Egyptian civilization has fascinated travelers and scholars since Herodotus initiated the tradition of Nile travelogues. To Greeks and Romans, Egypt was an ancient and exotic land, with peculiar customs, especially in terms of gender roles. Shops and markets in Egypt were run by women and men did the weaving. Collecting Egyptian antiqui- ties was already fashionable in Roman times, but modern Egyptology begins with the discovery of the Rosetta Stone, a slab of black basalt inscribed with a message in three forms of writing: hieroglyphic Egyptian, demotic Egyptian, and the Greek alphabet. Formal hiero- glyphs, ‘‘the words of the gods,’’ were not only a way of writing, but also a form of artistic expression. Egyptian scribes developed a simpliﬁed script known as demotic, but by the ﬁfth century, other forms of writing were adopted and the ancient writings became indecipherable.
The development of the ﬁrst true writing system has generally been credited to ancient Sumer, but in the 1990s, archaeologists discov- ered pictures and symbols inscribed on a limestone cliff in Egypt that might challenge that chronology. The carvings, including a tableau measuring 18 by 20 inches, appear to depict the exploits of a legendary king who played a critical role in the foundation of Egyptian civili- zation. Although these inscriptions were apparently created about 5,250 years ago, they seem to resemble later hieroglyphs.
Some scholars believe the inscription represents an early stage of writing, or proto- hieroglyphs. Similar symbols—inscribed on ivory, bone, and pottery— were found by archaeologists excavating a royal tomb at Abydos, which supports the conclusion that they represent the beginning of Egyptian script. These ﬁndings suggest that phonetic elements were present in Egyptian inscriptions before the Mesopotamian symbols reached their mature format.
Popular ideas about ancient Egypt have been shaped by romantic images of the elaborate tombs of the Pharaohs, such as Howard Carter’s 1922 discovery of the tomb of Tut-ankh-Amen, who had ruled for a brief period during the Eighteenth Dynasty. Egyptologists had previously explored many tombs in the Valley of the Kings near Luxor, but most had been thoroughly plundered by grave robbers over the centuries. Interest in Egyptian antiquities, as well as legends of a ‘‘Pharaoh’s Curse,’’ were revived by the remarkable ﬁndings in the tomb and the deaths of 12 of the archaeologists present at the opening of the tomb during the next seven years.
The tomb contained hundreds of precious objects, including the Pharaoh’s mummy, in a gold cofﬁn, nested within two outer cofﬁns. Tut-ankh-Amen, was only nine when he assumed the throne in 1333 B.C.E. Studies of his mummy conﬁrmed the tradition that he was only
about 18 when he died and proved that he was signiﬁcantly less hand- some than his beautiful golden death mask would suggest. Studies of the king’s mummy and his clothing indicate that he had abnormally wide hips, an abnormal curvature of the spine, and fusion of the upper vertebrae. Researchers note that these ﬁndings are consistent with a dis- order called Klippel-Feil syndrome, a rare spinal disorder that involves anomalies of the musculoskeletal system, kidneys, heart, and nervous system. If Tut-ankh-Amen had Klippel-Feil syndrome he would have had difﬁculty walking. The discovery of more than a hundred walking sticks among his grave goods seems to support this theory.
Ancient Greek writers from Homer to Herodotus praised the physicians of Egypt for their wisdom and skill, but the Greeks also knew Egypt as the ‘‘mother country of diseases.’’ Certainly, ancient Egyptian skeletons, portraits, writings, and, above all, mummies provide ample evidence of the crushing burden of disease in the ancient world. Although mummiﬁed bodies have been found in many parts of the world, for most people the term ‘‘mummy’’ conjures up the Egyptian mummy, as seen in museums and late-night horror shows. The term comes from a Persian word for bitumen (natural asphalt), reﬂecting the mistaken notion that ancient Egyptian bodies had been preserved and blackened by soaking in pitch.
