In Sickness and in Health: Preventative and Curative Health Care
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If one had to be ill in ancient times, the best place to do so would probably have been Egypt. Not that an Egyptian's chances of survival would have been significantly better than those of his foreign contemporaries, but at least people had the satisfaction of being treated by physicians whose were renowned all over the ancient world.
Unlike the injuries caused by accidents or fighting, which were dealt with by the zwn.w (sunu), or scorpion stings and snake bites for which the xrp srqt (kherep serqet), the exorcist of Serqet, knew the appropriate spells and remedies, illnesses and their causes were mysterious. The Egyptians explained them as the work of the gods, caused by the presence of evil spirits or their poisons, and cleansing the body was the way to rid the body of their influence.
Incantations, prayers to the gods - above all to Sekhmet the goddess of healing, curses, and threats, often accompanied by the injection of nasty smelling and tasting medicines into the various bodily orifices, were hoped to prove effective.
Montemhet, 4th prophet of Amen, put his faith in the god he served:
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I bow down to your (i.e. Amen's) name
May it be my physician,
May it drive pain away from me.
Statue inscription of Montemhet, Third Intermediate Period
M. Lichtheim, Ancient Egyptian Literature, Volume III, p.30
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Preventive measures included prayers and various kinds of magic, above all the wearing of amulets. The importance of the diet was partially recognized [30], and the natural human craving for diversity and rich well-irrigated soil resulted in a diet which was mostly reasonably balanced: carbohydrates from cereals, vitamins from fruit and vegetables, and proteins mostly from fish. Milk and milk products were just occasionally consumed, as were legumes, seeds and oil.
The Healers and Their Art
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The Egyptian priest-physician, wab sxmt (wab sekhmet), had a number of important functions. First, to discover the nature of the particular entity possessing the person and then attack, drive it out, or otherwise destroy it. This was done by some powerful magic for which rituals, spells, incantations, talismans and amulets were used. Sekhmet priests seem also to have been involved in the prevention of plagues, inspection of sacrificial animals and even veterinary medicine. Other healers like the zwn.w (sunu) and the za.w (sau) seem to have had recourse to the same methods and scriptures as the wab.
The role deities and their servants played in the healing process is described in the apocryphal story of Bentresh, a daughter of the chief of Bekhten, who fell ill, and Ramses II sent her Thutemhab, a scribe experienced in his heart, who can write with his finger. After Thutemhab had seen the princess and concluded that she was possessed of a spirit, he returned to Egypt, and Khonsu-in-Thebes-Beautiful-Rest agreed [51] that Khonsu-the-Plan-maker, the great god, smiting the evil spirits should be sent to Bekhten:
This god arrived in Bekhten in a full year and five months. Then the chief of Bekhten came, with his soldiers and his nobles, before Khonsu-the-Plan-Maker. He threw himself upon his belly, saying: "Thou comest to us, thou art welcome with us, by command of the King Usermare-Setepnere (Ramses II)."
Then this god went to the place where Bentresh was. Then he wrought the protection of the daughter of the chief of Bekhten. She became well immediately.
Tale written down in the late first millennium BCE
James Henry Breasted Ancient Records of Egypt, Part Three
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Physical medicines such as herbs were mostly expected to assuage the pain only, while magic effected the cure. A section in the Papyrus Ebers is about charms and invocations used to encourage healing. One spell, recited before taking an herbal remedy, reads as follows: "Come Remedy! Come thou who expellest (evil) things in this my stomach and in these my limbs!"
The wording of these spells is often followed by a recommendation, such as: "Truly excellent. Millions of times."
Not all of Egyptian medicine was based on wishful thinking (moreover we should never disregard the effect faith can have on our health), much was the result of experimentation and observation, and physical means supplemented the magical ones:
Magic is effective together with medicine. Medicine is effective together with magic.
From the Ebers papyrus
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Apart from spiritual healing and herbal medicine, they practiced massage.
Examination of a woman aching in her legs and her calves after walking
You should say of it 'it is discharges of the womb'.
You should treat it with a massage of her legs and calves with mud until she is well.
