Wednesday, November 30, 2011

Ancient Egyptian Medicine


In Sickness and in Health: Preventative and Curative Health Care

Sekhmet    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 he he had the satisfaction of being treated by physicians whose art was renowned all over the ancient world.
    Unlike the injuries caused by accidents or fighting, which were dealt with by the zwn.w (sunu),[37] or scorpion stings and snake bites for which the xrp srqt (kherep serqet) [37], 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 [9] 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:
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
    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

    The Egyptian priest-physician, wab sxmt (wab sekhmet) [37], 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) [52] and the zA.w (sau) [53] 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, §§ 433ff.
    Physical medicines such as herbs were mostly expected to assuage the pain only, while magic effected the cure. A section in the Papyrus Ebers [6] 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 [8] (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 [19]

    Apart from spiritual healing and herbal medicine, they practised 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

and manipulation and 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 [54]:
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
    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 practising healers. It has also been suggested that the Houses of Life, associated with Sekhmet, were teaching centres 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
    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 [45].
    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 [47]:
  • The Edwin Smith Papyrus 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 Gynaecological 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. 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
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, but did not have any understanding of the circulation of the blood
Now if the priests of Sekhmet or any physician [29] 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
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
    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
    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

    Everyday complaints like stomach upsetsbowel 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
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 [26]. 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 Psamtik 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 [71] - a common cause of anaemia, 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 [17].
    Insect borne diseases like malaria [63] 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 [32]. 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 [43]. 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 [13]diarrhoea,[76] dysenterytyphoidjaundice 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 favoured the outbreak of respiratory illnesses.[75]
A child's vertebra showing signs of tubercular infection; Source: V.EasyA child's vertebra showing signs of tubercular infection
Source: V.Easy
    Trichinae afflicted the pigs [69], parasitic worms [69] and tuberculosis the cattle and were occasionally passed on to the human population. Human tuberculosis [1] [34]was widespread; Leprosy on the other hand, caused by bacteria similar to the tubercle bacillus, is badly documented [66] 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 [67] and was a frequent cause of death, as was pneumonia [68].
    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 civilisation, 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 [74][38]arthritis [3], from which Ramses II suffered, and probably dementia[70]
    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;[77] 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."

    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 osteopetrosis. [28]

    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 Gynaecological 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 [35]. 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; [55] 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 [40]. Remains of 400 paupers buried at Giza during the first millennium BCE and discovered by Mark Lehner's AERA, show signs of malnutrition. there being a high incidence of haematological disorders present in the [bone] material, suggesting a sub-standard diet for this population.[78] Bad nutrition caused many other diseases as well. Because of vitamin and other deficiencies [2], dental abrasion, and bad mouth hygiene, caries and abscesses were the lot of many ancient Egyptians. [61]

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.[65]
    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. pEbers 192 [56])
    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.
    CorianderC. Sativum (e.g. pHearst 102, 124 [57]) 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.
    CuminCumin cyminum (e.g. pHearst 28, 55, 125 [57]) 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 flavouring. 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. pEbers 105, 415 [56]) or the ym-tree, were used in poultices and the like (e.g. pSmith 46 [20]). Tannic Acid derived from acacia seeds commonly helped for cooling the vessels (e.g. pHearst 95, 249) and heal burns. Castor oil, (e.g. pEbers 25 and 251 [56]) figs (e.g. pEbers 41 [56]) 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 [57]), 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, [31] 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 [49] as pain killer (e.g. pKahun 12 [58]), was imported from Punt.
    Minerals [31] and animal products were used too. Honey and grease formed part of many wound treatments, [20] mother's milk [59] 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 [20].
    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 [12].
    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 [33].

