You are on page 1of 324

PAIN,DISEASE AND ANALGESICS IN ANCIENT EGYPT

by

ROYJAMESLANE

A thesis submitted to the University of Birmingham for the degree of DOCTOROF PHILOSOPHY

Institute of Archaeology and Antiquity School of HistoricalStudies TheUniversity of Birmingham

June2003

ABSTRACT

Painis the indexfeature of disease since it promptsa request for treatment and its control is

intrinsicto the medicalsystem. The ability to controlpain shouldreflect the overall

of the medical system. Thishas not been previouslystudied.

effectiveness

ManyEgyptian medical terms are unclear. The thesis showssome unknown terms

may lexicallyderive from an adaptationof the type of painexperienced

in disease.Such a

systemof adaptive tenninology wouldprovide a basis of nomenclature. Otherterms of more

fundamentalimportance, such as aetiologicalmorbid features of disease, might equally be

moresimply explained.

Despitethe high incidence of painful diseasesin ancient Egypt,the controlof painwas

limited.There wasa lack of powerful analgesics.

Other substances

that might havebeen used

to produceanalgesia seem not to havebeen exploited. This may havebeen due to a'policy'of

multiple ingredient polypharrnacyso that the individual pharmacological

properties of

This would havehindered the progressof medical

substanceswere not separately

recognised.

treatment. Such a systemmay havebeen partof the treatment (itual per se. It may be that a

'secondary

system' of hometreatments

existedwhich either forced or perpetuated

this policy.

(74,014 words)

LISTOF CONTENTS

ChapterI- INTRODUCTION

  • 1.1 TheReputation

of EgyptianMedicine - BriefBackground

  • 1.2 ConnectionsBetween Egyptian and GreekMedicine PreviousStudies

-

on Pain,Disease and Treatment

  • 1.3 PlantSubstances-Entries

in the Medical Papyri -

CurrentReference

Sources

Problems

of Identification

-

1.4 TheMedical Papyri - Description

and Problems

1.5 (i)Table: Medical Papyri

1.5(ii) Plate: Berlin Papyrus (facing)

1.5(iii) Plate: London Papyrus (facing)

1.6Aims and Methods

Chapter2- PAIN

2.1Concepts

2.2Pain Relief

2.3Physicians

2.4Use of Analgesics

Chapter3- EGYPTIANTERMINOLOGY

3.1Words for Pain

  • 3.2 tfý, bdw

3.2(i) Plate:Berlin Papyrus 154

3.2(ii) The Vessel Book (Ebers 854/6, Berlin 163)

3.2(iii) The Leiden Papyrus 1,348 - Spell13

3.2(iv) Admonitions

of an EgyptianSage

3.2(v) Other Prescription

Entries for wbdw

3.2(vi) The Connections

3.2(vii) Conclusions

3.3 stt

of uýbdwwith GreekMedicine

on tfýbdw

3.4Adaptive Terminology

Chapter4- DISEASE

4.1Background

- Sources PreviousStudies

-

4.2Table: Medical Conditions

and FirstIdentifications

4.3Carcinomas

4.4Bone and JointDisease

4.5Dental Disease

4.6Parasitic Worms

4.7Respiratory Disease

4.8Accidents and Injuriies

1

5

9

14

14

24

24

27

32

40

41

44

48

50

59

66

70

73

74

81

84

86

100

121

122

126

133

137

142

145

Chapter5 MEDICINALPAINKILLING

SUBSTANCES

5.1Introduction

5.2Opium

5.2(i) Plate:Cypriote Ring Base Juglet

5.2(ii) Plate: Vessels and Standsfrom the Tomb of Kha

152

155

163

164

5.2(iii) Table: Opium Usage in England and AncientEgypt -

A Comparison

of LandRequired

5.3Cannabis in Egypt

5.4Cannabis,

Cocaine and Tobacco -The MunichMummies

5.4(i) Table:Summary of ResultsReported by Balabanova

and Team.

171

172

177

184

  • Chapter6- LETTUCE,CELERY FRUIT, MANDRAKE, LOTUS

6.1Lettuce

6.1(i) PrescriptionEntries for eftin theMedical Texts

6.1(ii) Melilot

6.1(iii) Wild Lettuce

6.2 (i) CeleryFruit

6.2(ii) Dawson and Aft

6.2(iii) Mitt in TheMedical Texts

6.2(iv) Summary

6.3Mandrake

6.4Lotus

6.4(i) PrescriptionEntries for Lotus

6.4(ii) Summary of PrescriptionEntries

6.4(iii) Conclusions on theLotus

Chapter7- DILL,JUNIPER, WILLOW, HENBANE,

MYRHH

7.1Dill

7.1(i) PrescriptionEntries for Dill

7.1(ii) Conclusions

on Entriesfor Dill

7.2Junipe

7.2(ii) Juniper in TheMedical Texts

7.2(iii) Conclusions

on Entriesfor Juniper

7.3Willow

7.3(i) PrescriptionEntries for Willow in theMedical Texts

7.5Henbane

7.5(i) PossiblePrescription

Entries for Henbane

7.5(ii) Henbane Toxicity

7.6Myrrh

7.6(ii) Characteristics of Myrrh

185

187

192

192

194

195

198

206

207

209

211

213

214

217

218

219

221

222

228

230

231

234

235

236

239

241

Chapter8 -ALCOHOL, SURFACEANALGESICS

8.1Alcohol

8.1(i) Alcohol Abuse

8.1(ii) Plate: Lady at Banquet, Guests at Banquet(facing)