Kahun Medical Papyrus
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Manipulation made extensive use of therapeutic herbs and foods, but surgery was only rarely part of their treatments. According to Herodotus there was a high degree of specialization among physicians:
The practice of medicine is very specialized among them. Each physician treats just one disease. The country is full of physicians, some treat the eye, some the teeth, some of what belongs to the abdomen, and others internal diseases.
Herodotus, Histories 2,84
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Nothing certain is known about the way physicians acquired their medical knowledge, but one surmises that after (or in parallel to) their formation as scribes they were apprenticed to practicing healers. It has also been suggested that the Houses of Life, associated with Sekhmet, were teaching centers for physicians.
When Harsiese, the fictional physician in the prologue to the Instruction of Ankhsheshonq was called to the royal court he underwent some quizzing by the king himself and then became a member of the medical team looking after the pharaoh:
Pharaoh asked him many things and he answered them all. of the chief physician; and the chief physician did nothing without consulting Harsiese son of Ramose about it. A few days later it happened that the chief physician went to his fathers (i.e. died) Harsiese son of Ramose was made chief physician, and he was given everything that belonged to the chief physician entirely...
The Instruction of Ankhsheshonq
M. Lichtheim: Ancient Egyptian Literature Vol. 3, p.161
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Like all scribal professions medicine was a domain dominated by men. But occasionally women succeeded not just in acquiring medical knowledge but also in climbing to the top of the scribal hierarchy.
An Old Kingdom female physician named Peseshet left a stela which recorded her positions of Overseer of Funerary Priestesses and of Overseer of Female Physicians.
Many of the poorer Egyptians probably had little contact with real physicians and called for the local medic, a workman like Paheripedjet at Deir el Medina who was frequently excused from his normal duties to attend to the sick. He seems to have had some medical knowledge, knew how to prepare medicines and made home visits.
The medical knowledge.
A few papyri have survived, from which we can learn about Egyptian medicine:
The Edwin Smith Papyrus
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Describing surgical diagnosis and treatments;
the Ebers Papyrus on ophthalmology, diseases of the digestive system, the head, the skin and specific maladies like aAa, which some think may have been a precursor of aids and others, perhaps more reasonably, consider to have been a disease of the urinary tract, a compilation of earlier works that contains a large number of prescriptions and recipes,
the Kahun Gynecological Papyrus,
the Berlin Medical Papyrus,
the London Medical Papyrus.
the Hearst medical papyrus repeats many of the recipes found in the Ebers papyrus.
the Demotic Magical Papyrus of London and Leiden contains a number of spells for treating physical ailments.
The treatments in these texts are often organized into groups. The Edwin Smith Papyrus for instance opens with eight texts concerning head wounds, followed by nineteen treatments of wounds to the face (forehead, eyebrows, nose, cheeks, temples, mouth, chin), six descriptions of how to deal with injuries to throat and neck, five dealing with collar-bones and arms, and seven with chest complaints.
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It appears that all this knowledge dates to the third millennium BCE, even though the papyrus itself is of a much later date. Some important notions concerning the nervous system originated with the Egyptians, a word for brain is used here for the first time in any written language: ... the membrane enveloping his brain, so that it breaks open his fluid in the interior of his head.
The Edwin Smith papyrus, case 6
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Acting conservatively, they knew how to treat injuries to the brain without killing the patient, but on the whole their understanding of the brain and its functions was superficial: they considered thinking to be a function of the heart.
Their dissection of bodies during mummification seems not to have added greatly to their knowledge of the inner workings of the human body. Possibly because mummifiers and physicians did not move in the same circles, but also because of the way the organs were removed; ripped out through a small incision in the corpse's flank or, in the case of the brain, scooped out in small portions through a nostril.
They had some anatomical knowledge though, had made the connection between pulse and heart. They also had understanding of the circulation of the blood, thank to head physician and genius Imhotep.
Now if the priests of Sekhmet or any physician put his hands (or) his fingers upon the head , upon the back of the head upon the two hands , upon the pulse , upon the two feet , he measures (h't ) the heart , because its vessels are in the back of the head and in the pulse ; and because its pulsation is in every vessel of every member.