Surgery

    At Saqqara there is the tomb of Ankh-Mahor, known as The Tomb of the Physician. In one of the wall pictures two men are having their extremities treated variously explained as manicure, massage or surgery. In the accompanying text the patient implores the physician: Do not let it be painful. The answer was ironical: I do (it) so you will praise it, (O) king! perhaps not in the best Egyptian bedside manner.
    At any rate, people at least occasionally survived surgery. Bodies of amputees from as early as the Old and Middle Kingdoms have been found which display signs of healing. Prostheses which show signs of wear, have also been discovered. The reasons for these amputations are unknown and none of the surviving medical texts mention the possibility of, let alone reasons for amputation as a therapeutic treatment. [64]
Circumcision performed on adolescent    Another picture shows what looks like the performance of a circumcision of adolescents [21] (the only instance of a depiction of this procedure) with the hieroglyphs saying The ointment is used to make it acceptable, which has been interpreted as meaning that a local anaesthetic was being used, though this reading is, as happens often in such inscriptions, doubtful. Poppies (Spn) [36] are occasionally mentioned in Egyptian medical literature. The physicians must have had a pretty good idea of their properties.
    It is difficult to estimate how pervasive the practice of circumcision was. The remains of mummies are of little help and literary evidence is scarce. During the New Kingdom both Merneptah and Ramses III had their slain enemies emasculated and their genitals collected. The lack of circumcision among the Libyans and their allies is repeatedly mentioned:
.... Libyans slain whose uncircumcised phalli were carried off: 6,359
as opposed to the
.... [Ek]wesh who had no foreskins, slain, whose hands were carried off, (for) they had no [foreskins] ......
and again enemies of unknown origin
.... in heaps, whose uncircumcised phalli were carried off to the place where the king was: 6,111 men ....
James Henry Breasted Ancient Records of Egypt Part Three, § 588
The fact that they collected uncircumcised genitals as trophies may indicate that this was unusual in their eyes.
    Boys destined for priesthood were circumcised as part of the initial ritual cleansing, which also included the shaving of the whole body. The practice of circumcision became more universal during the Late Period, perhaps as part of a rite of passage.
... the Colchians, Egyptians, and Ethiopians alone of all the races of men have practised circumcision from the first. The Phoenicians and the Syrians who dwell in Palestine confess themselves that they have learnt it from the Egyptians, and the Syrians about the river Thermodon and the river Parthenios, and the Macronians, who are their neighbors, say that they have learnt it lately from the Colchians. These are the only races of men who practise circumcision, and these evidently practise it in the same manner as the Egyptians. Of the Egyptians themselves however and the Ethiopians, I am not able to say which learnt from the other, for undoubtedly it is a most ancient custom; but that the other nations learnt it by intercourse with the Egyptians, this among others is to me a strong proof, namely that those of the Phoenicians who have intercourse with Hellas cease to follow the example of the Egyptians in this matter, and do not circumcise their children.
Herodotus Histories II
    Female 'circumcision', a barbarity to this day even more common in countries of equatorial East Africa than it is in Egypt, may have been practised occasionally [14][23], though many think that the only textual reference is really non-existent, the translation of the following passage being wrong and no mention of women being made:
... I was circumcised, together with one hundred and twenty men, and one hundred and twenty women ... 
Relief of surgical instruments found at Kom Ombo; Source: V.Easy    The knives used had stone blades. Flint or obsidian have edges sharper than modern surgical steel. It is small wonder that physicians would hesitate to replace sharp flint blades with comparatively dull metal ones, made first of bronze and later of iron. When metal instruments were finally used to any extent, the act of cauterizing accompanied it. In some procedures, the blade was heated until it glowed red, and then used to make incisions. It cut as well as sealed up the blood vessels, limiting bleeding [10].
    In the temple of Sobek there are reliefs of medical instruments: bone saws, suction cups, knives and scalpels, retractors, scales, lances, chisels and dental tools.
    Trepanation, practiced in many early cultures for a number of reasons, is not mentioned in any of the medical papyri, but seems to have been performed occasionally using mallet and chisel. Just 14 skulls, some healed or partially healed, have been found.[18] Limb amputations were also performed.

Dentistry

    As their diet included much abrasive material (sand and small stone particles from grinding the corn) the teeth of elderly ancient Egyptians were often in a very poor state.
Teeth of upper jaw, Tao IIUpper jaw of Tao II Seqenenre.
The teeth are heavily worn, but healthy and tartar free
G. Elliot Smith, plate III
Caries and the destruction of the enamel caused the loss of teeth at an early age and often killed as well. Mutnodjmed, pharaoh Horemheb's second wife and sister of Nefertiti, had lost all her teeth when she died in her forties. Djedmaatesankh, a Theban musician who lived around 850 BCE suffered from 13 abscesses, extensive dental disease and a huge infected cyst, which probably killed her aged about 35 [4].
    On the other hand, if there was no abrasion due to lucky circumstances, a person of the people would have a minimal incidence of caries and thus a perfect set of teeth, [61][73] thanks to the paucity of sugar in the diet of the ancient Egyptians. The well-to-do, whose food was more refined, seem to have suffered more from caries than the poor. During Roman times the incidence of caries appears to have grown among the population at large, possibly due to an increased consumption of sweeteners, but the level of tooth wear decreased, perhaps thanks to better sieving.[77]
    The Ebers Papyrus lists a number of remedies dealing with teeth, though the complaint at times is a bit obscure.
Another remedy for treating an itching tooth until the opening of the flesh: cumin, 1 part; resin of incense, 1 part; DAr.t-fruit, 1 part; crush and apply to the tooth.
Ebers no. 742
After Jean-Claude Schwarz, La médecine dentaire dans l'Égypte pharaonique, Bulletin de la Société d'Égyptologie, Genève 2 (Novembre 1979)
Head of the mummy of Amenhotep III    Caries was rare during the predynastic and became prevalent among upper class Egyptians as early as the Old Kingdom. By the end of pharaonic Egypt it was a disease which affected all social strata.[72] It was referred to as a worm gnawing a tooth which is at least comprehensible to us, and it has been suggested that they were sometimes treated by fillings made of resin and chrysocolla, a greenish mineral containing copper. There were also remedies for strengthening a tooth, forexpelling aches from the mouth, and for treating the blood eater - whatever that was.[60]
Head of the mummy of Amenhotep III. He had lost some of his front teeth due to alveolar abscesses of which he was still suffering at the time of his death.
(The matter filling the mouth cavity is resin used during mummification)
G. Elliot Smith, plate XXXV
    Swollen gums were treated with a concoction of cumin, incense and onion. Opium, the toxicity of which was well known, might be given against severe pain. At times holes were drilled into the jawbone in order to drain abscesses. But extraction of teeth, which might have saved the lives of many a patient, was rarely if ever practised. For most of ancient Egyptian history there was little or no effective dental treatment available [62] and sufferers mostly could only hope that the maxim in The Instruction of Ankhsheshonq"There is no tooth that rots yet stays in place" [39] would come true speedily.
Teeth wired together    A few examples of restorative dentistry are known. One mummy had three substitute teeth skillfully tied to the abutment teeth with fine gold wire, but it has been suggested that this was done post-mortem.

