410278

EGYPT INANCIENT PAIN,DISEASE ANDANALGESICS by ROYJAMESLANE

A thesissubmittedto the Universityof Birmingham for the degreeof OFPHILOSOPHY DOCTOR

Instituteof Archaeology andAntiquity Schoolof HistoricalStudies TheUniversityof Birmingham June2003

ABSTRACT Painis theindexfeatureof diseasesinceit promptsa requestfortreatment andits controlis intrinsicto the medicalsystem.The ability to controlpain shouldreflectthe overall Thishasnotbeenpreviously effectiveness of themedical system. studied. ManyEgyptianmedicaltermsare unclear.Thethesisshowssomeunknown terms in disease.Sucha maylexicallyderivefroman adaptation of the typeof painexperienced Othertermsof more systemof adaptivetenninology wouldprovidea basisof nomenclature. fundamentalimportance,such as aetiologicalmorbidfeaturesof disease,mightequallybe

moresimplyexplained. Despite in ancientEgypt,thecontrolof painwas thehighincidence of painfuldiseases limited.Therewasa lackof powerful Othersubstances thatmighthavebeenused analgesics. to produce Thismayhavebeendueto a'policy'of seemnotto havebeenexploited. analgesia multipleingredientpolypharrnacy propertiesof so that the individualpharmacological Thiswouldhavehindered theprogress substances werenotseparately of medical recognised. Sucha systemmayhavebeenpartof thetreatment treatment. (itualperse. It maybe thata 'secondary thispolicy. system'of hometreatments existedwhicheitherforcedor perpetuated

(74,014words)

LISTOFCONTENTS ChapterI- INTRODUCTION 1.1 TheReputation Medicine Brief Background of Egyptian Studies 1.2 Connections Previous Between Egyptian andGreekMedicine onPain,Disease andTreatment 1.3 PlantSubstances-Entries in theMedicalPapyri- Problems of Identification CurrentReference Sources 1.4 TheMedical Papyri- Description andProblems 1.5(i)Table:Medical Papyri 1.5(ii)Plate:BerlinPapyrus (facing) 1.5(iii)Plate:LondonPapyrus (facing) 1.6AimsandMethods

1 5 9 14 14 24 24 27

Chapter2- PAIN 2.1Concepts 2.2PainRelief 2.3Physicians 2.4Useof Analgesics

32 40 41 44

TERMINOLOGY Chapter3- EGYPTIAN 3.1WordsforPain 3.2 tfý, bdw 154 3.2(i)Plate:BerlinPapyrus 3.2(ii)TheVesselBook(Ebers854/6,Berlin163) 1,348- Spell13 3.2(iii)TheLeidenPapyrus Sage 3.2(iv)Admonitions of anEgyptian Entriesfor wbdw 3.2(v)OtherPrescription GreekMedicine 3.2(vi)TheConnections of uýbdwwith 3.2(vii)Conclusions on tfýbdw 3.3stt Terminology 3.4Adaptive

48 50 59 66 70 73 74 81 84 86 100

Chapter4- DISEASE Sources 4.1Background Previous Studies 4.2Table:Medical Conditions andFirstIdentifications 4.3Carcinomas 4.4BoneandJointDisease 4.5DentalDisease 4.6Parasitic Worms 4.7Respiratory Disease 4.8Accidents andInjuriies 4.9Summary

121 122 126 133 137 142 145 148

Chapter5 MEDICINAL PAINKILLING SUBSTANCES 5.1Introduction 5.2Opium 5.2(i)Plate:Cypriote RingBaseJuglet 5.2(ii)Plate:Vessels andStandsfromtheTombof Kha 5.2(iii)Table:OpiumUsagein England andAncientEgyptA Comparison of LandRequired

152 155 163 164

in Egypt 5.3Cannabis Munich Mummies 5.4Cannabis, Cocaine andTobacco -The byBalabanova 5.4(i)Table:Summary andTeam. of ResultsReported

172 177 184

171

Chapter6- LETTUCE,CELERYFRUIT,MANDRAKE, LOTUS

6.1Lettuce Entriesfor eftintheMedical Texts 6.1(i)Prescription 6.1(ii)Melilot 6.1(iii)WildLettuce 6.2 (i)CeleryFruit 6.2(ii)Dawson andAft 6.2(iii)Mitt inTheMedical Texts 6.2(iv)Summary 6.3Mandrake 6.4Lotus EntriesforLotus 6.4(i)Prescription 6.4(ii)Summary Entries of Prescription 6.4(iii)Conclusions ontheLotus

185 187 192 192 194 195 198 206 207 209 211 213 214

WILLOW, HENBANE, Chapter7- DILL,JUNIPER, MYRHH 7.1Dill EntriesforDill 7.1(i) Prescription 7.1(ii)Conclusions on EntriesforDill 7.2Junipe 7.2(ii)Juniperin TheMedical Texts 7.2(iii)Conclusions on EntriesforJuniper 7.3Willow 7.3(i)Prescription EntriesforWillowin theMedical Texts 7.5Henbane 7.5(i) Possible Prescription EntriesforHenbane 7.5(ii)Henbane Toxicity 7.6Myrrh 7.6(ii)Characteristics of Myrrh 7.6(iii)Myrrhin theMedical Texts

217 218 219 221 222 228 230 231 234 235 236 239 241 242

Chapter8 -ALCOHOL, SURFACE ANALGESICS 8.1Alcohol 8.1(i)AlcoholAbuse 8.1(ii)Plate:Ladyat Banquet, Guestsat Banquet (facing) 8.1(iii)TheMedicinal UsesofAlcohol 8 (iv)Dioscorides andAlcohol 8 (v)TheUseof AlcoholoutsidetheMedical Texts 8.2Surface Analqesics 8.2(i)Surface Analgesia andtheTombof Ankhmahor 8.2(ii)Circumcision (facing) ScenefromtheTombof Ankhmahor

249 251 253 254 256 257 258 261 263

Chapter9- PRESCRIPTION ANALYSIS 9.1Introduction 9.2Collation of Material 9.3Tables:Prescription Entriesin theMedical Texts Tables10.3(i)- (ix) 9.4Discussion 9.5Table:Percentage RatiosforInternal/External Treatments 9.6Table:Complex/ MinorConditions 9.7Conclusions

268 271

Chapter10- GENERAL CONCLUSIONS

286

272 278 279 282 284

11.Appendix- THEUSEOFEXCREMENT INPRESCRIPTION FORMULATIONS in Prescription 11.1Excrement Formulations 11.2HumanFaeces 11.3AnimalFaeces 11.4Summary Medical GLOSSARY Terms BIBLIOGRAPHY

291 291 293 296

CHAPTER1: INTRODUCTION

Medicine Brief Background 1.1TheReputation of Egyptian for theirskillsin medicine The ancientEgyptianshavelong enjoyeda greatreputation This Egyptian due from to the the world. reputation reports classical writersoutside principally believed their later that Greeks to the the very restricted not only area of medicine as was

' muchto thelandof thePharaohs. philosophy'owed Forexample,Homerdescribes Polydamna, the wifeof Thonis,as givingmedicinal plants'to Helenin Egypt,a countryproducingan infinitenumberof drugs...whereeach '0 from Bible: knowledge 2 Similarly, the virgin possesses men'. aboveall other physician (Jeremiah 45,11).3 Clementof daughterof Egyptin vainshaltthouuse manymedicines' hadsome in thesecondcenturyAD4tellsus morespecifically, Alexandria, thattheEgyptians has been It booksof knowledge, Oforty-two suggested content. of medical were six of which to thosecategories thatthesesixbooksmaycorrespond withinthe of diseaseandtreatments his known firmly fact, believed that 5 In Ebers medicalpapyrus medical currently papyri. quite bookNumber 6 40-'Remedies'. represented Herodotus discusses 'Nextto the Libyans' thehealthandmedicine of theEgyptians. they(theEgyptians) which are'thehealthiest peoplein theworld- aneffectof theirclimate ... Cyrus both 7Thereputation hasnosuddenchange'. Egyptian that and of physicians wassuch 8Thedescription Dariussentto Egyptformedicalassistance. by Herodotus of of thetreatment detailedandobserved the bodyduringthe embalming processappearsto be an accurate,

I J. Barnes, EarlyGreekPhilosophy (London, 1987),15.Theprocess Egyptian between andGreek ofconnection byA. B.Lloyd,Herodotus 1975),50-3. BookI/,Introduction (Leiden, viewsis,in part,explained 2Homer,TheOdyssey. Translated byJ. Lombardo (Indianapolis, 2000),iv,229Theinfluence on of theOdyssey Herodotus isdiscussed byLloyd,Herodotus Book/1,Introduction, 122-3. 3TheHolyBible,Authorized Version, 1611. 4C.Bryan,ThePapyrus Ebers(London, 1930),2-3. Egyptian 5J. F.Nunn,Ancient Medicine (London, 1996),24. 6TheotherfivebookswereAnatomy, Theywere Disease, Surgery, Diseases theEyeandDiseases of Women. Ebers,3. Books',afterHermes. to bytheGreeks Bryan,ThePapyrus asthe'Hermetic referred 7Herodotus, Histories 11: 77,Translation, 1996. G.Rawlinson London, (London, 1858).Reprinted 8Herodotus, Histories III:I andHistories 111: 132.

