World J. Surg.
28, 211-216, 2004
DOI: 10.1007/s00268-003-7073-x
Surgical History
Special Wound Healing Methods Used in Ancient Egypt and the Mythological
Background
Peter Sipos, M.D., Ph.D.,' Hedvig Gyory, Ph.D., 2 Krisztina Hagymasi, M.D., Ph.D., 3 Pal Ondrejka, M.D., Ph.D.,'
Anna Blazovics, Ph.D. 3
`2nd Department of Surgery, Semmelweis University, Kutvolgyi fit 4, 1125 Budapest, Hungary
2 Museum of Fine Arts, D6zsa Gyorgy (it 41, 1146 Budapest, Hungary
3 2nd Department of Internal Medicine, Semmelweis University, Szentkiralyi u. 46, 1085 Budapest, Hungary
Published Online: January 8, 2004
Abstract. The Egyptian civilisation is one of the oldest in history and was
renowned for its scientific and artistic achievements, and medicine was no
exception. The ancient Egyptians were masters in applying and arranging
bandages, and they recognized the cardinal signs of infection and inflam-
mation. Egyptian drug therapy can be regarded as having evolved from a
system rooted in magic and empirical observation. To illustrate how the
Egyptian wound healing methods provided a major stimulus for the devel-
opment of surgery, we conducted a literature search.
In modern medical practice, the treatment of skin wounds includes
the use of standard dressings, remediation of underlying problems,
debridement of nonviable tissue, restoration of adequate tissue
perfusion, limitation of pressure at the wound site, and control of
infection. Medicine itself was not practiced in a clinical-scientific
manner in ancient times; nevertheless many empirical observations
helped practitioners to use the products of science to improve
health and to assess the effectiveness of treatment. The history of
medicine includes many therapies that today seem ludicrous. For
example, the treatment of hot surfaces or inflammation is recorded
in the Papyrus of Ebers (Eb),' about 1500 years B.C. z Here a frog
was "warmed in oil and rubbed" on the patient's skin. This was one
of several possible treatments. (It is evident that with this method
the burns usually suppurated.) Another amazing, but potential ma-
terial for injuries was excrement. Because it was applied often, we
analyzed its use from several point of views.
Mythological Background
From a parapsychological perspective, a wound was an opening in
the body through which infernal beings could enter and leave. How
Correspondence to: Peter Sipos, M.D., Ph.D., e-mail: speter@kut.sote.hu
'Papyrus of Ebers (Eb) 603 chapter (c).
For the hieroglyphic version of the texts quoted, see Grapow H. Die
2
medizinischen Texte in hieroglyphischer Umschreibung autographiert.
Berlin, 1958. Latest translations: Westendorf W. Handbuch der altagypti-
schen Medizin II. Leiden-Boston-Köln, 1999.
WORLD
Journal of
SURGERY
© 2004 by the Societe
1 Internationale de Chirurgie
could the Egyptians assure more the defense of this gate than by a
material feared, and with good reason, even by the most horrible of
demons—that is, by application of excrement. Its efficacy could
only be increased one way: giving the origin.
Egyptian prescriptions commonly included the excrement of the
donkey. This animal personified the demons embodying the nega-
tive power that often caused illness; thus by annihilating the donkey
(e.g., during a rite of the feast of Osiris "the donkey of Seth" got
stung) one could expect to recover. The association of Seth with
wounds was close, whether the wound was received in battle or as a
consequence of the mythical fight between Horus and Seth for the
succession to the throne of Osiris. Because material in connection
with an animal might be a device through which people could get in
contact with the gods, it could also express the protective role of the
much-feared god himself. So the donkey could play a positive role.
That is why, according to the Book of the Dead (Bd), the deceased
personally rescued a donkey from an evil snake. 3 The other positive
function of the donkey in connection with wounds could be in his
role of guard. As a gatekeeper or the guard of the body of Osiris [1],
he does not allow entry to unauthorized persons. Thus the donkey
could contribute to the healing process of the wound in two differ-
ent magical ways, either by analogy or by opposition.
The medical papyri point to the fact that pernicious beings—
chiefly demons and deceased persons—could enter and leave the
organism through the openings of the body and thus harm people.
The Berlin papyrus (Bln) 4 speaks about an intruder, who must have
accomplished some negative alteration because the physician had
to do something against it. Clearly that practitioner needed a device
for casting out demons (Fig. 1). The best device was chosen, the
most disgusting even for demons, excrement. The mythological
background worked also as a psychological support [2], which re-
cent studies have shown can reduce pain perioperatively and in-
crease patient satisfaction. Other alternative therapies include en-
3 Book of the Dead (Bd) 40c.
4 Berlin papyrus (Bln) 71c.
212
Fig. 1. Bes amulet with the vessel called bes, Museum of Fine Arts (No.
