9 B.C.: The first mouth to mouth respirations

This painting from the early 1920s depicts Elisha after
he gave mouth to mouth breaths to revive a Shunamite boy

Mouth-to-mouth breathing was a technique that must have been trialed from time to time by ancient physicians as a last ditch effort to save a life. When it was first attempted will forever remain a mystery, although the first known description of it appeared in the Bible in the Second Book of Kings.

Elisha was born in 9 B.C. When he was a young man he met the prophet Elijah and became his faithful disciple. Elijah at this time was a very old man: he was something like 841 or 821 years old according to the Bible.  

While still a young man he observed his master lifted up to Heaven in a fiery chariot, and he said, "My father, my father, the chariot of Israel...!"  At that moment he stripped off his clothes and declared that he was the successor of Elijah, and his job was to spread the word of the Lord.

The Bible described him as performing many miracles through the guidance of the Hebrew God.  In the Second Book of Kings he is described as successfully resuscitating (or reanimating) the child of a Shunamite woman with mouth to mouth breathing:

And he went up, and lay upon the child, and put his mouth upon his mouth, and his eyes upon his eyes, and his hands upon his hands: and he stretched himself upon the child; and the flesh of the child waxed warm. Then he returned, and walked in the house to and fro; and went up, and stretched himself upon him: and the child sneezed seven times, and the child opened his eyes. (II Kings 4: 34-5)

The depiction here may have been the first recorded use of mouth to mouth breathing. This would entail the physician, in this case the prophet Elisha, placing his mouth over the child's mouth and nose, and exhaling. This would force a positive pressure breath into the child's air passages, thus providing the child with an artificial breath. This procedure may have been performed, albeit rarely, in both the ancient and primitive worlds.  (1)

This scene is estimated to have appeared during the 8th century before the birth of Christ. It is highly likely the procedure was learned by Elisha while he was in training, as most learned individuals of this time were educated in all knowledge of the day, including medical wisdom. So it is highly likely the procedure was tried before in a last ditch effort to save a life.

References:

1. Price, J.L., "The Evolution of Breathing Machines," Medical History, 1962, January, 6(1), pages 67-72; Price references The Bible, Kings, 4: 34

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400-1743: The first use of the term influenza

In the ancient world all diseases were attributed to the wrath of the "diety." If a Pandemic ravaged a village, town or nation, it was attributed to an angry god or spirit.  Both the ancient Greek poet Homer (800-701) and Hippocrates (460-370) described pandemics during their lifetimes.  It's probable some of these were attributed to the influenza virus.

Homer describes how Zeus used his thunderbolt to "punish impiety," and "for vengeance for an insult offered to his priest, the shafts of the Sun-god carried sickness into the Argive camp, destroying first the dogs and mules, and then thousands of warriors," writes Arthur Hopkirk, in his 1914 book "Influenza."  (1, page vii and viii)

In reality these warriors may have died of a pandemic caused by a virus or bacteria, such as influenza.  Although the ancients had no clue about the internal workings of the human body, nor about invisible invaders of the human body.  It was easier for them to believe in fake gods and attribute them when bad things like plagues happened.

"On mules and dogs th' infection first began;

And last, the vengeful arrows fix'd in man."

Those described as having sweats and chills (signs of a fever) were the most likely to succumb to the disease.  In man's desire to help his fellow man, the following were the remedies tried (1, page 15-16):

• Purging
• Venesection
• Bleeding by the ranal vein
• Emetics

And sometimes the remedy wreaked more havoc than the plague.  If ruthless venesection was performed, this in and of itself could have been the killer.  Yet the plague was blamed nonetheless.

The plague struck again and again.  In 412 B.C. the following was written regarding a plague in Rome (1, page 16):

“A plague, however, which broke out at that time and gave more alarm than it proved destructive, diverted the people’s attention from the forum and political disputes to look after their families and take care of their health. The city was all over oppressed with sickness, though no great mortality ensued.”

It struck again (or so historians think) in (1, page 20-26)...

• 827 A.D. in France and Germany
• 876 in Italy
• 889 in Germany
• 927 in France and Germany
• 996-97 in England
• 1173 in Germany and Italy (it was called "a dense fog" in Italy, first authentic outbreak)
• 1239
• 1311
• 1323 in Italy and France
• 1327-28
• 1357
• 1287 in France and Germany
• 1403 in Paris, France
• 1404
• 1410-11 in France
• 1413-14 in France
• 1427 in France caused a "Poisonous air."
• 1438
• 1482
• 1505
• 1510

The following quote comes from 1323 (3):  

In the year, 1323, and in the month of August, there was a pestilential wind, which caused nearly all the inhabitants of Florence to fall sick of cold and fever, and the same thing took place throughout almost of whole of Italy.

And the following from 1327 (3):

In the said year and month, there was throughout the whole of Italy an infection fever caused by cold; but few people died of it.

Regarding the 1387 outbreak, the following was written (4):

There came a general pestilence in the whole country, with cough and influenza, so that hardly one among ten remained healthy. 

Regarding the 1427 outbreak, an anonymous chronicler from St. Albans wrote (1, page 25-6):

In the beginning of October, a certain rheumy infirmity which is called 'mure' invaded the whole people, and so infected the aged along with the younger, that it conducted a great number to the grave. 

The remedy for the 1387 pandemic, which took few lives, was "decoctions of chamomile and coriander berries, sweetened with syrup and poppies; clymasta; diaphoretics; and low diet." (1, page 23)  This would have been a more pleasant remedy compared to what the ancient Greeks treated the symptoms.  

Many of the deaths that resulted occurred on the fifth or sixth day, and Hippocrates notes that death usually occurred on the seventh day.  Later, in the first century A.D., Galen agreed with Hippocrates that death usually occurred on the seventh day.  (1, page 17)

At some point in our history, sometime in the ancient world, the concept that little creatures in the air may be responsible for spreading some diseases was postulated, although who postulated this theory, and when, remains a mystery.

Hopkirk says the first to write of this concept may have been the Greek "polyhistorian" Varro (117-36 B.C.), who wrote the following:

It is to be observed that wherever there are marshy districts certain most minute animals will grow, which cannot be discerned by the eye; but, carried by the air, reach the body through the mouth and nostrils, causing serious disease." (1, page x)

Varro was referring to the malaria plague in "Corfu when Pompey was there with an army and fleet."  Although the same concept may be applied to other contagious diseases, such as influenza.  Varro recommended the following to prevent the spread of the disease malaria: (1, page x)

• Isolation
• Ventilation
• Destruction of insanitary dwellings
• Etc.