8.1(iii) The Medicinal Uses of Alcohol

8 (iv)Dioscorides

and Alcohol

  • 8 (v)The Use of Alcohol outside theMedical Texts

8.2Surface Analqesics

8.2(i) SurfaceAnalgesia and theTomb of Ankhmahor

8.2(ii) Circumcision

Scene from the Tomb of Ankhmahor

(facing)

Chapter9- PRESCRIPTIONANALYSIS

9.1Introduction

9.2Collation of Material

9.3Tables: Prescription

Entries in theMedical Texts

Tables10.3 (i) - (ix)

9.4Discussion

9.5Table: Percentage Ratios for Internal/External Treatments

9.6Table: Complex/ Minor Conditions

9.7Conclusions

249

251

253

254

256

257

258

261

263

268

271

272

278

279

282

284

Chapter10 -

GENERALCONCLUSIONS

286

11.Appendix - THEUSE OF EXCREMENT

IN PRESCRIPTION

FORMULATIONS

11.1Excrement

in PrescriptionFormulations

11.2Human Faeces

11.3Animal Faeces

11.4Summary

291

291

293

296

GLOSSARY MedicalTerms

-

BIBLIOGRAPHY

CHAPTER1: INTRODUCTION

1.1The Reputation

of EgyptianMedicine - BriefBackground

The ancient Egyptianshave long enjoyeda great reputation for their skills in medicine

dueto the reports from classical writers outside theEgyptian world. This reputation

principally

was not only restricted to the area of medicineas the Greekslater believedthat their very

much to theland of thePharaohs.

'

philosophy'owed

For example, Homerdescribes Polydamna,

the wifeof Thonis, as givingmedicinal

plants 'to Helenin Egypt, a countryproducing an infinite numberof drugs whereeach

...

physicianpossesses knowledge aboveall othermen'. 2 Similarly,from the Bible:'0 virgin

daughter of Egyptin vainshalt thou use manymedicines' (Jeremiah45,11). 3 Clement of

Alexandria,

in the secondcentury AD4tells us morespecifically,

thatthe Egyptianshad some

Oforty-twobooks of knowledge,

six of whichwere of medical content. It hasbeen suggested

thatthese six books maycorrespond

to those categoriesof disease and treatments

within the

currently known medicalpapyri. 5 In fact,Ebers quite firmlybelieved that his medicalpapyrus

bookNumber 40 -'Remedies'.

6

represented

Herodotusdiscusses the health andmedicine of the Egyptians. 'Next to the Libyans'

they(the Egyptians)

are 'thehealthiest people in the world - an effectof their climate

which

...

has no suddenchange'.

7 The reputationof Egyptian physicianswas such thatboth Cyrus and

Darius sent to Egyptfor medical assistance.

8The description

by Herodotus

of thetreatment of

the bodyduring the embalmingprocess appears to be an accurate, detailed andobserved

I J. Barnes, Early Greek Philosophy

views is,in

(London, 1987), 15. The processof connection

betweenEgyptian and Greek

byA. B.Lloyd, Herodotus

Book I/, Introduction(Leiden, 1975), 50-3.

part,explained

2 Homer,The Odyssey.

Translated

by J. Lombardo(Indianapolis,

2000), iv, 229The influence of theOdyssey on

Herodotusis discussed

by Lloyd, Herodotus

Book /1, Introduction,

122-3.

3The Holy Bible, Authorized

Version, 1611.

4C. Bryan,The Papyrus Ebers (London, 1930), 2-3.

5J. F. Nunn,Ancient Egyptian Medicine (London, 1996), 24.

6The other fivebooks were Anatomy, Disease, Surgery, Diseases the Eye and Diseases of Women. They were

referred to bythe Greeks as the'Hermetic

Books', after Hermes. Bryan, The Papyrus Ebers,3.

7Herodotus,

Histories 11: 77, Translation,

G. Rawlinson

(London, 1858). Reprinted

London, 1996.

9He also tells us that medicinewas practised 'on a planof separation;

summaryof the process.

eachphysician treats a single disorder and no more'. 10Certainly, the title of 'physician'

appeared to carryan elementof kudos within Egypt since it appearednot infrequently

within

"

the 'title lists' of important people.

Some of these medical titleshave additional qualifying

words followingthe word 'doctor which imply medical specialisation

e.g. swnwbt, 'doctor of

the stomach'? 12However, this division of the medicalsystem into specialists (oculists,dentists

which Herodotus maintainsexisted to the extent that 'the country

and evenproctologists)

is notsupported by othersources.

13In fact,the mainmedical papyri

swarmswith practitioners'

all containan amalgamof conditionswhich impliestheir use by generalpractitioners

rather

thanby specialists. It is obvious that Herodotusin medicalmatters, as in others,must be

14It is significant that any suspectaspects to his work

approachedwith somecircumspection.

might be attributedpartly to hislack of knowledge

of the Egyptianlanguage. In the samevein,

manyof the presumptionsregarding the prowessof the Egyptians emanate from, andwere

because of, the verynature of theEgyptian script.

perpetuated

Hieroglyphs

were for a long-time regardedas metaphysical

and symbolic such that,

'they caused to be erectedan enormous edifice of learning on thetotally false assumption

that

9 Herodotus, Histories 11: 86. For a discussion on the methodssee A. B. Lloyd,Herodotus Book 11, Commentary 1- 98,(Leiden, 1976), 354-64.

