PAIN,
DISEASE
AND ANALGESICS
IN ANCIENT
EGYPT
by
ROYJAMESLANE
A thesis submitted to the University of Birmingham for the degree of
DOCTOR OF PHILOSOPHY
Institute of Archaeology and Antiquity School of Historical Studies The University of Birmingham
ABSTRACT
Pain is the index feature of disease since it prompts a request for treatment and its control is intrinsic to the medical system. The ability to control pain should reflect the overall effectiveness of the medical system. This has not been previously studied.
Many Egyptian medical terms are unclear. The thesis shows some unknown terms may lexically derive from an adaptation of the type of pain experienced in disease. Such a system of adaptive tenninology would provide a basis of nomenclature. Other terms of more
fundamental importance, such as aetiological morbid features of disease, might equally be
more simply explained.
Despite the high incidence of painful diseases in ancient Egypt, the control of pain was limited. There was a lack of powerful analgesics. Other substances that might have been used to produce analgesia seem not to have been exploited. This may have been due to a'policy'of
multiple ingredient polypharrnacy so that the individual pharmacological properties of
substances were not separately recognised. This would have hindered the progress of medical treatment. Such a system may have been part of the treatment (itual per se. It may be that a 'secondary system' of home treatments existed which either forced or perpetuated this policy.
LIST OF CONTENTS Chapter I- INTRODUCTION
1.1 The Reputation of Egyptian Medicine - Brief Background 1 1.2 Connections Between Egyptian and Greek Medicine - Previous Studies
on Pain, Disease and Treatment 5
1.3 Plant Substances-Entries in the Medical Papyri - Problems of Identification -
Current Reference Sources 9
1.4 The Medical Papyri - Description and Problems 14
1.5 (i) Table: Medical Papyri 14
1.5 (ii) Plate: Berlin Papyrus (facing) 24
1.5 (iii) Plate: London Papyrus (facing) 24
1.6 Aims and Methods 27
Chapter 2- PAIN
2.1 Concepts 32
2.2 Pain Relief 40
2.3 Physicians 41
2.4 Use of Analgesics 44
Chapter 3- EGYPTIAN TERMINOLOGY
3.1 Words for Pain 48
3.2 tfý, bdw 50
3.2 (i) Plate: Berlin Papyrus 154 59
3.2 (ii) The Vessel Book (Ebers 854/6, Berlin 163) 66
3.2 (iii) The Leiden Papyrus 1,348 - Spell 13 70
3.2 (iv) Admonitions of an Egyptian Sage 73
3.2 (v) Other Prescription Entries for wbdw 74
3.2 (vi) The Connections of uýbdwwith Greek Medicine 81
3.2 (vii) Conclusions on tfýbdw 84
3.3 stt 86
3.4 Adaptive Terminology 100
Chapter 4- DISEASE
4.1 Background - Sources - Previous Studies
4.2 Table: Medical Conditions and First Identifications 121
4.3 Carcinomas 122
4.4 Bone and Joint Disease 126
4.5 Dental Disease 133
4.6 Parasitic Worms 137
4.7 Respiratory Disease 142
4.8 Accidents and Injuriies 145
Chapter 5 MEDICINAL PAINKILLING SUBSTANCES
5.1 Introduction 152
5.2 Opium 155
5.2 (i) Plate: Cypriote Ring Base Juglet 163
5.2 (ii) Plate: Vessels and Stands from the Tomb of Kha 164 5.2 (iii) Table: Opium Usage in England and Ancient Egypt -
A Comparison of Land Required 171
5.3 Cannabis in Egypt 172
5.4 Cannabis, Cocaine and Tobacco -The Munich Mummies 177 5.4 (i) Table: Summary of Results Reported by Balabanova and Team. 184
Chapter 6- LETTUCE, CELERY FRUIT, MANDRAKE, LOTUS
6.1 Lettuce 185
6.1 (i) Prescription Entries for eftin the Medical Texts 187
6.1 (ii) Melilot 192
6.1 (iii) Wild Lettuce 192
6.2 (i) Celery Fruit 194
6.2 (ii) Dawson and Aft 195
6.2 (iii) Mitt in The Medical Texts 198
6.2 (iv) Summary 206
6.3 Mandrake 207
6.4 Lotus 209
6.4 (i) Prescription Entries for Lotus 211
6.4 (ii) Summary of Prescription Entries 213
6.4 (iii) Conclusions on the Lotus 214
Chapter 7- DILL, JUNIPER, WILLOW, HENBANE, MYRHH
7.1 Dill 217
7.1 (i) Prescription Entries for Dill 218
7.1 (ii) Conclusions on Entries for Dill 219
7.2 Junipe 221
7.2 (ii) Juniper in The Medical Texts 222
7.2 (iii) Conclusions on Entries for Juniper 228
7.3 Willow 230
7.3 (i) Prescription Entries for Willow in the Medical Texts 231
7.5 Henbane 234
7.5 (i) Possible Prescription Entries for Henbane 235
7.5 (ii) Henbane Toxicity 236
7.6 Myrrh 239
7.6 (ii) Characteristics of Myrrh 241
Chapter 8 -ALCOHOL, SURFACE ANALGESICS
8.1 Alcohol 249
8.1 (i) Alcohol Abuse 251
8.1 (ii) Plate: Lady at Banquet, Guests at Banquet (facing) 253
8.1 (iii) The Medicinal Uses of Alcohol 254
8 (iv) Dioscorides and Alcohol 256
8 (v) The Use of Alcohol outside the Medical Texts 257
8.2 Surface Analqesics 258
8.2 (i) Surface Analgesia and the Tomb of Ankhmahor 261 8.2 (ii) Circumcision Scene from the Tomb of Ankhmahor (facing) 263
Chapter 9- PRESCRIPTION ANALYSIS
9.1 Introduction 268
9.2 Collation of Material 271
9.3 Tables: Prescription Entries in the Medical Texts
Tables 10.3 (i) - (ix) 272
9.4 Discussion 278
9.5 Table: Percentage Ratios for Internal/External Treatments 279
9.6 Table: Complex/ Minor Conditions 282
9.7 Conclusions 284
Chapter 10 - GENERAL CONCLUSIONS 286
11. Appendix - THE USE OF EXCREMENT IN PRESCRIPTION FORMULATIONS
11.1 Excrement in Prescription Formulations 291
11.2 Human Faeces 291
11.3 Animal Faeces 293
11.4 Summary 296
GLOSSARY - Medical Terms
CHAPTER 1: INTRODUCTION
1.1 The Reputation of Egyptian Medicine - Brief Background
The ancient Egyptians have long enjoyed a great reputation for their skills in medicine principally due to the reports from classical writers outside the Egyptian world. This reputation
was not only restricted to the area of medicine as the Greeks later believed that their very
philosophy'owed much to the land of the Pharaohs. '
For example, Homer describes Polydamna, the wife of Thonis, as giving medicinal plants 'to Helen in Egypt, a country producing an infinite number of drugs ... where each physician possesses knowledge above all other men'. 2 Similarly, from the Bible: '0 virgin daughter of Egypt in vain shalt thou use many medicines' (Jeremiah 45,11). 3 Clement of Alexandria, in the second century AD4 tells us more specifically, that the Egyptians had some