Influenza is known to cause much grief for those afflicted with it, although it causes only a few deaths.  Usually those who die from it are over the age of 65 or have some chronic underlying medical condition that is complicated by influenza.

Prior to the 16th century influenza was referred to by various names, depending on the geographic region of the person describing it.  Sometimes it was simply referred to as a pest, pestilence, or plague.  Historians determine if the "plague" was influenza by descriptions of the symptoms, a high morbidity, yet low mortality rate.  If many deaths resulted, chances are that particular plague was not influenza. (1, page 4-5)

The term influenza may actually have come from a misinterpretation of the Italian word influence.  The idea here is that around 1357 people believed the position of the stars "influenced" outbreaks of the disease.  Although how this term superseded all the other terms and made it's way into medical nomenclature remains a mystery.  (1, page 6)(2, page 31)

The following are just a few other names used to describe various pandemics or endemics most historians figure were influenza (1, pages 8-9):

1. Burzelen:  1307 in Germany (meaning to stumble?)
2. Le tac or le horion:  1411 in France
3. Tonawasches Fieber:  1414 in Germany (Because occurred in Danube district)
4. Coqueluche: 1414 in France (Caused oppressive pain in the head)(Victims wore cap on head)
5. Ladendo:  1427 in France
6. Schafkrankheit or Schafhusten:  1580 in Germany (Sheep's disease, cough)
7. Galanteriekrankheit or Modefieber: 1709 in Germany (Galant malady, fashionable fever)
8. Le Grippe:  1743 in France (from "agripper," meaning to sieze quickly and cause sore throat
9. Petite poste or petite courrier:  1762 in France
10. Zamporina:  Brazil in 1780
11. La Coquette:  France 1780-81
12. Russische Krankheit (lightning catarrh):  1782 in Germany (due to its sudden onset)
13. Corcunda (hunchback disease):  Brazil in 1816.  Violent cough made you hunch your back
14. Polka Fever:  1846-7 in Brazil

In Great Britain during the 14th and 15th centuries, common names were faucht and slaodan.  Creatan was a word derived from creat (chest), and was another common name.  In 1562 it was called "the newe acquayntance.  In 1580 "the gentle correction."  It was also referred to as "the jolly rant," "the new delight," "the Dunkirk rant," and "the knock-me-down fever." (1, page 9)

An outbreak in Britain in 1485 was described as "English Sweat." It was so back that "King Henry VII had to postpone his coronation," according to Evelyn Kelly and Claire Wilson in their 2011 book "Investigating Influenza and Bird Flu."  "The disease was treated with tobacco juice, lime juice, and bloodletting." (2, page 32)

Finally, in 1743, the term influenza was used to describe influenza.  No one knows why, but this is the term that stuck, and has since made it's way to medical nomenclature.  The only exception was in Germany, where the Grippe was the term commonly used as of 1743.  

While the names varied through early history, the "grip" the disease held on it's victims were similar:

• Catarrh:  Inflammation of the respiratory tract (nasal congestion)
• Fever:  Usually over 100 degrees
• Chills:  Associated with the fever
• Headache:
• Body or muscle aches: Especially of the back, arms and legs
• Dry cough: Helps spread the disease from one victim to the next
• Fatigue and weakness:  General feeling of tiredness
• Suspended Business: Many stopped working to take care of their families

It's generally the commonality of symptoms described, the high rate of morbidity, and low mortality, that has allowed historians to feel confidence these epidemics and pandemics were probably influenza.  

References:

1. Hopkirk, Arthur F., "Influenza: It's History, Nature, Cause and Treatment," 1914, New York, Charles Scribner and Sons
2. Kelly, Evelyn B., PhD and Claire Wilson, "Investigating influenza and Bird Flu: Real facts and real lives," 2011, Enslow Publishers, U.S., Chapter 2, "The History of Influenza," pages 29-47
3. Hopkirk, op cit,Gluge, "in the course of his argument, quotes the following passages from Buoninsegni’s Istoria Fiorentina, Florence, 1580." The passages are recorded on page 21 of Hopkirk's book.  
4. Hopkirk, op cit, from Jakob von Konigshoven Stassburg Chronicles, of 1387, as recorded by Hopkirk on page 22 of his book

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400 B.C.-200 A.D.: A history of 'vital air'

Air has existed since the beginning of our existence, that we know for sure.  Without air we wouldn't have life, and people must have figured that out at an early date.  They also must have figured out early that breathing is necessary for life, considering when people stop breathing life ends.  (7, page 473)

Primitive people and ancient societies didn't know about air, let alone about oxygen. However, as far back as 1000 B.C., ancient Hindu physicians who wrote the Charaka and Sustrata recognized both the presence of the lungs and the 'prana vayu,' a substance in the air that many historians believe was oxygen. (5)

"Charaka (500 B.C.) mentions the head, the chest, the ears, the tongue, the mouth and the nose as the seat of 'prana vayu.'  Sustrata (1000 B.C) spoke of 'prana vayu' as flowing in the mouth. What else can this 'prana vayu' be identified with," said S.K. Jindal in his 2008 book, "Oxygen Therapy." (5)

Anaximenes of Miletus (585-525 B.C.) believed that air "was the primary principle," and he referred to is at the pneuma, or "the breath of life," said William Henry Osler, the father of modern medicine. He said the "pneuma was described by Anaximens as the "psychic force that animates the body and leaves it at death -- 'our soul being air, holds us together'" (9, pages 38-39)

Yet it was Empedocles (490-430 B.C.), a pre-Socratic Greek philosopher, who first conceived the idea that air contained a substance that was vital to life. He defined air as one of the four basic elements: air, water, earth and fire. Everything that we see is made up of these substances, and health of animals and humans was determined by the equilibrium of these four substances. (9, page 40)

He was also the first to describe respiration:

"As soon as that humidity, of which there is a great store on the first formation of the foetus, begins to be diminished, the air insinuating itself through the pores of the body succeeds it; after this the natural heat, by its tendency to make its escape, drives the air out, and when this natural heat enters the body again the air follows it afresh. The former of these actions is called Inspiration, and the latter Expiration."  (1, page 47-48)

He described how with the inspiration air entered into the body, and that it was circulated through the body by the "continuous motion" of the blood, and that it nourishes the heart and the mind.  Empedocles explains that the heart "nourished in the sea of blood which courses in two opposite directions: this is the lace where is found for the most part when men call Thought; for the blood round the heart is Thought in mankind." (2, page 186)

He also may have been the first to observe of the "faetus in utero" that "respiration commenced before birth."