'on 9 He tells the that a planof separation; practised of process. also us was summary medicine 'physician' 10 Certainly, title the disorder treats of a single and no more'. eachphysician infrequently kudos it Egypt to within not since appeared within appeared carryan elementof " Someof thesemedicaltitleshaveadditional the 'titlelists'of important qualifying people. 'doctor following imply 'doctor the of e. g. word which medicalspecialisation swnwbt, words 12However,thisdivisionof the medicalsystemintospecialists(oculists,dentists the stomach'?

maintains existedto the extentthat 'the country and evenproctologists) whichHerodotus is notsupported byothersources. 13Infact,themainmedicalpapyri withpractitioners' swarms rather of conditions whichimpliestheiruseby generalpractitioners all containan amalgam in medicalmatters,as in others,mustbe It is obviousthat Herodotus thanby specialists. his to 14 is It that work aspects some suspect with circumspection. any significant approached

In thesamevein, language. partlyto hislackof knowledge of theEgyptian mightbeattributed from,andwere the prowessof the Egyptians emanate manyof the presumptions regarding because of,theverynatureof theEgyptian script. perpetuated Hieroglyphs andsymbolicsuchthat, werefor a long-time regardedas metaphysical that 'theycausedto beerectedanenormous edificeof learning onthetotallyfalseassumption

19 Herodotus, Histories11:86. Fora discussion Book11,Commentary on the methodsseeA. B. Lloyd,Herodotus 98,(Leiden,1976),354-64.

Histories 11: 84. 10Herodotus, 11Udjahorresnet to metheofficeof chief a highofficerunderCambyses reportsintal that,'Hismajesty assigned Fromhis'autobiography M.Lichtheim, Museum), ona standing physician'. naophorous statue(nowin theVatican Ancient Egyptian Volume Literature 3: The Late Period (Berkeley, 1980), 37. 12Nunn,Ancient Egyptian Medicine, 118. 13Infact thetitleswhichdenotespecialism fewin percentage arerelatively of thetotalandseemto relateto the OldKingdom. Ghalioungui brieflysuggests theory.A thatthismaybedueto someunderlying changein medical Magicand theoryto oneof unityof thebody.P. Ghalioungui, moveawayfromtheconcept of 'compartmental' Science in Ancient Medical Egypt(London, 1963),74.However it seemsaslikelythatthesetitlesmerelylosttheir form.ThiscanbeseenwithEnglish ties e.g. thetitle'knighthas originalimplications anddeveloped a honorary lostitsoriginaladversarial implication. is Equally, for Health' State thepresenttitleof 'Secretary a political not of appointment medical 14Thepointof medical is discussed has'gonetoofar in byLloydwhoalsoconsiders specialism thatHerodotus HemakesthepointthatEgyptian hisconclusions. 'accumulated officesand physicians a widerangeof medical dutiesandsocouldhardlybecalledspecialists', Lloyd,Herodotus, Book//, 1-98,350.

2

Egypt this ' 5 It is that had resultedlin significance'. probable eachsign a complex andallegorical learning later in Roman Empire becoming the of a source as renowned andevenverymuch

have the 16Consequently, Egyptian theoCCUlt. may of ancient medicine anyconsiderations and Indeedsomemodemstudieshavefalselyattributeda inherentdangerof overestimation. it 'in part have Egyptian to to explain and attempted medicine modernmedicalunderstanding by fillingin the gaps,andby recourseto preconceived notionsof Egyptianinfluenceon Greek

have 'practiced 17 Egyptians to Even the theories'. only ancient are alleged not now, medical in a rationalanddeductive butalsoto havebeenthe'inventors of clinical medicine manner', Egyptian 18 Conversely be to tendency there ancient regard observation'. mightpossibly a 19 medicineas eithermagicor magico-religious and essentiallywithoutany rationalelements.

Medicalpracticelike religionand magichad a stronglyritualisedaspectand the borders line between thethreewereoftenfluid.Equally, themagical of approach another gave element to a medical foranexcuseuponfailure. problem andmustalsohaveallowed focus to Mostrecently Egyptian tendency been has on specific there with a medicine in termsof resources Whilstthiscanbeappreciated and andoftenesotericareasof medicine. Specific it canalsoserveto distractfroma holisticassessment. examples aregiven specialism, laterwithinthe text.20A holisticoverviewis imperativein orderto assessthe actualabilityof the

in termsof medicalmatters Anassessment ancientEgyptian practitioner. prowess of Egyptian fromsucha holisticoverview. mightbeachieved

15P. R. S. Moorey,AncientEgypt(Oxford,1992),3. A recentstudyon the significance to of hieroglyphs knowledge that the 'djed' column'previously thoughtto have a primaryreligious anatomical concluded J. K.LangandH.Kolenda, thespinalcolumn', 'Firstappearance significance' wasusedto symbolise andsenseof Historical 152-5.However, theterm'spinal JoumalofNeurosurgery97, (2002), column'in ancientEgypt. vignette', it seemsnotto be so sinceratherthetermn2k3tseemsto apply,seeJ. Walker,Studiesin AncientEgyptian Anatomical Terms(Warminster, 1996),197-202. 16Therewasgeneral knowledge, 31-2. Ghalioungui, Science, MagicandMedical surrounding secrecy 17M.Marganne, Terms', Forum3 (1993), 'GreekMedical 37. 18A. Martin-kaguz inancientEgyptandtheSchool 34, Neurology Review etal.,'Neuroscience ofAdexandria', (2002),1183-94. 19G.Pinch,MagicinAncient Egypt(London, 1994),140-2. 20See,forexample, pages111-2.

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is the The essentialingredientto the understanding system of any scientific i. level' 'sub how the process. e. theunobserved understanding of a particular process worksat Without its but body to Intermsof medicine thisequatesnotto theanatomy the physiology. of For be disease the the knowledge example, appreciated. cannot aetiology of physiology of blood the its heart have been the with andof connections manyearlysocieties would awareof thatthearteriescarriedblood,otherwise gavea andbloodvessels.Galen,whodemonstrated was strictly of physiology confusingdescription of the bloodvesselssincehis knowledge flow 21It wasnot untilHarvey,in the seventeenth demonstrated the limited. of century,who 22 in Thus, be bloodwithinthecirculatory human to that understood. came physiology system is to appreciate theextentto which oneproblem an evaluation of ancientEgyptian medicine, I considerthat we muststart with the the Egyptianswere awareof basicphysiology. If the ancient best, been have that, this and patchy. very selective presumption at must have internal diseases Egyptians basic then no obvious could wereunawareof physiology Thiswasessentially Forexample, theposition whilstGalen aetiology. of theRomanphysicians. coulddeal with (obvious)externalproblemshe acceptedthat internaltreatmentswere diffICUlt.23

Withouta properknowledge treatmentwith medicinalsubstances of physiology

cannotproperlybe targeted.Anydrugregimewould,at best,be an ad hoc administration followedby rejectionor selectionof a compound decideduponthe basisof any observed fromempirical requiredor adverseeffects.Thatis notto saythatadministration of medicines to Forthisreasonit is important experience wouldproducean inefficient systemof treatment. in detail.Thiswill be carriedout in examinethe Egyptianprescriptions andtheiringredients Chapter 9. 21G.Sarton,Galenof Pergamon (Lawrence Kansas, 1954),48-51.Galenwasa Greekbomin 0 30in Pergamon Therearesome16booksof to MarcusAurelius. andwholeftfor Romein 175.Therehe wascourtphysician Materia Medica to him,although ascribed mostarespurious. 22In fact Harveywasreluctant Sarton,Galenof to publishbeing'carefulnot to offendthe Galenicreaders', Pergarnon, 47.Thisshowstherehadbeenlittleadvance forover1500years. in medical thought 23L. G. Ballester, (London, 'Galenasa Medical Practitioner, in V. Hutton(ed.), Galen:Problems andProspects 1981).