Oforty-two books of knowledge, six of which were of medical content. It has been suggested that these six books may correspond to those categories of disease and treatments within the
currently known medical papyri. 5 In fact, Ebers quite firmly believed that his medical papyrus represented book Number 40 -'Remedies'. 6
Herodotus discusses the health and medicine of the Egyptians. 'Next to the Libyans' they (the Egyptians) are 'the healthiest people in the world - an effect of their climate
... which has no sudden change'. 7 The reputation of Egyptian physicians was such that both Cyrus and
Darius sent to Egypt for medical assistance. 8 The description by Herodotus of the treatment of
the body during the embalming process appears to be an accurate, detailed and observed
I J. Barnes, Early Greek Philosophy (London, 1987), 15. The process of connection between Egyptian and Greek views is, in part, explained by A. B. Lloyd, Herodotus Book I/, Introduction (Leiden, 1975), 50-3.
2 Homer, The Odyssey. Translated by J. Lombardo (Indianapolis, 2000), iv, 229 The influence of the Odyssey on Herodotus is discussed by Lloyd, Herodotus Book /1, Introduction, 122-3.
3 The Holy Bible, Authorized Version, 1611.
4 C. Bryan, The Papyrus Ebers (London, 1930), 2-3.
5 J. F. Nunn, Ancient Egyptian Medicine (London, 1996), 24.
6 The other five books were Anatomy, Disease, Surgery, Diseases the Eye and Diseases of Women. They were referred to by the Greeks as the 'Hermetic Books', after Hermes. Bryan, The Papyrus Ebers, 3.
7 Herodotus, Histories 11: 77, Translation, G. Rawlinson (London, 1858). Reprinted London, 1996. 8 Herodotus, Histories III: I and Histories 111: 132.
summary of the process. 9 He also tells us that medicine was practised 'on a plan of separation; each physician treats a single disorder and no more'. 10 Certainly, the title of 'physician'
appeared to carry an element of kudos within Egypt since it appeared not infrequently within the 'title lists' of important people. " Some of these medical titles have additional qualifying words following the word 'doctor which imply medical specialisation e. g. swnwbt, 'doctor of
the stomach'? 12 However, this division of the medical system into specialists (oculists, dentists
and even proctologists) which Herodotus maintains existed to the extent that 'the country swarms with practitioners' is not supported by other sources. 13 In fact, the main medical papyri all contain an amalgam of conditions which implies their use by general practitioners rather
than by specialists. It is obvious that Herodotus in medical matters, as in others, must be
approached with some circumspection. 14 It is significant that any suspect aspects to his work
might be attributed partly to his lack of knowledge of the Egyptian language. In the same vein, many of the presumptions regarding the prowess of the Egyptians emanate from, and were
perpetuated because of, the very nature of the Egyptian script.
Hieroglyphs were for a long-time regarded as metaphysical and symbolic such that, 'they caused to be erected an enormous edifice of learning on the totally false assumption that
9 Herodotus, Histories 11: 86. For a discussion on the methods see A. B. Lloyd, Herodotus Book 11, Commentary 1- 98, (Leiden, 1976), 354-64.
10 Herodotus, Histories 11: 84.
11 Udjahorresnet a high officer under Cambyses reports int al that, 'His majesty assigned to me the office of chief physician'. From his 'autobiography on a standing naophorous statue (now in the Vatican Museum), M. Lichtheim, Ancient Egyptian Literature - Volume 3: The Late Period (Berkeley, 1980), 37.
12 Nunn, Ancient Egyptian Medicine, 118.
13 In fact the titles which denote specialism are relatively few in percentage of the total and seem to relate to the Old Kingdom. Ghalioungui briefly suggests that this may be due to some underlying change in medical theory. A move away from the concept of 'compartmental' theory to one of unity of the body. P. Ghalioungui, Magic and Medical Science in Ancient Egypt (London, 1963), 74. However it seems as likely that these titles merely lost their original implications and developed a honorary form. This can be seen with English ties e. g. the title 'knight has
lost its original adversarial implication. Equally, the present title of 'Secretary of State for Health' is a political not medical appointment
14 The point of medical specialism is discussed by Lloyd who also considers that Herodotus has 'gone too far in his conclusions. He makes the point that Egyptian physicians 'accumulated a wide range of medical offices and duties and so could hardly be called specialists', Lloyd, Herodotus, Book //, 1-98,350.
each sign had a complex and allegorical significance'. ' 5 It is probable that this resultedlin Egypt becoming renowned in the Roman Empire and even very much later as a source of learning
and
theoCCUlt.
16Consequently,
any
considerations
of ancient
Egyptian
medicine
may
have
the
inherent danger of overestimation. Indeed some modem studies have falsely attributed a modern medical understanding to Egyptian medicine and have attempted to explain it 'in part
by filling in the gaps, and by recourse to preconceived notions of Egyptian influence on Greek
medical theories'. 17 Even now, the ancient Egyptians are alleged not only to have 'practiced medicine in a rational and deductive manner', but also to have been the 'inventors of clinical observation'. 18 Conversely there might possibly be a tendency to regard ancient Egyptian
medicine as either magic or magico-religious and essentially without any rational elements. 19
Medical practice like religion and magic had a strongly ritualised aspect and the borders between the three were often fluid. Equally, the magical element gave another line of approach to a medical problem and must also have allowed for an excuse upon failure.