Aristotle (384-322 B.C.), a Greek philospher and student of Plato (and teacher to Alexander the Great), mentioned "air" as one of the essential elements of life.  He observed that air had weight when he wrote that "a bladder filled with air was heavier than an empty bladder." (6, page 19)

He did not know that there was a difference between arteries and veins, although he did know that both were filled with blood. He also knew that the heart was the key to "circulation" of the vital spirit.  He actually came up with the term vessels as he noted the vessels contained the blood as in a vase. The lungs inhaled the spirits and pneuma from the air from the trachea (which he referred to as the arteria, because it contained air. Hippocrates also referred to the trachea as the arteria. (9, page 72)

Praxagoras of Athens (born 340 B.C.) believed that "pulsation was only in the arteries, and maintained that only the veins contained blood, and the arteries air," writes William Henry Osler.  "As a rule the arteries are empty after death, and Praxagoras believed that they were filled with an aeriform fluid, a sort of pneuma, which was responsible for their pulsation."  He was among the first to study the pulse. (9, page 72)

Archimides (287-212 B.C.), a Greek mathemetician and stronomer, wrote that "air is weighed in air." (6, page 19)

In the 3rd century B.C., Erasistratos (335-280 B.C.) of the School of Alexandria, in Egypt, recognized the relationship between air and blood and that air was essential for life to exist.Around 294 B.C. Erasistratos "taught that arteries carried blood to the various parts of the body; those vessels carried air and air only, and the blood was carried in the other vessels, the veins."  (7, page 473)

He also believed the heart contained no blood (8, page 94)  In fact, Osler explains, it's for this reason arteries got their name, as the term "artery" comes from the Greek term arteria, or air.  The trachea was referred to as the windpipe, or arteria tracheia, also known as "the rough air tube." (9, page 72)

Erasistratos contested that air contained a substance (a pneuma) that, once it entered the body, it was transformed into this "vital pneuma" that was essential for life.  This transformation was performed in the "left ventricle of the heart and, together with blood, results in heat, energy, and life.... a part of the vital pneuma enters the brain where it turns into 'psychic pneuma.'  This psychic pneuma processes sensory perceptions and renders possible understanding and knowledge."  (3, page 8)

Osler adds that this "vital pneuma"  was also the cause of the heart beat, "the source of innate heat of the body, and it maintained the processes of digestion and nutrition." It's sent to the brain where an animal spirit is formed, and this spirit is sent to the nerves of the body to give the person emotion and sensation and motion. Osler explains that when we use the terms "high spirits" and "low spirits," these terms come from the views of Erasistratos and other ancient Greek philosophers.  (9, page 73)

By 70-160 A.D. Athenaeus of Cicilia opened what was called the "pneumatic school" of medicine that "flourished" for many years.  The pneumatic theory held that there was a pneuma in the air that was inhaled, transported to the heart by vessels, and then transported to the rest of the body by vessels.  This pneuma was therefore essential for good health and life, for maintaining a balance of the four humors by maintaining an appropriate level of heat and moisture. (2, page 291)

Aretaeus of Cappadocia (130-200 A.D.), a physician from ancient Greece, believed the heart was "the exciting cause or principle of respiration," according to Hamilton, "being seated in the centre of the lungs, which it inspires with a desire for fresh air. The lungs he did not believe to be susceptible of pain, from being composed of a loose sort of substance like wool; rough cartilaginous arteries, according to him, were dispersed throughout them; they were unprovided with muscles, and furnished only with some small and slender nerves, by means of which their motion was produced." (1, page 32)

Middle Ages diagram of Galen's concept of blood flow

Aelius Galen (130-200 A.D.), a famous Greco-Roman physician, studied the heart extensively  Osler notes that he "studied particularly the movements of the heart, the actions of the valves, and the pulsatile forces in the arteries.  He observed venous blood was darker, and believed it provided nutrition to the body. Arterial blood was thinner and brighter, and this was because it contained an abundance of "vital spirit," or vital air.  Arterial blood was warmed in the left ventricle, and this heat was sent to all the organs of the body.(9, page 80).

Galen also observed, as did Erasistratus, that the veins and arteries communicate by small pores and small vessels that allows for the mingling of spirits and blood. He did not, however, know the blood circulated, as he though it made it's way to the organs by small pores. However, some historians, including Osler, believe he was very close to figuring this out, and if given more time he probably would have. He did not see the heart as a pump, but as a fireplace, notes Osler. (9, page 80)

He believed the purpose of the heart was to warm the blood.  He believed the left ventricle purified the blood and sent pure blood to the vital organs, such as the liver.  (7, page 473)

It should also be known that, according to Phillip Crampton in his 1839 "Outlines of the history of medicine, nothing remains of the writings of Erasistratos, so much of what we know about his anatomical discoveries comes from the writings of Galen. Crampton said that Galen described Galen's view of the passage of blood and air through the body this way:

According to him, the air passes from the lungs to the heart, which performs the functions of a smith's bellows, attracting the air by the dilatation of the left auricle ; from the left auricle it passes by the arteries which contain air, or rather animal spirits, to every part of the body. The veins contain all the blood, and according to this supposition, fever and inflammation are the consequence of any portion of blood passing, by an error loci, from the veins into the arteries. (10, page 519)

Galen supported this view and added to it.  Crampton explains it was Galen who was perhaps the first to describe human respiration:

Some notion of the state of experimental philosophy in the time of Galen, may be formed from the account which he gives of the experiment by which he Convinced the assembled physicians and philosophers of Rome, that air was contained within the cavity of the chest, between the lungs and the pleura costalis; he says he explained to them the manner in which the air passed from the lungs through the cribriform plate of the sethmoid bone into the ventricles of the brain, in which a true respiration was performed, the organ rising and falling in correspondence with the motions of the chest, and the air escaping through the sutures and the palate (10, page 520)

So Galen supported the views of Erasistratos and then expanded upon them. He agreed with Erasistratus that some pneuma in the air was inhaled, warmed in the heart, and sent to the body by a series of vessels and cannals and pores.  He also believed something of waste was exhaled.  He actually proved by experiments Erisistratos wrong when he asserted the arteries contained air not blood.  Galen proved arteries contained blood.  (7, page 473)(9, page 82)