4

Pain, Studies Previous betweenEqyDtian 1.2 Connections Medicine Greek on and and Disease andTreatment Beforethe understanding of the Egyptianlanguagebecamepossible,throughthe 24 deciphering its hieroglyphs, historical Egypt sources. of reliedon classical most accounts of Egyptianmedicineis no exception and its understanding wasonlyreallypossiblewiththe translationof the medicalpapyriin the last century.Priorto this, reliancewas from Greek

However, by Herodotus, Diodorus thisprevious reliance accounts, principally andDioscorides. duringtheGreekperiodswithinEgypt sources onclassical andthepractice of Greekmedicine hascreatedpresumptions thatsomeaspectsof Greekmedicine mustderivefromEgyptian theory.Thisis particularly so in the aetiologyof the diseaseprocess.Medicalelementsof Aristotle's theory workandthatof the CnidianSchoolaresaidto be basedon an Egyptian 25It is whichitselfresultedfromthe observation of the decayprocessduringmummification. thatthenaturaldesiccation to givethe human generally accepted of buriedbodiesappeared forman immortality During by the processof mummification. whichwasartificially attempted mummification anyintestinal withdecayandso became spillagewouldhavebeenassociated it as theantithesis to preservation. bySteuerwhoproposed Thisphenomenon wasrecognised the basisfor the Egyptian According to Steuerwaste understanding of the diseaseprocess. in thebody'sintestinal tractnotonlybecame elements associated withdecaybutwerethought to containa precursor he alsoproposed thatthis agentwas agentto disease.Importantly Saunders to Steuer later This by actuallynamedbytheEgyptians and was proposed - tvhdw. betheseminallinkbetween by GreekandEgyptian 26 link it It is that assumed often medicine. a

24Thisis demonstrated by Brugsch's Dynasty, relianton classical reconstruction previously of theTwenty-fifth (andtranslation) sources GebelBarkal. Stelaof Piye'from untilthediscovery of the'Victory 25S.lkrarnandA.Dodson, TheMummy inAncient Egypt(London, 1998),15. 26R.0. Steuer, ' "dw'. aetiological Supplement to Bulletin in ancientEgyptian of principle of pyaemia medicine', Historyof Medicine10 (1948).R. 0. Steuer,AncientEgyptian 1959). (Berkeley, J. B. Medicine Cnidian and Saunders, TheTransition fromAncient 1963). Egyptian Kansas, to GreekMedicine (Lawrence

5

Egyptian for links 27 in In be little there to with otherwriters passim. reality evidence appears beyond theclaimsof Greekwriters.Mostof theseareimprecise andoften andGreekmedicine 28It is, therefore, important thattherecan be shownto be actual subsequently plagiarised. for theconnections by Steuer. 29However, thishasproduced a somewhat evidence proposed of asindicators confused situation withcertainEgyptian medicaltermseitherbeingconsidered in in The disease. terminology a pathological processor merelydescriptions respectof of pain

30Theydo beenreviewed, byKoltaandTessenoW. thishasrecently summarised andappraised to notentirelyconcurwithSteuerbutstillviewivbdwas an agentwhichactsas a precursor disease.However, theirreviewfailsto considerthe negativeimplications of the argument. Asidefrom any significance if the termdescribesa of Egyptianand Greekconnections, precursoragentratherthan pain per se then the terminologyfor pain is reduced.That is, if

forevidence of certaintermsarediseaseindicators ratherthantermsforpainthenthepotential because it wouldwilllimitcertain painfuldiseaseis reducedandviceversa.Thisis important terminology to thediseaseprocess ratherthanactualtermsforpainandso reducethenumber identified if framework. Equally, terms Egyptian these the of painfulconditions medical within thesignificance referto thediseaseprocess of diseaseit questions ratherthanthesymptoms It also createsproblemswhen attemptingto match and reasonsfor sometreatments. in orderto identifydiseases symptoms withinthemedical papyri.

27See,forexample, Pages36-7. 28Barnes, EarlyGreekPhilosophy, 15-16. Allthereferences to EgyptcomefromGreekwriterswhoaresomewhat Forexample, themselves. Isocrates his hasPythagoras confused goingto Egyptto studyandwhichinfluenced laterpronouncements. Yet,Herodotus hashimfirmlyresident implies thatPythagoras in Samos but,nevertheless, ideathatthesoulis immortal Histories 11: 123. it is bom, stoletheEgyptian andentersintoanother when animal Thebeliefinthetransmigration inotherpartsoftheworld,seeA. independently of soulsseemsto havedeveloped B.Lloyd,Herodotus Book11Commentary, 99-182 (Leiden, 1988), 59. 29R.0. Steuer, Ancient Egyptian because it is Medicine is important (Berkeley, 1959).Thisproposal andCnidian the 'links'betweenGreekandEgyptian a constructive one.Otherwise thoughtall comeunsubstantiated and fromtheGreeksthemselves. Egypt Pythagoras Forexample, to did gratuitously told that visit only are not we 28-9). studybutthathewasthefirstto bring(that)philosophy Busiris to Greece (Isocrates, 30K.S.KoltaandH.Tessenow, 'Schmerzen' Schmerzstoffe Bedeutung F5ulnisprinzip vonw, einem zur oder -bdw, Terminus der Medizin', ZAS127(2000), zentralen alt5gypfischem 38-52.

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from Apart Anypreviousresearch lacking. in is distinctly Egypt one on pain ancient shortarticleby Dawson on terminology withinhisseriesof studiesin themedicaltextsthere havebeenno directdiscussions 31 Theworkby Dawson and on thesubject. on terminology his Whilst identification forms for basis later the of many medicinalplant often reviews. identifications Hisworkin thisareahasbriefly remainvalidothershavesincebeendiscounted. in his discussionof the termstt and in considering touchedon painterminology the individual

Dawson of certainplantsubstances. of painwhilst properties considered stt to be a symptom it as pathological factor,albeitwithdifferentfunctions, othershaveproposed onewhichwas intrinsic to anEgyptian 32Thus, likewhdwit is regarded either concept of thediseaseprocess. in the factor,whichis onefundamentally asa symptom of disease significant or aspathological interpretation of diseaseandits treatment.

In comparison therehasbeensubstantial andcontinued studyon diseasein ancient Egypt.However, the largescaleappraisals of Egyptiandiseaseare earlyones.Duringthe Smith, Jones by Ruffer, Elliot period1890-1930 workonpaleopathology carried out mainly was 33Thesestudieswerepossiblebecause andtheirteammembers. of of fundingandbecause theassociated workbeingcarriedoutin thesamegeographical areas.Infact,theyaretheonly realoverallappraisals of diseasesincelaterworkhas by necessity of financeor discipline thespecificratherthantheholistic.Mostveryrecentworkhasbeenspecificin veeredtowards thestudyof DNAdecayratesin humanremains byMarotaet al,34of dental remit:forinstance, by KeitaandBoyce35 andcranialporosities agentsfromthe anda reviewof contraceptive

31W.R.Dawson, 'Studies intheEgyptian intheEgyptian texts11', JEA19(1933),133-7. 'Studies medical medical 41-6.'Studies textsIll',JEA20(1934), intheEgyptian 185-8. textsIV, JEA20(1934), medical 32Grundriss, VI1,814-5. T. Bardinet, Lespapyrus (Pads,1995). deF8gypte m6dicaux pharaonique 33M.A. Ruffer,'Historical Studies Mummies', M6moires Institutde Ftgypt6 (1911),3, 'Studiesin on Egyptian Pathology, (Chicago), 1921.G.ElliotSmith,'ReportontheHuman SurveyofNubia. TheArchaeological Remains', Report for1907-8 (Cairo,1910). 341.Marotaet al.,'DNAdecayratein papyriandhumanremains fromEgyptian sites',American archaeological Journal Anthropology 117(2002), 310-18. ofPhysical 35S. 0. Keitaand A. J. Boyce,'Diachronic duringthe pattersof dentalhyperplasias andvaultporosities intheNaqada 13, (2001), 733-43. American predynastic Biology region,UpperEgypt' Journal Human of ,