The Edwin Smith papyrus, case 1
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This knowledge reached Greece through the doctors of Alexandria. The anatomical properties they were best aware of were superficial, pertaining to accessible body parts such as bones of limbs or the infants' fontanelles
fluttering under the fingers like the weak place of an infant's crown before it becomes whole
The Edwin Smith papyrus, case 6
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Often we cannot translate the specialist expressions used in the medical texts, both of the affected body parts such as the mt.w, generally translated as "vessels" or the like and apparently comprising blood vessels, sinews and nerves, and the ingredients of their medicines. Sometimes their knowledge was either not very exact or unfortunately expressed. One will wonder for a few moments underneath what the bronchi were to be found:
"A dislocation in his two collar-bones" means a displacement of the heads of his sickle-bone(s). Their heads are attached to the upper bone of his breast to his throat, over which is the flesh of his gorge, that is the flesh that is over his bosom. Two ducts (i.e. the bronchi) are under it: one on the right and (one) on the left of his throat (and) of his bosom; they lead to his lungs.
The Edwin Smith papyrus, case 34
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That this theoretical knowledge was often successfully applied is proven by archaeological finds in the workers' tombs at Gizeh for instance. Skeletons with broken arms that had been set, a man who had survived the amputation of a leg by fourteen years and another brain surgery by two years.
The diseases
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Everyday complaints like stomach upsets, bowel trouble and headaches went probably mostly untreated, even if the physicians could offer remedies:
For the evacuation of the belly:
Cow's milk, 1; .grains, 1; honey 1; mash, sift, cook; take in four portions.
To remedy the bowels:
Melilot (?), 1; dates, 1; cook in oil; anoint sick part.
To refresh an aching head:
Flour, 1; incense, 1; wood of wa, 1; waneb plant, 1; mint (?), 1; horn of a stag, 1; sycamore (?) seeds, 1; seeds of [ (?)], 1; mason's plaster (?), 1; seeds of zart, 1; water, 1; mash, apply to the head.
To renew bowel movements in a constipated child:
An old book, boil in oil, apply half on the belly to reestablish evacuation.
Ebers Papyrus
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G. Maspero, Etudes de mythologie et d'achéologie égyptiennes III, 1898, pp.289f.
The common cold plagued the ancient Egyptians as it still does us today, and their remedy, the milk of a mother who has given birth to a boy, was probably as effective as anything we have got today. Moreover they had a tried and true spell to go with it.
May you flow out, catarrh, son of catarrh, who breaks the bones, who destroys the skull, who hacks in the marrow, who causes the seven openings in the head to ache.
Ebers Papyrus
While some Egyptians lived to a ripe old age like Ramses II or Psalmist I's daughter Nitocris who reigned as God's Wife for more than sixty years, the age at death was only in a minority of cases above thirty-five years, with bilharziasis (schistosomiasis) - a disease difficult not to contract in a country flooded for months every year - a common cause of anemia, female infertility, a debilitating loss of resistance to other diseases and subsequent death.
The Ebers Papyrus addresses some of the symptoms of the disease and in two columns discusses treatment and prevention of bleeding in the urinal tract (haematuria) [6]. The Hearst Papyrus cites antimony disulfide as a remedy.
Insect borne diseases like malaria and trachoma, an eye disease, were endemic; plagues spread along the trade routes and a number of yadet renpet (jAd.t rnp.t) epidemics reported in Egyptian documents are thought by some to have been outbreaks of bubonic plague.
The following charm has been interpreted as referring to the plague, as one of its symptoms is a dark discoloration of the skin:
Spell for the disease of the Asiatics: Who is all-knowing like Re? Who is thus all-knowing? This god who blackens the body with char-coal? May this Highest God be seized!
pHearst 11,12
After a German translation in Jürgen Kraus, Die Demographie des Alten Ägypten, Göttingen 2004, p.187
Mosquitoes also spread filarial worms which caused the disfiguring elephantiasis.
This disease was not very prevalent but caused immense suffering to its victims.
Infectious diseases were rampant in the relatively densely populated Nile valley, where practically the whole population lived within a narrow strip of land along the river, which at times was only a few hundred metres wide, and their incidence was dependent to some degree on the seasons.