Arthur John Brock, in the introduction of his 1916 translation of some of Galen's works, explains Galen's thoughts on how blood and air flowed through the body:

In his opinion, the great bulk of the blood travelled with a to-and-fro motion in the veins, while a little of it, mixed with inspired air, moved in the same way along the arteries; whereas we now know that all the blood goes outward by the arteries and returns by the veins; in either case blood is carried to the tissues by blood-vessels, and Galen's ideas of tissuenutrition were wonderfully sound. (10, page xxxvi)

He also explained that the "spongy flesh of the lungs acts upon the air we inhale converting it to a subtler product, pneuma.  This refined breath passes through very find 'pores' into branches of the pulmonary vein, and thence is 'attracted,' with blood, by the attractive faculty into the left ventricle of the heart, where it encounters more hot blood and becomes metamorphosed into life giving, i.e. 'vital' pneuma." As the pneuma is 'transported' to the various parts of the body it is further metamophosed.  (4, page 45)

Why were there two sets of vessels for the same fluid? Galen wondered.  And he speculated, as historian William Hamilton notes that:

the great vein (vena cava) was the great reservoir of the blood, while the aorta was the recipient of the spirits, and that, notwithstanding the proximity of the mouths of the veins and arteries to each other, the blood, during the continuance of health, did not enter the vessels in which the spirits flow; but, when this arrangement happens to be disturbed by any violence, that the blood forces its way into the arteries, and occasions more or less disorder of the system. The only use which he assigned to the process of respiration was to supply the arteries with air (what he referred to as vital air).

Yet this is all just speculation, and there were many theories as to what this 'vital air' contained.  Regardless, Galen was so well respected by the medical community that his theory grabbed a hold and held a prominent position in the minds of physicians for the next 1,900 years.  This theory held strong even when better wisdom became available.

References:

1. Hamilton, William, "A History of Medicine, Surgery and Anatomy," 1831, Vol. I, London, New Burlington
2.  Prioreschi, Plinio, "A History of Medicine: Greek Medicine," Vol. II, 1994, 2004, 2nd ed., NE,  Horatius Press
3. Tesak, Juergen, Chris Code, "The History of Aphasia: Theories and Protagonists," 2008, New York, Psychology Press
4. Wilson, Nigel, "Encyclopedia of Ancient Greece," 2006, NY, Taylor and Francis
5. Jindel, S.K.,Ritesh Agarwal, "Oxygen Therapy," 2009,2nd ed., Jaypee Brothers, pages 5-8
6. Tissier, page 19
7. Hill, Leonard, "Recent Advances in Physiology and bio-chemistry," 1908, London, Edward Arnold
8. Garrison, Fielding H, "An introduction to the history of medicine," 3rd edition, 1922, Philadelphia and London, W.B. Saunders Company, page 95
9. Osler, William, "The Evolution of Modern Medicine: A series of lectures at Yale University on the Silliman Foundation in April, 1913," New Have, Yale University Press, 1921,
10. Crampton, Phillip, "Outlines of the history of medicine from the earliest historic period to the present time, intended to illustrate the connextion between the progress of anatomy and the improvements of the healing arts," read before the Royal College of Surgeons on November 29, 1838, published in The Dublin Journal of Medical Science, 1839, Volume 14, Dublin, Published by Hodges and Smith, pages 504-533
11. Galen, writer, Arthur John Brock, translator, "Galen: On the Natural Faculties," 1916, London and New York, William Hienemann and G.P. Putnam's Sons

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124-200 A.D.: Roman physicians describe tracheotomies

Knowledg of mouth to mouth breathing and the operation of tracheotomy was carried from ancient Greece to ancient Rome by the physician Asclepiades of Bythinia. (124-40 B.C.).

Prior to Asclepiades the Romans had a negative view of the harsh medicine of the Greeks, although Asclepiades was able to convince the Romans that Greek medicine could be useful for saving lives and soothing the minds of the sick.

Once again I quote Renouard:

Asclepiades of Bythinia, had the idea of opening a passage for the air, by making an incission into the larynx or trachea; but the authors who report this fact do not describe the operation he adopted. After him, no one dared attempt tracheotomy until Antyllus, who practiced it several times, and described his mode of operating.  (1, pages 448-449)

Antyllus, a Greek physician who lived in Rome sometime between the birth of Jesus and the 4th century (and probably in the 2nd century), had a fragment of his writings preserved by Paulus Aegineta (625-690), some of which provides one of our first accounts of the surgical procedure:  

"The incision should be made in the trachea, under the larynx, about the third or fourth ring. This situation is most eligible, because it is not covered by any muscles, and no vessels are near it. The patient's head must be kept back, in order that the trachea may project more forward. A transverse cut is to be made between two of the rings, so as not to wound the cartilage, only the membrane." (2)(3)(also see 5, page 521)

The GrecoRoman physician Galen (120-200 A.D.) stated that Aesculapius (around 100 A.D.) was the first to recommend tracheotomy, so we may speculate Galen also used it.   Both Aeretaeus (130-200 A.D) and Caelius-Aurelianus (5th century) mention the recommendation by Aesculapius, although Aeretaeus condemned the procedure out of fear the cartilage would not heal, and Caelius talked of it as a rash procedure never put into practice.  (2)(5, page 521)

Galen also described tracheostomies, and described inflating lungs with bellows through a hole in the trachea.  (4) 

Chances are Galen performed his experiments on animals, probably pigs, dogs or apes.  Yet even if he never performed it on a human, his efforts may have been the first mechanical breaths. 

So, like ancient Greek physicains, ancient Roman physicians were knowledgeable of the operation of tracheotomy, and performed experiments that would be picked up by later physicians who would have had better knowledge of anatomy.   

References:

1. Lee, W.L., A.S. Stutsky, "Ventilator-induced lung injury and recommendations for mechanical ventilation of patients with ARDS," Semin. Respit. Critical Care Medicine, 2001, June, 22, 3, pages 269-280
2. Fourgeaud, V.J, "Medicine Among the Arabs," (Historical Sketches), Pacific medical and surgical journal, Vol. VII, ed. V.J. Fourgeaud and J.F. Morse, 1864, San Fransisco, Thompson & Company,  pages 193-203  (referenced to page 198-9)
3. "Biographical Dictionary of the society for the diffusion of useful knowledge," Longman, Brown, Green and Longmans, volume III, 1843, A. Spottingwood, London, page 124-5
4. Szmuk, Peter, eet al, "A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age," Intensive Care Medicine, 2008, 34, pages 222-228
5. Mackenzie, Morrell, "Diseases of the throat and nose, Volume I, 1880, Philadelphia, Presley Blakiston

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870 B.C.: The first description of artificial resuscitation

Elijah resuscitating a child 

Similar to other ancient civilizations, the Jews believed life and death, and health and sickness, were the result of the desires of their God, the Lord. Likewise, in the rare cases when a person was believed to be dead and then brought back to life, this was due to the wishes of their God, the Lord.

