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.
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
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)
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)
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.
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