The Asclepion
Prof. Nancy Demand, Indiana University
- Bloomington
Medicine in Ancient Egypt
Historically, many Egyptologists focused
primarily on the very visible aspects of ancient Egyptian society,
such as the pyramids, much to the bain of those interested in
more than just monumental architecture. From the beginning of
the scholarly study of Egypt's past there have been few scholars
who recognized the importance of the process of disease and health
on a population. With the turn of the century, new archaeological
discoveries, increased knowledge of Egyptian language and writing,
and the advent of more sophisticated medical techniques, new
life was breathed into the study of disease and health in the
ancient Nile Valley. It was this period that saw the academic
study of Egyptian disease segregated into three distinct categories.
The first is the study of medical Papyri.
Early on it was recognized that the textual material of the Dynastic
Period pertaining to the recognition and treatment of disease
was extremely important for understanding both the state of health
as well as the concept of disease in ancient Egypt. The second
is the study of the artistic representation of disease in the
Nile Valley. The Egyptian's predilection to portrayl life in
a relatively realistic manner offers an excellent opportunity
for the study of disease. The third, and perhaps most obvious,
is the study of human remains, both skeletal and soft tissue,
of ancient Egyptians. With the advent of increasingly sophisticated
medical techniques at the beginning of the 20th century, as well
as those complex medical techniques in use today, the analysis
of Egypt's veritable wealth of human remains provided a tremendous
boost to the study of the state of disease and health in the
ancient Nile Valley.
Medical Papyri
The Edwin Smith Papyrus
The Edwin Smith Surgical Papyrus is, without
a doubt, one if the most important documents pertaining to medicine
in the ancient Nile Valley. Placed on sale by Mustafa Agha in
1862, the papyrus was purchased by Edwin Smith. An American residing
in Cairo, Smith has been described as an adventurer, a money
lender, and a dealer of antiquities.(Dawson and Uphill: 1972).
Smith has also been reputed as advising upon, and even practicing,
the forgery of antiquities.(Nunn 1996:26) Whatever his personal
composition, it is to his credit that he immediately recognized
the text for what it was and later carried out a tentative translation.
Upon his death in 1906, his daughter donated the papyrus in its
entirety to the New York Historical Society. The papyrus now
resides in the collections of the New York Academy of Sciences.
In 1930, James Henry Breasted, director
of the Oriental Institute at the University of Chicago, published
the papyri with facsimile, transcription, English translation,
commentary, and introduction. The volume was accompanied by medical
notes prepared by Dr. Arno B. Luckhardt. To date, the Breasted
translation is the only one if its kind.
The Edwin Smith papyrus is second in length
only to the Ebers papyrus, comprising seventeen pages (377 lines)
on the recto and five pages (92 lines) on the verso. Both the
recto and the verso are written with the same hand in a style
of Middle Egyptian dating.
The Ebers Papyrus
Like the Edwin Smith Papyrus, the Ebers
Papyrus was purchased in Luxor by Edwin Smith in 1862. It is
unclear from whom the papyrus was purchased, but it was said
to have been found between the legs of a mummy in the Assassif
district of the Theben necropolis.
The papyrus remained in the collection
of Edwin Smith until at least 1869 when there appeared, in the
catalog of an antiquities dealer, and advertisement for "a
large medical papyrus in the possession of Edwin Smith, an American
farmer of Luxor."(Breasted 1930) The Papyrus was purchased
in 1872 by the Egyptologist George Ebers, for who it is named.
In 1875, Ebers published a facsimile with an English-Latin vocabulary
and introduction.
The Ebers Papyrus comprises 110 pages,
and is by far the most lengthy of the medical papyri. It is dated
by a passage on the verso to the 9th year of the reign of Amenhotep
I (c. 1534 B.C.E.), a date which is close to the extant copy
of the Edwin Smith Papyrus. However, one portion of the papyrus
suggests a much earlier origin. Paragraph 856a states that :
"the book of driving wekhedu from all the limbs of
a man was found in writings under the two feet of Anubis in Letopolis
and was brought to the majesty of the king of Upper and Lower
Egypt Den."(Nunn 1996: 31) The reference to the Lower
Egyptian Den is a historic anachronism which suggesting
an origin closer to the First Dynasty (c. 3000 B.C.E.)
Unlike the Edwin Smith Papyrus, the Ebers
Papyrus consists of a collection of a myriad of different medical
texts in a rather haphazard order, a fact which explains the
presence of the above mentioned excerpt. The structure of the
papyrus is organized by paragraph, each of which are arranged
into blocks addressing specific medical ailments.