No one knows what they called it, although by the 18th century it was referred to as reanimation, and by the mid 20th century it was referred to as resuscitation. Both terms work equally well, as animate comes from the Latin term anamatus which comes from anima, meaning "to give life to" or to breathe. It may also come from the Greed word anemos for wind. Likewise, suscitate is a Latin term for "to stir up or rouse." (1)

The first description of an animation or a suscitation was when, through Adam, God created Eve: 

Adam was all alone in the garden with no one to help him. So, God put Adam into a deep sleep and took one of his ribs and formed it into a woman to be Adam's wife. Adam named her "Eve."

The work of the Lord could also be done through a prophet.  The Lord God had many prophets over the years covered in the Bible, among the first was a prophet named Elijah.  He is believed to have lived in the Northern Kingdom of Israel sometimes around 870 or 850 B.C.  

He is described as performing many miracles through the assistance of the Lord. In the First Book of Kings he is described as resuscitating (or reanimating). A Sidonian widow woman was taking care of him during a drought when her son fell ill and became apparently dead. She approached Elijah with the body of her son: 

Some time later the son of the woman who owned the house became ill. He grew worse and worse, and finally stopped breathing. She said to Elijah, “What do you have against me, man of God? Did you come to remind me of my sin and kill my son?”

“Give me your son,” Elijah replied. He took him from her arms, carried him to the upper room where he was staying, and laid him on his bed. Then he cried out to the Lord, “Lord my God, have you brought tragedy even on this widow I am staying with, by causing her son to die?” Then he stretched himself out on the boy three times and cried out to the Lord, “Lord my God, let this boy’s life return to him!”

The Lord heard Elijah’s cry, and the boy’s life returned to him, and he lived. Elijah picked up the child and carried him down from the room into the house. He gave him to his mother and said, “Look, your son is alive!”

Then the woman said to Elijah, “Now I know that you are a man of God and that the word of the Lord from your mouth is the truth.” (Kings 1: 17-24)

The Sidonian widow at first appears to be angry at Elijah and his God for allowing her child to become sick and to die. Perhaps she doubts Elijah because she is a Sidonian widow and not an Israelite. Once the miracle is performed, she no longer has any doubts that he is a prophet of the Lord, and that he is a healer.

Elijah "stretched himself out on the boy three times." Why is this such a vague description? It was perhaps because the authors of the Bible were not concerned with what Elijah did, as all the Jewish people needed to know about medicine was that the Lord brings sickness and health. By obeying the Lord, the Lord will heal. By disobeying the Lord, the Lord will not heal. That's all people needed to know.

They did not need to know that Elijah was educated in all the wisdom of the land. They did not need to know that among his education involved knowledge of physics, chemistry, philosophy, mathematics, and medicine. They did not need to know that the procedure he performed on the boy was a method of artificial resuscitation. What he did, the method he used, was only eluded to because it did not matter. 

References:

1. Definitions come from merriam-webster.com,  http://www.merriam-webster.com/dictionary/animate and http://www.merriam-webster.com/dictionary/suscitate, accessed 9/26/2013

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5000-50 B.C.: Egyptian gods of healing

If you were sick with asthma-like symptoms, or any other ailment for that matter, in ancient Egypt you would worship one of the gods of health and healing.  You would probably continue to worship one or more of these gods in health in the hopes that you and your family would stay healthy.  

If you traveled to one of the temples or shrines  for health and healing, a revelation would come to you in your sleep, and be interpreted by one of the priests.  If you were too suck to travel to a temple, a physician who specializes in your ailment would be summoned to your home.  In either case, the priest/physician used knowledge, recipes and incantations provided by the gods to heal you.

Yet the physicians were not alone in keeping the gods happy.  This task was also laid upon every citizen of Egypt, and for this reason there were temples and shrines all over the nation.  Henry Sigerist, in his 1951 book, "A History of Medicine: Primitive and Archaic Medicine," said:

The gods and the dead were considered ever present, influencing man's destinies at every moment, with needs that the living had to satisfy. They needed homes, temples, and tombs, and they got the best homes of the country.  They needed food, and received it in the form of sacrifices.  They required constant attention and it was given to them by means of preayers and manifold rites.  The house had a shrine in front of which a lamp was kept burning.  Shrines could be found on the wayside and along the river.  and the traveler stopped for a moment, offering a prayer and a few flowers.  Days of public worship, with processions, dances, and general rejoicing, marked the eternal rhythm of nature, celebrating the fertility of the soil or the completion of the harvest, or commemorating events in the life of the gods. (Sigerist, page 268)

Egyptian Mythology centered in Heliopolis, according to egyptianhistory.about.com. It was based on the Ennead of Heliopolis (near Memphis, in the Nile Delta of lower Egypt), which was "the group of gods who created the world." The creation of the world goes something like this, according to egyptianhistory.about.com:

"In the theology of the Ennead (or ogdoad group) of Heliopolis, there is recognition of a time before there was anything. It was thought there was a creative potential in the primeval water, which was personified as the self-generated Nun. From the waters emerged Atum, the source of all creation, often depicted as the sun god Re-Atum who produced Shu and Tefnut when he masturbated or spat... Ennead means a group of 9, but often the list is larger, including wives, offspring, and a splitting up of Atum-Re into two separate deities. Here are the basic 9": (21)

• Atum (Atum-Re): The spirit that lived inside Nun (see below)
• Shu: Male created by Atum-Re. He represents air or emptiness
• Tefnut: Sister of Shu. She was goddess of moisture. 
• Geb: Earth god - Shu and Tefnut's male offspring
• Nut: Sky goddess - Shu and Tefnut's female offspring
• Osiris: God of the dead - son of Geb and Nut
• Seth: Evil brother of Osiris - son of Geb and Nut
• Isis: Wife/sister of Osiris and mother of Horus
• Nephthys: Goddess of the dead - wife/sister of Seth

These gods were the Ennead, and were essentially the ruling class of the world. There were also four creator gods who created mankind and everything that went with it. These gods were as follows: 

1. Atum: Caused the division of the sexes; as Ra-Atum, he represented the evening sun." (22)
2. Khnemu: Water god and creator of mankind on her potter's wheel (22)
3. Re (Ra, Ammon Re, Amon Re): Creator of the gods
4. Ptah (Pteh, Peteh, Pitah): He created things just by thinking of them and speaking their names with his tongue. (23) He was never created, he just exist, he just "is." He is god of craftsmen and architects. He is husband of Sekhmet and the father of Nefertum and Imhotep (see below).