For the ancient Egyptians, life after death was of paramount importance, but success in the afterlife depended on preservation of the body so that the soul would have a suitable place to dwell. Within their tombs, wealthy Egyptians were surrounded by grave goods meant to provide for their comforts in the next world. In addition to the treasures that lured grave robbers (and archaeologists) to even the most well-protected tombs, mummies were accompanied by ‘‘texts’’ painted on the walls of their tombs and cofﬁns and written texts known as the Book of the Dead. These ‘‘books’’ contained collections of spells and maps to guide the recently departed along the path taken by the dead. The tombs of some of Egypt’s earliest known pharaohs provide evidence of human sacriﬁces. Scholars concluded that the kings of the ﬁrst dynasty were already so powerful and so obsessed with the afterlife that court ofﬁcials, servants, and artisans were killed so that they could serve their ruler in the afterlife. Some of the grave goods included the names and titles of those dispatched to serve their pharaoh.
In predynastic Egypt (before 3100 B.C.E.), bodies were wrapped in skins or linen and interred in shallow graves in the desert. If the body was not discovered by jackals or otherwise disturbed, the hot dry sand would draw out moisture from the soft tissues, leaving the body looking rather like tanned leather, but still recognizable several thousand years later. Simple sand burials continued to be the norm for peasants, but during the Dynastic Period, the burial chambers of pharaohs and other
Much has been made of the ‘‘mysteries’’ of Egyptian mummiﬁ- cation, but the basic steps were simple: removing the viscera, thoroughly drying the cadaver, and wrapping the desiccated corpse. Over the course of almost three thousand years, the methods and quality of work- manship of the embalmers varied, but the basic methodology remained essentially the same.
Desiccation could have been achieved by techniques used to pre- serve food and hides, such as salting ﬁsh or pickling vegetables. Perhaps there was some aesthetic obstacle to preserving a pharaoh like a pickle. A secret and mysterious procedure would surely provide a better pas- sage to eternity. In place of hot, dry sand, or a vinegar brine, embalmers used natron, a naturally occurring mixture of salts, as a drying agent and removed the organs most susceptible to rapid decay. The heart, which was regarded as the ‘‘seat of the mind,’’ was left inside the body.
Herodotus left the best known account of embalming, but his dis-cussion contains much doubtful material and represents a late, possibly degenerate, state of the art. According to Herodotus, there were three methods of mummiﬁcation, which varied in thoroughness and price. For the ‘‘ﬁrst class’’ procedure, the embalmers drew out the brain through the nose with an iron hook. The intestines were removed through a cut made along the ﬂank, the abdominal cavity was washed with palm wine and aromatics, the belly was ﬁlled with exotic spices, and the eviscerated body was kept in natron for 70 days. When embal- ming was completed, the corpse was washed, wrapped in bandages of ﬁne linen, smeared with gum, and enclosed in a wooden case shaped like a person.
If the embalmers were asked to follow a more economical course, they would omit the removal of the brain and the incision into the abdominal cavity. Instead, they injected ‘‘cedar oil’’ into the belly through the anus and embalmed the body in natron. Seventy days later, they removed the plug from the anus and allowed the oil and dissolved bowels to escape. The cadaver, now reduced to skin and bones, was returned to the relatives. Poorer people could only expect a simple purge to cleanse the belly and 70 days of embalming.
Herodotus was apparently mistaken about certain details of the embalming process. Other sources indicate that the embalmers used juniper oil rather than cedar oil and that the entire mummiﬁcation process took 70 days, of which 40 were devoted to dehydrating the body by packing it, inside and out, with bags of natron pellets. Sometimes, the embalmers resorted to simpliﬁed procedures, neglecting evisceration and employing onions and garlic in place of the proper aromatic preser- vatives. Poor workmanship and outright fraud are manifest in mummy packs where the viscera were badly mutilated, bones broken or lost, and animal remains or pieces of wood were used to ﬁll out the form. Chemists have attempted to recreate and analyze the components of ancient preservatives. Some scientists believe that an extract of cedar wood was used because cedar contains a chemical called guaiacol that is not present in juniper oil. Chemists were able to compare their cedar wood preparation with surviving samples of unused embalming material. The cedar wood preparation prevented the growth of bacteria and was quite effective in preserving animal tissues.