10Herodotus,

Histories 11: 84.

11Udjahorresnet a high officerunder Cambyses reports int al

Fromhis 'autobiography

physician'.

that,'His majestyassigned

statue (nowin

to me the officeof chief

theVatican Museum),

M. Lichtheim,

ona standingnaophorous

AncientEgyptian Literature Volume3: TheLate Period (Berkeley,

-

1980), 37.

12Nunn, Ancient Egyptian Medicine,

118.

13In fact

thetitles which denote specialismare relatively fewin percentageof thetotal andseem to relate to the

Ghalioungui

briefly suggests thatthis

change in medical theory.A

Ghalioungui,

may bedue to

someunderlying

'compartmental'

theory to

thebody. P.

Magic and

oneof unityof

OldKingdom.

moveaway fromthe conceptof

Medical Science in AncientEgypt (London, 1963), 74. However it

original implications

lostits

and developed

seemsas likelythat these titles merely losttheir

e.g.

thetitle 'knight has

a honoraryform. This can be seenwith Englishties

original adversarial implication. Equally, the present title of 'Secretary of Statefor Health' is a political not

medical appointment

14The pointof medical specialism

is

discussedby Lloyd whoalso considers

that Herodotushas 'gone too far in

his conclusions.

He makes the point thatEgyptian physicians

'accumulated

a widerange of medical offices and

duties andso could hardlybe calledspecialists',

Lloyd,Herodotus,

Book //, 1-98,350.

2

Egypt

eachsign had a complexand allegorical

'

5It is probable thatthis resultedlin

significance'.

becoming renowned in the RomanEmpire andeven very much later as a sourceof learning

and theoCCUlt.

16Consequently,

of ancient Egyptian

medicinemay havethe

anyconsiderations

inherentdanger of overestimation.

Indeed somemodem studies havefalsely attributeda

to Egyptian medicineand have attempted

to explain it 'in part

modernmedical understanding

by fillingin the gaps,and by recourse to preconceivednotions of Egyptianinfluence on Greek

medical theories'.

17 Even now, the ancient Egyptians are allegednot only to have'practiced

medicine in a rationaland deductive manner', but also to havebeen the 'inventors of clinical

18Conversely there mightpossibly be a tendencyto regardancient Egyptian

observation'.

medicineas eithermagic or magico-religiousand essentiallywithout any rationalelements. 19

Medical practice like religionand magic had a stronglyritualised aspect and the borders

betweenthe three wereoften fluid.Equally, the magical element gave another line of approach

to a medical problem and must also have allowed for anexcuse upon failure.

Most recentlywith Egyptian medicine therehas been a tendencyto focus on specific

andoften esoteric areas of medicine. Whilstthis can be appreciated

in terms of resourcesand

it canalso serve to distractfrom a holistic assessment.

Specific examplesare given

specialism,

later within the text.20 A holistic overview is imperativein order to assess the actualability of the

ancient Egyptian practitioner.

An assessment

of Egyptian prowess in terms of medical matters

might be achieved from sucha holistic overview.

15P. R. S. Moorey,Ancient Egypt (Oxford, 1992), 3. A recentstudy on the significanceof hieroglyphsto

anatomical knowledge concluded that the 'djed'

column 'previouslythought to have a primaryreligious

'First appearanceand sense of

(2002), 152-5. However,

was used to symbolise

the spinalcolumn', J. K.Lang and H. Kolenda,

Historical

significance'

theterm'spinal column'inancientEgypt.

vignette', JoumalofNeurosurgery97,

it seemsnot to be so sincerather the term n2k3tseems to

Anatomical

Terms (Warminster,

1996), 197-202.

apply,see J. Walker,Studies in AncientEgyptian

16There wasgeneral secrecy surrounding

17M. Marganne,

knowledge,

Ghalioungui,

Magic and Medical Science, 31-2.

'Greek Medical Terms', Forum 3 (1993),37.

18A. Martin-kaguz

(2002),1183-94.

et al., 'Neuroscience

in

ancient Egypt and theSchool of Adexandria',

Neurology

Review 34,

19G. Pinch, Magic in AncientEgypt (London, 1994), 140-2.

20See, for example,

pages 111-2.

3

The essential ingredientto the understandingof any scientificsystem is the

of how a particularprocess works at the'sub level' i. e. the unobservedprocess.

understanding

In terms of medicine this equatesnot to the anatomyof thebody but to its physiology.

Without

the knowledge of physiology the aetiologyof disease cannot be appreciated.

For example,

manyearly societies would havebeen awareof theheart andof its connectionswith theblood

and blood vessels. Galen, who demonstratedthat the arteriescarried blood, otherwisegave a

confusing description of the blood vesselssince his knowledge of physiologywas strictly

limited. 21 It was not until Harvey,in the seventeenthcentury, who demonstratedthe flow of

blood within the circulatorysystem thathuman physiologycame to be understood.

22Thus, in

an evaluationof ancient Egyptian medicine, one problem is to appreciate

the extent to which

the Egyptians were awareof basic physiology. I consider that we must start with the

that, at best,this must havebeen very selectiveand patchy. If the ancient

presumption

Egyptians wereunaware of basic physiology theninternal diseases could have no obvious

This wasessentially

the positionof theRoman physicians.