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ignores 36 However for this the sometimes papyri. concern unwittingly, medical specific,albeit I In thesis Egyptian this the moreprosaicyet fundamental will aspectsof ancient medicine. thewideraspects 4).Thisis in orderto produce a listof thebroad of disease(Chapter consider be list life. The disease feature Egyptian that should of were a common of categories disease level is if it be instructive to towards the of of overall an understanding representative andtreatmentin ancientEgyptian.It is anticipatedthatpainwill be a prominentfeaturein most

disease the categodes. of Intermsof thetreatment studies of painin ancientEgypttherehavebeennoprevious in Anyconsiderations havebeentheresultof research andnooveralldiscussion. of analgesics 37 for during discussion the ritual. specific situations, other example, of a supposed circumcision In termsof treatment mostof theprevious workis basedon thefewshortreviewsof Dawson Certainmedicinal There have been no collectiveappraisals. on medicinalsubstances. havereceived butnotdirectlyin consideration abilities. substances attention of theirpain-killing In termsof narcoticsubstances thishasbeenin respectof otheraspectsof theplantsrather the Forexample, thanon theiranalgesic the opiumpoppyproduces or hypnoticproperties. Its use leavessignificant narcoticopiumresinwhichis a powerfulandimportant painkiller. butthetimeandmethod socialtracesonsociety.It wasknownbytheRomanS38 of introduction is based intoEgyptis uncertain. Theviewthatits usewaswidespread in the NewKingdom 39However, is Merrillees by thediscussion upontheworkof Merrillees. notconcerned of opium implications the but ratherwiththe movement withits pharmacological of goodsthroughout Aegeanduringthe BronzeAge.Similarlythe lotushas receivedmuchattentionbut for its supposed eroticassociations or psychedelic properties ratherthanits narcoticor analgesic (See,Chapters 5.2and6.4). properties. 36J. Guiter, 'Contraception BIFAO101(2001), 221-36. enýgypteancienne',

37M. M. EI-Ansary,'Historyof Pain Reliefby AncientEgypfians',MiddleEastJoumalOf Anaesthesiology 10 (1989),99-105. 38Itsuse(andabuse)is reportedby PlinyandGalen.SeeChapter5.2on opium. 39R. S. Merrillees, 'Opiumtradein the BronzeAgeLevant'Antiquity36 (1962),292. ,

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Current Entdes Identification in Medical 1.3 PlantSubstances Problems the Papvd of Sources Reference TheEgyptian for diseases. Asidefrommagical medicalpapyrigivelistsof treatment involvethe administration thesetreatments of a wide rangeof and surgicalapproaches These invariably in were used substances. combination.An eclecticrangeof productswas utilised.This even includedthe use of animaland humanexcreta.In view of the supposed

between to thisthesis, theintestinal connections contentsand whdw,I will,in theAppendix entriesfor faeces(ps). examinethe prescription

TheEgyptian bedividedintodrugsof mineral, treatments prescription canessentially animalor plantorigin.Drugsof animalandmineralorigintendto appearequallyrecorded is possible.Forexamplecommonsubstances outsidethe medicalcontextandso identification

likenatron,ochre,beer,milk,honeyandbloodallappearwidelyoutsidethemedical papyri. In contrasttheactualidentification 40Thereareno of medicinal plantsis problematic. is madeby name pictorialrepresentations of plantswithinthe medicaltextsandreference

41Whilst for themeaning thereis considerable alone. agreement of theEgyptian wordsfor 42.Someplantshave manyherbalsubstances, othersare lesscertainandmanyunknown. beenfoundintactin tombsandplantremains havebeenisolated 43Other fromexcavation sites. plantsfeaturewidelyoutsidethe medicaltextsandso theiridentifications are morecertain. Outsidethesetextsthe pictorialrepresentations of plantsare commonbut are sometimes beyondformandso allowfor misidentification. difficultto distinguish Forinstance, grapesin frommelonsunlessthe plantis shownprovidedwitha representations areindistinguishable

40L. Manniche, AnAncientEgyptianHerbal(London, 1999),159-62. 41Thiscontrastswiththe 'rule'of laterherbalswhereproperidentification is consideredvital.E. g: (byillustration) OrtusSanitatis1491,DeHistoriaStirpium1542. 42Nunn,AncientEgyptianMedicine,153-5. 43Manniche, AncientEgyptianHerbal,40,147,149,151.

9

supportto implythevine.Theperseafruithasthesameoutlineandcolouras themandrake insomeinstances, 44 impossible. fruitmakingidentification, bydeterminatives Theformsof plantsin themedicaltextsaresometimes recognisable Thisis a problem buttheactualpadof theplantis rarelyspecified. sincethepharmacological of constituents of a plantcanoftenvaryacrossits parts.In otherwordsthechemical contents the leavesmaybe differentto the roots.Thisis vitalto the assessment of anypharmacological

These For is important the arepowerful of salicylates. example, an source willowplant activity. anti-pyreticandanti-inflammatory agents.Howeverit is onlythe barkthat contains analgesics,

45Alsotheotherwise innocuous thesesalicylates. planthasleaveswhichcontainoxalic rhubarb 46 acidwhichis toxic,butwhichis notpresentintheediblestalks. It is notwithoutsignificance thatthepartof a plantis rarelydefinedwithinthemedical Thiscouldeitherbe thatit wasnota relevantfactorfor the practitioner. texts.Thissuggests becausethe partto be usedwas alreadyunderstood werenot or becauseits properties be It important that stated not plant would appreciated.seemsunlikely suchan aspectof a for itsdesiredpharmacological have been the effects. sinceselection vital of correctpartwould This it seemsmorelikelythatthepharmacological Therefore not appreciated. properties were is not surprisingin view of the Egyptianpracticeof using multipleingredientsin a single

47It may evenbe that any prescription whichwouldhaveobscuredindividualproperties. totheprocess properties pharmacological wereactuallyincidental of treatment. Theidentification fromtheirappearance in themedical of substances papyrirelieson a lexicalconnectionS48 of matchingphysicalappearances, combination and pharmacological Oftenpharmacological againstknownreference canonlybe properties substances. properties by by reference is to the indexmedicalcondition that the matching assumed of prescription; 44Manniche AncientEgyptianHerbal,160. 45C. Newallet al.,HerbalMedicines (London,1996),268-9. 46Newall,HerbalMedicines, 228. 47Thisis discussedin detailin Chapter9. 48Therearesometmesusefulconnections withCoptic.

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is This treatments. often diseaseagainstthe knownpharmacological properties of reference themselves are symptoms or clear not are many medical conditions since problematic ambiguous. found in the botanical their References to Egyptian are properties plantnamesand herbalof Dioscorides, illustrated a Greekphysician whoworkedas a militarysurgeonunder into English The translation 600 49Hisworkcontains Nero. entries. substance plant and over fromtheGreekdatesfromtheseventeenth andassociated references century.Thebotanical Greek, Roman in Latin, The and are given plant names are generallysound. pharmacology Egyptian the few However, despite Egyptian. of most connections, names with phonetic a often identification. 50 in help liftle and offer erroneous namesseem

Thefirst modemmajorpublication on ancientEgyptianbotanicalsourceswasthe identifications first in Loret the by of many which centurywork nineteenth considerable der Grundriss VI Volume Dawson the 51 Following Egyptian of and plantspeciesweremade. MedizinderaltenAgypter52therehasbeenmoreworkin termsof botanical studiesby and important the 54Themagnusopusof Charpentier 53andGermer. Charpentier most remains Aufr&re is botanical but its than rather medicalor pharmacological. emphasis work, reference hassincepublished which naturalsubstances seriesof twenty-seven a detailedlexicological 55Theworkof Bouloson medicinal includessubstances plantsof significance. of medicinal in information distribution NorthAfricaprovides present uses on current useful andmedicinal

(ed.) (Oxford Translated byJ. Goodyer (1655),R.T. Gunther TheGreekHerbalOfDioscorides. 49Dioscorides, NewYork,1959. Reprinted 1934). to be a later2ndcenturyaddition 50TheEgyptian namesaresaidby Manniche andnotgivenby Dioscorides Egyptian Herbal,163.Thepointis notmadebyGoodyer AnAncient Manniche, himself, orGunther. 2ndEd.(Paris,1892). 51V.Loret,LaflorePharaonique (hereafter, der Medizinder AftenAgypter.9 volumes(Bedin,1954-1973), 52H. Grapow,et al., Grundriss Grundriss). 1981). (Paris, dematdriaux 6pigraphiques Recued 53G.Charpentier, 6 la botanique de 118gypte antique relatifs 1979).Flora OberArzneimiftelpflanzen 'Untersuchnung in AltenAgypten,PhDThesis(Hamburg, 54R. Germer, Agypte(MainzamRhein,1985). despharaonische 55S. Aufr6re,'budes de lexicologie et et d'histoirenaturelleIV-V[',BIFA084 (1984),1-21.'budes de lexicologie BIAFO86 (1986),1-32.'budes de lexicologieet d'histoirenaturelleXVIII-XXVI', d'histoirenaturelleVIII-XV11', BIFAO87 (1987),21-44.

