Unfortunately, except for a few fragmentary medical papyri, the texts used for teaching the art of medicine in the Houses of Life have been lost. The eight surviving medical papyri were composed between about 1900 and 1100 B.C.E., but they are probably compilations and copies of older medical texts. In modern translations, the surviving medical papyri constitute only about two hundred printed pages.
Remedies and case histories taken from the Ebers, Smith, and Kahun papyri provide the most signiﬁcant insights into ancient Egyp- tian ideas about health and disease, anatomy and physiology, and magic and medicine. The other medical texts include collections of remedies, aphrodisiacs, incantations against disease, descriptions of fertility tests, and spells for the safety of pregnant women and infants.
The Ebers papyrus, which was probably written about 1500 B.C.E., is the longest, most complete, and most famous of the medical papyri. Named after Georg Ebers, who obtained the papyrus in 1873 and pub- lished a facsimile and partial translation two years later, it is an encyclo- pedic collection of prescriptions, incantations and extracts of medical texts on diseases and surgery taken from at least forty older sources. The Ebers papyrus was apparently planned as a guide for the three kinds of healers: those who dealt with internal and external remedies, surgeons who treated wounds and fractures, and sorcerers or exorcists who wrestled with the demons of disease.
Although the ancients did not see any reason for a strict separation between natural and supernatural diseases, there was a tendency for what might be called ‘‘realistic’’ prescriptions to be grouped together with diseases that could be treated with a reasonable chance of success. Incurable disorders are generally clustered together with more magically oriented practices. Healers were warned against causing additional suf- fering by undertaking useless treatments. In hopeless cases, ointments and incantations were preferable to the knife.
Many recipes, at least in translation, call for incomprehensible, exotic, or seemingly impossible ingredients, like Thot’s Feather and Heaven’s Eye, which may have been cryptic or picturesque names for ordinary medicinal herbs. No doubt Egyptian pharmacists would have ridiculed prescriptions calling for ‘‘fox’s gloves’’ (digitalis), ‘‘pretty lady’’ (belladonna), or ‘‘male duck’’ (mandrake).
About seven hundred drugs, combined in a variety of ways to create more than eight hundred formulas, are found in the Ebers papyrus. Drugs were administered as pills, ointments, poultices, fumigations, inhalations, snuffs, gargles, suppositories, enemas, and so forth. Physi- cians apparently relied on specialized assistants and drug collectors, but sometimes they prepared their own remedies. In contrast to Mesopo- tamian custom, Egyptian prescriptions were precise about quantities.
Although components were usually measured by volume rather than by weight, the instruments used in the preparation of drugs included balances, as well as mortars, mills, and sieves.
Remedies fortiﬁed by spells were said to open and close the bowels, induce vomiting, expel worms and demons, cure fevers, rheumatism, cough, bloody urine, dysentery, and a plethora of other diseases. Hemorrhages, wounds, and crocodile bites could be dressed with a mixture of oil, honey, and roasted barley, and covered with fresh meat. Other prescriptions called for crocodile dung, human urine, myrrh, beans, dates, and ostrich eggs. Gold, silver, and precious stones were identiﬁed with the ﬂesh and limbs of gods; thus, they were used in amulets and talismans to ward off disease. Less exotic minerals, such as sulfur, natron, and heavy metal salts, were commonly associated with skin diseases, but one interesting ointment called for burnt frog in oil. Minerals were used either in their native form or as powders recycled from broken pottery, bricks, or millstones.
Diseases of the eye were apparently as much a problem in ancient Egypt as they are today in many parts of the Middle East, India, and Africa. Blindness was not uncommon, as indicated by various docu- ments and paintings. For a disorder that was probably night blindness (a common sign of vitamin A deﬁciency), roasted ox liver was enthusi- astically recommended. Another remedy for impaired eyesight consisted of honey, red ochre, and the humor of a pig’s eye, which the healer poured into the patient’s ear.