Smallpox, diarrhea, dysentery, typhoid, jaundice and relapsing fever were responsible for many deaths, above all during spring and summer. The ubiquity of water during the inundation brought with it a different set of ailments, chief among them probably malaria, which were the main cause for mortality in late autumn; while the cooler weather of autumn and winter seems to have favored the outbreak of respiratory illnesses.
A child's vertebra showing signs of tubercular infection
Source: V.Easy
Trichinae afflicted the pigs, parasitic worms and tuberculosis the cattle and were occasionally passed on to the human population. Human tuberculosis was widespread; Leprosy on the other hand, caused by bacteria similar to the tubercle bacillus, is badly documented and was apparently relatively rare, possibly because of an immunity TB sufferers acquired. Some think that leprosy originated in Egypt and spread to the Levant and Europe along the migration and trade routes, others contend that there is no proof of its existence in ancient times.
Silicosis of the lungs, the result of breathing in airborne sand particles, is documented and was a frequent cause of death, as was pneumonia.
The various kinds of malignant tumors were almost as frequent then as they are nowadays in comparable age and gender groups.
Eye infections are a common complaint in Africa. In ancient Egypt they were at least in part prevented by the application of bactericidal eye paint. The ingredients of some of the remedies may not have been as difficult to come by in a civilization, where the brain of the dead was removed in little bits from the skull during mummification and discarded, as it would be in a modern western country:
Prescription for the eye, to be used for all diseases which occur in this organ:
Human brain, divide into its two halves, mix one half with honey, smear on the eye in the evening, dry the other half, mash, sift, smear on the eye in the morning.
Ebers Papyrus
G. Maspero, Etudes de mythologie et d'achéologie égyptiennes III, 1898, p.290.
The hard physical toil, often repetitive, caused great harm to the bones and joints of the labourers after only a few years of being subjected to it. Those who survived into old age were victims of the same infirmities that still plague the aged like cardio-vascular diseases, arthritis, from which Ramses II suffered, and probably dementia.
Congenital diseases were not infrequent and often brought about early death as the burials of infants bear out. Their causes may have been environmental, nutritional or social.
Inbreeding, not infrequent among the royals, was probably also not rare among the common people largely bound to the soil: the occurrence of a sixth finger or toe in mummies, interpreted by some as the result of inbreeding, has been noted a number of times, as has the high incidence of spina bifida occulta in the Bahariye Oasis during Graeco-Roman times; but there is no evidence that the union of healthy close relatives would result in defective offspring in populations which are not isolated.
Open wounds were often treated with honey, but sepsis was one of the commonest causes of death. When lockjaw set in due to a tetanus infection, physicians knew they were powerless against this affliction:
Thou shouldst say regarding him: "One having a gaping wound in his head penetrating to the bone, perforating the sutures of his skull; he has developed ty, his mouth is bound, (and) he suffers with stiffness in his neck. An ailment not to be treated."
The Edwin Smith papyrus, case 7
Instances of diseases, which are rare today, were also found: in a First Intermediate Period cemetery at Abydos the skeleton of a child has been discovered which had suffered from osteoporosis.
Little is known about pregnancy and childbirth in ancient Egypt, and on the basis of a few literary hints one surmises that, unless there were extraordinary problems, physicians were not involved. There was a store of knowledge concerning women, as is reflected in the Kahun Gynecological papyrus, the Greater Berlin Papyrus and others, which dealt with urinary problems, pains in the abdomen, legs and genitals, fertility and conception.
Dietary deficiencies
A restricted diet caused or aggravated a number of ailments, some with fatal outcome. There were times when malnutrition was widespread. Prehistoric dental records suggest that health was poor during much of that period, and improved with the increasing adoption of agriculture; but even in historic times when the supply of food was generally assured, the growth of the population was often stunted. Grown males reached a height of about 1.60 m and females 10 cm less during the early Middle Kingdom. Because of vitamin and other deficiencies.