Listed below are some of the most revered gods among the ancient Egyptian. These are the gods you'd pray to for health and healing, for both the individual and for the nation in general*:

1.  Ra:  According to Britannica.com he was the sun god. He was also creator of the gods, himself and eight others. He traveled to the underworld every night and, in order to be born again for a new day, had to "vanish the evil serpent Apopis He is often referred to as Re or Pra. by the Fourth 

2.  Osiris: He was the god of the underworld and the afterlife. (1) According to Britannica.com he was one of the most important gods. He was the "god of fertility and the embodiment of the dead and resurrected king." He was also responsible for sprouting vegetation and the annual flood (the inundation) of the Nile. He was mainly responsible, however, for "renewal of life in the next world." According to legend, "Osiris was slain or drowned by Seth, who tore the corpse into 14 pieces and flung them over Egypt. Eventually, Isis and her sister Nephthys found and buried all the pieces, except the phallus, thereby giving new life to Osiris, who thenceforth remained in the underworld as ruler and judge. His son Horus successfully fought against Seth, avenging Osiris and becoming the new king of Egypt. " He was also called Usir.

3.  Isis: She was the wife and sister of Osiris, as in those days it was acceptable for mortals and the deity to marry siblings. She was god of the afterlife or the underworld, and the mother of Horus, and also the mother of the Pharaoh. She earned respect for her medical wisdom when she brought her son Horus back to life. She proved her power when she healed her son, Horus, restoring him to life. She was therefore believed to have medical power, and was worshiped as a god of medicine. It was her wrath that was believed to be the cause of many diseases.(2)(3) (9, page 23) She also had many medical remedies named after her, mainly because she was seen as the inventor of many of these remedies. According to Johann Bass, in his 1889 history of medicine, "Ibis was popularly supposed to have been the hallowed inventor of one of the most useful medical operations -- the use of clysters -- for it was believed that when constipated she administered herself with the aid of her long bill." (2, page 16)

4.  Horus: He is sometimes likened to the Greek god Aesculpius, as many temples of him were built where the sick slept during the night in hopes the god would appear during the night and offer a remedy. He is also referred to as Oris. The trio of Isis, Osiris, and Horus are often referred to as the holy trinity or a holy family. He communicated with the Pharaohs so that the various kings and queens were the keepers of all the knowledge of the gods on behalf of the Egyptian people. He is often referred to as the Apollo of the Greeks. (2,3)

5.  Thoth: He was the best friend of Osirus, and writer, clerk or secretary to the gods, and is thought to be the creator of the arts and sciences, particularly the art of medicine. As secretary he was the inventor of writing, and the author of all the wisdom of the gods. He is believed to have shared his knowledge with a priest, who wrote down this knowledge for all physicians to have access to. These writings are referred to as the Hermetic books, as this god was referred to as Hermes in ancient Greece. Some suspect the priest he communicated with was Imhotep, which is how Imhotep gained much of his wisdom. He often appears as having the head of an ibis. The ibis was thought to be skilled in the art of healing, as it used its bill to provide clysters to itself. It was therefore believed to be the inventor of medical operations. Other names for Thoth are Thout, Thuti, Theath, Thouth, Thot and Taaut. The Greeks called him Hermes Trismegistus, and the Romans called him Mercury. (2)(3)(9, page 24)(10, page 4 and 5) Bambilla, a surgeon of Vienna around the year 1783, traced the history of medicine back to Tubal Cain, who was the "grandson of Cain, and the great grandson of Adam, who lived about 3875 years before the birth of our Savior." He believed Tubal Cain and Thoth were one and the same. He believes this link is "ingenious and plausible... as the 22nd verse of the 4th chapter of Genesis explicitly informs us, 'an instructor of every artificer in brass and iron.'" (10, page 4) As you will see, many of the gods of the ancient world were probably once real people whose legend made them a god.

6.  Imhotep: We know now that he was an actual person who lived sometime around 1600 B.C. Some historians thought he actually communicated with the god Thoth. As time went by after his death, he was so revered that his legacy turned him into a god of health and healing. Many temples were built to him where people traveled to for a revelation of healing during the night while they slept. He is also sometimes referred to as being similar to the Greek god Aesculpius.

7.  Pacht: He often appears as having a head of a cat, and this, perhaps, is why the Egyptians revered the cat as a symbol of health and healing. They believed to abuse a cat was to cause ill health. He was the god responsible for health and healing of pregnant women and children.

8. Sekhmet: The god of healing. According to Britannica.com, "a goddess of war and the destroyer of the enemies of the sun god Re. Sekhmet was associated both with disease and with healing and medicine. Like other fierce goddesses in the Egyptian pantheon, she was called the 'Eye of Re.' She was usually depicted as a lioness or as a woman with the head of a lioness, on which was placed the solar disk and the uraeus serpent." (?) He also may have been the Egyptian patron goddess of surgeons, and she watched over physicians as they performed surgery, which usually didn't involve anything more than resetting broken bones or cauterizing wounds or sores with a flaming hot tool heated by fire. (Sigerist, page 326)

9.  Hathor: Goddess of fertility and childbirth, who was later adapted as Aphrodite by the Greeks. According to Britannica.com she was the goddess of the sky, women, fertility and love. She was usually represented in the form of a cow, and was associated with motherhood.