For example, whilst Galen

aetiology.

could deal with (obvious) externalproblems he accepted that internaltreatments were

diffICUlt.23 Without a proper knowledge of physiology treatment with medicinal substances

cannotproperly be targeted.Any drug regimewould, at best,be an ad hoc administration

followedby rejectionor selectionof a compound decided upon the basis of any observed

requiredor adverseeffects. Thatis not to say that administrationof medicines from empirical

experiencewould produce an inefficient systemof treatment. For this reason it is important to

examine the Egyptian prescriptionsand theiringredients in detail.This will be carriedout in

Chapter9.

21G. Sarton, Galen of Pergamon(Lawrence

Kansas, 1954), 48-51. Galen wasa Greekbom in 0 30in Pergamon

andwho leftfor Romein 175.There he

MateriaMedica ascribed to

wascourt physician to MarcusAurelius. There aresome 16 books of

him, althoughmost are spurious.

22In fact Harvey wasreluctant to publish being'careful not to offend the Galenic readers', Sarton,Galen of

Pergarnon,

23L. G.

1981).

47. This shows therehad been little advance in

medical thought for over 1500 years.

Ballester,

'Galen as a Medical Practitioner,

in V. Hutton(ed. ), Galen:Problems

and

Prospects(London,

4

1.2 Connectionsbetween EqyDtian and Greek and Medicine

-

PreviousStudies on Pain,

Disease and Treatment

Beforethe understandingof the Egyptianlanguage became possible, throughthe

deciphering

of its hieroglyphs,

most historical accountsof Egypt reliedon classical sources.

24

Egyptian medicine is no exceptionand its understandingwas only reallypossible with the

translation of the medicalpapyri in the last century. Prior to this, reliancewas from Greek

accounts, principally by Herodotus, Diodorus and Dioscorides. However, this previousreliance

onclassical sources and the practiceof Greek medicine duringthe Greek periodswithin Egypt

has createdpresumptions

that someaspects of Greek medicinemust derivefrom Egyptian

theory.This is particularlyso in the aetiologyof the disease process. Medical elementsof

Aristotle's workand that of the CnidianSchool are said to be based on an Egyptiantheory

which itself resulted fromthe observationof the decay process during mummification.

25It is

generallyaccepted thatthe natural desiccation

of buriedbodies appeared to give the human

form an immortality

whichwas artificially attempted by the processof mummification.

During

mummificationany intestinal spillagewould havebeen associatedwith decay andso became

the antithesis to preservation. This phenomenonwas recognised by Steuer whoproposed it as

the basisfor the Egyptian understandingof the disease process. Accordingto Steuer waste

elements in thebody's intestinal tract notonly became associatedwith decaybut were thought

to containa precursoragent to disease.Importantly he also proposed that this agentwas

actuallynamed bythe Egyptians

- tvhdw. This was later proposed by Steuer and Saundersto

bethe seminal linkbetween Greek and Egyptian medicine.

26It is a linkthat it oftenassumed by

24This is demonstratedby Brugsch's reconstruction

of

sourcesuntil thediscovery

(and translation)

the Twenty-fifthDynasty, previouslyreliant on classical

Bulletin of

of the'VictoryStela of Piye'fromGebel Barkal.

pyaemia in ancient Egyptian medicine',

25S. lkrarn and A. Dodson, The Mummy in AncientEgypt (London, 1998), 15.

26R. 0. Steuer,' "dw'.

aetiological

principle of

History of Medicine10 (1948).R. 0.

Saunders,

Supplement

to

Steuer,Ancient Egyptian and

CnidianMedicine (Berkeley, 1959). J. B.

Kansas, 1963).

The Transition

from Ancient Egyptian to GreekMedicine

(Lawrence

5

otherwriters in passim.

27In reality there appears to be little evidence for links with Egyptian

and Greek medicine beyondthe claimsof Greek writers. Most of these are imprecise andoften

28It is, therefore,important that there can be shown to be actual

subsequentlyplagiarised.

evidence for the connectionsproposed by Steuer. 29 However, this has produceda somewhat

confusedsituation with certain Egyptian medical terms either being consideredas indicators of

a pathological process or merely descriptions of pain in disease.The terminologyin respectof

thishas recently been reviewed,

byKolta and TessenoW.

30They do

summarised

and appraised

notentirely concur with Steuerbut stillview ivbdw as an agentwhich acts as a precursor to

disease.However, their review fails to consider the negative implications

of the argument.

Asidefrom any significanceof Egyptian and Greek connections,

if the term describes a

precursoragent rather than pain per se then the terminologyfor pain is reduced. That is, if

certain terms are diseaseindicators rather thanterms for pain thenthe potential for evidenceof

painful diseaseis reducedand vice versa. Thisis important because it

wouldwill limit certain

terminologyto thedisease processrather than actual termsfor painand so reduce the number

of painfulconditions identified within the Egyptian medical framework.

Equally, if theseterms

refer to thedisease processrather thanthe symptomsof diseaseit questions the significance

and reasons for some treatments.It also createsproblems when attempting to match

in order to identifydiseases within the medical papyri.

symptoms

27See, for example, Pages36-7.

28Barnes, Early Greek Philosophy,

15-16. All the references

to

Egypt come fromGreek writerswho are somewhat

confused themselves. For example, Isocrateshas Pythagoras going to Egyptto studyand which influencedhis

later pronouncements.