    The profession of dental physician seems to have existed since the early third millennium: Hesi-re is the first known Doctor of the Tooth. But apart from this and a few other, less famous, Old Kingdom instances, dentistry as a medical specialty is rarely if at all mentioned until the Graeco-Roman Period.

Prostheses and cosmetics

[Image: Artificial toe; Source: Jon Bodsworth]Prosthesis worn by the owner while still alive,
3rd Intermediate Period;
Source: Jon Bodsworth
    Prostheses were generally of a cosmetic character, such as an artificial toe made of cartonnage at the British Museum, or added as a preparation for afterlife such as a forearm on a mummy in Arlington Museum (England) and an artificial penis and feet on another mummy in the Manchester Museum . A wooden big toe prosthesis has also been found [24] which must have improved the walking capabilities of its wearer, a fifty to sixty year old woman, after her big toe had been amputated, possibly because of gangrene [27]. A glass eye with a white eyeball and a black pupil, but lacking an iris, was probably inserted into the empty eye socket of a mummy rather than used by a living person [42].
Artificial toe; British MuseumCosmetic prosthesis, the toenail inlay has been lost;
Source: British Museum

    Physicians performed other cosmetic tasks as well. Apart from prescribing lotions, salves and unguents for skin care, they also produced remedies against the loss of hair and graying, which was combatted by an ointment made with blood from the horn of a black bull. Hair loss was hoped to be stopped by a mixture of honey and fats from crocodiles, lions, hippos, cats, snakes, and ibex.

The role of Egyptian medicine in history

    Egyptian physicians were much sought after in the Ancient World, despite the fact that possibly but little was added to the canon of knowledge after the First Intermediate Period (about 2000 BCE). Ramses II sent physicians to the king of Hatti and many rulers, the Persian Achaemenids [16] among them, had Egyptian doctors in attendance.
    Their treatments were based on examination, followed by diagnosis. Descriptions of the examination - the most exacting part of a physician's job - are lengthier than both the diagnosis or the recommended treatment (cf. the Edwin Smith Surgical Papyrus).
Another remedy: When you see a man in whose neck is mucilaginous matter and he suffers from the joint of his neck, he suffers from his head and the vertebrae of his neck are stiff, his neck is heavy. it is impossible to look at his belly or very difficult.

Then you shall say: someone having mucilaginous matter in his neck.

Then you shall cause him to anoint himself and to apply ointment, so that he will improve at once.

pEbers 294 (51,15ff)
after a German translation by Dr. Peter Brügger
    The pots containing medicines were (at least occasionally) labeled, stating the remedy's composition and how to use it. A certain little pink pot bears the following hieratic inscription: [Image: Label] which, read from right to left, means:
Saw dust, acacia leaves, galena, goose fat. Bandage with it.
After Serge Sauneron: Une recette égyptienne de collyre, BIFAO 57 (1958), p.158
The label does not mention the body part to which the salve is to be applied, but acacia tree products and galena were frequently used to treat eye complaints.

    Treatment was conservative: if no remedy was known then only such steps were to be taken which would not endanger the patient. Some head wounds for instance, considered as an ailment not to be treated [20] might just be anointed externally with an unguent forestalling infection or the patient might be tied at his mooring stakes, until the period of his injury passes by  [20] in order to prevent him from causing further damage to himself.
    On the other hand much of the ancient Egyptian pharmacopoeia and many medical practices were ineffective, if not downright deleterious: e.g. excrement used in medicines will only in the rarest of cases prove to be wholesome, and if applied as wound dressing may well cause tetanus poisoning, yet dung continued to be used in Europe until the Middle Ages. The reliance on magic and faith may well have retarded the development of more rational views of the causes of diseases and their cures. On the other hand, the strong belief of the patient in the divine origins of the cure may well have been a large part in its effectiveness, and in the absence of anything better often the only support a physician could give the natural healing processes.
    Egyptian theories and practices influenced the Greeks, who furnished many of the physicians in the Roman Empire, and through them Arab and European medical thinking for centuries to come [48].
Source

7 comments:

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