Paragraphs 1-3 contain magical spells designed
to protect from supernatural intervention on diagnosis and treatment.
They are immediately followed by a large section on diseases
of the stomach (khet), with a concentration on intestinal
parasites in paragraphs 50-85.(Bryan 1930:50) Skin diseases,
with the remedies prescribed placed in the three categories of
irritative, exfoliative, and ulcerative, are featured in paragraphs
90-95 and 104-118. Diseases of the anus, included in a section
of the digestive section, are covered in paragraphs 132-164.(Ibid.
50) Up to paragraph 187, the papyrus follows a relatively standardized
format of listing prescriptions which are to relieve medical
ailments. However, the diseases themselves are often more difficult
to translate. Sometimes they take the form of recognizable symptoms
such as an obstruction, but often may be a specific disease term
such as wekhedu or aaa, the meaning of both of
which remain quite obscure.
Paragraphs 188-207 comprise "the book
of the stomach," and show a marked change in style to something
which is closer to the Edwin Smith Papyrus.(Ibid.: 32)
Only paragraph 188 has a title, though all of the paragraphs
include the phrase: "if you examine a man with a…,"
a characteristic which denotes its similarity to the Edwin Smith
Papyrus. From this point, a declaration of the diagnosis, but
no prognosis. After paragraph 207, the text reverts to its original
style, with a short treatise on the heart (Paragraphs 208-241).
Paragraphs 242-247 contains remedies which
are reputed to have been made and used personally by various
gods. Only in paragraph 247, contained within the above mentioned
section and relating to Isis' creation of a remedy for an illness
in Ra's head, is a specific diagnosis mentioned. (Bryan 1930:45)
The following section continues with diseases
of the head, but without reference to use of remedies by the
gods. Paragraph 250 continues a famous passage concerning the
treatment of migraines. The sequence is interrupted in paragraph
251 with the focus placed on a drug rather than an illness. Most
likely an extract from pharmacopoeia, the paragraph begins: "Knowledge
of what is made from degem (most likely a ricinous plant
yielding a form of castor oil), as something found in ancient
writings and as something useful to man."(Nunn 1996: 33)
Paragraphs 261-283 are concerned with the
regular flow of urine and are followed by remedies "to cause
the heart to receive bread."(Bryan 1930:80). Paragraphs
305-335 contain remedies for various forms of coughs as well
as the genew disease.
The remainder of the text goes on to discuss
medical conditions concerning hair (paragraphs 437-476), traumatic
injuries such as burns and flesh wounds (paragraphs 482-529),
and diseases of the extremities such as toes, fingers, and legs.
Paragraphs 627-696 are concerned with the relaxation or strengthening
of the metu. The exact meaning of metu is confusing
and could be alternatively translated as either mean hollow vessels
or muscles tissue.(Ibid.:52) The papyrus continues by
featuring diseases of the tongue (paragraphs 697-704), dermatological
conditions (paragraphs 708-721), dental conditions (paragraphs
739-750), diseases of the ear, nose, and throat (paragraphs 761-781),
and gynecological conditions (paragraphs 783-839).
Kahun Gynecological Papyrus
The Kahun Papyrus was discovered by Flinders
Petrie in April of 1889 at the Fayum site of Lahun. The town
itself flourished during the Middle Kingdom, principally under
the reign of Amenenhat II and his immediate successor. The papyrus
is dated to this period by a note on the recto which states the
date as being the 29th year of the reign of Amenenhat III (c.
1825 B.C.E.). The text was published in facsimile, with hieroglyphic
transcription and translation into English, by Griffith in 1898,
and is now housed in the University College London.
The gynecological text can be divided into
thirty-four paragraphs, of which the first seventeen have a common
format.(Nunn 1996: 34) The first seventeen start with a title
and are followed by a brief description of the symptoms, usually,
though not always, having to do with the reproductive organs.
The second section begins on the third
page, and comprises eight paragraphs which, because of both the
state of the extant copy and the language, are almost unintelligible.
Despite this, there are several paragraphs that have a sufficiently
clear level of language as well as being intact which can be
understood. Paragraph 19 is concerned with the recognition of
who will give birth; paragraph 20 is concerned with the fumigation
procedure which causes conception to occur; and paragraphs 20-22
are concerned with contraception. Among those materials prescribed
for contraception are crocodile dung, 45ml of honey, and sour
milk.(Ibid:35)
The third section (paragraphs 26-32) is
concerned with the testing for pregnancy. Other methods include
the placing of an onion bulb deep in the patients flesh, with
the positive outcome being determined by the odor appearing to
the patients nose.