Yet,Herodotus

has him firmly resident in

stole theEgyptian idea that the soul is

Samosbut, nevertheless,

Thebelief in thetransmigration

B.Lloyd, Herodotus

impliesthat Pythagoras

123.

immortal andenters into anotheranimal when it is bom,Histories 11:

havedeveloped

of soulsseems to

independently

in otherparts of the world,see A.

because it is

Book 11 Commentary,

99-182 (Leiden, 1988), 59.

29R. 0. Steuer,Ancient Egyptian and

30K. S. Kolta and H.Tessenow,

CnidianMedicine (Berkeley,

1959). This proposal is important

a constructiveone. Otherwisethe 'links'between Greek and

fromthe

Greeksthemselves.

gratuitously

study butthat he was thefirst to

Egyptianthought all comeunsubstantiated

and

For example, we are toldthat notonly did Pythagoras

Busiris 28-9).

zur Bedeutung

visit Egyptto

bring(that) philosophyto Greece (Isocrates,

'Schmerzen'

Schmerzstoffe

oder F5ulnisprinzip

von w, -bdw, einem

Terminusder alt5gypfischem

zentralen

Medizin', ZAS 127 (2000), 38-52.

6

Any previousresearch on pain in ancient Egyptis distinctlylacking. Apart from one

shortarticle by Dawson on terminology

within his seriesof studies in the medical textsthere

havebeen no directdiscussions

on the subject. 31 The work by Dawson on terminology

and

medicinalplant identification

often formsthe basisfor later reviews. Whilst manyof his

identifications

remainvalid others have since beendiscounted.

His work in this area hasbriefly

touched on pain terminologyin his discussion of the term stt and in considering the individual

propertiesof certainplant substances. Dawson consideredstt to be a symptomof painwhilst

others have proposed it as pathological

factor, albeitwith differentfunctions, onewhich was

intrinsicto an Egyptian conceptof thedisease process.

32Thus, like whdw it is regardedeither

asa symptomof disease or aspathological

factor, which is one fundamentally

in the

significant

interpretation of disease and its treatment.

In comparison

therehas been substantial

and continued study on diseasein ancient

Egypt.However, the large scaleappraisals of Egyptiandisease are earlyones. Duringthe

period 1890-1930

was carried out mainly by Ruffer,Elliot Smith, Jones

workon paleopathology

and theirteam members.

33These studieswere possible because of funding and because of

the associatedwork being carriedout in the samegeographical areas. Infact, they are the only

realoverall appraisals of disease since later work has by necessityof finance or discipline

veered towardsthe specificrather thanthe holistic. Most veryrecent work hasbeen specific in

remit: for instance, the studyof DNAdecay rates in human remains by Marota et al, 34 of dental

andcranial porosities by Keita and Boyce35

and a reviewof contraceptiveagents fromthe

31W. R. Dawson, 'Studies in theEgyptian

medical texts11', JEA 19 (1933), 133-7. 'Studies in theEgyptian medical

textsIll', JEA 20 (1934), 41-6. 'Studies in theEgyptian medical textsIV, JEA20 (1934), 185-8.

32Grundriss,

VI1,814-5.

T.

Bardinet,

Les papyrusm6dicaux

deF8gypte pharaonique

(Pads,1995).

33M. A. Ruffer,'Historical Studies on EgyptianMummies', M6moires Institut de Ftgypt6 (1911),3, 'Studiesin

Pathology,

(Chicago),

1921. G. Elliot Smith, 'Report on theHuman Remains',

The Archaeological

Surveyof Nubia.

Reportfor 1907-8(Cairo, 1910).

341. Marota et al., 'DNAdecay rate in

Journal of Physical Anthropology

papyriand human remains fromEgyptian archaeological

sites', American

117 (2002), 310-18.

35S. 0. Keita and A. J. Boyce,'Diachronic pattersof

in

theNaqada region, UpperEgypt'

predynastic

and vaultporosities duringthe

dentalhyperplasias

AmericanJournal of HumanBiology 13,(2001), 733-43.

,

7

medicalpapyri. 36However this concern for the specific,albeit unwittingly,

ignores

sometimes

the moreprosaic yet fundamental

aspectsof ancient Egyptian medicine. In thisthesis I will

consider the wideraspects of disease(Chapter 4). This is in order to producea list of thebroad

categoriesof diseasethat were a common feature of Egyptianlife. The list should be

if it is to be instructivetowards an understandingof the overall level of disease

representative

and treatmentin ancient Egyptian.It is anticipated that painwill be a prominent featurein most

of thedisease categodes.

In terms of thetreatment of pain in ancient Egyptthere have been no previousstudies

andno overall discussion.

Any considerations

havebeen the resultof research in

of analgesics

for example, duringthe discussion

ritual. 37

otherspecific situations,

of a supposedcircumcision

In terms of treatment mostof the previouswork is based on thefew shortreviews of Dawson

on medicinalsubstances. There have been no collectiveappraisals. Certain medicinal

have receivedattention but not directlyin considerationof their pain-killingabilities.

substances

In terms of narcoticsubstances

thishas been in respectof otheraspects of the plantsrather

than on their analgesicor hypnotic properties. For example, the opiumpoppy produces the

narcoticopium resin which is a powerfuland important painkiller. Its use leaves significant

social traces on society. It was knownby the RomanS38

but the time andmethod of introduction

intoEgypt is uncertain. The view thatits usewas widespread

in the NewKingdom is based

upon the workof Merrillees.

