma, thus reducing the proliferation of harmful micro organisms.
Moreover, it ispossible that the snake saliva had an antiseptic, anti-bacterial, and anti-inflammatory activity and that this was beneficial in stopping bacterial keratitis. This treatment was still applied by the Greek people until the 19th century, and it was used by Professor G. Kostomiris in the 1880s.
The study of mythological references to ophthalmol-ogy suggests that these accounts in fact hide reliablemedical observations of the ancient Greeks.
With the development of philosophy and scientific thinking by the Ionian philosophers, this knowledge was to eventually lead to a search for the etiology involved in the observations and to take the form of modern medical science, which acknowledges Hippocrates as its father.