day Egypt.56More recentlyBaum has publisheda work on ancientEgyptiantrees and shrubs.

have but The emphasisis on pictorialrepresentation distribution specimens some and significance57 pharmacological OutsideEgypt a developedand recordedmedicalsystemwas used by the Thereis no evidence between Babylonians themand andAssyrians. of anycross-influences in termsof medicaltheories.Butit is possible thattherewassomein termsof theEgyptians medicalknowledgeduringperiodsof intensecontact,such as the Amarnaperiod.58Many medicinalplantsubstanceswereknownto the Babylonians andAssyriansand their modeof

Workon theidentification of theseandtheirusewithin usemayparallelthatof theEgyptians. 591-lis Assyrian HerbalandDictionary themedical of systemhasbeencarriedoutbyThompson. Botanystillremainthemainreferences in thisareaalthough Assyrian thesevolumes arenow from date dated. These based lists texts the rather are plant andmedicinal which oncuneiform is madeto these BC.Crossreference to the first millennium endof the secondmillennium worksin thisthesiswhensimilarEgyptian plantsarediscussed. In termsof Egyptianprescriptions the collectedvolumesin and their ingredients in thisarea. Germanof the Grundfiss 60remainthemajorreferences andlatterlyWestendoff fromall themedicalpapyri.VolumeVI of theGrundriss, Theycollateinformation albeitprinted Egyptian in 1959,stillremains thecitedcomplete Furthermore the Grundriss pharmacopoeia. intoGerman collatesdiseaseintocategories andgivestranslations medicalterms. of Egyptian The difficult. Manyhoweverstill remainuncertain diseases whichmakesdiagnosis of some by theassumption is furtherconfused to diseaserather situation of sometermsas precursors thanasdescription of diseasesymptoms, as discussed s latertwovolume above.Westendorf 56L. Boulos,Medicinal Rantsof NorthAfrica(AJgonac: 'use'shouldbe Michigan, 1983).Thetermmedicinal fromactualpharmacological distinguished 'folkI consider thatin manycasesheis merelydescribing properties. lore'assumptions astotheirproperties. Arbresetarbustes deI'Egypte 57N.Baum, (Leuven, 1988). ancienne 58Seepage42below. Thompson, 59R. Campbell TheAssyrian Herbals(London,1924).A Dictionary of AssyrianBotany(London, 1949). Handbuch 60W.Westendorf, derAltagyptischen WestendoM. (hereafter, Medizin. 2 volumes (Leiden, 1999),

12

hieroglyphs benefits is the Grundriss the of an abbreviated versionof without work essentially buthasupdates onsomeof theGrundriss omissions. ortransliteration, in thattheycontain in the Egyptianmedicalpapyriaredistinctive Thepresc(iptions ingredients ingredients. For Eb663 different thirty-seven andmany contains example, multiple otherscontainin excessof ten. Thisis unusualand differsfrommoderntreatmentsand even

Herbalwhich 61It contrasts, in particular, fromancientherbals. withtheentriesin theAssyrian in Egyptian the items. Despite 'anomaly' this neither medicine contains single generally GrundfissnorWestendorf ingredientanalyses.In Chapter9 of this thesis offeranyprescription

in discussed fromtheprescription I havecollatedalltheinformation entriesforthesubstances between Thisis doneon thebasisof efficacyandof the relationships theprevious chapters. beforethis ingredient In fact,therehavebeenno overallprescription appearances. analyses thesis.I considerthatthis has beenan important of ancient omissionin the consideration Egyptian Thisis because I believethattheEgyptian mayhave of formulation medicine. method Multiple ingredients limitedtheexploitation musthavehindered of pharmacological substances. is limitation If individual this the recognition the of properties of pharmacological properties. in the medical shownto be validthenit mustrenderthe efficacyof the individualprescriptions

papyrisuspect.It mayalsocallintoquestionthefundamental abilityof the ancientEgyptian By this I meanthat treatments physician. wouldhavebeenpart of the ritualratherthan treatment perse.

Latin 61TheOldEnglishHerbarium datesfromc.1OOOAD 5th text. from is Anglo-Saxon translation a century and an fixing E. Water Its entriesare oftenfor a singleingredientor if in combination agent. g. or generallywitha solvent lily (nym/aeaalba)for a swollenstomach;'for the sameusethe rootsandgiveto the patientto eat for ten days', 'For eye painand swellingtakethe plantcalledapiumor wild celerypoundedwellwith breadand lay it on the from,A. vanArdsall,MedievalHerbalRemedies(NewYork,2002),178,201. eyes'.Englishtranslations

13

Papyd- Descdotion 1.4TheMedical andProblems in this Thefollowing tableis a list of the mainmedicalpapyriwhichare mentioned thesis.Thesearethemostimportant generalworksknownfromancientEgypt.As suchthey listsof 62The medicalpapyriareessentially the bulkof writtenmedicalevidence. represent treatments undera nameddisease; eachentryis terseandcontains scantdetail.Asidefrom its causesomesurgicalcasesthereis littleor no elaboration on the disease,particularly Theycontainlittle,or no,evidence possession. exceptin casesof demonic of anyphysiology lists.However,thisstylecannotbe takento reflect or pathologybut ratherserveas prescription

in the anylackof medicalknowledge or otherwise sincemodernformularies are presented sameway.The datesof the copiesare approximate and are takenfrom Nunnwithout

63They thanorderofsizeorimportance. comment. arelistedinchronological orderrather

TABLE1.5 (i) in thetext) MedicalPapyri(mentioned TITLE

LOCATION

APPROXIMATEDATE CONTENTS OFCOPY

111, IV,V Ramesseurn

Oxford

170OBC

(Ram)

gynaecological,

paediatric ophthalmic,

EdwinSmith(Sm)

NewYork

1550BC

surgical,trauma

Ebers(Eb)

Leipzig

150OBC

generalmedical

Hearst(H)

UCLA,California

145OBC

generalmedical

London(Lond)

London(BM10059)

130OBC

magical,medical

Berlin(Bin)

Berlin

120OBC

magical,medical

e Abbreviationsin parenthesesarethose used in the text.

62Otherthanmedical Thesewereremedies Knownexamples date ostraca. writtenona stoneor pottery medium. fromthe Amamaperiodthroughto the Romanperiod.F. Jonckheere, Prescriptions m6dicalesur ostraca Wratiques (Brussels, 1954). Egyptian 63Nunn,Ancient Medicine, 25.

14

Thesepapyriweremostlyfoundwithinthe lastonehundredyearsandofferedfor privatesale withinthe then vigorousantiquitiesmarket.They came with virtuallyno Theyareconsequently (apartfromtheRamesseum Papyrus) provenance. namedaftereithera formularies laidout modernowneror theirultimaterestingplace.Theyareessentially medical in paragraphs, headedbya description thetreatments eachgenerally of themedical condition, for whicharethendescribed. Apartfromhumanremains, thesepapyriiformthe basisupon whichmostEgyptianmedicalstudiesrely. Likewisethis thesiswill rely on thesefor its analyses. Thetwomostimportant medicalpapyriaretheEdwinSmithandtheEbers.TheEdwin SmithPapyruswasfirsttranslated by Breasted in 1930andlatertranslated intoGermanin VolumeIV of the Grundriss in 1958.64 A laterGerman translation wassubsequently produced by Westendorf in

1966.65

EdwinSmithcomprises 48 mainparagraphs, withsome13 'sub-

cases'andis secondonlyin lengthto Ebers.It is primarilyconcerned withsurgicalcases, for industrial injuriesin particularly onesof severeinjuryor trauma.In viewof the potential 66The just suchinjuries. ancientEgyptit is possiblethatthe casesin EdwinSmithdescribe injuriesdescribedin the latterare so numerous that the sourceof its contentshas been to comefromanindustrial (pyramid/ ) siteratherthana battlefield suggested quarry? situation. Thisis because in thelatterit wouldbedifficultto findadequate 67 timeto devoteto treatmentS. However, Ralstonin a morerecentevaluation that of 'CaseFour'in EdwinSmithconsiders Breasted becauseof the rarityof suchinjurieswithinhis limited waswrongin his diagnosis in civilianlife. The headinjuriescausedsinceby roadtrafficaccidentshave experience produced complexinjuriespresenting to someof thosein Edwin parallelsfor comparison Smith.ThishasallowedRalstonto suggestthatthe injuriesin CaseFourmighthavebeen 64J. H Breasted,TheEdwinSmithPapyrus(Chicago,1930). 65W.Westendorf, EdwinSmithPapyrus(Bern,1966). 66B. L. Ralston,'MedicalReinterpretation of CaseFourof the EdwinSmithSurgicalPapyrus',JEA62 (1976),11621. 67Ghaliounghui, MagicandMedicalScience,44.