Most recently with Egyptian medicine there has been a tendency to focus on specific and often esoteric areas of medicine. Whilst this can be appreciated in terms of resources and specialism, it can also serve to distract from a holistic assessment. Specific examples are given
later within the text. 20 A holistic overview is imperative in order to assess the actual ability of the
ancient Egyptian practitioner. An assessment of Egyptian prowess in terms of medical matters might be achieved from such a holistic overview.
15 P. R. S. Moorey, Ancient Egypt (Oxford, 1992), 3. A recent study on the significance of hieroglyphs to anatomical knowledge concluded that the 'djed' column 'previously thought to have a primary religious significance' was used to symbolise the spinal column', J. K. Lang and H. Kolenda, 'First appearance and sense of
the term'spinal column'in ancientEgypt. Historical vignette', JoumalofNeurosurgery97, (2002), 152-5. However, it seems not to be so since rather the term n2k3t seems to apply, see J. Walker, Studies in Ancient Egyptian Anatomical Terms (Warminster, 1996), 197-202.
16 There was general secrecy surrounding knowledge, Ghalioungui, Magic and Medical Science, 31-2. 17 M. Marganne, 'Greek Medical Terms', Forum 3 (1993), 37.
18 A. Martin-kaguz et al., 'Neuroscience in ancient Egypt and the School of Adexandria', Neurology Review 34, (2002), 1183-94.
19 G. Pinch, Magic in Ancient Egypt (London, 1994), 140-2. 20 See, for example, pages 111-2.
The essential ingredient to the understanding of any scientific system is the understanding of how a particular process works at the 'sub level' i. e. the unobserved process.
In terms of medicine this equates not to the anatomy of the body but to its physiology. Without the knowledge of physiology the aetiology of disease cannot be appreciated. For example,
many early societies would have been aware of the heart and of its connections with the blood and blood vessels. Galen, who demonstrated that the arteries carried blood, otherwise gave a confusing description of the blood vessels since his knowledge of physiology was strictly
limited. 21 It was not until Harvey, in the seventeenth century, who demonstrated the flow of blood within the circulatory system that human physiology came to be understood. 22 Thus, in an evaluation of ancient Egyptian medicine, one problem is to appreciate the extent to which the Egyptians were aware of basic physiology. I consider that we must start with the
presumption that, at best, this must have been very selective and patchy. If the ancient Egyptians were unaware of basic physiology then internal diseases could have no obvious aetiology. This was essentially the position of the Roman physicians. For example, whilst Galen could deal with (obvious) external problems he accepted that internal treatments were
diffICUlt. 23 Without
a proper knowledge of physiology treatment with medicinal substances cannot properly be targeted. Any drug regime would, at best, be an ad hoc administration followed by rejection or selection of a compound decided upon the basis of any observed
required or adverse effects. That is not to say that administration of medicines from empirical experience would produce an inefficient system of treatment. For this reason it is important to
examine the Egyptian prescriptions and their ingredients in detail. This will be carried out in Chapter 9.
21 G. Sarton, Galen of Pergamon (Lawrence Kansas, 1954), 48-51. Galen was a Greek bom in 0 30 in Pergamon and who left for Rome in 175. There he was court physician to Marcus Aurelius. There are some 16 books of
Materia Medica ascribed to him, although most are spurious.
22 In fact Harvey was reluctant to publish being 'careful not to offend the Galenic readers', Sarton, Galen of Pergarnon, 47. This shows there had been little advance in medical thought for over 1500 years.
23 L. G. Ballester, 'Galen as a Medical Practitioner, in V. Hutton (ed. ), Galen: Problems and Prospects (London, 1981).
1.2 Connections between EqyDtian and Greek and Medicine - Previous Studies on Pain, Disease and Treatment
Before the understanding of the Egyptian language became possible, through the deciphering of its hieroglyphs, most historical accounts of Egypt relied on classical sources. 24
Egyptian medicine is no exception and its understanding was only really possible with the
translation of the medical papyri in the last century. Prior to this, reliance was from Greek
accounts, principally by Herodotus, Diodorus and Dioscorides. However, this previous reliance on classical sources and the practice of Greek medicine during the Greek periods within Egypt
has created presumptions that some aspects of Greek medicine must derive from Egyptian theory. This is particularly so in the aetiology of the disease process. Medical elements of
Aristotle's work and that of the Cnidian School are said to be based on an Egyptian theory which itself resulted from the observation of the decay process during mummification. 25 It is
generally accepted that the natural desiccation of buried bodies appeared to give the human form an immortality which was artificially attempted by the process of mummification. During
mummification any intestinal spillage would have been associated with decay and so became the antithesis to preservation. This phenomenon was recognised by Steuer who proposed it as the basis for the Egyptian understanding of the disease process. According to Steuer waste elements in the body's intestinal tract not only became associated with decay but were thought to contain a precursor agent to disease. Importantly he also proposed that this agent was actually named by the Egyptians - tvhdw. This was later proposed by Steuer and Saunders to
be the seminal link between Greek and Egyptian medicine. 26 It is a link that it often assumed by
24 This is demonstrated by Brugsch's reconstruction of the Twenty-fifth Dynasty, previously reliant on classical sources until the discovery (and translation) of the'Victory Stela of Piye'from Gebel Barkal.