Rheumatism is the diagnosis suggested by descriptions of chronic aches and pains in the neck, limbs, and joints. Treatment for this pain- ful condition included massages with clay or mud and ointments con- taining herbs, animal fat, ox spleen, honey, wine dregs, natron, and various obscure materials. The recommendation that certain remedies be applied to the big toe suggests that gout was one of these painful disorders.
Not all prescriptions in the medical papyri were for life-threatening conditions. The medical texts also contain recipes for cosmetics and hair restoratives, such as a mixture of burnt hedgehog quills mixed with oil. Another ingenious recipe could be applied to the head of a woman one hated in order to make her hair fall out. Cosmetics generally reﬂect only vanity and the tyranny of fashion, but cleansing unguents, per- fumes, and pigments probably had valuable astringent and antiseptic properties.
Another example of the lighter side of ancient medicine comes from the study of masticatories or quids, materials that are chewed but not swallowed. The masticatory favored by the Egyptians was the stem of the papyrus plant. The Greeks thought the Egyptian habit of chewing papyrus stems and spitting out the residue was ludicrous and squalid, until they too took up the custom. Resin-based pellets and balls of natron and frankincense were chewed to purify and sweeten the breath. Other masticatories were said to prevent disorders of the teeth and gums.
The Kahun papyrus, which was probably composed about 1900 B.C.E., consists of fragments dealing with gynecology and veterinary medicine, including methods for detecting pregnancy, predicting the sex of the fetus, and preventing conception. One of the contraceptives was basically a pessary (vaginal suppository) containing crocodile dung. Other prescriptions call for a plug (rather like a contraceptive sponge) made with honey and natron, an extract of the acacia plant, and a gum-like material. Later contraceptive prescriptions kept the spirit of the Egyptian recipe, but substituted elephant dung for that of the croco- dile. Greek observers noted that the Egyptians seemed to regulate the size of their families without infanticide. This suggests that even the most noxious and bizarre pessaries might work if they functioned as mechanical barriers, or spermicides, or caused a total lack of interest in sexual intercourse. Prolonged lactation, which tends to suppress ovu- lation, and a three-year interval between births were considered essential for the health of mother and child.
Although midwives were probably the main childbirth attendants, physicians were acquainted with various gynecological conditions, including prolapse of the uterus, cancer, leucorrhoea, dysmenorrhea, amenorrhea, and menopause. Because the uterus was thought to be a mobile organ that could cause mischief by wandering about the body, doctors prescribed special fumigants to lure it back to its proper posi- tion. Complex and noxious mixtures were recommended for wandering uterus, abnormal delivery, and miscarriage. Such remedies were said to warm the breasts, cool the womb, regulate menstruation, and increase milk production. Generally, these medicines were taken as fumigants, douches, or suppositories, but in some cases, the woman simply sat on the remedy. Fertility tests were based on the assumption that in fer- tile women free passages existed between the genital tract and the rest of the body. Therefore, when the woman sat on a test substance, such as date ﬂour mixed with beer, vomiting proved that conception could occur and the number of vomits corresponded to the number of future children. Once pregnancy was established, the physician studied the effect of the patient’s urine on the germination and growth of wheat and barley seedlings in order to predict the sex of the child. Of course, such tests had at least a ﬁfty–ﬁfty chance of being correct.
Ancient texts indicate that women gave birth while squatting on so-called magical bricks decorated with religious symbols and images of the gods that protected the health of mothers and infants. A remarkable example of these birth bricks was discovered by archaeologists excavating the ruins of Abydos, an ancient city in southern Egypt. A painted brick found among the artifacts in a 3,700-year-old house depicted a mother with her newborn baby, female assistants, and Hathor, the cow goddess associated with birth and motherhood. An image of the sun god and his guardians presumably invoked magical protection for the fragile life of the newborn babe.
