Chapter 8
Staying Healthy: Diseases and Medicine
In This Chapter
Meeting the doctors
Combining medicine and magic
Diagnosing illnesses and diseases
Curing ailments
Disease is something that plagues every society (pun intended) – ancient and modern.
Medical papyri and mummified remains provide ample evidence of the diseases from which the ancient Egyptians suffered. These remnants also help paint a clear picture of the medical profession in Pharaonic Egypt, including some ill-conceived treatments as well as some surprisingly effective cures. By the end of this chapter, I’m sure you’ll never complain about the Health Service again!
In this chapter, you meet the ancient Egyptian physicians, consult their records, and marvel at the ingenuity – and flat-out bizarreness – of many of the cures, some of which form the basis of modern medicine.
Examining Egypt’s Overall Health
Numerous surviving medical records, human remains, and even a close study of the settlements can give a detailed view of the general health of the Egyptians.
Evidence in the workmen’s village at Amarna indicates the rampant presence of bed bugs, fleas, and rats – all of which aid the spread of disease. Additional evidence suggests that a plague (similar to the bubonic plague) spread throughout the city of Amarna during the 18th dynasty, killing many people including most of the royal family (see Chapter 4).
Other epidemics probably occurred due to the crowded living conditions, but they are difficult to trace in the archaeological record, especially if they weren’t as fatal as the bubonic plague.
The average Egyptian had a tough life and probably suffered from one or all the following ailments:
Dental abscesses, which resulted in tooth loss and dissolution of the jaw bone
Parasitic intestinal worms, the most common being bilharzia
Breathing disorders due to the sandy environment
Osteoarthritis
Blindness, especially among the workmen who constructed the tombs of the kings
Based on the study of the thousands of mummies from Egypt, the average age at death was only 36 years, although a number of exceptions exist. The individuals who did live into their 40s, 50s, and 60s, however, came from all walks of life, so status and wealth were not necessarily factors in life expectancy. Living to a ripe old age was more luck than judgement; the numerous fatal diseases and infections affected all Egyptians.
Becoming an Egyptian Physician
Becoming a physician in ancient Egypt involved study and training – in both medical procedures and religious ceremony. The following sections explore the process of becoming a doctor.
Practising magical medicine
Unfortunately, the medical practice that the ancient Egyptian people had to endure was not totally scientific. They were a superstitious population who believed that many ailments had a supernatural cause – the vengeance of a deity, an evil spirit, or the evil eye cast by an enemy.
As a result, patients turned to gods as well as physicians in times of illness. Practical medicine was very closely tied to religion and was often accompanied by religious incantations recited by medically trained priests. Most physicians were in fact priests who used magic and incantations to supplement practical medicine in an effort to appease the spirit or god. Priests were held in high esteem because they conversed with the divine on a daily basis.
The priests of some deities were more inclined than others to turn to medicine. The most important deities associated with medicine were
Sekhmet, the lioness-headed goddess of war, epidemics, and plagues
Selqet, the scorpion goddess, whose priests were approached to treat bites and stings from venomous reptiles, scorpions, and tarantulas
Thoth, the ibis-headed god of knowledge, who was often accredited with writing the healing formulae
Most professions were passed on from father to son (refer to Chapter 2), so some priestly families who turned their hand to medicine held the profession for generations. A well-trained and effective physician was no doubt busy, well paid, and respected within the community. Neighbouring countries held Egyptian doctors in high esteem, and records show that foreign kings requested the treatment of an Egyptian doctor.
Medical training
In order to qualify as an elite physician, a young medical student was trained in the House of Life, an unusual institution of learning that provided medical, scribal, and priestly training, as well as housing an extensive library. See Chapter 2 for more insight into the House of Life.
Medical training and priestly training probably went hand in hand. Most House of Life institutions were attached to temples. This was the case at Bubastis, Edfu, Amarna, and Kom Ombo. The most famous House of Life was set up by Imhotep (the builder of the step pyramid at Saqqara) at Memphis; it was in use from the Old Kingdom until the Graeco-Roman period – a period of more than 2,000 years.