15

fracture by Egyptian battle by as previously axeor evena sword,not accidental caused an date for the implications it has injuries indeed then If the wereasa resultof a sword suggested. 68 by Breasted. implied Old Kingdom it it beyond the text; the since puts well of freeof themagical EdwinSmithdiffersfromtheothertextsin thatit is virtually content andrational anempirical whichis a varyingfeatureof theothers.In thissenseit demonstrates that the The treatment. to such outset stated at of cases are realistically prognoses approach in from declared It differs thatmanymorecasesare the other papyri are untreatable. also some specificallydefined.This is done by the use of glosseswhichgive additionaland specific

from injury. Unfortunately, theotherpapyriso information such glosses are absent an regarding is difficult.TheEdwinSmithsurgical thattheexactidentifications of somemedicalconditions has 155013C. It from date by is the to taken, about style of writing, a copy generally papyrus it been features have the appearance to been that of added give suggested archaic since to the legendary 69Breastedactuallyattributedit (somewhat 'reveredantiquity'. poetically) believe is that It difficult to Vizier (alleged) Imhotep: Djoser to and physician. priest,architect, in by have been someone written personally sucha repository of surgicalexpertisecould Imhotep's position. is because This TheEbersPapyrus is thelargestandmostimportant papyrus. medical itsclearwritingandthesizeandtherangeof medical conditions condition, of itsgoodphysical is stressedby thegravitasof its statedFirstDynastyorigin, whichit contains.Its importance the to '-found in writingsunderthefeetof Anubisin Letopolis brought the of majesty andwas kingof UpperandLowerEgyptDen',(Eb856a). Nodoubtthisgavesomereassurance as to 70It is by farthewidestrangingof themedicaltextsand thequalityandso efficacyof theteXt.

to 68Thisis becausetheswordwasa laterintroduction, Ralston,JEA62,119.However,it is notunreasonable supposethatsurgicaltextswereup-datedafter'new'caseswereencountered. 69Nunn,AncientEgyptianMedicine,27. 70Similarly,endorsements of medicaltextsaregivenin otherforms.Eb468is a hair-restorer withthe endorsement thatit wasmadefor the 'motherof a king. Theremedyin Lond25is statedto have'camedownfromthe sky'and weretakenintothesafecustodyof (thelearned)kingKhufu.

16

Edwin However, 8T7 include fourteen unlike consists of some paragraphs magicspells. which frommanydifferentsources. Smith,its orderis notlogicalandit appearsto be a compendium

likely be it is to because However, its its more completeness, of widecontentand physical for This that presented were medicallyrepresentative. presumes all medicalconditions treatment,or recordedas such. It is possiblethat sometypesof medicalconditionswere excludedfromthe 'official'or recordedtreatmentsof the medicalpapyri.Thiswas,perhaps, because theavailability or becauseof the use of ineffectual andcostof practitioners remedies, of treatmentsoutsidethe papyri.This possibility- the use of homenostrumsand their laterin Chapter9. significance ontherecorded evidence willbediscussed However,thereis somesemblanceof orderin Ebersin that manyconditionsare groupedtogether.Butmanyremediesare simplylistedunderthe title 'anotherremedy'.This thatthesemayhavebeencopiedoutof order. alsoallowsforthepossibility TheEbersPapyrusis importantin thatit containsa Widerangeof medicalconditions. is This However, liberal interpretation text. for the has this of notall areclearand allowed some 71 wherebyan enthusiasticattemptto match particularlyso with the Ebbelltranslation, Unfortunately conditionsto knownmedicalconditionshas resultedin spuriousconclusions. theseare oftenperpetuated into othersourcesandofferedas evidenceof modemmedical common conditions suchasanginaanddiabetes-72 for Theothermedicalpapyriarelessimportant in this terms reference of generallyand thesis.TheHearstPapyrusis a generalmedicalwork.It differsfromEbersin thatit is arranged in diseasesections.In thissenseit is usefulas an aidto categorise andcomparetreatments. Forexample,H59-70concem'urinaryirregularities' remediesmust suchthatthe associated is disease Suchclearassociation alsoconcerntheseconditions. not always of remedywith

71B.Ebbell,ThePapyrus Ebers(Oxford,1937). 72Nunn,AncientEgyptianMedicine, diseasesandso 30. Anginaand maturity-onset diabetesare age-related lessprominent in highearlymortality proportionally societies.

17

foundin the more randomEbers.The HearstPapyrushas only 260 prescriptionentries in Ebers. found direct 877 in Ebers but 100 to the these equivalents compared as are almost of The BerlinPapyrushas some204 medicalentriesmanyof whichare identicalto Ebers.In particularBln163duplicatesEb856,the longsectionsconcerned withthefunctionof the the mtw TheLondonPapyrusis in poorphysicalconditionconsisting of 60 prescriptions in Ebers. majorityof whicharemagical.Some23entrieshavedirectequivalents is known.It wasdiscovered TheRamesseurn Papyrusis uniquein thatits provenance in 1896by Quibellin a tombshaftin the Ramesseurn at Thebes.Gardiner, whofirstpublished 73 The the hieratictext, suggestedthat this tomb belongedto a medicalpractitioner. Ramesseurn Papyrusis in threeparts:RamIII coversthe eyes,gynaecology anddiseasesof children.RamIV is mainlyconcernedwith diseasesof womenand childrenand RamV is principallyconcernedwith remediesfor the mttv In no partsare thereany corresponding parallels withsectionsof Ebersor theotherpapyrus. TheKahunPapyrusis a shortgynaecological textof whichthereareno parallels within by Griffithsin 1899.It is of an theothertexts.It wasdiscovered by Petrieandfirsttranslated earlierdatethanthe othertextsandis actuallydatedfromthe MiddleKngdom.It is in poor physicalcondition withmanylacunae. In termsof translation, the mostimportantmedicalpapyrus,the Eberspapyruswas first publishedin facsimileby EberS74 in 1875and subsequently translatedinto Germanin 1890.Thereare twopublished translations of the textintoEnglish.Thefirstwasby Bryanin 1930andfollowedby Ebbellin 1937.75 Theyareessentially translations Neitheris satisfactory. to translation of theGermanoriginal.Theformerversionby Bryanhasa gratuitous approach English the whichhas possiblyunwittingly readers. some confusion amongst sown seedsof Themostscholarlyanddefinitivetranslations but Grundriss German the the are volumesof 73k H.Gardiner, TheRamesseurn Papyri(oxford,1955). 74G.M.Ebers,Papyrus Ebers,2 volumes (Leipzig,1875). 75Ebbell,ThePapyrus Ebers.Bryan,ThePapyrus Ebers. 18

Thefactthat translations 50 yearsold (Vol.1,1954). eventheseparticular arenowapproaching from1954to 1973illustrates thisserieswascompleted theenormous amountof effortrequired to evaluateEgyptianmedicine. But,conversely the lengthof timemayalsoserveto illustratea caveatwhichmightbelikenedto 'thepaintingof theForthBridge'. Thediscovery of themedicalpapyriallowedforthestudyof ancientEgyptian medicine.