10.  Bes: Diety of childbirth. According to Britannica.com she was a minor god "represented as a dwarf with large head, goggle eyes, protruding tongue, bowlegs, bushy tail, and usually a crown of feathers...The god’s figure was that of a grotesque mountebank and was intended to inspire joy or drive away pain and sorrow, his hideousness being perhaps supposed to scare away evil spirits.He was portrayed on mirrors, ointment vases, and other personal articles. He was associated with music and with childbirth and was represented in the “birth houses” devoted to the cult of the child god." (6) She was also god of marriage, music, happiness and protection

11.  Apis: He was the sacred bull deity who was skilled in art of healing who originated in the First Dynasty of Egypt around 2800-3100. He was the fertility god concerned with multiplication of grains and herbs. He later became associated with Osirus, god of the underworld, and (5) He may have been a real person, as Greek mythology states he was king of the Argives, and he resigned in order to "travel to Egypt for the express purpose of reclaiming the inhabitants from barbarity, and instructing them in the art of civilized life." He became the Egyptian king, and they "worshipped him after his death, under the similitude of an ox." (10, page 11)

12.  Serapis: Skilled in art of healing, he's considered by some as the inventor of medicine. Also called Sarapis. He was Egyptian god of the sun. He was the god of the underworld until Ptolomy I Soter updated his image for the Greeks during the days of Alexandria (around 300 B.). He was then revered as the sun god and a god of healing and fertility. He was later worshiped by the Romans as well. (4)

13.  Paean: He is physician to the gods, and is mentioned in the epic poem by Homer (800 B.C.), the Odyssey: "... there the earth, the giver of grain, bears greatest store of drugs, many that are healing when mixed, and many that are baneful; there every man is a physician, wise above human kind; for they are of the race of Paeon." In Homer's Illiad Paeon can be seen giving medicine to the god of war Ares, who is wounded in battle by the mortal Diomedes. (11) According to Britanicca.com, Paean became associated with the Greek god Apollo and Apollo's son Asclepius, who were both associated with health and healing. (12) Another spelling is Paeon, or Paeeon.

14.  Seth (Set, Setesh, Sutekh, Suty): According to Britannica.com he was the principle god of Upper Egypt. He is believed to be of mythical origin mainly because he hi represented by various forms, although the canine is the most frequent form. He was "Originally Seth was a sky god, lord of the desert, master of storms, disorder, and warfare—in general, a trickster. Seth embodied the necessary and creative element of violence and disorder within the ordered world." Pharoahs as early as the 2nd Dynasty (2775-2650 B.C) recognized themselves as either Seth, Horus, or both. When the Hyksos ruled Egypt they worshiped Seth alongside their own god Baal. (13) His first wife was Nephtys, and later on his wife was sister of Nephtys, Isis. He killed and mutilated his brother Osiris before his wife of Osiris gathered the pieces, reassembled, him, embalmed him, and brought him back to life as a god. This mythology symbolizes the belief of the Egyptians in the afterlife and the importance of mummification.

15.  Baal: This was a god of the Hyksos, and since they used their chariots and stellar weapons to defeat the Egyptians and rule the land for a while, we must consider their gods as well. Baal ruled Egypt with the Egyptian God Seth during the First Intermediate Period. It's also interesting to note that Baal is referenced to often in the Bible as one of the gods Moses and the Hebrew God had to compete with. (14, page 231) According to Britannica.com, Baal was worshiped by many Mediterranean societies, especially those originating in Canaan, or by the Canaanites. He was among the most important of all the gods, which makes sense considering his influence over the Hebrews. Baal designated the universal god of fertility, and in that capacity his title was Prince, Lord of the Earth. He was also called the Lord of Rain and Dew, the two forms of moisture that were indispensable for fertile soil in Canaan. In Ugaritic and Old Testament Hebrew, Baal’s epithet as the storm god was He Who Rides on the Clouds. In Phoenician he was called Baal Shamen, Lord of the Heavens." (15)

16. Theoris: She gave birth to the world, and was the protector of pregnant women. According to Sigerist, "she appears with the features of a pregnant hippopotamus standing on her hind legs. Sometimes she holds the hieroglyph that means 'protection' in one paw and the sign of life in the other. Her statues are usually small, having been used as amulets, but there are also larger ones." (14, page 242)

17.  Nephtys (Nebthet): She was the sister of Isis, and, like Isis,had the ability to heal. Wikepedia.com notes she and her sister watched over funerary rites because they were both protectors of the mummy. She is the wife of Seth. While her sister represented the life or re-birth experience, she represented the death experience. Some myths have her as the mother of funerary deity Anubis. (17)

18. Anubis: He is the jackal headed god of mummification and afterlife. He is the son of Nephtys and Seth, according to Wikepedia. (18)She was goddess of fertility and childbirth. She was also the goddess of benevolence, joy, and jokes. She was also goddess of healing and health. She was also goddess of generosity and marriage.

19. Nut: According to About.com she is the mother goddess and goddess of the sky. "She is often shown as an arch over the earth and as a protector and nourisher of the dead. (She) is the sun, Re's mother, whom she produces daily and swallows nightly. She is also mother of the stars which are shown inside her. She is part of the Ennead. In the theology of Heliopolis, Nut is a daughter of Shu and Tefnut, granddaughter of Atum, and mother of Osiris, Isis, Seth, and Nephthys. Another version has Nut the mother of the "epagomenal" (19) Henry Sigerist said that "a charm to ease childbirth was spoken over the two bricks on which the woman in labor knelt and it was said furthermore than a sacrifice should be brought to the goddess Nut, by placing mean, geese, and frankincense on a fire." (20, page 281)

20.   Heket: She was yet another goddess of fertility. (20, page 288)

21.  Khnuma (khnemu): she was Heket's sister, who "on the potter's wheel molded the child and his ethereal double, his Ka. (20, page 288) She molded mankind using the potter's wheel, and through her water she "breathed life" into men and women. (22) It must be understood here that water was understood as the chief source of life, and physicians were masters of this water, and were able to use it through their "water" potions to heal the sick and wounded. So worshiping gods of the water, such as Khnuma, was very important.

22.  Nun (Nu): He is the water. Before creation mankind and all it needed to survive arose out of the water (Nu), and at the end of the world it will return to the water. According to Britannica.com his name means "primeval waters." He is the father of Re. He created eight members of the ogdoad group of gods of Hermopolis, all except for Atum who just is (see above). The world was created out of the mud from the waters of Nun. The creation myth was recreated every day as the sun arose out of the waters of chaos,of Nun. He was also the source of the annual flooding of the Nile. (24)

23.  Other: Aker was god of earth, fields and poisons, anecdotes and weaving. Ami ruled over fire. Amu was god of dawn. Anquet was goddess of water, the source of life. Apep was god of darkness, night, storm, and death. Apit is goddess of nursing. Ashkit was goddess of wind. Ashu was another water god. Auf was god of peace, rest and courage. Auit was goddess of nurses and children. Bait was goddess of the soul. Buto offered protection from evil. Heh was god of longevity, happiness and eternity. Heqet was goddess of fertility, childbirth and creation. She also offered protection, which is a form of prophylaxis. Khepera was god of healing and exorcism. He was god of miracles and compassion. Nefertem (Nefertum, Nefertemu) was a god associated with Atum was a flower that grew from the waters after the world was created. By his tears he created mankind. He grew into "the water lily of the sun," and was often referred to as "he who is beautiful."