Although doctors were formally trained, they did not need to pass exams in order to practice. Like today’s medical profession, a strict hierarchy according to ability and experience was in place:
Senenu
(lay physicians)
were
the lowest-ranking doctor. They were often scribes who could read medical texts.
Kherep senenu
were controllers of doctors and oversaw the work of a number of senenu physicians.
Sau (magic physicians) were generally priests of Sekhmet, who were medically qualified, but only treated individuals whom the goddess had punished in some way.
Shepherd of the Anus of Pharaoh
was a spectacular title for the physician who gave enemas to the king.
Specialists
were doctors who focused on one particular ailment, much like a medical professional today. Ancient Egyptian specialties included eyes, teeth, mouth, stomach pain, and ‘uncertain diseases’.
Rather than a student choosing and pursuing a branch of medicine as a career, the position was dictated by the skills held. Some doctors were therefore more qualified than others.
Equipping the physician’s office
After physicians were trained, they needed to establish a practice.
Full-time priests with medical training were resident in the temples. They no doubt only had a small number of patients whom they treated in the House of Life. Other physicians who were not priests had to set up independently and treat the people in their villages, perhaps only on a part-time basis. A physician could also be employed by a rich household. Personal physician would have been a more satisfactory position to hold than village doctor.
Doctors also needed to collect a set of instruments with which to practise their art. In a sixth-dynasty tomb at Saqqara, belonging to Qar, the senior physician of the royal palace, a complete set of surgical tools was discovered, including 30 scalpels and tweezers, which seem to be the primary tools for most treatments.
The temple of Kom Ombo features an image of a complete set of medical tools, which corresponds with the items in the tomb of Qar. A corresponding list on the Edwin Smith Papyrus (a medical papyrus) contains the following items:
A rush (a plant stem with a sharpened end, used with a knife for cutting treatments)
A fire drill (two wooden sticks to rub together to burn growths)
A knife/chisel
A cupping glass to create a vacuum on the skin
A thorn (to burst blisters)
Heated broken glass (for eye treatments – ow!)
Swabs, tampons, and linen material
Knives, salve spoons, and mortars
Most of these instruments seem sensible enough and are still used today. For example, popping blisters with a sharp instrument (like a thorn) is commonplace, and burning off warts is an effective way of getting rid of them. Indeed, the only item on the list that seems slightly dubious is the hot broken glass used to treat eye conditions. It doesn’t bear thinking about; even if swabs and linen pads could mop up whatever comes out, this treatment would make your eyes more than water!
Two top docs
More than 100 ancient Egyptian physicians are known by name, all of them from the elite of society. Two stand out from these known doctors:
Hesy-re is the first known physician in history, dating back to the third dynasty. Hesy-re held the title of Chief of Dentists and Physicians and was clearly a man of high position in the royal court. His tomb is located just north of the Step pyramid of Djoser.
Peseshet was the only female physician known from Egyptian history, living in the fourth dynasty. She was titled Lady Overseer of the Lady Physicians. Although no other female physicians are known until the Ptolemaic period, the fact that Peseshet oversaw lady doctors suggests enough female doctors existed to require an overseer.
To charge or not to charge?
Although loads of information about ancient Egyptian medicine and doctors exists, no surviving information explains how much certain treatments cost or how services were paid for. No evidence exists that the Government hired state physicians to treat the ailments of the populace, as British general practitioners do. The only exception to this appears to be at the workmen’s village of Deir el Medina (see Chapter 2 for more on this village). The Government provided the physicians at this location to ensure only that the workmen were fit to build the tombs. The state paid the Deir el Medina doctors a lower wage than all other workers at the site. Perhaps they subsidised their low wages through charging their patients.
Visiting the Doctor
After they were trained and equipped, new physicians could start practising.
More than 1,200 ancient Egyptian medical records have survived, giving detailed insight into what a consultation with a physician was like. These medical papyri include
A professional medical oath, similar to the Hippocratic oath
A description of the process of interviewing patients regarding symptoms and conducting physical examinations
Information about pregnancy and gynaecology (see the section ‘Considering Women’s Health’, later in this chapter, for more details)
Descriptions of wounds and diseases of the eye, skin, and anus
Descriptions of bites from humans, pigs, and hippopotami (the life of ancient Egyptian postmen was clearly a lot more dangerous!)
