11 May

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.

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