Egyptian physicians were remarkably specialized, but there is no mention of pediatrics, a ﬁeld based on the age of the patient rather than speciﬁc parts of the body, as a separate area of specialization. There were, however, remedies and spells for the health of infants and prescriptions for obscure childhood diseases, bed-wetting, retention of urine, cough, and teething. For example, chewing on a fried mouse was recommended to ease the pain of cutting teeth and an old letter boiled in oil was said to cure retention of urine. Since the child was com- monly breast-fed for three years, remedies could be given to the mother or wet nurse.
Since the Egyptians made mummies of humans and other animals, they had the opportunity to study comparative anatomy. Archaeolo- gists have discovered the skeletons or mummies of lions, baboons, ibis, ﬁsh, cats, dogs, and crocodiles in tombs and special cemeteries. Never- theless, despite centuries of experience with mummiﬁcation, Egyptian anatomical concepts remained rudimentary. The embalmers, who belonged to a special guild of craftsmen, were not practicing physicians or disinterested scientists. Even the embalmers seem to have been ambivalent about the task of opening the body. As part of the ritual that preceded this act, a man called the scribe drew a mark along the ﬂank. The man who actually made the incision was symbolically abused and driven away with stones and curses.
Haruspicy, divination through the study of animal organs, offered another source of anatomical information. Since the structure, size, and shape of organs used for divination were important omens, haruspicy probably provided a greater impetus to anatomical study than mummi- ﬁcation. Support for this hypothesis is found in the animal-like hiero- glyphic signs used for human organs. Egyptologists have catalogued names for over a hundred anatomical signs; many names apply to parts of the all-important alimentary canal. The nerves, arteries, and veins, in contrast, were poorly understood and essentially undifferentiated.
Physiological and pathological phenomena were explained in terms of the movement of ﬂuids in a system of channels that brought nourish- ment to the body just as the ﬂooding of the Nile brought nourishment to the land. A complicated system of vessels carried blood, mucus, water, air, semen, urine, and tears. The heart, the ‘‘seat of the mind,’’ was clearly regarded as a major gathering place for the vessels, but there was another conﬂuence of channels in the vicinity of the anus. Because the rectum and anus were associated with dangerous decaying matter, the arrangement of the vessels exposed the entire system to contami- nation with the products of internal decay.
As a sign of its special signiﬁcance, the heart was left in the body during mummiﬁcation. ‘‘Weighing the heart’’ was an important step in the judgment of the dead by the gods. Afraid that their hearts might not measure up, the Egyptians carefully fortiﬁed their tombs with magical amulets designed to secure successful judgments. By weighing the heart of the dead, the gods could measure their moral worth. In the living, the physician measured health by placing his ﬁngers on the pulses of the head, neck, stomach, and limbs, because the heart spoke out through the vessels of the body. Indeed, knowledge of the heart and its move- ments was called the ‘‘physician’s secret.’’ The physician knew that fainting occurred when the heart could no longer speak. If the heart and its vessels became contaminated with decaying matter or heat from the rectum, the patient would experience illness, debility, and ultimately loss of consciousness.
In 1862, Edwin Smith (1822–1906), a pioneer Egyptologist, pur-chased a papyrus scroll that had been found in a grave near Luxor. Smith’s attempts to decipher the document were not very successful. But when James Henry Breasted (1865–1935) completed his translation of the scroll in 1930, he revolutionized ideas about the relative weight of magic, empiricism, and surgery in Egyptian medicine. Breasted envi- sioned the Smith papyrus as a document in a class by itself, because it was a systematic collection of case histories that offered the physician important anatomical and physiological information. Sections of the Smith papyrus were copied from texts so ancient that the idioms and concepts in the originals had already become virtually incomprehen- sible. Therefore, the scribe who compiled the document had to include explanations that would make the text useful to his contemporaries, thus providing valuable information for modern Egyptologists.
The 48 cases preserved in the Smith papyrus were arranged system- atically from head to foot in order of severity. Each case consists of a title, instructions to the physician, the probable prognosis, and the proper treatment. Ailments were divided into three categories: those that were almost deﬁnitely curable, those that were treatable, but uncertain, and incurable disorders for which no treatment should be attempted.