One of the most peculiar uses of Egyptian mummies was the medieval practice of grinding mummies into a powder used as a remedy for wounds and bruises. By the end of the sixteenth century, ‘‘mummy powder’’ could be found in every apothecary shop in Europe. The irony of making medicines by destroying remains meant to secure eternal life was noted by English physician Sir Thomas Browne (1605–1682), author of Religio Medici (1642), who observed that mummies spared by time and previous conquerors ‘‘avarice now consumeth. Mummy is become merchandise .. . and Pharaoh is sold for balsams.’’
Long after the vogue of ‘‘mummy powder’’ had passed, William Konrad Roentgen’s (1845–1923) discovery of X-rays revived Western interest in Egyptian antiquities. During the initial wave of excitement, some eight thousand mummies were studied in a rather crude and hurried manner. At the School of Medicine in Cairo, the formidable trio composed of Sir Grafton Elliot Smith (1871–1937), anatomist, Sir Marc Armand Ruffer (1859–1917), bacteriologist, and Alfred Lucas (1867–1945), chemist, pioneered methods of analyzing mummiﬁed tissues and experimented with mummiﬁcation methods.
More recently, paleopathologists have subjected mummies to X-ray examination, CT scanning, electron microscopy, chemical analyses, immunological evaluations, and other analytic techniques that provide signiﬁcant data with minimal damage. Biochemical techniques have been used to detect malaria, various forms of anemia, and the eggs of parasitic worms. Well-preserved mummies offer information about parasitic diseases, trauma, infections, metabolic and genetic defects. For example, biochemical studies of the mummy of a man who died about 1500 B.C.E. provided evidence for what is probably the earliest known case of alkaptonuria, a metabolic disease due to the absence of an enzyme needed to break down the amino acids phenylalanine and tyrosine.
The ﬁrst lessons learned from modern autopsies and X-ray studies of mummies concerned the health hazards associated with the life-giving Nile. The fertile soil and irrigation ditches fed by the Nile River harbored hordes of parasitic worms. Calciﬁed eggs found in mummies reﬂect the prevalence of schistosomiasis (bilharzia or snail fever) in ancient Egypt. At least ﬁve species of schistosomes are known to infect humans: Schistosoma mansoni, S. japonicum, S. mekongi, S. intercalatum, and S. haematobium. The snail in which the parasitic worm (schistosome) completes an essential stage of its life cycle ﬂourishes in stagnant irri-
gation canals. Human infections begin when the free-swimming larval form of the parasite penetrates the skin of the new host. Changing form, the parasites enter the capillaries and lymphatic vessels and begin their migration to various organs. Severe infestations can result in damage to the lungs, liver, intestines, and urinary tract. Although schistosomiasis does not kill outright, the chronic irritation caused by the worm and its eggs leads to increasing mental and physical deterioration throughout the victim’s life. Mature worms produce eggs throughout their three to ﬁve year lifespan. When eggs are excreted in fresh water, they produce a new form that infects certain freshwater snails. After a reproductive stage in the snail, new parasites are produced that attack mammalian hosts and continue the cycle.
Epidemiologists estimate that schistosomiasis now affects about two hundred million people in sub-Saharan Africa, Brazil, Venezuela, the Caribbean, China, Indonesia, the Philippines, Cambodia, and Laos. Despite major advances in control, schistosomiasis continues to spread to new geographic areas. Environmental changes that result from the development of water resources and the growth and migration of populations can facilitate the spread of schistosomiasis. For example, the construction of the Aswan High Dam in Egypt virtually eliminated S. haematobium from the Nile Delta, but it allowed the establishment of S. mansoni in upper Egypt.
Winds as well as waters were the source of debilitating conditions.
Winds blowing in from the desert carried ﬁne particles of sand that lodged in the lungs and caused sand pneumoconiosis, a disorder similar to the black lung disease found among coal miners. Sand pneumoco- niosis can be detected by electron microscopy of mummiﬁed lung tissue, but because only the elite were mummiﬁed, it is not possible to tell how common this disorder was among the masses of peasants. Another dis- order of the lungs known as anthrocosis was the result of the inhalation of carbon particles coming from burning wood.