25 S. lkrarn and A. Dodson, The Mummy in Ancient Egypt (London, 1998), 15.
26 R. 0. Steuer, ' "dw'. aetiological principle of pyaemia in ancient Egyptian medicine', Supplement to Bulletin of History of Medicine 10 (1948). R. 0. Steuer, Ancient Egyptian and Cnidian Medicine (Berkeley, 1959). J. B. Saunders, The Transition from Ancient Egyptian to Greek Medicine (Lawrence Kansas, 1963).
other writers in passim. 27 In reality there appears to be little evidence for links with Egyptian and Greek medicine beyond the claims of Greek writers. Most of these are imprecise and often subsequently plagiarised. 28 It is, therefore, important that there can be shown to be actual evidence for the connections proposed by Steuer. 29 However, this has produced a somewhat confused situation with certain Egyptian medical terms either being considered as indicators of
a pathological process or merely descriptions of pain in disease. The terminology in respect of
this has recently been reviewed, summarised and appraised by Kolta and TessenoW. 30 They do not entirely concur with Steuer but still view ivbdw as an agent which acts as a precursor to
disease. However, their review fails to consider the negative implications of the argument. Aside from any significance of Egyptian and Greek connections, if the term describes a
precursor agent rather than pain per se then the terminology for pain is reduced. That is, if
certain terms are disease indicators rather than terms for pain then the potential for evidence of painful disease is reduced and vice versa. This is important because it would will limit certain terminology to the disease process rather than actual terms for pain and so reduce the number
of painful conditions identified within the Egyptian medical framework. Equally, if these terms
refer to the disease process rather than the symptoms of disease it questions the significance and reasons for some treatments. It also creates problems when attempting to match symptoms in order to identify diseases within the medical papyri.
27 See, for example, Pages 36-7.
28 Barnes, Early Greek Philosophy, 15-16. All the references to Egypt come from Greek writers who are somewhat confused themselves. For example, Isocrates has Pythagoras going to Egypt to study and which influenced his
later pronouncements. Yet, Herodotus has him firmly resident in Samos but, nevertheless, implies that Pythagoras stole the Egyptian idea that the soul is immortal and enters into another animal when it is bom, Histories 11: 123.
The belief in the transmigration of souls seems to have developed independently in other parts of the world, see A. B. Lloyd, Herodotus Book 11 Commentary, 99-182 (Leiden, 1988), 59.
29 R. 0. Steuer, Ancient Egyptian and Cnidian Medicine (Berkeley, 1959). This proposal is important because it is a constructive one. Otherwise the 'links' between Greek and Egyptian thought all come unsubstantiated and gratuitously from the Greeks themselves. For example, we are told that not only did Pythagoras visit Egypt to study but that he was the first to bring (that) philosophy to Greece (Isocrates, Busiris 28-9).
30 K. S. Kolta and H. Tessenow, 'Schmerzen' Schmerzstoffe oder F5ulnisprinzip zur Bedeutung von w,
-bdw, einem zentralen Terminus der alt5gypfischem Medizin', ZAS 127 (2000), 38-52.
Any previous research on pain in ancient Egypt is distinctly lacking. Apart from one short article by Dawson on terminology within his series of studies in the medical texts there
have been no direct discussions on the subject. 31 The work by Dawson on terminology and medicinal plant identification often forms the basis for later reviews. Whilst many of his identifications remain valid others have since been discounted. His work in this area has briefly
touched on pain terminology in his discussion of the term stt and in considering the individual
properties of certain plant substances. Dawson considered stt to be a symptom of pain whilst others have proposed it as pathological factor, albeit with different functions, one which was
intrinsic to an Egyptian concept of the disease process. 32Thus, like whdw it is regarded either as a symptom of disease or as pathological factor, which is one fundamentally significant in the
interpretation of disease and its treatment.
In comparison there has been substantial and continued study on disease in ancient Egypt. However, the large scale appraisals of Egyptian disease are early ones. During the period 1890-1930 work on paleopathology was carried out mainly by Ruffer, Elliot Smith, Jones and their team members. 33 These studies were possible because of funding and because of the associated work being carried out in the same geographical areas. In fact, they are the only real overall appraisals of disease since later work has by necessity of finance or discipline veered towards the specific rather than the holistic. Most very recent work has been specific in
remit: for instance, the study of DNA decay rates in human remains by Marota et al, 34 of dental and cranial porosities by Keita and Boyce35 and a review of contraceptive agents from the
31 W. R. Dawson, 'Studies in the Egyptian medical texts 11', JEA 19 (1933), 133-7. 'Studies in the Egyptian medical texts Ill', JEA 20 (1934), 41-6. 'Studies in the Egyptian medical texts IV, JEA 20 (1934), 185-8.
32 Grundriss, VI 1,814-5. T. Bardinet, Les papyrus m6dicaux de F8gypte pharaonique (Pads, 1995).
33 M. A. Ruffer, 'Historical Studies on Egyptian Mummies', M6moires Institut de Ftgypt 6 (1911), 3, 'Studies in Pathology, (Chicago), 1921. G. Elliot Smith, 'Report on the Human Remains', The Archaeological Surveyof Nubia.
Report for 1907-8 (Cairo, 1910).
34 1. Marota et al., 'DNA decay rate in papyri and human remains from Egyptian archaeological sites', American Journal of Physical Anthropology 117 (2002), 310-18.
35 S. 0. Keita and A. J. Boyce, 'Diachronic patters of dental hyperplasias and vault porosities during the predynastic in the Naqada region, Upper Egypt' , American Journal of Human Biology 13, (2001), 733-43.
medical papyri. 36 However this concern for the specific, albeit unwittingly, sometimes ignores the more prosaic yet fundamental aspects of ancient Egyptian medicine. In this thesis I will
consider the wider aspects of disease (Chapter 4). This is in order to produce a list of the broad categories of disease that were a common feature of Egyptian life. The list should be
representative if it is to be instructive towards an understanding of the overall level of disease
and treatment in ancient Egyptian. It is anticipated that pain will be a prominent feature in most
of the disease categodes.