The section called the ‘‘Book of Wounds’’ describes treatments for fractures, dislocations, bites, tumors, ulcers, and abscesses. Broken bones were set in splints made from ox bones, supported by bandages soaked in quick-setting resin. Recognizing the poor prognosis for com- pound or open fractures (fractures in which the broken ends of the bone have pierced the skin), the doctor who was prepared to ‘‘contend with’’ simple or closed fractures considered an open fracture an ailment beyond treatment. Plasters or adhesive bandages were generally used to close wounds, but some injuries called for sutures. The Egyptian surgeon used a variety of bandages, adhesive plasters, splints, braces, drains, plugs, cleansers, and cauteries, as well as bronze implements, including scalpels and needles. Excavations at the tomb of a Fifth Dynasty physician revealed many bronze surgical implements, as well as statues of gods and goddesses.
Although the Egyptians were familiar with the sedative effects of opium and henbane, there is no direct evidence of their use as surgical anesthetics. A scene depicting male circumcision accompanied by a text that states: ‘‘This is to render it agreeable,’’ has been interpreted as evi- dence of anesthesia. However, the inscription that accompanies a simi- lar depiction of this operation says: ‘‘Hold him so that he does not fall.’’ Since circumcision was a religious ritual, it fell within the province of the priest and would not be discussed in a medical treatise. The surgical tools used in circumcision are shown in some Egyptian temples. One illustration seems to represent an initiation ritual, but there is debate about whether a priest is being circumcised or doing a circumcision.
Although Amenhotep II and III were circumcised, the mummies presumed to be those of their predecessors, Amenhotep I and Ahmose I, were uncircumcised. Studies of early male mummies indicate that male circumcision was not uncommon in the Old Kingdom, but the practice was probably more common among priests and royalty in later periods. Although there are panels depicting the male operation, no such pictures of female circumcision, now generally known as female genital mutilation, are known. Even today there is a similar pattern; the circumcision of a boy is a public celebration, but that of a girl is conducted privately, without celebration.
Female circumcision, which consists of excising the clitoris and other external female genitalia, persists in the region today. Inﬁbulation, the most extreme form of female genital mutilation involves removing the entire clitoris, the labia minora, and parts of the labia majora. The Greek geographer Strabo, who visited Egypt about 25 B.C.E., reported that it was customary among the Egyptians to circumcise male children and excise females. The operation was generally done when children were about 14 and almost ready for adult roles.
Unfortunately, the ‘‘Books of Wounds’’ is incomplete. The scribe apparently stopped writing in the middle of an interesting account of afﬂictions of the spine and left the rest of that ‘‘page’’ blank. When he resumed work, he apparently turned to another source and copied out recipes to ‘‘transform an old man into a youth of twenty’’ and incantations against ‘‘the wind of the pest of the year.’’ This abrupt transition may be symptomatic of the gradual transformation of prior- ities in Egyptian culture over the millennia, during which engineering, astronomy, science, and medicine stagnated, while superstition and magic ﬂourished.
In 322 B.C.E. Alexander the Great (356–323 B.C.E.) conquered Egypt and brought it into the sphere of Hellenistic culture. How much the Greeks learned from the Egyptians and how much they taught them is difﬁcult to determine. By this late stage, much of the esoteric knowledge of ancient Egypt had been forgotten, although medicine, mathematics, and technology would ﬂourish once again, at least for a brief time, in the great city of Alexandria in Egypt. Under the Roman Empire, Egypt played an important role in the network of maritime and overland trade routes that linked Rome to Arabia and India, as well as Egypt. Trade items included ivory, tortoise shells, drugs, slaves, peppercorns, frankin- cense, and myrrh. Port cities along the Egyptian shore of the Red Sea supported maritime trade routes that rivaled the Silk Road, but they were eventually abandoned, buried by desert sands, and forgotten.