Sand particles found in bread and other foods consumed by both the rich and the poor caused a severe form of dental attrition. Frequent sandstorms contaminated most foodstuffs, adding grit to everything, while the soft stones used for milling grain added their share of residue. Very few mummies had healthy teeth. Sometimes the teeth were so worn down at the crown that the pulp or even the root was exposed. On the other hand, cavities were fairly rare and standards of cleanliness were very high. Obsessive about cleanliness and personal hygiene, the ancient Egyptians used natron as a cleansing agent for the mouth. They also chewed on reeds to cleanse and massage the teeth and gums.
Other disorders found in mummies include tuberculosis, hardening of the arteries, and arthritis. Worn down by these ever present hazards, help- less in the face of disease and traumatic accidents, even the most privileged were unlikely to attain a life span greater than 40 years. Probably few of
these ancient Egyptians actually resembled the life-like, idealized portraits that adorned their cofﬁns and tombs. Evidence of atherosclerosis, a con- dition associated with various disorders of the heart and blood vessels, including stroke, heart attacks, and peripheral vascular disease, has been found in Egyptian mummies. During mummiﬁcation the aorta was often left in the mummy. Ruffer reported that atheromas, just like those found in the arteries of his contemporaries, could be found in almost all of the arteries he had been able to salvage from Egyptian mummies. Nevertheless, some examples of remarkable longevity did occur. For example, studies of the mummy of Rameses II indicated that he had suffered from arthritis, atherosclerosis, calciﬁcation of the temporal arteries, dental lesions with infectious complications. Although he was presumably physically and mentally feeble during the last years of his life, Rameses II was 90 years of age when he died.
Before the introduction of modern techniques for determining the age of ancient materials, Egyptologists depended on indirect methods, such as evaluating the decorations on the cofﬁn and the name and grave goods of the deceased person. But identiﬁcations were generally tentative and sometimes incorrect because many tombs and mummies had been vandalized by grave robbers. Egyptian priests rescued and rewrapped many royal mummies, but the bodies often ended up in mismatched cofﬁns with new identities. Researchers are now able to convert data from CT scans into realistic three-dimensional (3D) images of mummies without removing the outer wrappings. Using this method, scientists can explore previously unknown aspects of Egyptian burial rituals and ﬁnd artifacts placed inside mummies, such a ceramic bowl that appeared in images of the head of a three thousand-year-old mummy.
Carbon-14 dating can be used to estimate the age of mummies, if uncontaminated samples of ﬂesh or bone collagen are used. But it is difﬁcult to remove impurities from the mummiﬁcation materials from tissue samples and rather large parts of the body must be sacriﬁced in order to study bone collagen. X-ray analysis can provide valuable data about medical and dental diseases, estimates of age at death, and morphological variations. It can also spare modern scholars from the embarrassing mistakes that sometimes occurred when nineteenth century archaeologists, trying to enliven their lectures, unwrapped the mummy of some great Egyptian prince only to ﬁnd the body of a princess or, worse yet, a baboon. In addition to diagnosing the ills of ancient pharaohs, modern medical techniques have been used to ‘‘cure’’ mummies suffering from ‘‘museum ailments’’ caused by improper storage, display, and the ravages of insects, fungi, and bacteria.
The abundance of diseases that ﬂourished in Egypt provides a rationale for Herodotus’ observation that the whole country swarmed with highly specialized physicians dedicated to care of the eyes, head, teeth, stomach, and obscure ailments. Not all ancient physicians were
specialists, but there is evidence that specialists, lay physicians, priests, and magicians worked in harmony and referred patients to each other as appropriate. One specialist called Iri, Shepherd of the Anus (or Keeper of the Bottom), held a place of honor among court physicians. Often referred to as the ﬁrst proctologist, the Keeper of the Royal Rectum might have served primarily as the pharaoh’s enema-maker. According to Egyptian mythology, the enema itself had a noble origin: it was invented by the god Thot.