Details of recommended treatments and prescriptions
Most of the recommended practices are exactly the same as those in use today, but some fascinating differences appear as well, as the following sections discuss.
Examining patients
There were more male than female doctors, so both men and women may have visited male doctors, although the records are silent on this. One of the medical papyri indicates that male doctors dealt with feminine problems.
The Ebers Papyrus (a medical papyrus) describes in detail the procedure for examining a patient. This method of diagnosis is similar to modern practice. The doctor began an examination with an interview, to try to understand the symptoms from which the patient was suffering.
The doctor then monitored the patient’s pulse and carried out studies of bodily discharges, such as urine, stools, phlegm, and blood, noting any irregularities. Then the doctor examined the reflexes.
After all examinations were complete, the diagnosis was announced. Because not all illnesses had names, the diagnosis was normally just a statement about whether the doctor would try to treat the patient. The diagnosis came in three forms:
An ailment that I will treat
An ailment that I will contend
An ailment not to be treated
Only 14 of the 48 cases on the Ebers Papyrus were seen to be hopeless and therefore not treatable. Of the other 34 patients, the physicians thought they would just have a go and see what happened.
They then prescribed whatever they felt was most appropriate. The prescriptions were very specific regarding dosage and duration, and all were adjusted according to age, giving a child a smaller dosage than an adult.
Treating patients
Egyptian physicians were more interested in trying to cure ailments than preventing illness.
Of the few surviving records of preventive methods, most seem fairly straightforward, such as bathing regularly. Physicians recommended wearing eye make-up to reflect the sun from the sensitive eye area and to prevent insects from entering the eye. They also advised the burning of incense (see the section ‘Alternative methods’, later in this chapter, for more on aromatherapy) to help fumigate houses and temples and keep the malaria-carrying mossies away.
If an ailment was obvious, like a wound or a broken bone, the prescribed cure was purely medicinal. For example, non-infected wounds were sealed by stitching with a needle and thread, and raw meat was placed on wounds on the first day to aid with the healing. (This method is known today as an efficient way to stop bleeding.)
Although the physicians turned to the gods for aid with difficult cases, they did have a remarkable understanding of human anatomy, due to the practice of mummification. The Edwin Smith Papyrus deals with surgical techniques such as amputations, stitching, and removing rogue objects from within the body (such as arrows).
If an ailment was internal with no obvious cause, it was believed to have a supernatural origin, and the gods were addressed for a cure.
Under oath
Most Egyptian physicians were also priests. Because medicine was not these people’s main profession, the Egyptian version of the Hippocratic oath is somewhat abbreviated and has a moral element. The tomb of Nenkh-Sekhmet, Chief of Physicians from the fifth dynasty, includes the following declaration:
Never did I do anything evil towards any person.
To modern eyes, many of the cures and treatments used by the ancient Egyptians could be said to break this oath. But in the ancient Egyptians’ mind, they were doing their best to cure whatever ailments came their way.
Common afflictions – and their cures
Just like today, ancient physicians seemed prepared to treat most things. Whether the prescriptions worked is open to question, but some of the ingredients used, especially for the less serious cases, form the basis of modern medicine and could have been effective. For example, the ancient Egyptians used:
Figs for constipation: High in dietary fibre, figs are still consumed today to aid in digestive regularity.
Honey for coughs and cataracts: In modern medicine, honey is used to treat wounds, burns, and ulcers and is effective against different types of bacteria, acting as an antibiotic.
Copper for cleaning wounds: Today’s scientists know that copper prevents bacteria build-up.
Poppies to soothe crying children: The poppy is the basis of narcotics such as opium and morphine and would indeed have made a child drowsy.
Yeast for digestive disorders: The Egyptians also applied yeast to boils and ulcers. Today yeast is known to be a good source of vitamin B complex and is effective as an antibiotic.
Digestive disorders
Parasitic worms were one of the most common ailments that ancient Egyptians suffered with. These critters were virtually impossible to treat, and many mummies contain evidence of worms setting up home in internal organs. Parasites included:
Bilharzia, which was caught from water snails in stagnant water. It caused anaemia, loss of appetite, urinary infection, and loss of resistance to other diseases.