In terms of the treatment of pain in ancient Egypt there have been no previous studies and no overall discussion. Any considerations of analgesics have been the result of research in other specific situations, for example, during the discussion of a supposed circumcision ritual. 37
In terms of treatment most of the previous work is based on the few short reviews of Dawson on medicinal substances. There have been no collective appraisals. Certain medicinal
substances have received attention but not directly in consideration of their pain-killing abilities. In terms of narcotic substances this has been in respect of other aspects of the plants rather than on their analgesic or hypnotic properties. For example, the opium poppy produces the
narcotic opium resin which is a powerful and important painkiller. Its use leaves significant social traces on society. It was known by the RomanS38 but the time and method of introduction into Egypt is uncertain. The view that its use was widespread in the New Kingdom is based
upon the work of Merrillees. 39 However, the discussion of opium by Merrillees is not concerned with its pharmacological implications but rather with the movement of goods throughout the
Aegean during the Bronze Age. Similarly the lotus has received much attention but for its
supposed erotic associations or psychedelic properties rather than its narcotic or analgesic properties. (See, Chapters 5.2 and 6.4).
36 J. Guiter, 'Contraception en ýgypte ancienne', BIFAO 101 (2001), 221-36.
37 M. M. EI-Ansary, 'History of Pain Relief by Ancient Egypfians', Middle East Joumal Of Anaesthesiology 10 (1989), 99-105.
38 Its use (and abuse) is reported by Pliny and Galen. See Chapter 5.2 on opium. 39 R. S. Merrillees, 'Opium trade in the Bronze Age Levant'
, Antiquity 36 (1962), 292.
1.3 Plant Substances - Entdes in the Medical Papvd - Problems of Identification - Current Reference Sources
The Egyptian medical papyri give lists of treatment for diseases. Aside from magical and surgical approaches these treatments involve the administration of a wide range of
substances. These were invariably used in combination. An eclectic range of products was utilised. This even included the use of animal and human excreta. In view of the supposed
connections between the intestinal contents and whdw, I will, in the Appendix to this thesis,
examine the prescription entries for faeces (ps).
The Egyptian prescription treatments can essentially be divided into drugs of mineral, animal or plant origin. Drugs of animal and mineral origin tend to appear equally recorded
outside the medical context and so identification is possible. For example common substances
like natron, ochre, beer, milk, honey and blood all appear widely outside the medical papyri.
In contrast the actual identification of medicinal plants is problematic. 40 There are no pictorial representations of plants within the medical texts and reference is made by name
alone.
41Whilst
there
is considerable
agreement
for the meaning
of the Egyptian
words
for
many herbal substances, others are less certain and many unknown. 42. Some plants have been found intact in tombs and plant remains have been isolated from excavation sites. 43 Other plants feature widely outside the medical texts and so their identifications are more certain. Outside these texts the pictorial representations of plants are common but are sometimes difficult to distinguish beyond form and so allow for misidentification. For instance, grapes in
representations are indistinguishable from melons unless the plant is shown provided with a
40 L. Manniche, An Ancient Egyptian Herbal (London, 1999), 159-62.
41 This contrasts with the 'rule' of later herbals where proper identification (by illustration) is considered vital. E. g: Ortus Sanitatis 1491, De Historia Stirpium 1542.
42 Nunn, Ancient Egyptian Medicine, 153-5.
43 Manniche, Ancient Egyptian Herbal, 40,147,149,151.
support to imply the vine. The persea fruit has the same outline and colour as the mandrake fruit making identification, in some instances, impossible. 44
The forms of plants in the medical texts are sometimes recognisable by determinatives but the actual pad of the plant is rarely specified. This is a problem since the pharmacological contents of a plant can often vary across its parts. In other words the chemical constituents of
the leaves may be different to the roots. This is vital to the assessment of any pharmacological
activity. For example, the willow plant is an important source of salicylates. These are powerful
analgesics, anti-pyretic and anti-inflammatory agents. However it is only the bark that contains
these salicylates. 45Also the otherwise innocuous rhubarb plant has leaves which contain oxalic acid which is toxic, but which is not present in the edible stalks. 46
It is not without significance that the part of a plant is rarely defined within the medical texts. This suggests that it was not a relevant factor for the practitioner. This could either be
because the part to be used was already understood or because its properties were not appreciated. It seems unlikely that such an important aspect of a plant would not be stated since selection of the correct part would have been vital for its desired pharmacological effects. Therefore it seems more likely that the pharmacological properties were not appreciated. This
is not surprising in view of the Egyptian practice of using multiple ingredients in a single
prescription which would have obscured individual properties. 47 It may even be that any pharmacological properties were actually incidental to the process of treatment.
The identification of substances from their appearance in the medical papyri relies on a
combination of matching physical appearances, lexical connectionS48 and pharmacological properties against known reference substances. Often pharmacological properties can only be
assumed by reference to the index medical condition of the prescription; that is by matching
44 Manniche Ancient Egyptian Herbal, 160.
45 C. Newall et al., Herbal Medicines (London, 1996), 268-9. 46 Newall, Herbal Medicines, 228.
47 This is discussed in detail in Chapter 9.
48 There are sometmes useful connections with Coptic.
disease against the known pharmacological properties of reference treatments. This is often problematic since many medical conditions are themselves not clear or symptoms are ambiguous.
References to Egyptian plant names and their botanical properties are found in the illustrated herbal of Dioscorides, a Greek physician who worked as a military surgeon under
Nero. 49 His work contains over 600 plant and substance entries. The translation into English from the Greek dates from the seventeenth century. The botanical references and associated
pharmacology are generally sound. The plant names are given in Latin, Greek, Roman and often Egyptian. However, despite a few names with phonetic connections, most of the Egyptian
names seem erroneous and offer liftle help in identification. 50
The first modem major publication on ancient Egyptian botanical sources was the considerable nineteenth century work by Loret in which the first identifications of many
Egyptian plant species were made. 51 Following Dawson and Volume VI of the Grundriss der Medizin der alten Agypter 52 there has been more work in terms of botanical studies by and Charpentier 53 and Germer. 54 The magnus opus of Charpentier remains the most important
reference work, but its emphasis is botanical rather than medical or pharmacological. Aufr&re has since published a detailed lexicological series of twenty-seven natural substances which includes substances of medicinal significance. 55 The work of Boulos on medicinal plants of
North Africa provides useful information on current distribution and medicinal uses in present
49 Dioscorides, The Greek Herbal Of Dioscorides. Translated by J. Goodyer (1655), R. T. Gunther (ed. ) (Oxford 1934). Reprinted New York, 1959.