52696), Budapest. 22-25th Dynasty. (Reprinted with permission of the Mu-
seum of Fine Arts, Budapest.)
ergy healing, guided imagery, hypnosis [3], prayer, and relaxation
techniques [4]. Brief hypnosis intervention may reduce postsurgical
perceived pain intensity, perceived pain affect, and anxiety; de-
crease comorbidity; and enhance postsurgical recovery and reha-
bilitation [5].
Therapy
There were five routes of drug administration; oral, rectal, vaginal,
topical, and fumigation, in many forms—as pills, cakes, supposito-
ries, ointments, drops, gargles, fumigations, and baths. The liquid
vehicles were usually water, milk, mucus, beer, and wine, each
sweetened with honey or dates. While over 70% of Egyptian treat-
ments were administered topically, a tenth of these are thought to
have exerted their effects elsewhere.
Components from animals appear in 42% of all prescriptions in
the Ebers papyrus. Approximately a third of these are fat or grease,
both of which were likely used as vehicles. Fat and grease were
often used in the formation of ointments for topical application.
Approximately one third of animal-derived drugs were products of
urine, eggs, feces, or milk. Finally, structural components of animal
carcasses such as blood, bone, meat, and skin were used in one third
of prescriptions. There was a wide range of animals from which
animal constituents were obtained, including cow, goose, donkey,
man, cat, pig, mouse, goat, sheep, bat, hippopotamus, antelope,
dog, fish, insect, ostrich, pigeon, pelican, raven, frog, lizard, snake,
tortoise and crocodile [6].
The Ebers Papyrus contains more than 50 prescriptions in which
feces are believed to be active components, used for internal and
external application. To explain the effect of these compounds by
World J. Surg. Vol. 28, No. 2, February 2004
today's medical standards, we must recognize the importance of
secondary metabolites of bacterial and fungal origin that are found
in fecal matter. In fact, feces have been shown to be rich in antibi-
otic substances. Thus, the use of fecal matter was based on magical
assumptions but was supported by empirical observations. It is fur-
ther known that every animal has different microflora, and corre-
spondingly produces a different antibiotic complement—hence the
use of fecal matter from a wide variety of organisms.
Human feces contain about 75 % water, 25 % dry material, where
the bacterial content is cc. 30%, inorganic material 15%, fat, and
derivatives 5%. The existence of practically all of the elements can
be demonstrated in feces, but iron, calcium, magnesium, and phos-
phate contents are significant. The glucocorticoids participate in
the enterohepatic circulation, and about 15% of the secreted cor-
tisol is excreted in the feces. The amount of cortisol/corticosterone
secreted varies among species. Humans and apes secrete primarily
cortisol, birds only corticosterone. Feces also contain large quanti-
ties of diamins, as cadaverin, putrescin, and phenol compounds,
especially the polyphenols, which might hinder the life functions of
the bacteria [7]. These compounds have antioxidant qualities and
they contribute to the odor of feces. Forty genera of bacteria, rep-
resented by at least 400 species, can be cultured from the feces of a
healthy human. An ecosystem with more than 400 species of bac-
teria, plus protists and fungi, constitutes a jungle of competitive
species and individuals. Some species are mutualists; others, com-
mensals. Still others are potential pathogens. To prevent the occur-
rence of septic shock from the high content of endotoxins, the bile
acids inhibit their absorption. The enzyme content of the feces
helps increase the function of the effective substance in a topical
ointment (e.g., the trypsin [8] in the case of products originating
from animals). It seems likely that the material used was gathered
from the ground and that the hot desert sun burned through the
feces and the UV radiation killed some of the bacteria.
The ancient Egyptian medical men might have used feces for
fumigation, as the substance is excellent combustible material (be-
cause of its fat and fibers content). Through the burning process,
various narcotic gases and vapors are released. These by-products
irritate the mucous membrane and elicit cough and hyperemia. The
sulfuric gases, when present in large concentrations, can lead to
dizziness, a euphoric condition and ultimately to fainting. These
experiences may create the sense of being in the demonic sphere.