High standards of professional behavior were expected of the physician, who was told: ‘‘Do not mock at the blind; do not scoff at dwarfs; do not injure the lame, do not sneer at a man who is in the hand of God (of unsound mind).’’ Medical specialization in ancient Egypt was primarily the result of the religious doctrine that no part of the body was without its own god. Like the gods they served, priest– physicians tended to specialize in a particular organ or disease. Pharma- cists traced the origin of their art to Isis, who had imparted the secrets of remedies to her son Horus. All who participated in the work of the Houses of Life attached to the temples, as well as the embalming estab- lishments, claimed the god Anepu as their patron. However, responsi- bility for the ‘‘necessary art’’ as a whole was eventually ascribed to Imhotep, the ﬁrst physician known to us by name.
A prodigy and master of all ﬁelds of learning, Imhotep designed and built the famous Step Pyramid of Sakkara, served the Pharaoh Zoser (or Djoser, r. 2630–2611 B.C.E.) as vizier, minister of state, archi- tect, chief priest, sage, scribe, magician–physician, and astronomer. Imhotep, no less than Asclepius, the Greek god of medicine, is a power- ful symbol and true ancestral god of the healing profession. Imhotep’s career as a healer can be divided into three phases: ﬁrst, as a physician in the court of Zoser; second, as a medical demigod (ca. 2600–525 B.C.E.); and third, as a major deity (ca. 525 B.C.E.–550).
When Imhotep died, the sick ﬂocked to the temple that had been built over his grave. The cult of Imhotep eventually spread from Memphis throughout Egypt and Nubia. Excavations of the temples of Imhotep suggest that ‘‘temple sleep,’’ or therapeutic incubation, so closely associated with the Greeks, was really of Egyptian origin. Priests carefully tended to the sick and encouraged their expectation that the god would appear and effect miraculous cures. The priests used ‘‘holy water,’’ baths, isolation, silence, suggestion, and therapeutic dreams in their healing rituals. As a god who healed the sick, granted fertility to barren women, protected against misfortune, and gave life to all, Imhotep understandably became one of the most popular gods. Although worship of Imhotep sharply declined by the end of the second century, he remained a major deity in Memphis into the fourth century.
Some scholars have argued that magic was the motive force behind almost all the achievements of the Egyptians, but others have defended
Imhotep, the Egyptian god of medicine.
the ancients against the charge that their medicine was little more than superstition and magic. Operating within the context of ancient society, physician and patient expected incantations and charms to increase the efﬁcacy of treatment; certainly they would do no harm. Spells and stories about the healing acts of the gods were a source of comfort and hope that enhanced the effect of remedies and surgical procedures. For example, before changing a bandage, the healer could offer a prayer, such as: ‘‘The one whom the god loves, him he shall keep alive.’’ This prayer could be turned into a spell by adding: ‘‘It is I whom the god loves, and he shall keep me alive.’’ Many aspects of the evolution of the medical profession in ancient Egypt remain obscure; even the etymology of the word for physician is unclear.
Some scholars interpret the hieroglyph for physician—an arrow, a pot, and a seated man—as ‘‘the man of the drugs and lancet,’’ or ‘‘opener of the body,’’ while others suggest ‘‘man of pain,’’ or ‘‘the one who deals with disease.’’ Worse yet, the same term was also used for the ‘‘tax valuer.’’ Priest–physicians were expected to conduct a detailed examination of the patient to observe symptoms and elicit signs. The physician noted general appearance, expression, color, swellings, stiffness, movements, odors, respiration, perspiration, excretions, and listened to the patient’s account of the history of the illness. The physician was allowed to touch the patient to study the quality of the pulse, abdomen, tumors, and wounds. Functional tests, such as having the patient move in particular ways, were conducted to elicit information, follow the course of the disease, and evaluate the success of treatment.
Not all of the Egyptian healers were priests; lay physicians and magicians also offered their special services to the sick. The priest– physician enjoyed the highest status, but some individuals acquired qualiﬁcations in two or three categories. Physicians and surgeons were assisted by specialists in the art of bandaging, a skill that had its origin in mummy wrapping. The government paid lay physicians to oversee public works, armies, burial grounds, the sacred domains, and the royal palace. Despite uncertainty about the precise role played by the insti- tutions known as the Houses of Life in the religious, medical and intellectual life of ancient Egypt, they seem to have functioned along the lines of an ‘‘open college’’ or ‘‘think tank,’’ rather than a formal school or temple. Unfortunately, the collections of papyrus scrolls that were stored at the Houses of Life have not survived.