50 The Egyptian names are said by Manniche to be a later 2nd century addition and not given by Dioscorides himself, Manniche, An Ancient Egyptian Herbal, 163. The point is not made by Goodyer or Gunther.
51 V. Loret, La flore Pharaonique 2nd Ed. (Paris, 1892).
52 H. Grapow, et al., Grundriss der Medizin der Aften Agypter. 9 volumes (Bedin, 1954-1973), (hereafter, Grundriss).
53 G. Charpentier, Recued de matdriaux 6pigraphiques relatifs 6 la botanique de 118gypte antique (Paris, 1981).
54 R. Germer, 'Untersuchnung Ober Arzneimiftelpflanzen in Alten Agypten, PhD Thesis (Hamburg, 1979). Flora des pharaonische Agypte (Mainz am Rhein, 1985).
55 S. 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'histoire naturelle XVIII-XXVI', BIFAO 87 (1987), 21-44.
day Egypt. 56 More recently Baum has published a work on ancient Egyptian trees and shrubs.
The emphasis is on pictorial representation and distribution but some specimens have pharmacological significance57
Outside Egypt a developed and recorded medical system was used by the Babylonians and Assyrians. There is no evidence of any cross-influences between them and the Egyptians in terms of medical theories. But it is possible that there was some in terms of
medical knowledge during periods of intense contact, such as the Amarna period. 58 Many medicinal plant substances were known to the Babylonians and Assyrians and their mode of
use may parallel that of the Egyptians. Work on the identification of these and their use within the medical system has been carried out by Thompson. 591-lis Assyrian Herbal and Dictionary of Assyrian Botany still remain the main references in this area although these volumes are now
rather dated. These are based on cuneiform plant lists and medicinal texts which date from the end of the second millennium to the first millennium BC. Cross reference is made to these works in this thesis when similar Egyptian plants are discussed.
In terms of Egyptian prescriptions and their ingredients the collected volumes in German of the Grundfiss and latterly Westendoff 60 remain the major references in this area. They collate information from all the medical papyri. Volume VI of the Grundriss, albeit printed
in 1959, still remains the cited complete Egyptian pharmacopoeia. Furthermore the Grundriss collates disease into categories and gives translations into German of Egyptian medical terms.
Many however still remain uncertain which makes diagnosis of some diseases difficult. The situation is further confused by the assumption of some terms as precursors to disease rather than as description of disease symptoms, as discussed above. Westendorf s later two volume
56 L. Boulos, Medicinal Rants of North Africa (AJgonac: Michigan, 1983). The term medicinal 'use' should be distinguished from actual pharmacological properties. I consider that in many cases he is merely describing 'folk- lore' assumptions as to their properties.
57 N. Baum, Arbres et arbustes de I'Egypte ancienne (Leuven, 1988). 58 See page 42 below.
59 R. Campbell Thompson, The Assyrian Herbals (London, 1924). A Dictionary of Assyrian Botany (London, 1949).
60 W. Westendorf, Handbuch der Altagyptischen Medizin. 2 volumes (Leiden, 1999), (hereafter, WestendoM.
work is essentially an abbreviated version of the Grundriss without the benefits of hieroglyphs or transliteration, but has updates on some of the Grundriss omissions.
The presc(iptions in the Egyptian medical papyri are distinctive in that they contain multiple ingredients. For example, Eb663 contains thirty-seven different ingredients and many
others contain in excess of ten. This is unusual and differs from modern treatments and even
from ancient herbals. 61 It contrasts, in particular, with the entries in the Assyrian Herbal which generally contains single items. Despite this 'anomaly' in Egyptian medicine neither the
Grundfiss nor Westendorf offer any prescription ingredient analyses. In Chapter 9 of this thesis
I have collated all the information from the prescription entries for the substances discussed in
the previous chapters. This is done on the basis of efficacy and of the relationships between ingredient appearances. In fact, there have been no overall prescription analyses before this thesis. I consider that this has been an important omission in the consideration of ancient
Egyptian medicine. This is because I believe that the Egyptian method of formulation may have limited the exploitation of pharmacological substances. Multiple ingredients must have hindered the recognition of the properties of individual pharmacological properties. If this limitation is
shown to be valid then it must render the efficacy of the individual prescriptions in the medical
papyri suspect. It may also call into question the fundamental ability of the ancient Egyptian physician. By this I mean that treatments would have been part of the ritual rather than treatment per se.
61 The Old English Herbarium dates from c. 1 OOOAD and is an Anglo-Saxon translation from a 5th century Latin text. Its entries are often for a single ingredient or if in combination generally with a solvent or fixing agent. E. g. Water lily (nym/aea alba) for a swollen stomach; 'for the same use the roots and give to the patient to eat for ten days', 'For eye pain and swelling take the plant called apium or wild celery pounded well with bread and lay it on the eyes'. English translations from, A. van Ardsall, Medieval Herbal Remedies (New York, 2002), 178,20 1.
1.4 The Medical Papyd - Descdotion and Problems
The following table is a list of the main medical papyri which are mentioned in this thesis. These are the most important general works known from ancient Egypt. As such they
represent the bulk of written medical evidence. 62 The medical papyri are essentially lists of treatments under a named disease; each entry is terse and contains scant detail. Aside from
some surgical cases there is little or no elaboration on the disease, particularly its cause -
except in cases of demonic possession. They contain little, or no, evidence of any physiology
or pathology but rather serve as prescription lists. However, this style cannot be taken to reflect
any lack of medical knowledge or otherwise since modern formularies are presented in the same way. The dates of the copies are approximate and are taken from Nunn without
comment.
63They
are listed
in chronological
order
rather
than
order
of size
or importance.
TABLE1.5 (i)
Medical Papyri (mentioned in the text)
TITLE LOCATION
Ramesseurn 111, IV, V Oxford
(Ram)
Edwin Smith (Sm) New York
Ebers (Eb) Leipzig
Hearst (H) UCLA, California
London(Lond) London (BM10059)
Berlin (Bin) Berlin
APPROXIMATE DATE CONTENTS
OF COPY
170OBC gynaecological,
ophthalmic, paediatric
1550BC surgical, trauma
150OBC general medical
145OBC general medical
130OBC magical, medical
120OBC magical, medical
e Abbreviations in parentheses are those used in the text.