In the Egyptian prescriptions feces were usually applied in com-
bination with other vegetal, animal, or mineral materials. Each
component of these prescriptions can be reasonably explained, and
all are appropriate in terms of their effect. Minerals and metals in
the Egyptian pharmacopeia included antimony, copper, salt, alum,
carbon from charred wood, and possibly iron from meteorites. The
black paints used for beautifying men's and women's eyes were pro-
duced by a composition of antimony or lead sulfide. The green
color in eye make-up came mainly from malachite, found in the
eastern desert and the Sinai. Cupric carbonate/cupric hydroxide
salt was also used by the ancient Egyptians, both cosmetically and
medicinally. Worn as an eye shadow, malachite would have pro-
tected against eye infections from organisms such as Pseudomonas
aeruginosa and Staphylococcus aureus, for which it has potent bac-
tericidal effects. Also chrysocolla, copper silicate, which is a lovely
blue-green, was used. These natural substances were inherently an-
tiseptic. Interestingly, copper preparations are the main agents of
the present century against trachoma, the blinding infection very
common in Egypt [9].
Sipos et al.: Wound Healing in Egypt
Materials other than excrement also disposed some magical
power. For example, wax is the product of bees, and bees were in-
deed basic elements for the Kingdom. They are fixed in the royal
title for Upper Egypt in the expression "belonging to the bee."
Honey can be beneficial as a wound dressing because it inhibits the
growth of microorganisms and is hygroscopic, thus attracting an
abundant secretion of leukocytes and antibodies. Honey was by far
the most popular Egyptian drug. It is mentioned in 500 out of 900
remedies.
Gluconic acid was recently found to be the principal acid in
honey. The acid-producing enzyme in honey is a glucose oxidase
producing glucuronic acid (gluconolactone) and hydrogen perox-
ide from glucose. The enzymatic oxidation of glucose takes place
very slowly in undiluted honey and at much higher rates as honey
was diluted. Honey has an inhibitory effect on the postoperative
peritoneal adhesions [10], because of its high density and slow ab-
sorption from the peritoneal cavity. Honey with an average level of
antibacterial activity could be expected to be effective in preventing
the growth of Pseudomonas on the surface of a wound even if the
honey were diluted more than tenfold by exudation from the wound
[11]. The traditional honey therapy appears to have enormous po-
tential in solving modern-day problems of methicillin-resistant
Staphylococcus aureus infected leg ulcer [12].
Aside from their physical properties, all of these materials have
mythological connations [13]. The red ochre reminded Egyptian
people of the color of blood. The sycamore was the tree of Hathor, s
Nut' [14], and Isis. The sun was thought to rise between the two
malachite sycamore trees.'
Wine [15] was used in relatively high quantity, probably to might
make elixirs more palatable. Clearly the Egyptian people would
have had a distaste for feces. Also the alcohol helped dissolve the
various components. Wine is known to contain numerous antioxi-
dant, antiseptic, and antiphlogistic compounds, such as flavonoids.
Patients drinking these elixirs mightwake up ecstatic, sensing a little
of the joy of the gods' world.
Mild antiseptics like frankincense, date-wine, turpentine, and
acacia gum were also used in the Egyptian pharmacopeia [16].
Modern research has shown that a hot water extract of Matricaria
chamomilla has an antibacterial effect. It completely inhibits the
growth of Staphylococcus aureus, Streptococcus strains, Lepto-
spira, and Trichomonas. Leptospira are particularly nasty organ-
isms; they are carried by rats and can enter the body through skin
abrasions when working in contaminated water. Because of the ex-
tensive irrigation networks in Egypt, Leptospira is likely to have
been a common illness, and it appears they knew how to treat it.
Matricaria oil can exert a strong anti-inflammatory effect because it
contains large amounts of a-bisabolol. This compound is known to
exert a powerful anti-inflammatory effect on damaged skin, espe-
cially when the skin has been weakened and cracked by exposure to
strong sunlight.
Respiratory burst-derived oxidants support healing. Oxidants
serve as cellular messengers to promote healing. Natural herbal
remedies, proanthocyanidins or condensed tannins are a group of
biologically active polyphenolic bioflavonoids that are synthesized
by many plants. Proanthocyanidins and other tannins facilitate
5 See, e.g., Bd, 68c.
'See, e.g. Bd, 59c (var. Ba).
7 Bd, 109c.
213
wound healing. A combination of grape seed proanthocyanidin ex-
tract and resveratrol (a major component of purple grape juice and
red wine) facilitates inducible vascular endothelial growth factor
expression, a key element supporting wound angiogenesis [17].
Wound Care and Dressing
The surgical treatment of abscesses or cysts was described in the
Ebers Papyrus' as "Instructions for a swelling of pus.... A disease
that I treat with knife-treatment .... If anything remains in its
pocket, it recurs." Advice for infected wounds included recommen-
dations to apply a decoction of willow, 9-1 ' which contains salicin,
and astringents of copper and sodium salts.
Heliotherapy (exposure to ultraviolet sunrays) is also mentioned
in the Ebers Papyrus: 12 "The body is anointed and exposed to the
sun." Egypt was the first country in history to practice the tradition
of hair trimming to avoid insect infestation.
The Egyptians used a method known as infusion to extract the
oils from aromatic plants and incense and this was probably one of
the earliest ways of using aromatics. 13,14 Artificial fragrance was
widespread in every facet of life. Frankincense was burned at sun-
rise in temples as an offering to the gods, and myrrh was typically
offered too. The Egyptians were experts at embalming, using aro-
matics to help preserve flesh. In everyday life they used massage
with fragrant oils after bathing, and they wore perfume cones on
their head during banquets.
An essential part of any wound management protocol is wound
dressing. Those who have seen a mummy have a good example of
the Egyptian embalmers mastery of the art of applying and arrang-
ing bandages [18]. The same skill was also available for the benefit
of the living. For patients who were wounded, bandages were used
to cover and keep in place the medicaments described. Egyptian
linen was highly prized in the Old World. The linen produced var-
ied in texture from the finest silk-like gauze to a canvas-like coarse-
ness, this is evident in the specimens displayed in museums around
the world that house sizeable Egyptian collections.
The edges of a clean-cut wound were brought together either
with adhesive tape rs or stitching." This is the first mention in his-
tory of "stitching" a wound (Fig. 2). Other wounds were not su-
tured, but kept open.
A hot fire-drill was employed in cauterization. Fresh meat was
applied to a wound on the first day as an efficient hemostatic and
mechanical agent. In the following days, the treatment involved as-
tringents, herbs, and honey. "Having stitched it, you should lay
fresh meat upon his wound the first day. You should not bind it.
s Eb, 869c.
9 Eb, 582, 766c.
' ° Bln, 87.
"Smith papyrus (Sm) 41.
' 2 Eb, 657c.
13 Gyory H, Blazovics A." ... that Su prepared for himself.... " Fitote-
rapia 1999;4(4):98-103.
14 Gyory H. Fenugreek and Almond Oils in Ancient Egypt—"Let there be
brought very much hemait plants, about 2 sacks." Fitoterapia 2001;6(1):4-
11.
15 Sm, 10, 27.
16 Sm, 23, 26.
214 World J. Surg.
Fig. 2. Medical instruments: Bronze needle (No. 52737) and hook (No.
52738). Museum of Fine Arts, Budapest (size in cm). (Reprinted with per-
mission of the Museum of Fine Arts, Budapest.)
Moor as his injury passes by. You should treat it afterward with
grease, honey, and lint every day, until he recovers.s 17
Egyptian surgeons also applied sour or moldy bread to wounds,"
the antibiotic of their time. They recognized granulation tissue and
at times it was encouraged and at other times it was discouraged
(Fig. 3, 4):
When you examine a man with an irregular wound ... and that
wound is inflamed ... (there is) a concentration of heat; it pours
out of the opening of that wound against your hand; the lips of the
wound are reddened and that man is hot in consequence; then you
must say: a man with an irregular wound ... a sickness that I can
treat. Then you must make a cooling substance for him to draw the
heat out. . . leaves of the willow. 19
This information confirms that the ancient Egyptians recognized
the cardinal signs of infection and inflammation, and they also
knew that the bark and leaves of willow trees tended to reduce in-
fection. The antiseptic qualities of willow bark are well known to
modern science.
Special use of feces was the muck of flies, which contains both
their excrement and their spittle. It was collected from walls, 20
which means that a certain quantity of adobe, dust, and other im-
purities—and perhaps even some whitewash—were included.
"Sm, 3.
18 Eb, 70.
19 Sm, 41.
20
Eb, 782.
Vol. 28, No. 2, February 2004
Moreover it seems likely that the collected material was not only
the product of flies but also of other insects [20], which used to spit
or pass on walls. It is obvious that people attributed a health-giving
quality to fly-specks. Because numerous flies had previously settled
and left their specks on wounds their physical effectiveness was rec-
ognized, but in association with the mediation of some deities. The
role of the fly-speck is magically explicable on the one hand by the
principle similis similibus: flies set in great numbers on bleeding
meat, and they naturally leave their mark. those tiny little dots,
which harden in a minute, can be observed to dry the bleeding
wound as well. On the other hand, the principle of pars pro toto
might serve to explain the use of insect muck: as courageous as the
fly, so could its excrement fight against the invasive demons. Its
appearance, perceptible by the naked eye, could be the maggot de-
briding the putrid wounds.