Guinea worm, which was caught through drinking contaminated water.
Trichnella and taenia, which were caught by eating undercooked meat.
Tape worm, which was caught via contact with contaminated animals. It resulted in ulcers, within which the tape worm laid eggs.
Enemas seem to have been common, for the elite at least, and this may have eliminated some of the worms, but not many. The Egyptians, sadly, would just have had to live with them and deal with the symptoms.
Other diseases and disorders
For more serious cases, the cures were a little hit and miss and may not have been so successful. Because many of the following diseases are internal conditions, Egyptian doctors were unable to identify the causes and only treated the symptoms, which were pain, coughing, or physical changes. Common diseases and treatments included:
Tuberculosis: No cure existed, but doctors eased coughing by having patients inhale mixtures of cream, carob, date kernels, and honey.
Sand pneumoconiosis: No cure existed for this condition, caused by breathing in the sand and dust from the surrounding environment. Doctors relied on the same cough-soothing remedies as for tuberculosis.
Arthritis and osteoarthritis: Doctors massaged patients with fragrant oils that eased pain.
Broken bones: Wooden splints were used for mending long bones. Splints of linen were inserted into the nostril to mend a fractured or broken nose. Plaster casts – made of cow’s milk mixed with barley or acacia leaves mixed with gum and water – were used to set breaks or fractures.
Cataracts: Doctors applied a mixture of tortoise brain and honey to the eye and recited a religious incantation.
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Keep ya jaw on
A treatable bone disorder in ancient Egypt was dislocation of the jaw. The cure for this is described in the Edwin Smith papyrus.
When you examine a man with a lower jaw that is displaced, and you find his mouth open, so that you cannot close his mouth; then you should put your finger on the end of both jaw bones in the inside of his mouth, and put your thumbs under his chin; then you must let them [the displaced joint bone] fall together in their places . . . bandage them with the imr.w [what this is, is a mystery!] and honey every day until he is better.
None of the records specify why jaw dislocation was so common, but possibly because the biting surfaces of teeth were often very worn (see the section ‘Opening Up and Saying “Agh”: Dentistry’, later in this chapter), many Egyptians ended up moving their mouths in strange ways to be able to chew without excessive pain. Just a theory!
Alternative methods
Aromatherapy. Incense was very popular in Egypt. It was burnt to sweeten the air and fumigate homes (it also acted as a hallucinogen!). It was also regularly used in temple rituals; records from 1200 BC note that at Karnak temple, 2,189 jars and 304,093 bushels of incense were burnt in a single year!
Incense was used in temple sanatoria, dormitories where the ill slept overnight in order to be sent messages from the gods via dreams. The sleep was induced by burning incense that produced hallucinations. The priests then interpreted these dreams and instructed patients as to what tasks they needed to perform in order to be cured. Call me a cynic, but the priests were clearly onto a good thing – the assigned tasks inevitably financed the temple in one way or another.
Enemas. One aspect of Egyptian preventive medicine that has made a comeback is the regular use of enemas and colonic irrigation. The Shepherd of the Anus was a specialist who performed enemas, which were practised as a means of maintaining general good health.
Enemas were believed to have been introduced by Thoth, the ibis-headed god of knowledge. The ibis was often observed pushing water into its own rectum with its long beak to evacuate the bowels. The Egyptians followed suit – hopefully with a softer instrument!
Electroshock. A more bizarre alternative treatment involved giving the patient electric shocks, using the electric ray (malapterusus electricus), which swam in the Nile from at least the fifth dynasty.
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Scribonius Largus (45 AD), physician to Emperor Claudius, records how electric rays were used in early Egyptian medicine for the cure of general pain:
When they come, one places a living electric ray under the foot of the patient. The patient then stands on a wet beach, covered as long as possible with water, until the foot is asleep up to the level of the knee.
How this technique was supposed to stop pain – other than making you forget about it – I don’t know. I can’t decide what’s worse, the pain or the cure!