62 Other than medical ostraca. These were remedies written on a stone or pottery medium. Known examples date from the Amama period through to the Roman period. F. Jonckheere, Prescriptions m6dicale sur ostraca Wratiques (Brussels, 1954).
63 Nunn, Ancient Egyptian Medicine, 25.
These papyri were mostly found within the last one hundred years and offered for private sale within the then vigorous antiquities market. They came with virtually no provenance. They are consequently (apart from the Ramesseum Papyrus) named after either a modern owner or their ultimate resting place. They are essentially medical formularies laid out
in paragraphs, each generally headed by a description of the medical condition, the treatments for which are then described. Apart from human remains, these papyrii form the basis upon which most Egyptian medical studies rely. Likewise this thesis will rely on these for its
analyses.
The two most important medical papyri are the Edwin Smith and the Ebers. The Edwin Smith Papyrus was first translated by Breasted in 1930 and later translated into German in
Volume IV of the Grundriss in 1958.64 A later German translation was subsequently produced by Westendorf in 1966.65 Edwin Smith comprises 48 main paragraphs, with some 13 'sub- cases' and is second only in length to Ebers. It is primarily concerned with surgical cases,
particularly ones of severe injury or trauma. In view of the potential for industrial injuries in ancient Egypt it is possible that the cases in Edwin Smith describe just such injuries. 66 The injuries described in the latter are so numerous that the source of its contents has been suggested to come from an industrial (pyramid/ quarry? ) site rather than a battlefield situation. This is because in the latter it would be difficult to find adequate time to devote to treatmentS. 67
However, Ralston in a more recent evaluation of 'Case Four' in Edwin Smith considers that Breasted was wrong in his diagnosis because of the rarity of such injuries within his limited experience in civilian life. The head injuries caused since by road traffic accidents have
produced complex injuries presenting parallels for comparison to some of those in Edwin Smith. This has allowed Ralston to suggest that the injuries in Case Four might have been
64 J. H Breasted, The Edwin Smith Papyrus (Chicago, 1930). 65 W. Westendorf, Edwin Smith Papyrus (Bern, 1966).
66 B. L. Ralston, 'Medical Reinterpretation of Case Four of the Edwin Smith Surgical Papyrus', JEA 62 (1976), 116- 21.
67 Ghaliounghui, Magic and Medical Science, 44.
caused by an Egyptian battle axe or even a sword, not by accidental fracture as previously suggested. If indeed the injuries were as a result of a sword then it has implications for the date
of the text; since it puts it well beyond the Old Kingdom implied by Breasted. 68
Edwin Smith differs from the other texts in that it is virtually free of the magical content which is a varying feature of the others. In this sense it demonstrates an empirical and rational
approach to treatment. The prognoses of cases are realistically stated at the outset such that some are declared untreatable. It also differs from the other papyri in that many more cases are
specifically defined. This is done by the use of glosses which give additional and specific
information regarding an injury. Unfortunately, such glosses are absent from the other papyri so that the exact identifications of some medical conditions is difficult. The Edwin Smith surgical
papyrus is a copy generally taken, by the style of writing, to date from about 155013C. It has since been suggested that archaic features have been added to give it the appearance of
'revered antiquity'. 69 Breasted actually attributed it (somewhat poetically) to the legendary Imhotep: priest, architect, Vizier to Djoser and (alleged) physician. It is difficult to believe that such a repository of surgical expertise could have been personally written by someone in
Imhotep's position.
The Ebers Papyrus is the largest and most important medical papyrus. This is because of its good physical condition, its clear writing and the size and the range of medical conditions which it contains. Its importance is stressed by the gravitas of its stated First Dynasty origin,
'-found in writings under the feet of Anubis in Letopolis and was brought to the majesty of the king of Upper and Lower Egypt Den', (Eb856a). No doubt this gave some reassurance as to the quality and so efficacy of the teXt. 70 It is by far the widest ranging of the medical texts and
68 This is because the sword was a later introduction, Ralston, JEA 62,119. However, it is not unreasonable to suppose that surgical texts were up-dated after'new' cases were encountered.
69 Nunn, Ancient Egyptian Medicine, 27.
70 Similarly, endorsements of medical texts are given in other forms. Eb468 is a hair-restorer with the endorsement that it was made for the 'mother of a king. The remedy in Lond25 is stated to have 'came down from the sky' and were taken into the safe custody of (the learned) king Khufu.
consists of some 8T7 paragraphs which include fourteen magic spells. However, unlike Edwin
Smith, its order is not logical and it appears to be a compendium from many different sources.
However, because of its wide content and its physical completeness, it is more likely to be
medically representative. This presumes that all medical conditions were presented for treatment, or recorded as such. It is possible that some types of medical conditions were excluded from the 'official' or recorded treatments of the medical papyri. This was, perhaps,
because of ineffectual remedies, the availability and cost of practitioners or because of the use of treatments outside the papyri. This possibility - the use of home nostrums and their
significance on the recorded evidence will be discussed later in Chapter 9.
However, there is some semblance of order in Ebers in that many conditions are grouped together. But many remedies are simply listed under the title 'another remedy'. This
also allows for the possibility that these may have been copied out of order.
The Ebers Papyrus is important in that it contains a Wide range of medical conditions. However, not all are clear and this has allowed for some liberal interpretation of the text. This is
particularly so with the Ebbell translation, 71 whereby an enthusiastic attempt to match conditions to known medical conditions has resulted in spurious conclusions. Unfortunately
these are often perpetuated into other sources and offered as evidence of modem medical common conditions such as angina and diabetes-72
The other medical papyri are less important generally and in terms of reference for this thesis. The Hearst Papyrus is a general medical work. It differs from Ebers in that it is arranged
in disease sections. In this sense it is useful as an aid to categorise and compare treatments. For example, H59-70 concem 'urinary irregularities' such that the associated remedies must also concern these conditions. Such clear association of remedy with disease is not always
71 B. Ebbell, The Papyrus Ebers (Oxford, 1937).
72 Nunn, Ancient Egyptian Medicine, 30. Angina and maturity-onset diabetes are age-related diseases and so proportionally less prominent in high early mortality societies.
found in the more random Ebers. The Hearst Papyrus has only 260 prescription entries compared to 877 in the Ebers but almost 100 of these are found as direct equivalents in Ebers.