The fourth and final section contains two
paragraphs which do not fall into any of the previous categories.
The first prescribes treatment for toothaches during pregnancy.
The second describes what appears to be a fistula between bladder
and vagina with incontinence of urine "in an irksome place."(Ibid.
35)
The Investigation of Disease Patterns
Through Human Remains and Artistic Representations
Parasitic Diseases
Schistosomiasis (bilharziasis)
Of the three main species of the platyhelminth
worm Schistosoma, the most important for Egypt are S.
mansoni and S. haematobium. There is a complex
life cycle alternating between two hosts, humans and the fresh
water snail of the genus Bulinus. The infection is caught
by humans who come into contact with the free swimming worm which
the snail releases in the water. The worm penetrates the intact
skin and enters the veins of the human host. The main symptom
of the presence of the parasite is haematuria which results in
serious anemia, loss of appetite, urinary infection, and loss
of resistance to other diseases. There may also be interference
with liver functions.
One of the finest archaeological examples
for the existence of schistosomiasis in ancient Egypt was the
discovery of calcified ova in the unembalmed 21st Dynasty mummy
of Nakht. Upon medical examination, the mummy not only exhibited
a preserved tapeworm, but also ova of the Schistosoma haematobium
and displayed changes in the liver resulting from a schistosomal
infection.(Millat et al. 1980:79)
Bacterial and Viral Infections
Tuberculosis (Mycobacterium tuberculosis)
Ruffer (1910) reported the presence of
tuberculosis of the spine in Nesparehan, a priest of Amun of
the 21st Dynasty. This shows the typical features of Pott's disease
with collapse of thoracic vertebra, producing the angular kyphosis
(hump-back). A well known complication of Pott's disease is the
tuberculous suppuration moving downward under the psoas major
muscle, towards the right iliac fossa, forming a very large psoas
abscess.(Nunn 1996:64)
Ruffer's report has remained the best authenticated
case of spinal tuberculosis from ancient Egypt. All known possible
cases, ranging from the Predynastic to 21st Dynasty were reviewed
by Morse, Brockwell, and Ucko (1964) as well as by Buikstra,
Baker, and Cook.(1993) These included Predynastic specimens collected
at Naqada by Petrie and Quibell in 1895 as well as nine Nubian
Specimens from the Royal College of Surgeons of England. Both
reviewers were in agreement that there was very little doubt
that tuberculosis was the cause of pathology in most, but not
all, cases. In some cases, it was not possible to exclude compression
fractures, osteomyelitis, or bone cysts as causes of death.
The numerous artistic representation of
hump-backed individuals are provocative but not conclusive. The
three earliest examples are undoubtedly of Predynastic origin.
The first is a ceramic figurine reported to have been found by
Bedu in the Aswan district. It represents an emaciated human
with angular kyphosis of the thoracic spine crouching in a clay
vessel.(Schrumph-Pierron 1933) The second possible Predynastic
representation with spinal deformity indicative of tuberculosis
is a small standing ivory likeness of a human with arms down
at the sides of the body bent at the elbows. The head is modeled
with facial features carefully indicated. The figure is shown
with a protrusion of the back and on the chest.(Morse 1967: 261)
The last Predynastic example is a wooden statue contained within
the Brussels Museum. Described as a bearded male with intricate
facial features, the figure has a large rounded hunch-back and
an angular projection of the sternum.(Jonckheere 1948: 25)
As well, there are several historic Egyptian
representations which indicate the possibility of tuberculosis
deformity. One of the most suggestive, located in and Old Kingdom
4th Dynasty tomb, is of a bas relief serving girl who exhibits
localized angular kyphosis. A second provocative example has
its origin in the Middle Kingdom. A tomb painting at Beni Hasan,
the representation shows a gardener with a localized angular
deformity of the cervical-thoracic spine.(Morse 1967: 263)
Poliomyelitis
A viral infection of the anterior horn
cells of the spinal chord, the presence of poliomyelitis can
only be detected in those who survive its acute stage. Mitchell
(Sandison 1980:32) noted the shortening of the left leg, which
he interpreted as poliomyelitis, in the an early Egyptian mummy
from Deshasheh. The club foot of the Pharaoh Siptah as well as
deformities in the 12th Dynasty mummy of Khnumu-Nekht are probably
the most attributable cases of poliomyelitis.