Massage and reflexology. An image from the fifth-dynasty tomb of Ankhmahor at Saqqara shows patients’ hands and feet being massaged by practitioners in order to relieve aches and pains. This is thought to be the earliest image of reflexology in the world.
In a literary papyrus known as Papyrus Westcar, from the Middle Kingdom, the 110-year-old magician Djedi instructed ‘his servant at his head to smear him and another to rub his legs’, which indicates a form of physiotherapy which perhaps relieved some of the aches and pains of arthritis.
Satisfied customers?
Although the records don’t mention the costs of medical examinations and prescriptions, patients most likely paid for a doctor’s services. Because money was not used for most of the Pharaonic period, patients would have paid in goods. Whether patients paid before, after, or on the success of a treatment is unknown. However, numerous inscriptions are dedicated to various deities in gratitude for curing diseases. Whether a doctor was thanked with a gift was no doubt left to the discretion of the individual.
Opening Up and Saying ‘Agh’: Dentistry
The ancient Egyptians suffered greatly from dental problems, and clearly their pain threshold must have been very high considering the horrendous things festering in their mouths.
Not many dentists are known from ancient Egypt, although eight dentists have been identified from the Old Kingdom. Three of these names were discovered in three tombs in August 2006 (although the mummies had long been destroyed by looters). Three of these dentists also held the title of doctor. If dentists didn’t always have a separate title, identifying them from doctors is difficult.
Wearing thin
The teeth were worn to such an extent that the enamel completely disappeared, leaving the sensitive inner pulp exposed. This exposed dental pulp then became infected, resulting in abscesses, swelling, and huge amounts of pain. In many instances, the abscesses were in the advanced stages and ate away at the bone of the jaw, resulting in tooth loss.
Little could be done to cure these abscesses other than draining the wound. The doctor or dentist used a flint knife to cut into the infection, and inserted a hollow reed to encourage the flow of pus out of the abscess. The ancient doctors knew that if they left any pus within the abscess it would recur, and they would have to go through the whole process again.
The ancient Egyptians seem to have figured toothache was normal, because the absentee records from Deir el Medina, which record excuses for days off work, show that no one took time off for toothache. (I know for a fact that if I had weeping abscesses, I would take at least a couple of days off!)
On a more positive note, the ancient Egyptians did not suffer from caries (decay) because of the very limited sugar in their diet. The elite sweetened their food with honey, but this was a luxury out of most people’s reach. Only a handful of mummies show the start of dental caries, but almost every adult mummy has wear on the biting surface of their teeth.
The quest for fresh breath
With a mouth full of abscesses, the breath of the ancient Egyptians would have been somewhat ripe, to say the least.
The Egyptians did, however, do their best to clean their teeth using the frayed end of a twig. This technique resulted in the highly polished appearance of the teeth of many ancient Egyptian mummies.
The medical records have numerous prescriptions for freshening the breath, including chewing on cinnamon, frankincense, myrrh, and fragrant plants mixed with honey.
Considering Women’s Health
Some of the medical papyri focus primarily on the health of women – particularly on fertility, childbirth, and health during pregnancy.
Specific women’s health topics included:
Contraception: Excrement of crocodile dispersed finely in sour milk or honey and natron was used to avoid pregnancy. Both concoctions were used as a tampon and inserted into the vagina. And I am sure the resulting smell encouraged abstinence – a foolproof form of contraception.
Fertility: The woman was advised to sit over a mixture of sweet ale and mashed dates. If she vomited, she was sure to give birth in the future; the number of times she vomited equalled the number of children she would have. If she didn’t vomit, no children.
Pregnancy test: The woman was supposed to urinate on barley and emmer wheat. If both of the seeds grew, she would give birth. If the barley grew first, she would give birth to a boy; if the emmer sprouted first, she would give birth to a girl. If neither grew, she was not pregnant. (When this method was recently tested, it didn’t determine the sex, but, if a woman is pregnant, the grain does grow within a short period of time. When male urine was used, nothing happened.)
Amenorrhoea: This is the premature stopping of the menstrual cycle and was ‘cured’ by giving a women a substance to drink for four days that induced vomiting. If the women vomited blood, her menstrual cycle would start again.