39However, the discussion

of opium by Merrilleesis notconcerned

with its pharmacological

implicationsbut ratherwith the movement of goods throughout the

Aegeanduring the BronzeAge. Similarly the lotushas receivedmuch attention but for its

or psychedelicproperties rather thanits narcoticor analgesic

supposederotic associations

(See,Chapters 5.2 and 6.4).

properties.

36J. Guiter,'Contraception

en

ýgypte ancienne',

BIFAO101 (2001), 221-36.

37M. M. EI-Ansary,'History of Pain Reliefby AncientEgypfians', Middle East Joumal Of Anaesthesiology10

(1989),99-105.

38Its use (and abuse) is reported by Pliny and Galen.See Chapter 5.2 on opium.

39R. S. Merrillees,'Opium trade in the BronzeAge Levant' ,

Antiquity36 (1962),292.

8

1.3 PlantSubstances Entdesin the MedicalPapvd - Problems of Identification Current

-

-

ReferenceSources

TheEgyptian medicalpapyri give lists of treatment for diseases. Aside from magical

and surgicalapproaches thesetreatments involve the administrationof a wide rangeof

substances. These were invariably used in combination. An eclecticrange of productswas

utilised. This even includedthe use of animaland human excreta. In view of the supposed

betweenthe intestinal contentsand whdw, I will, in the Appendixto thisthesis,

connections

examine the prescriptionentries for faeces(ps).

TheEgyptian prescription

treatments

canessentially be dividedinto drugs of mineral,

animalor plantorigin. Drugs of animaland mineralorigin tendto appearequally recorded

outside the medicalcontext and so identificationis possible. For examplecommon substances

like natron,ochre, beer, milk, honey and blood all appearwidely outside the medical papyri.

In contrast the actual identification

of medicinal plants is problematic.

40There are no

of plants within the medical texts and reference is made by name

pictorialrepresentations

41Whilst there is considerable

for the meaningof the Egyptian

words for

alone.

agreement

many herbal substances,

others are less certainand manyunknown.

42.Some plants have

beenfound intact in tombs andplant remains havebeen isolated from excavationsites. 43Other

plants feature widelyoutside the medical texts andso theiridentifications

are morecertain.

Outsidethese texts the pictorialrepresentations

of plants are common but are sometimes

difficultto distinguishbeyond form andso allow for misidentification.

Forinstance, grapes in

are indistinguishable

from melonsunless the plant is shownprovided with a

representations

40L. Manniche, An AncientEgyptian Herbal (London, 1999), 159-62.

41This contrastswith the 'rule' of

laterherbals whereproper identification(by illustration) is consideredvital. E. g:

OrtusSanitatis 1491, De HistoriaStirpium 1542. 42Nunn, Ancient Egyptian Medicine, 153-5. 43Manniche, Ancient Egyptian Herbal, 40,147,149,151.

9

support to implythe vine. The persea fruithas the sameoutline and colour as the mandrake

fruit making identification,

in some instances,

impossible.

44

Theforms of plants in the medical texts aresometimes

bydeterminatives

recognisable

butthe actualpad of the plant is rarelyspecified. Thisis a problemsince the pharmacological

contentsof a plantcan often vary across its parts. In otherwords the chemical constituents

of

the leaves may be differentto the roots. This is vital to the assessment of any pharmacological

activity. For example, the willowplant is an important sourceof salicylates.

These arepowerful

analgesics,anti-pyretic and anti-inflammatoryagents. Howeverit is only the barkthat contains

these salicylates.

45Alsothe otherwise innocuous

rhubarbplant hasleaves whichcontain oxalic

acidwhich is toxic,but which is notpresent in the ediblestalks. 46

It is notwithout significance

thatthe partof a plant is rarely defined within the medical

texts.This suggests thatit wasnot a relevant factorfor the practitioner.

This couldeither be

becausethe part to be usedwas alreadyunderstood or becauseits propertieswere not

It seemsunlikely that suchan important aspectof a plantwould not be stated

appreciated.

sinceselection of the correctpart would havebeen vital for its desired pharmacological

effects.

Thereforeit seemsmore likelythat the pharmacological properties were not appreciated. This

is not surprising in view of the Egyptian practiceof using multiple ingredientsin a single

prescriptionwhich would have obscured individual properties.

47It may even be that any

were actually incidental to the processof treatment.

pharmacological

properties

Theidentification

of

fromtheir appearance

in the medical papyri relies on a

substances

lexical connectionS48

combinationof matchingphysical appearances,

and pharmacological

propertiesagainst known referencesubstances.

Often pharmacological

can only be

properties

assumed by reference to the index medicalcondition of the prescription; thatis by matching

44Manniche Ancient Egyptian Herbal, 160. 45C. Newall et al., HerbalMedicines (London, 1996), 268-9. 46Newall, Herbal Medicines, 228. 47This is discussedin detailin Chapter9.

48There aresometmes useful connections with Coptic.

10

This is often

disease against the known pharmacological

properties of reference treatments.

problematicsince manymedical conditions are themselves not clear or symptomsare

ambiguous.