The Berlin Papyrus has some 204 medical entries many of which are identical to Ebers. In particular Bln163 duplicates Eb856, the long sections concerned with the function of the mtw The London Papyrus is in poor physical condition consisting of 60 prescriptions the majority of which are magical. Some 23 entries have direct equivalents in Ebers.
The Ramesseurn Papyrus is unique in that its provenance is known. It was discovered in 1896 by Quibell in a tomb shaft in the Ramesseurn at Thebes. Gardiner, who first published the hieratic text, suggested that this tomb belonged to a medical practitioner. 73 The
Ramesseurn Papyrus is in three parts: Ram III covers the eyes, gynaecology and diseases of children. Ram IV is mainly concerned with diseases of women and children and Ram V is
principally concerned with remedies for the mttv In no parts are there any corresponding parallels with sections of Ebers or the other papyrus.
The Kahun Papyrus is a short gynaecological text of which there are no parallels within the other texts. It was discovered by Petrie and first translated by Griffiths in 1899. It is of an earlier date than the other texts and is actually dated from the Middle Kngdom. It is in poor physical condition with many lacunae.
In terms of translation, the most important medical papyrus, the Ebers papyrus was first published in facsimile by EberS74 in 1875 and subsequently translated into German in
1890. There are two published translations of the text into English. The first was by Bryan in
1930 and followed by Ebbell in 1937.75 Neither is satisfactory. They are essentially translations of the German original. The former version by Bryan has a gratuitous approach to translation which has possibly unwittingly sown the seeds of confusion amongst some English readers. The most scholarly and definitive translations are the volumes of the German Grundriss but
73 k H. Gardiner, The Ramesseurn Papyri (oxford, 1955). 74 G. M. Ebers, Papyrus Ebers, 2 volumes (Leipzig, 1875). 75 Ebbell, The Papyrus Ebers. Bryan, The Papyrus Ebers.
even these particular translations are now approaching 50 years old (Vol. 1,1954). The fact that this series was completed from 1954 to 1973 illustrates the enormous amount of effort required
to evaluate Egyptian medicine. But, conversely the length of time may also serve to illustrate a caveat which might be likened to 'the painting of the Forth Bridge'.
The discovery of the medical papyri allowed for the study of ancient Egyptian medicine.
Initially, the situation regarding Egyptian medicine, 'in the Ebers papyrus appears as a contradictory mixture of magic and of some important elements of anatomy, pharmacology and
pathology. 76 It is fair to say that the view of Egyptian medicine was re-evaluated following the translation by Breasted of the Edwin Smith papyrus into English in 1930. Ghalioungui suggests
that this has created two views of Egyptian medicine: one 'pre-Breasted' and the other 'post- Breasted'. 77The Edwin Smith text demonstrates a rational approach to medical problems, particularly in the field of surgery, which is based on acute and empirical observations of
practice and procedures. For instance, various therapeutic 'accessories' are mentioned which equate to modem surgical use: flax placed in wounds as an absorbent, flax drains for wounds,
sutures, cautery and the use of splints! 8
Paradoxically, whilst no doubt a watershed in terms of translation, the Edwin Smith
Papyrus may have unwittingly pushed the presumption of empirical application too far. The expertise shown in Edwin Smith does not necessarily extend across all the medical papyri. Simply stated the Edwin Smith Papyrus is a surgical treatise. The nature of the injuries is apparent, and so any treatment must be empirical - fractures cannot be set by incantations. So, whilst the approach to injuries and physical problems appears to have been based on fairly sound methods this was not necessarily the case with disease.
Breasted's translation was not without its problems. The lay-out of the papyrus is well organised but the text is unfinished. Several of the terms found in Edwin Smith appear for the
76 Ghalioungui, Magic and Medical Science. 58. 77 Ghalioungui, Magic and Medical Science, 58. 73 Ghalioungui, Magic and Medical Science, 64.
first and currently the only time. He himself lacked professional anatomical knowledge, which he acknowledged. 79More significantly, he never doubted that the diseases described by the ancient physician were known to modern medicine and that given proper translation could be defined. Whilst this approach might sound reasonable, Ralston has since re-evaluated two cases which show Breasted's diagnoses to be faulty because of this presumption. 80
It may be that the accident of discovery and the sequence of translation of the medical papyri have proved to be adouble-edged sword'. The present situation in respect of the overall
appreciation of Egyptian medicine is still far from satisfactory. The first translations of the
medical papyd date back to a pedod when knowledge of the Egyptian language was still being
developed. Another problem is that early language pioneers were by necessity lexicographers not medical scientists.
All the medical texts are in hieratic, except the Ramesseum V. The transcription from hieratic is sometimes difficult because of problems in actually reading the text itself. Also,
another problem is that some medical papyri were discovered either damaged or incomplete. Plates 1.5 (ii) (iii), show examples of the incomplete nature of the Berlin and London papyri because of damage.
The first translations of the London and Hearst papyd were made into German by Wreszinski in 1909 and 1912 respectively. 81 Subsequent German translations appear in the
volumes of Grundfiss and Westendorf. Leake produced a short English translation of the Hearst in 1952.82 It lacks transliteration and full ingredient lists, but is useful in terms of disease classification. Whilst the Grundfiss and Westendorf translations are sometimes commendably
79 Breasted, The Edwin Smith Surgical Papyrus, xix, 80 Ralston, JEA 62,116-21.
81 W. Wreszinki., Der Grosse Medizinische Papyrus des Berliner Museums (Leipzig, 1909), Der Londoner Medizinische Papyrus (British Museum No. 1005) Hearst in Transkription, Obersetzung, und Kommentar (Leipzig,
1912).
82 C. D. Leake, The Old Egyptian Medical Papyri (Chicago, 1952).