We also have to include here the rest of the ennead and creator gods: Atum, Shu, Tefnut, and Geb. Plus there are vver 5,000 other gods were worshiped, and many of these had healing powers. Also, any one of them had powers to cause disease if you earned their wrath. (1)

So you can see that there was a fine line in the ancient world between mythology and the priesthood and medical practice, all being influenced by mythology; all being influenced by the gods. "As diseases were considered to be the effects of the anger of the gods," says Robley Dunglison in his 1872 history of medicine, "they could not be cured until the wrath of these estimated powerful beings was appeased. The awe, however, with which the dieties were regarded, and the weaknesses of the diseased, required the aid of mediators who might improve pardon for them. In the hands of the priests, consequently, the healing art was nothing more than an absurd worship paid to the different divinities of the country..." (9, page 27)

While physicians had access to natural medicines, these medicine were believed to have worked by magical means, and and these remedies were essentially gifts from one or another of the gods. Temples were build to worship most of these gods, with some of the more famous in Memphis, Thebes and Heliopolis. Priests were educated at these temples regarding the wisdom of the gods, and the sick would sleep in them in the hopes the god would appear and offer a remedy while they slept The process of priestly preparations --perhaps consisting of burning insence, making animal sacrifices and incantations -- and of the godly appearance revelation of a remedy was called an inundation.

The most commonly sought out temples for healing were probably those of Thoth and later Imhotep, who are most likened to the Greek god Aesculpius, who also has a significant impact on our medical history.

As you might imagine, these Egyptian inundations had a significant impact on Greek medicine, with the most common temples visited by the Greeks being held at Heliopolis.

*Most of these gods have more than one name, depending on who was referring to them.  To the best of my ability I will list as many of these names as I can.  The power and influence of these gods varied, with some gods gaining more influence and others less over time.  For the sake of simplicity I'm just listing the basic components of these gods. 

Further reading:

• 5000-50 B.C.: Egyptian gods educate physicians
• 5000-50 B.C.: The role of the Bible in medicine
• 5000-50 B.C.: The Ebers Papyrus: the first asthma remedy?
• 800 B.C.- 800 A.D.: Asclepius will heal your asthma
• 2600 B.C.: Imhotep invents rational medicine

References:

1. Carruthers, Martyn, "Ancient Egyptian Healing:, www.soulwork.net, http://www.soulwork.net/projects/ancient_egypt_healing.htm, acce, accessed 3/21/13
2. Baas, Johann Herman, author, Henry Ebenezer Sanderson, translator, "Outlines of the history of medicine and the medical profession," 1889, New York, pages 14-17
3. Bradford, Thomas Lindsley, "Quiz questions on the history of medicine: form the lectures of Thomas Lindsley Bradford, M.D," 1898, Philadelphia, pages 3-4
4. "Serapis," Britannica.com, http://www.britannica.com/EBchecked/topic/523970/Serapis, accessed 3/21/13
5. "Apis," Britannica.com, http://www.britannica.com/EBchecked/topic/29660/Apis, accessed 3/21/13
6. "Bes" Britannica.com, http://www.britannica.com/EBchecked/topic/62971/Bes, accessed 3/21/13
7. "Hathor," Britannica.com, http://www.britannica.com/EBchecked/topic/256862/Hathor, accessed 3/21/13
8. "Re," Britannica.com, http://www.britannica.com/EBchecked/topic/492674/Re, accessed 3/21/13
9. Dunglison, Robley, author, Richard James Dunglison, editor,  "History of Medicine from the earliest ages to the commencement of the nineteenth century," 1872, Philadelphia, Lindsay and Blakiston
10. Hamilton, William, "The history of medicine, surgery, and anatomy, from the creation of the world to the commencement of the nineteenth century," 1831, volume I, London, Henry Colburn and Richard Bentley
11. "Paean (god)," Wikepedia.com, http://en.wikipedia.org/wiki/Paean_(god)#cite_note-2, accessed 3/29/113; references referred to (1) : Homer, "Odyssey," Book 4, line 219, http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0136%3Abook%3D4%3Acard%3D219 ,accessed 3/29/13; and (2)  Homer, "Iliad," Book 5, line 899, http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0134%3Abook%3D5%3Acard%3D899, accessed 3/29/13
12. "Paean," Britannica.com, http://www.britannica.com/EBchecked/topic/438077/paean, accessed 3/29/13
13. "Seth,"Britannica.com, http://www.britannica.com/EBchecked/topic/536211/Seth, accessed 4/18/13
14. Sigerist, Henry E,' "A History of Medicine: Primitive and Archaic Medicine," volume I, 1951, New York, Oxford University Press
15. "Baal(ancient Deity)", "Britannica.com, http://www.britannica.com/EBchecked/topic/47227/Baal, accessed 4/18/13
16. "Amon (Egyptian god)," Britannica.com, http://www.britannica.com/EBchecked/topic/21208/Amon, accessed 4/18/13
17. "Nehthys," Wikepedia.com, http://en.wikipedia.org/wiki/Nephthys, accessed 4/18/13
18. "Anubis," Wikepedia.com, http://en.wikipedia.org/wiki/Anubis, accessed 4/18/13
19. "Nut- Egyptian Goddess," ancienthistory.about.com, http://ancienthistory.about.com/od/nutmyth/g/050110Nut.htm, accessed 4/20/13
20. Sigerist, Henry E, "A History of Medicine: Archaic and Primitive Medicine," volume I, 1951, New York, Oxford University Press
21. "Ennead of Heliopolis," ancienthistory.about.com, http://ancienthistory.about.com/od/egyptmyth1/g/051710EnneadofHeliopolis.htm, accessed 4/20/13. The Ennead was defined in a variety of places, although I find this one to be the simplest to understand, at least for our purposes. 
22. "Egypt-Gods," ancienthistory.about.com, http://ancienthistory.about.com/od/egyptmyth/a/071809EgyptianGodsTable.htm, accessed 4/20/13
23. "Ancient Egypt: the Mythology," egyptianmyths.net, http://www.egyptianmyths.net/ptah.htm, accessed 4/20/13
24. "Nun," Britannica.com, http://www.britannica.com/EBchecked/topic/422462/Nun, accessed 4/20/13