Herbal Medicine
Herbs played a major part in Egyptian medicine. The plant medicines mentioned in the Ebers papyrus for instance include opium, cannabis, myrrh, frankincense, fennel, cassia, senna, thyme, henna, juniper, aloe, linseed and castor oil - though some of the translations are less than certain. Cloves of garlic have been found in Egyptian burial sites, including the tomb of Tutankhamen and in the sacred underground temple of the bulls at Saqqara. Many herbs were steeped in wine, which was then drunk as an oral medicine.
Egyptians thought garlic and onions aided endurance, and consumed large quantities of them. Raw garlic was routinely given to asthmatics and to those suffering with bronchial-pulmonary complaints. Onions helped against problems of the digestive system. (e.g. Ebers 192
Garlic was an important healing agent then just as it still is to the modern Egyptian and to most of the peoples in the Mediterranean area: Fresh cloves are peeled, mashed and macerated in a mixture of vinegar and water. This can be used to gargle and rinse the mouth, or taken internally to treat sore throats and toothache. Another way to take garlic both for prevention as well as treatment is to macerate several cloves of mashed garlic in olive oil.
Applied as an external liniment or taken internally it is beneficial for bronchial and lung complaints including colds. A freshly peeled clove of raw garlic wrapped in muslin or cheesecloth and pinned to the undergarment is hoped to protect against infectious diseases such as colds and influenza.
Coriander, C. Sativum (e.g. pHearst 102, 124 was considered to have cooling, stimulant, carminative and digestive properties. Both the seeds and the plant were used as a spice in cooking to prevent and eliminate flatulence, they were also taken as a tea for stomach and all kinds of urinary complaints including cystitis.
Coriander leaves were commonly added fresh to spicy foods to moderate their irritating effects. It was one of the herbs offered to the gods by the king, and seeds were found in the tomb of Tutankhamen and in other ancient burial sites.
Cumin, Cumin cyminum (e.g. Hearst 28, 55, 125 is an umbelliferous herb indigenous to Egypt. The seeds were considered to be a stimulant and effective against flatulence.
They were often used together with coriander for flavoring. Cumin powder mixed with some wheat flour as a binder and a little water was applied to relieve the pain of any aching or arthritic joints. Powdered cumin mixed with grease or lard was inserted as an anal suppository to disperse heat from the anus and stop itching.
Leaves from many plants, such as willow, sycamore, acacia (e.g. Ebers 105, 415 or the ym-tree, were used in poultices and the like (e.g. Smith 46. Tannic Acid derived from acacia seeds commonly helped for cooling the vessels (e.g. pHearst 95, and heal burns. Castor oil, (e.g. Ebers 25 and 251 figs (e.g. Ebers 41 and dates, were used as laxatives.
Tape worms, the snakes in the belly, were dealt with by an infusion of pomegranate root in water, which was strained and drunk. The alkaloids contained in it paralyzed the worms' nervous system, and they relinquished their hold. Ulcers were treated with yeast, as were stomach ailments.
Some of the medicines were made from plant materials imported from abroad. Mandrake (e.g. pHearst 109, 168, 185, introduced from Canaan and grown locally since the New Kingdom, was thought to be an aphrodisiac and, mixed with alcohol, induced unconsciousness.
Cedar oil, an antiseptic,originated in the Levant. The Persian henna was grown in Egypt since the Middle Kingdom, and - if identical with henu mentioned in the Ebers Papyrus - was used against hair loss. They treated catarrh with aloe which came from eastern Africa. Frankincense , containing tetrahydrocannabinol and used like hashish as pain killer (e.g. Kahun 12, was imported from Punt.
Minerals and animal products were used too. Honey and grease formed part of many wound treatments, mother's milk was occasionally given against viral diseases like the common cold, fresh meat laid on open wounds and sprains, and animal dung was thought to be effective at times.
A cosmetics jar at the Cairo Museum bears the legend: "Eye lotion to be dispersed, good for eyesight." An Egyptian papyrus from 1500 BCE discusses recipes for treating conjunctivitis and cornea, iris, and eyelid problems. Lead-based chemicals like carbonates and acetates were popular for their therapeutic properties.
Malachite used as an eye-liner also had therapeutic value. In a country where eye infections were endemic, the effects of its germicidal qualities were appreciated even if the reasons for its effectiveness were not understood.
hotep: