Egypt: Ancient Egypt Medical Care

The Life of Ancient Egyptians

For Every Malady a Cure

Of all the branches of science pursued in ancient Egypt, none achieved such popularity as medicine. Homer put it aptly in the Odyssey (IV, 229-232):

That fecund land brings forth abundant herbs, Some baneful, and some curative when duly mixed. There, every man's a doctor; every man Knows better than all others how to treat
All manner of disease ...

There was even a degree of specialization quite remarkable for the time, if we are rightly informed. Herodotus (II, 84) asserts that "The practice of medicine is so divided among them that each physician treats one disease, and no more. There are plenty of physicians everywhere. Some are eye-doctors, some deal with the head, others with the teeth or the belly, and some with hidden maladies...'

The usual term for a doctor was sunu, written with an arrow-shaped symbol that, it had been suggested, was an allusion to the use of arrowheads to lance abscesses. Some doctors belonged to the priesthood, including priests of the goddess Sakhmet, patroness of diseases, remedies and physicians, and of the lector-priests (khery-heb). Some again were counted among the scribes, as shown in such titles as 'chief doctor and scribe of the word of god'. Many enjoyed ecclesiastical as well as lay titles.

Like other professions doctors had their hierarchy. Besides ordinary doctors there were senior doctors, inspectors, overseers and masters of physicians and the 'Chief of Physicians of the South and the North', a kind of minister of health. Royal and palace doctors had their special hierarchy and titles.

The Belgian scholar Frans Jonckheere counted 82 doctors known by name, many with titles suggesting specialization in some defined area. Hermann Grapow, however, is probably right in thinking of them as simply exemplifying the various skills which the doctor might possess.

Thus the 6th-dynasty court physician and high priest Pepyankh, known as Iry, was not only 'doctor to the king's belly' and 'shepherd of the king's anus', but also 'the king's eye-doctor'. There has been much dispute recently as to whether dentistry ranked as a separate calling; there are only five references to it in the Old Kingdom and another isolated one in the 2 6th dynasty. Nor has it yet been settled whether any of the doctors known to us conducted research.

There were no female nurses to help the doctors, but we do know of male nurses, dressers, masseurs and lay therapists. It would be wrong to see connections between the medical profession and that of the embalmers, priests of the god Anubis. Contrary to older ideas that Egyptian doctors took part in the preparation of mummies to improve their knowledge of anatomy, it must be re-emphasized that most of their information came from ancient texts in which descriptions of the internal organs were based on analogy with animal bodies.

The embalming procedure had nothing in common with medical autopsies. The physician learnt his trade in the Houses of Life, notably at Per Bastet in the New Kingdom and at Abydos and Sais in the Late Period. He was no doubt given some practical experience, but chiefly he had to study what was already written. As the Ebers Papyrus says: 'His guide is Thoth, who lets the scrolls speak for themselves, compiles treatises and expounds knowledge to the savants and doctors who follow in his path.'

Diodorus too confirms this (I, 82, 3): '[They] administer their treatments in accordance with a written law which was composed in ancient times by many famous physicians.' From his further statement that 'on their military campaigns and on their journeys in the country they all receive treatment free of charge', it appears that for some people, at least, there was a system of free medical aid, such as we know existed also at Deir el-Medina. But on other occasions doctors expected to be handsomely reimbursed, as we can tell from a scene in the I 8th-dynasty tomb of the doctor Nebamun at Dra Abu el-Naga. There we see a patient, supported by his wife, (both dressed in Syrian style), being handed some medicine by Nebamun's orderly.

Behind this group and on another register is a file of servants bringing the doctor his fee - a copper ingot, a set of vessels (full, no doubt) and several little slave-girls.

The medical texts were not only the fount of professional knowledge but an insurance against possible failure. Diodorus saw this clearly (I, 8 2): 'If they follow the rules of this law as they read them in the sacred book and yet are unable to save their patient, they are absolved from any charge; but if they go contrary to the law's prescriptions they must submit to a trial with
death as the penalty.'

Of the eight extant medical compendia the most important is the Ebers Papyrus, a collection of about 700 prescriptions for treating internal diseases arranged according to the organ concerned. This was built up between the 4th millennium BC and the New Kingdom through the continual addition of fresh material. The Hearst Papyrus, by contrast, probably represents the memoranda of a practicing doctor of the I 8th dynasty in which he had written out remedies from other works, the Ebers Papyrus among them.

The Edwin Smith surgical papyrus shows a profound empirical knowledge of the different types of injuries and how to treat them: this is a copy from the Second Intermediate Period of a work at least 1000 years older. Other medical documents include the Great Berlin Papyrus, the London Papyrus, Chester Beatty Papyrus NO.VI, Papyrus Ny Carlsberg NO.VIII and the Kahun Papyrus, the last dealing with gynecology. These are largely copies of Old Kingdom treatises made during the Middle and New Kingdoms.

Examination of both medical and non-medical documents has convinced many investigators that the ancient Egyptians knew their anatomy in fair detail. In addition to externally visible features there are many names of internal organs well known from butchery and cooking.

Notions of physiology and disease were all anchored in the concept of the heart as the center of the organism. It was the site of the soul, the reasoning faculty, qualities of character, and emotions. It was through the heart that god spoke, and the Egyptian received knowledge of god and god's will. The heart was one's partner: it spoke to a person in his or her solitude.

It was at the same time the engine of all the bodily functions, not only of one cardinal function, the circulation, as modern science revealed. From the heart proceeded channels (metu) linking all parts of the body together.

These channels, the Egyptians believed, conveyed not only the blood, but also air (reaching the heart from the nose, they thought), tears, saliva, mucus, sperm, urine, nutriment and feces, as well as harmful substances (wehedu) conceived to be the agents of pain and illness. Not only blood vessels were considered as metu, but also the respiratory tract, tear duct, ducts of various glands, spermatic duct, the muscles, tendons and ligaments.

The female organs were likewise seen as tubes open into the internal cavity; the eye was supposed to communicate with the car and the only purpose of the brain was to pass mucus to the nose, with which it was also thought to be connected. The Egyptian idea of the human body, then. was as a network of interconnecting channels and analogous to the branches of the Nile and the artificial canals of their own country. It was soon realized that in some of the metu the heart 'spoke' and a doctor could 'measure the heart' from this beat. But he could only tell if the heart was going faster or slower by comparing the patient's pulse with his own.

The concept of circulation was still beyond the Egyptians' knowledge, since they did not distinguish between arteries and veins, nor appreciate that the blood returned to the heart. The precondition of good health, they thought, was free flow through the metu: ailments arose when they became blocked, just as with irrigation canals.

Thus if a woman was infertile this was because the sexual channel was closed, and constipation or accumulation of the blood were likewise causes of disease. Harmful substances might find their way into the metu through the natural orifices, mainly by the ingestion of bad food. But they could also originate inside the gut, and doctors were therefore much exercised to ensure its regular evacuation. Sometimes seeing worms in the stool, they deduced that these too might have come into the body through the mouth and cause a disease.

With externally visible damage like wounds and fractures the causes were often obvious. But with many internal ailments doctors were at a loss, so they imputed them to irrational influences, usually gods - either hostile and malignant deities, or well-intentioned ones who sent down plagues as a punishment for wrongdoing. Sickness might also be the work of evil demons, or of an envious neighbor's evil eye.

It would far exceed the scope of this chapter even to enumerate the diseases of ancient Egyptians that our researches have so far revealed. The evidence comes from several sources; from identification of their names and from their description in the texts, from their characteristic appearance in portrayals of the human body, from the study of pathological tissues in mummies and, in the case of diseases of bones and teeth, from the examination of human skeletal remains from burial sites. The study of all these sources constitutes the recently defined discipline of paleopathology.

According to medical texts the ancient Egyptians recognized some 200 types Of sickness, though there is no mention of diseases of the lungs, liver, gall-bladder, spleen, pancreas or kidneys - the symptoms evidently eluded them. We can of course never be sure what any named disease refers to unless its symptoms or recommended treatment are mentioned in the same context.

The descriptions of external lesions and in particular of wounds are fairly clear. A wound is said to have a 'mouth' and 'lips' and may 'go as far as the bone'. It is usually accompanied by bleeding, which in the case of severe injuries to the skull, may come from the nose and ears too. The Ebers Papyrus (Case 8) mentions that a skull fracture hemorrhaging into the brain can cause paralysis, on the same side of the body it says, not the opposite side - perhaps this was a copyist's error.

The Smith Papyrus (Case 7) quotes a man with a gaping head-wound as showing the symptoms of tetanus: 'His mouth is locked tight ... his brow is convulsively contorted and he has the expression of a man crying.' The Egyptians distinguished simple fracture, sedj, where the bone is broken in two, and complicated fractures, peshen, resulting in numerous fragments.

Conditions characterized by a bulging of the affected part were classified either as shefut, commonly translated as 'swellings' but in view of some scholars references to a liquid content possibly including abscesses too, or as henhenet and aat, thought to denote tumors. The former were treated with dressings, the latter by excision. Most of the ophthalmic and internal maladies mentioned in the texts are difficult to identify with certainty. The only unambiguous ones are constipation, inflammation of the rectum, cystitis, and blood in the urine, usually due (in Egypt) to bilharzia, equated by Ebbell and Jonckheere with the disease aa.

We are on safer ground where we can find illustrations drawn by artists with a feeling for characteristic changes of appearance. The Queen of Punt, familiar to us from a relief in the temple of Hatshepsut at Deir el-Bahari, suffered from abnormal obesity, probably lipodystrophy. The eunuchoid appearance of Akhenaten towards the end of his reign suggests Frohlich's syndrome resulting from malfunction of the pituitary gland or of the mesencephalon, most probably due to a tumor. There are many depictions of dwarfs, distinguishable from the ethnic pygmies of Africa by their abnormal proportions.

One important achievement has been the examination of fragments of lung tissue overlooked by the embalmers when they were removing the soft parts from inside the body. It has shown that Egyptian lungs, like ours, contained coal dust in the lymphatic nodules (anthracosis), probably through inhaling smoke from open fires. Hypertrophied connective tissue between the alveoli, and the lymphatic vessels of other mummies proved to contain minute sharp-edged particles of silicates, felspars and other granite minerals (silicosis).

In other cases lungs were found to be covered with dust of fine desert sand (pneumoconiosis). Other mummies again showed changes characteristic of pneumonia, sometimes complicated by pleuritis or pericarditis.

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