Referencesto Egyptian plantnames and theirbotanical propertiesare foundin the

illustratedherbal of Dioscorides,

a Greek physicianwho worked as a militarysurgeon under

Nero. 49 His workcontains over 600 plantand substance entries. Thetranslation into English

fromthe Greekdates from the seventeenthcentury. Thebotanical referencesand associated

pharmacologyare generallysound. The plant namesare given in Latin,Greek, Roman and

often Egyptian.However, despite a few nameswith phoneticconnections, most of the Egyptian

namesseem erroneous and offer liftlehelp in identification.

50

The first modemmajor publication on ancient Egyptianbotanical sourceswas the

considerablenineteenth century work by Loretin which the first identifications

of many

Egyptian plantspecies were made. 51Following Dawson and VolumeVI of the Grundrissder

Medizinder alten Agypter 52there has been morework in terms of botanical studies by and

Charpentier

53 and Germer.

54 The magnusopus of Charpentier

remains the most important

referencework, butits emphasis is botanical rather than medical or pharmacological.

Aufr&re

has sincepublished a detailedlexicological

seriesof twenty-seven

naturalsubstances

which

includes substancesof medicinal significance.

55The workof Boulos on medicinal plants of

NorthAfrica providesuseful information

on current distribution

andmedicinal uses in present

by J. Goodyer(1655), R. T. Gunther(ed. ) (Oxford

49Dioscorides,

The Greek Herbal Of Dioscorides.

Translated

1934).Reprinted

New York, 1959.

50The Egyptian namesare said by Mannicheto be a

himself, Manniche,

An Ancient Egyptian

later2nd centuryaddition and not

given by Dioscorides

Herbal, 163. The point is notmade byGoodyer

or Gunther.

51V. Loret, La flore Pharaonique

2nd Ed. (Paris, 1892).

52H. Grapow, et al., Grundrissder Medizinder Aften Agypter. 9 volumes (Bedin,1954-1973),

(hereafter,

Grundriss).

53G. Charpentier,

Recued de matdriaux

6pigraphiques

antique (Paris,1981).

relatifs 6 la botaniquede

118gypte

Ober Arzneimiftelpflanzen

in

Alten Agypten, PhDThesis (Hamburg,

54R. Germer,'Untersuchnung

1979). Flora

Agypte (Mainz am Rhein,1985).

des pharaonische

55S. Aufr6re,'budes de lexicologie et d'histoire naturelle IV-V[',BIFA0 84 (1984),1-21. 'budes de lexicologie et

d'histoire naturelle VIII-XV11', BIAFO 86 (1986),1-32. 'budes de lexicologie et d'histoirenaturelle XVIII-XXVI',

BIFAO87 (1987),21-44.

day Egypt.56 More recently Baum has publisheda work on ancient Egyptiantrees and shrubs.

The emphasis is on pictorialrepresentation

and distributionbut somespecimens have

pharmacological

significance57

OutsideEgypt a developed and recordedmedical system was used by the

Babylonians

and Assyrians. There is no evidenceof anycross-influences

betweenthem and

the Egyptiansin terms of medical theories.But it is possible thatthere wassome in terms of

medical knowledgeduring periodsof intense contact,such as the Amarna period. 58Many

medicinalplant substances were knownto the Babylonians and Assyrians and their modeof

usemay parallel that of the Egyptians.

Work on theidentification

of

these and their usewithin

the medical system hasbeen carriedout byThompson.

591-lis

Assyrian Herbal and Dictionary

of

AssyrianBotany stillremain the mainreferences

in this areaalthough these volumesare now

rather dated.These are based on cuneiformplant lists andmedicinal texts which datefrom the

endof the secondmillennium to the first millennium BC.Cross reference is made to these

works in thisthesis whensimilar Egyptian plantsare discussed.

In terms of Egyptian prescriptionsand their ingredientsthe collectedvolumes in

German of the Grundfiss and latterlyWestendoff

60 remain the majorreferences

in this area.

They collate informationfrom all the medical papyri. VolumeVI of the Grundriss,

albeitprinted

in 1959, still remains the citedcomplete Egyptian pharmacopoeia.

Furthermorethe Grundriss

collates diseaseinto categoriesand gives translationsinto German of Egyptian medical terms.

Manyhowever still remainuncertain which makes diagnosis of some diseasesdifficult. The

situation is further confused by the assumptionof some terms as precursors

to disease rather

than as description

of disease symptoms,

as discussed above. Westendorf

s latertwo volume

56L. Boulos,Medicinal Rants of NorthAfrica (AJgonac:

Michigan, 1983). The term medicinal 'use' should be

distinguished

from actualpharmacological

their properties.

I

consider thatin manycases heis merely describing'folk-

properties.

lore' assumptions

57N.

as

to

Baum, Arbres etarbustes deI'Egypte ancienne (Leuven, 1988).

58See page 42below.

59R. Campbell Thompson, The Assyrian Herbals (London, 1924). A Dictionaryof AssyrianBotany (London,

1949).

60W. Westendorf, Handbuch der Altagyptischen Medizin. 2

volumes (Leiden, 1999), (hereafter,

WestendoM.

12

work is essentiallyan abbreviatedversion of the Grundriss

without thebenefits of hieroglyphs

or transliteration,

but has updateson some of theGrundriss

omissions.

in

The presc(iptions

the Egyptian medicalpapyri are distinctivein thatthey contain

multiple ingredients.