Initially,the situationregarding Egyptianmedicine, 'in the Eberspapyrusappearsas a contradictory mixture of magicandof someimportant of anatomy, elements pharmacology and 76It is fairto saythattheviewof Egyptian following the pathology. medicine wasre-evaluated byBreasted translation in 1930.Ghalioungui intoEnglish of theEdwinSmithpapyrus suggests thatthishascreated twoviewsof Egyptian one'pre-Breasted' andtheother'postmedicine: Breasted'. 77TheEdwinSmithtextdemonstrates to medicalproblems, a rationalapproach in the fieldof surgery, particularly of observations whichis basedon acuteandempirical 'accessories' Forinstance, practice andprocedures. which arementioned varioustherapeutic to modem flaxdrainsforwounds, equate surgical asanabsorbent, use:flaxplacedinwounds sutures, cautery andtheuseofsplints!8 Paradoxically, in termsof translation, theEdwinSmith whilstno doubta watershed Papyrusmayhaveunwittinglypushedthe presumption too far. The of empiricalapplication expertiseshownin EdwinSmithdoesnot necessarily extendacrossall the medicalpapyri. Simplystatedthe EdwinSmithPapyrusis a surgicaltreatise.The natureof the injuriesis So, incantations. fractures be by apparent, andso anytreatment cannot set mustbeempirical whilstthe approachto injuriesand physicalproblemsappearsto havebeenbasedon fairly thiswasnotnecessarily soundmethods thecasewithdisease. Breasted's translation Thelay-outof the papyrusis well wasnotwithoutits problems. butthetextis unfinished. organised Severalof thetermsfoundin EdwinSmithappearfor the 76Ghalioungui, Magicand MedicalScience.58. 77Ghalioungui,Magicand MedicalScience,58. 73Ghalioungui,Magicand MedicalScience,64.

19

knowledge, firstandcurrently theonlytime.Hehimselflackedprofessional which anatomical by the described 79Moresignificantly, he neverdoubtedthatthediseases he acknowledged. be known translation to that could givenproper were modernmedicine and ancientphysician two defined.Whilstthis approach Ralstonhassincere-evaluated mightsoundreasonable, 80 diagnoses to befaultybecause caseswhichshowBreasted's of thispresumption. It maybethattheaccident of themedical of translation of discovery andthesequence in respect of theoverall sword'.Thepresentsituation papyrihaveprovedto beadouble-edged appreciationof Egyptianmedicineis still far from satisfactory.The first translationsof the

date back Egyptian language being knowledge the to was still of papyd a pedod when medical lexicographers by Anotherproblem is thatearlylanguage developed. pioneers were necessity scientists. notmedical from V. Thetranscription All themedicaltextsarein hieratic,exceptthe Ramesseum hieraticis sometimes difficultbecauseof problemsin actuallyreadingthe text itself.Also, or incomplete. anotherproblemis thatsomemedicalpapyriwerediscovered eitherdamaged Plates1.5(ii) (iii),showexamples of the incomplete natureof the BerlinandLondonpapyri because of damage.

Thefirst translations of the Londonand Hearstpapydweremadeinto Germanby Wreszinski in 1909and 1912respectively. 81Subsequent Germantranslations appearin the Leakeproduceda shortEnglishtranslation of the volumesof Grundfissand Westendorf. It lackstransliteration Hearstin 1952.82 lists,butis usefulin termsof disease andfullingredient Whilstthe Grundfiss translations commendably classification. andWestendorf aresometimes

79Breasted,TheEdwinSmithSurgicalPapyrus,xix, 80Ralston,JEA62,116-21. 81W. Wreszinki.,Der GrosseMedizinischePapyrusdes BerlinerMuseums(Leipzig,1909),Der Londoner Papyrus(BritishMuseumNo. 1005)Hearstin Transkription, (Leipzig, Obersetzung, Medizinische undKommentar 1912). 82C. D. Leake,TheOldEgyptianMedicalPapyri(Chicago,1952).

20

however, this byothersin some interpretation can, allowforthepossibility cautious of spurious

areas. uncertain between Whilstthereis considerable between the notably papyri, repetition someof the Ebers,Hearstand Berlin,it is not unreasonable to believethat we are still only in Thepassage of a verysmallfractionof theoriginalnumbers. possession of of time,destruction duringtombrobberies property andthefiresin thelibraryof Alexandria areperhapsamongst the reasonsfor this. Also we can only speculateon how these texts were actuallyused: possiblyas

83Sincethe medicalpapyriare only teachingaids or as part of an academicrepository. formularies it mightbe presumed thatseparate withoutanymedicalinformation medicaltexts if in factthere theirabsence perse existedasteaching aids.Consequently maybe instructive It is perhapspossible treatments. thatmaster wasno medicaltheorybeyondthatof empirical textswouldhavebeenpresentin oneof thepr cnb84or 'Houses copiesof themedical of Life' Thesewereprobably to thetemples. whichwereattached scribe-based centresandalsomay haveservedas 'book'repositories facilities. 85 We teaching or centresof documentation with have no idea how many papyriwere producedand more importantlyno idea how Forexample, Leakesuggests thatthe arethosewhicharein our possession. representative HearstPapyrusmayhavebeenusedas a 'hands-on'formulary. 86It has little systematic beingplacedwithoutanylogicalsequence. As such,it groupsof prescriptions organisation, thatthiswasan individually drawnfrom seemsprobable requested collationof prescriptions the veryfact of repetition othersources.However, acrossthe medicalpapyridoesperhaps implythatwearein possession knowledge. of thecoreof prescription

83Perhaps theyweresimplycarriedby thephysician, The thismighthavebeenphysically although restrictive. 'magical' papyri, whichoftenfeatureincantations, wouldpresumably aspartof theritual. needtobepresent Egyptian 84Nunn,Ancient Medicine, 131. 85Ghalioungui, MagicandMedical Science, 28.A. H.Gardiner, 'TheHouseof Life,JEA24(1938),157-179. 86Leake,TheOldEgyptian Medical Papyn).

21

fall broadly Theproblems interpretation the translation the medicalpapyri with of and diseaseor pharmaceutical intotwoareas:firstly,whereit is impossible to identifysymptoms, ingredients connotations. widerpathological andsecondly wherecertaintermshavepossible frequently drug the Problems and will substances of arisewith the identification of many in the absenceof moreevidence. Thecombination of multiple probablyremainunresolved identification. hinders for to conditions, produce a single remedy, often uncertain substances The inabilityto producean accurateand completeEgyptianpharmacopoeia will always of drugtreatment.Theproblemswithsubstanceidentification precludea completeassessment

havebeen in respectof identification havecreatedconfusion wherebymanyassumptions Lichtheim, intoothersources.As an example, scholar, a respected perpetuated erroneously translatesan itemin a literarytextfromthe MiddleKingdomas laudanum,whichshe perhaps confuseswith 'poppy'.87Laudanumresults from the macerationof opium in pure alcohol and

wasknownto the Egyptians at this period.Thus,whatappearsa simple, neitheringredient in thisarea. erroris reallymoreinsidious andis typicalof thecreationof confusion gratuitous term Ebbelltotallyconfusedthe word9ndt in Eb732.He translatedit as the anatomical 'prepuce'rather than the generallyacceptedword acacia (thorn). 88 This resultedin his

froma circumcision, interpretation of Eb732as thetreatment of complications ratherthanan injuryarisingfrom 'acacia'thoms.89This was then given as evidencethat circumcisionwas

in ancientEgypt.90 practiced EI-Ansary in a paperpromisingly entitled'Historyof PainReliefbyAncientEgyptians' describes (mandrake) theEgyptians usingmandragora somniferum officinalis andpapaverum (opiumpoppy)as analgesics andstatesthatthey'weremixedwithotherdrugsto be usedas

87Eitherthisor sheintendsandmisspellstheword'ladanum, ' butthe 'damage'is stilldone.M. Lichtheim,Ancient EgyptianLiteratureVol.1:TheOldandMiddleI(ingdom(Berkeley,1975),214. Agyptisch-Deutsch 88R. Hannig,GrossesHandw6iferbuch Hannig),831. (Mainz,1995),(hereafter, 670. 89Westendorf, 90Ebbell,ThePapyrusEbers,103.