A woman physician known as Peseshet held the title ‘‘Lady Direc-tor of Lady Physicians,’’ indicating that Peseshet supervised a group of women practitioners. An interesting group of women surgeons used ﬂint chisels and stick drills with which they worked at a patient until blood was drawn. Such treatments were especially recommended for headache. Many Egyptian queens were well versed in medicine and pharmacology, including Mentuhetep (ca. 2300 B.C.E.), Hatsheput (ca. 1500 B.C.E.), and Cleopatra (60–30 B.C.E.). At the Temple of Sais, near the Rosetta Mouth of the Nile, there was a medical school where
Egyptian mummies, pyramids, and the embalming process as depicted in a seventeenth century French engraving.
women professors taught obstetrics and gynecology to female students. Women may have studied at the medical school at Heliopolis.
According to Egyptian medical theory, human beings were born healthy, but were innately susceptible to disorders caused by intestinal putrefaction, visible or occult external entities, and strong emotions, such as sorrow, unrequited love, and homesickness. The body was con- stantly threatened by noxious winds caused by changes in the weather, or by spirits and ghosts. Worms and insects represented exogenous causes of disease, but the term worms included both real and imaginary agents, or a misperception of bits of tissue, mucus, or blood clots that appeared in feces and wounds. Whether disease was due to visible or occult causes, cure required forcing the morbid agents from the body by purging or exorcism. Healer and patient would expect to see signs of the departing invader in the excretions and secretions of the patient.
Many threats to health were avoidable, intermittent, or random, but intestinal decay was a constant and inescapable danger. Obviously, food was needed to sustain life, but as it passed through the intestinal tract it was subject to the same putrid processes that could be observed in rotting foods, wounds, and unembalmed corpses. If the products of decay were strictly conﬁned to the intestines, eating would not be so dangerous, but putrid intestinal materials often contaminated the sys- tem of channels that carried blood, mucus, urine, semen, water, tears, and air throughout the body, causing localized lesions and systemic dis- eases. Health could only be maintained by frequent use of emetics and laxatives to purge the body of intestinal putrefaction. Convinced that the rectum was a particularly dangerous center of decay, the Egyptians relied on remedies designed to soothe and refresh the oriﬁce and keep it from twisting or slipping. Thus, the Keeper of the Royal Rectum truly deserved the honors due to a specialist with primary responsibility for the health of the pharaoh.
Herodotus noted the Egyptian concern with internal sources of decay and reported that three days each month were set aside for purg- ing the body with emetics and enemas. These prophylactic purges were not the only preventive measures taken by the Egyptians in their pursuit of health. Cleanliness of body was even more valued by the Egyptians than by the Greeks. Rules for the disinfection of dwellings and proper burial of the dead sprang from a combination of hygienic and religious motives. Fear of exacerbating intestinal putrefaction by the ingestion of impure foods and drink encouraged protective food inspection and dietary restrictions. Despite the preoccupation with diet and health, overeating, drunkenness, disorders due to unwholesome foods, famine, and starvation were not uncommon.
Popular accounts of Egyptian medicine have presented it as either ‘‘mere superstition’’ or as a mysteriously advanced science, but neither extreme is correct. The ancient Egyptians could distinguish magic and medicine as separate activities, but they expected the effects of the combination to be synergistic. The efﬁcacy of magic rested upon the spell, the rite, and character of the practitioner. Words used in the spell were so powerful in both their written and spoken forms that objects over which an incantation had been spoken became protective amulets. Spells were recited over a mixture of drugs before giving them to the patient. Many remedies were noxious substances meant to make the patient too repulsive an abode for disease-causing demons. Patients suffering from conditions that might be ascribed to ‘‘sug- gestion,’’ might be challenged or even cured with noxious remedies such as charred beetles mixed with fat. Ritual acts or gestures added power to words. Rituals varied from simple symbolic acts, such as tying knots in a thread in order to bind up the agents of disease, to elaborate ceremonies combining music, dance, drugs, and divination. Other magi- cal methods were based on the principle of transfer. For example, a migraine headache might be transferred to a ﬁsh applied to the affected side of the head.