An 18th or 19th Dynasty funerary staele
shows the doorkeeper Roma with a grossly wasted and shortened
leg accompanied by an equinus deformity of the foot. The exact
nature of this deformity, however, is debated in the medical
community. Some favor the view that this is a case of poliomyelitis
contracted in childhood before the completion of skeletal growth.
The equinus deformity, then, would be a compensation allowing
Roma to walk on the shortened leg. Alternatively, the deformity
could be the result of a specific variety of club foot with a
secondary wasting and shortening of the leg.(Nunn 1996: 77)
Deformities
Dwarfism
Dasen (1993) lists 207 known representations
of dwarfism. Of the types described, the majority are achondroplastic,
a form resulting in a head and trunk of normal size with shortened
limbs. The statue of Seneb is perhaps the most classic example.
A tomb statue of the dwarf Seneb and his family, all of normal
size, goes a long way to indicate that dwarfs were accepted members
in Egyptian society. Other examples called attention to by Ruffer
(1911) include the 5th Dynasty statuette of Chnoum-hotep from
Saqqara, a Predynastic drawing of the "dwarf Zer" from
Abydos, and a 5th Dynasty drawing of a dwarf from the tomb of
Deshasheh.
Skeletal evidence, while not supporting
the social status of dwarfs in Egyptian society, does corroborate
the presence of the deformity. Jones (Brothwell 1967:432) described
a fragmentary Predynastic skeleton from the cemetery at Badari
with a normal shaped cranium both in size in shape. In contrast
to this, however, the radii and ulna are short and robust, a
characteristic of achondroplasia. A second case outlined by Jones
(Ibid.:432) consisted of a Predynastic femur and tibia,
both with typical short shafts and relatively large articular
ends.
Cited References
Breasted, J.H. The
Edwin Smith Surgical Papyrus (University
of Chicago Press: University of Chicago, 1930).
Brothwell, D. "Major Congenital
Anomalies of the Skeleton," in Diseases in Antiquity:
A Survey of Disease, Injuries, and Surgery in Early Populations
(eds.) A.T. Sandison and D. Brothwell (Charles C. Thomas: Springfield,
1967).
Bryan, P.W. The
Papyrus Ebers (Geoffrey Bles: London,
1930).
Buikstra, J.E.; Baker, B.J.; Cook, D.C.
"What Disease Plagues the Ancient Egyptians?
A Century of Controversy Considered," In Biological Anthropology
and the Study of Ancient Egypt (eds.) W,V. Davies and R.
Walter (British Museum Press: London, 1993).
Dasen, V. Dwarfs
in Ancient Egypt and Greece (Clarendon
Press: Oxford, 1993).
Dawson, W.R. and E.P. Uphill. Who Was Who in Egyptology
(Egyptian Exploration Society: London, 1993).
Jonckheere, F. "Le
Bossu des Mussées Royaux D'Art et D'Histoire de Bruxelles,"
Chronique D'Égypt (45) 25, 1958.
Millet, N.; Hart, G.; Reyman, T.; Zimerman,
A.; Lewein, P. "ROM I: Mummification
for the Common People," in Mummies, Disease, and Ancient
Cultures (eds.) Aiden and Eve Cockburn (Cambridge University
Press: Cambridge, 1980).
Morse, D. "Tuberculosis,"
in Diseases in Antiquity: A Survey of Diseases, Injuries,
and Surgery in Early Populations (eds.) A.T. Sandison and
D. Brothwell (Charles Thomas: Springfield, 1967).
Morse, D.; Brothwell, D.; Ucko, P.J.
"Tuberculosis in Ancient Egypt,"
in American Review of Respiratory Diseases (90), 1964).
Nunn, J.F. Ancient
Egyptian Medicine (University of
Oklahoma Press: Norman, 1996).
Ruffer, M.A. "Potts'che
Krankheit an Einer Ägyptischer Mumie aus der Zeiy der 21
Dynastie," in Zur Historischen Biologie der Krankheiserreger
(3), 1910.
"On Dwarfs and Other Deformed Persons,"
Bulletin de Societé D'Archéologie D'Alexandrie
(13)1, 1911.
Sandison, A.T. "Diseases
in Ancient Egypt," in Mummies, Disease, and Ancient Cultures
(eds.) Aiden and Eve Cockburn (Cambridge University Press: Cambridge,
1980).
Schrumph-Pierron, B. "La
Mal de Pott en Égypt 4000 Ans Avant Notre Ére,"
Aesculpe (23)1933.