Larval therapy was routinely used until antibiotics were intro-
duced. Maggots are chemical factories. They produce a powerful
mixture of proteolytic enzymes that break down necrotic tissue and
liquify it. The maggots then ingest this liquid. In the process, they
ingest, and digest, the bacteria in the wounds/ Their secretions in-
crease the pH of the wound to around 8 to 8.5 by the production of
ammonia, which inhibits the growth of some bacteria. Maggots also
secrete antimicrobial chemicals. Their presence in the wound
stimulates granulation tissue formation and fibroblast develop-
ment, thereby accelerating the healing process.
Diagnosis
In ancient Egypt, surgical work was considered preparation for
medical treatment, and was independent of it.
A diagnosis is always introduced by the words: "Thou should say
concerning him [the patient] ..." and ends with one of three state-
ments:
1. An ailment, which I will treat."
2. An ailment with which I will contend. 22
3. An ailment not to be treated. 23
Three diagnoses consist of this final hopeless verdict and nothing
more. These are the earliest surviving examples of observation and
conclusion, the oldest known evidences of an inductive process in
the history of the human mind. Parallel with the systematic use of
these three verdicts is a similar series of temporal clauses bearing
more directly on the condition of the Patient although not so regu-
larly employed, and placed at the end of the treatment. These read:
A. Until he recovers. 24
B. Until the period of his injury passes by. 25
C. Until you know that he has reached decisive point. 26
The matter-of-factness and soberness of those early medical
texts is very impressive. The doctor who wrote them down was not
only an experienced man but a wise one, whose general point of
view sometimes adumbrates that of the Hippocratic writings. For
21 See, e.g., Sm, 2.
22
See, e.g., Sm, 4.
23
See, e.g., Sm, 6.
24
See, e.g., Sm, 1.
u See, e.g., Sm, 5.
See, e.g., Sm, 21.
26
Sipos et al.: Wound Healing in Egypt
example, he recommends an expectant attitude, trusting in the
healing power of nature, or he recommends waiting "until thou
know that he [the patient] has reached a decisive point"; this re-
minds us of the Hippocratic notion of "crisis."
Conclusions
Our knowledge of the pharmacopoeia of ancient Egypt is clearly
inadequate to support many sweeping generalizations about the ef-
fectiveness of the drug therapy regimens. Drawing actual conclu-
sions concerning the efficacy of the pharmacological treatments of
the doctor, as swnw or priest of Sakhmet or amulet-man/wizard, is
difficult for a number of reasons, including incomplete pharmaco-
peia translations, difficulty in defining the conditions to be treated,
and lack of information about how often a therapy was used. Nev-
ertheless, Egyptian drug therapy can be regarded as having evolved
from a system rooted in magic that developed from empirical ob-
servation.
Résumé. La civilisation d'Egypte est une des plus anciennes de 1'histoire et
reconnue pour ses accomplissements scientifiques et artistiques: la medecine
n'a pas ete une exception. Les egyptiens ont brilles particulierement en
matiere d'application et de soins par les pansements; ils reconnaissaient
les signs cardinaux de l'infection et de l'inflammation. La therapeutique
medicamenteuse des egyptlens pent etre regardee comme ayant evolue it
partir d'un systeme dont les racines relevaient it la fois de la magie et de
l'observation empirique. Afin d'illustrer comment la methode de cicatrisation
des egyptiens etait un stimulus majeur dans le developpement de la chirurgie,
nous avons mene une recherche bibliographique.
Resumen. La civilizacion egipcia es una de las mas antiguas en la historia
de la humanidad y es famosa por sus logros cientificos y artisticos, y la
medicina no fue excepci6n. Los antiguos egipcios fueron maestros en la
aplicacion de vendas, y reconocieron los signs principales de la infecci6n
y la inflamacion. La terapia farmacologica egipcia se desarroll6 a partir de
un sistema magico y de la observacibn empirica. Hemos realizado una
investigacion de la literature con el proposito de ilustrar cSmo el metodo
egipcio de cicatrizacidn de las heridas signific6 un estimulo mayor para el
desarrollo de la cirugia.
215
Fig. 3. Text of column 13 of the Smith Papyrus
with instruction no. 41, 18th Dynasty (Reprinted
from Breasted [19], with permission.)
Fig. 4. Hieroglyphic interpretation of column 13
of the Smith Papyrus with instruction no. 41, 18th
Dynasty. (Reprinted from Breasted [19], with
permission.)
Acknowledgments
This study was supported by the Hungarian National Research
Foundation (OTKA 029252) and the Hungarian Ministry of Wel-
fare (ETT 250/2000).
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