For example, Eb663 contains thirty-sevendifferent ingredients

andmany

otherscontain in excessof ten. This is unusualand differsfrom modern treatments and even

from ancient herbals.

61 It contrasts, in particular, with the entries in theAssyrian Herbal which

generallycontains single items.Despite this 'anomaly'in Egyptian medicineneither the

Grundfiss nor Westendorf offerany prescription ingredient analyses. In Chapter9 of this thesis

  • I have collatedall theinformation

from the prescriptionentries for the substances

discussedin

the previouschapters. Thisis done on the basis of efficacyand of the relationships

between

ingredient appearances.

In fact,there have been no overallprescription

analyses beforethis

thesis.I consider that this has been an important omission in the considerationof ancient

Egyptian medicine.

Thisis becauseI believe that the Egyptian methodof formulation

may have

limitedthe exploitationof pharmacological

Multipleingredients

must havehindered

substances.

the recognitionof the propertiesof individual pharmacological

properties. If

this limitationis

shown to be valid thenit mustrender the efficacyof the individual prescriptions in the medical

papyrisuspect. It mayalso call into question the fundamental

abilityof the ancient Egyptian

physician. By this I mean that treatments would havebeen part of the ritualrather than

treatment perse.

61The OldEnglish Herbarium dates from c.

1OOOAD and is an Anglo-Saxontranslation from a 5th century Latintext.

Its entriesare often for a single ingredient or if in combinationgenerally with a solvent or fixing agent. E. g. Water

lily (nym/aea alba) for a swollenstomach; 'for the sameuse the rootsand

'For eye pain and swelling take the plantcalled apium or wild

to the patient to eat for ten days',

give

celerypounded well with bread and lay it on the

eyes'. Englishtranslations from, A. van Ardsall,Medieval Herbal Remedies (New York,2002), 178,20 1.

13

1.4The Medical Papyd - Descdotion

and Problems

Thefollowing table is a list of the mainmedical papyri which are mentioned in this

thesis.These are the most important generalworks knownfrom ancient Egypt.As such they

represent the bulk of writtenmedical evidence.

62The medicalpapyri are essentially lists of

undera named disease; eachentry is terse andcontains scant detail.Aside from

treatments

somesurgical cases thereis little or no elaborationon the disease, particularly its cause -

except in casesof demonic possession.

They contain little, or no,evidence of anyphysiology

or pathology but ratherserve as prescription lists.However, this stylecannot be takento reflect

any lack of medical knowledge or otherwisesince modern formularies

are presented in the

sameway. The dates of the copiesare approximateand are takenfrom Nunn without

63They

are listedin chronological

order rather than orderof size or importance.

comment.

TABLE1.5(i)

MedicalPapyri (mentioned in the text)

TITLE

LOCATION

APPROXIMATEDATE CONTENTS

Ramesseurn111, IV, V Oxford

(Ram)

EdwinSmith (Sm) NewYork

Ebers(Eb)

Hearst(H)

London(Lond)

Berlin (Bin)

Leipzig

UCLA,California

London(BM10059)

Berlin

OF COPY

170OBC

1550BC

150OBC

145OBC

130OBC

120OBC

e

Abbreviationsin parenthesesare those used in the text.

gynaecological,

ophthalmic, paediatric

surgical, trauma

generalmedical

generalmedical

magical,medical

magical,medical

62Other than medical ostraca. These wereremedies

from the

Wratiques(Brussels,

potterymedium. Known examples

Prescriptions

date

written on a stoneor

Amama period throughto the Roman period. F. Jonckheere,

1954).

m6dicale sur ostraca

63Nunn, Ancient Egyptian Medicine,

25.

14

These papyriwere mostly found within the last one hundred yearsand offered for

privatesale within the then vigorousantiquities market. They came with virtuallyno

They areconsequently

(apartfrom the Ramesseum

Papyrus) namedafter either a

provenance.

modernowner or their ultimateresting place. They areessentially

medical formularieslaid out

in paragraphs,

each generally headedby a description

of the medical condition, thetreatments

for whichare thendescribed. Apart from human remains, these papyrii formthe basis upon

whichmost Egyptian medicalstudies rely. Likewisethis thesis will rely on thesefor its

analyses.

Thetwo most important medical papyri are theEdwin Smith and theEbers. The Edwin

SmithPapyrus was firsttranslated by Breastedin 1930 and latertranslated into German in

VolumeIV of the Grundrissin 1958.64A later German translation

wassubsequently

produced

by Westendorf

in

  • 1966.65 EdwinSmith comprises 48 mainparagraphs,

with some 13 'sub-

cases'and is secondonly in lengthto Ebers.It is primarilyconcerned with surgicalcases,

particularlyones of severe injury or trauma.In viewof the potential for industrial injuries in

ancient Egyptit is possible thatthe cases in EdwinSmith describe just such injuries.

66 The

injuriesdescribed in the latter are so numerous that the sourceof its contents has been

to come from an industrial (pyramid/ quarry?

)

suggested

siterather than a battlefield situation.

Thisis becausein thelatter it would bedifficult to find adequate timeto devoteto treatmentS.

67

However, Ralston in a morerecent evaluation of 'CaseFour' in EdwinSmith considers that

Breasted waswrong in his diagnosisbecause of the rarityof such injuries within his limited

experience in civilian life. The headinjuries causedsince by road traffic accidents have

producedcomplex injuries presentingparallels for comparison to som