22

localanalgesicsfor stiff or painfuljoints'.91This is despitethe absenceof mandrakefromthe

to opium(App,opium,poppy papyriandtheexistence of onlyone(disputed) medical reference his ) in internal for in (Eb782). Merrillees, the an course of classicwork seeds? remedy a child jugsfromCyprusduringtheNewKingdom, that: of poppyshaped concludes ontheimportation 'opiumplayeda vital part in everydaylife and must have been as indispensablein the

92Thisis despitea totallackof evidence household forsucha statement. as aspirinis today'. (SeebelowChapter 5-2).Consequently, manygeneralworkson Egyptian medicine areflawed becauseof the repetitionof errors.It maybe that theseare overlookedbecauseof the cross

disciplines of scienceand history.I believethat the failureto fully appreciate scientific implications thatreflecton andto drawon otherdisciplines mayactuallyproduceproblems Forinstance, fromthe so called'Munich the revelations matterswithhistorical significance. Mummies'by Balabanova despitethe enormous and her team still remainunresolved forOldandNewWorldlinks.93 implications In conclusion, someof thetermswithinthe medicalpapyriareuncertain andothers Somehaveimplications confusing. of widerpathological connotations, andthereis a minefield of problems.Someof thesetermswere probablyso fundamental as to be obviously by theodginalreaderso thattheyappearwithoutfurtherelaboration in thetexts. understood Theabsenceof suchelaboration mightimplythatwe maybe missingancillaryexplanatory theorytexts.It maysimplybethatthemedicalpapyriwerejustformularies medical withoutany However,I am concerned that someanalyses or pathological physiological associations. havebeenexaggerated, theirsignificance regardinq about conclusions resultingin erroneous knowledge the Egyptians' the aetiology of physiology, of diseaseandlinkswithlaterGreek thought.Onesuchtermis whdw.It is usedon severaloccasions in the medicalpapyribut 91M. M. EI-Ansary, 'A Historyof PainReliefby AncientEgyptians,MiddleEastJournalOf Anaesthesiology 10 (1989),99-105. 92R. S. Merrillees, 'Opiumtradein theBronzeAgeLevant',Antiquity36 (1962),292. 93SeeChapter5.4.

23

to derivefromtheverbwbd-'to suffer. unlikesometermsis neverdefinedin gloss.It appears 94Gardiner hasformedthe basisof extensive initiallyby Steuer. Itssignificance consideration it seemsto be eithera 95Basically, simplygivethedefinition of wbdwas 'pain'. andFaulkner linkedwith the transmission termfor painor a factorintrinsically of painanddiseaseand in theaetiology fundamentally significant of disease.It hasalsobeenallegedto be thefactor forms linkbetween Egyptian Forthisreasonthisand thecommon andGreekmedicine. which in thechapteronterminology. otherwordsforpainwillbefullyconsidered

94Steuer,Bulletinof Historyof Medicine10(11948). 95A. Gardiner,EgyptianGrammar3rded. (oxford, 1957).Reprinted1973,562. R. 0. Faulkner,A Concise Dictionary of MiddleEgyptian(Oxford,1962).Reprinted1991,68.

24

PLATE 1.5 (ii)

*--WNW&

iv

-t4, 1ý

ýpl

IA .

ý..

!ý 01 .01 .

7-To e,.

1. .'o

i,

.1 1-1 jo

%-t\

",

look) " --U4.

,, k-!,

Aw

Zjcz,

JK

4ý1'i

AA. A

A

sic VP

0ý-

*...

,,

641,

%,

I..

Z-24

I

tv

#4ktll

-

QL) 1"Z

- I too.

BERLINPAPYRUS Paoe2 -shovAnatypical darnaae (TakenfromWreszinskiEdWon,1909)

PLATE1.5(iii)

"Lana,

clap

-Z-Al

.

t. J

VI)

LONDON PAPRUS Paae2- showinaextensivedamaas (rakenfromWreszinski Edrdon,1912)

1.6AimsandMethod Theoriginalintention behindthisthesiswasan aimto produce of anoverallappraisal Egyptian the the standardof ancientEgyptianmedicineand the effectiveness ancient of Theintrinsicproblemto achievetheseendsis of timerestraints becauseof the physician. potentialscopeand volumeof the subjectarea.Therefore,in an attemptto circumventthis

hurdle,it wasnecessary to isolatethoseaspectsof diseaseandtreatments thatwouldbeboth intrinsicandrepresentative of thewhole.Thus,theconsideration chosen of painwascarefully for this thesis.I believethat an appraisalstartingwith a singleaspect,'pain', may help to

widerconclusions. expedite 'Painmakesusconscious to thatbelongs thatsomething of ourbodiesandsignalizes 96Pain,to the patient,is an importantaspectof disease.An 'effective' us is threatened'. to paincontrolshouldfollowtheempirical to thetreatment approach of injuriesfound approach in theEdwinSmithpapyrus. in dealingwithpain Therationale andtheabilityof theEgyptians should,therefore, reflectthegeneraleffectiveness andabilities. of theirmedical organisation Painis the first indicatorof diseasefor the patient.In this respectit is a common disease denominator importantly its but of disease.Notonlyis paintheindexsymptom within treatment by the patient.In thisthesisthe abilityof the ancient can be effectively assessed Egyptianphysicians to treatpainwill be assessedby theirabilityto effectively utilisethe foranalgesia. I willbasically thisin twoways.Firstly:by medical substaoces available approach thoseanalgesic knownto havebeenavailable selecting substances andthento lookfor their appearance withinprescriptions of the medicaltexts.Thereasonsfor theirselectionwill be 5-8).Secondly, to examinethose givenin detailwithinthe relevantdiscussion(Chapters in whichthesesubstances fact in being they prescriptions appearandto consider are whether usedto treatpain.

96H.E.Sigerist, Medicine', 'Primitive History 2 volumes (1951),1:116. ofMedicine.

27

Medicinal for whichthey fromthediseases substances cannotbe viewedin isolation Also,I appreciate It canonlybeviewed thatpaincannotbeviewedin isolation. wereintended. Therefore disease this the state. as a holisticindicatorif it is considered within associated thesiswill alsoconsiderdiseasein ancientEgyptin Chapter4 of thisthesis.I will notonly considerthe type and extentof diseasebut importantlythe degreeof pain as a factorwithin

Theactualmethods thosediseases. indetailwithinthechapter. The of approach arediscussed listof disease. Thisdeliberately aimis to produce anoverallandrepresentative contrasts with currentspecialistresearch.Thiswill be achievedby selectingthe maincategoriesof diseasein

the majorityof recorded an attemptto producea list of categories whichshouldrepresent diseasein ancientEgypt.Fromthislisttheextentof painas a featurewillbe considered by referenceto the individualdiseases.If painis the predominant symptomwithindiseasethenit

fortreatment shouldequallyidentifya dynamic analgesics. In respect to havebeenusedbythe of thetreatment alleged of pain,manycompounds Egyptians havebeenthe sourceof discussion as hypnotics; or painkillers andstudy.These includeopium,cocaineandthe lotus.It is important to considertheiravailability substances thesignificance anduse.Thisis because and of theirusegoesfar beyondthepharmaceutical historicalimplications. Theseandother'painkilling' mayhaveimportant will be substances fullyin laterChapters 5-8.Theselection considered of thesesubstances andthereasonsfor theirselection laterundertherelevant willbediscussed sections. Beforethetreatment to lookfirstly I consider it is necessary of paincanbediscussed, Thisis essential for tworeasons.Firstly,paincannotbe viewedoutsidea at its terminology. BythisI meanthatthelevelsof painwhichareacceptable socialframework. within astolerable diseasearesociallycontrolled andso equallycanbe sociallydefined.In thissenseobjective In painis moreoftendefinedbysocialreference thanbysubjective reference. someconditions due different to to sufferingmaybe considered a normalor inevitable suffering condition and

28

Thiscanoccurevenif painlevelsareidentical despitetheformercondition disease. notbeing described Thisis important of painwhichmay as a 'disease'. sinceit affectstheterminology is This disease the a valid or otherwise. actuallyalter actualclassification of conditions as by defined forboththeancientandmodernmodels. being Oneexample social analysis pain of referenceis the processof childbirth.In modemWesternsocietythe painsof childbirthare

97Indeedthispainis to betheworsttypeof painthatwomencansuffer. considered generally the painof oftenusedas an upperlimitcomparatorin paincomparison charts.98Accordingly,

is notconsidered hasbecome todayandso its treatment childbirth a mainpartof acceptable the birthprocess.However, thishasnot alwaysbeenthecasesincepainwasconsidered a $normal'part of the processfor differentreasons. 99Consequently, sincepain was normal,it

to bedefinedaspainandimportantly doesnotrequiretreatment. ceasesnecessarily Thetreatment of painwithanalgesics withina societymustbeviewedagainstsucha for framework terminology Thus,it is important to consider theEgyptian of socialacceptability. theterminology pain.Thisis because andmayaid maybereflective of sucha socialframework its understanding. Secondly, it is necessary theextentand to quantitate andmoreimportantly degreeof painwithindisease. Withoutanunderstanding thisquantification of painterminology is notpossible. Tothisendthethesiswillconsider forpain,since in somedetailtheterminology definitions extended maywellprovidefor painto be a largerfeaturewithinsomediseasesin the medicalpapyri.If this is indeedthe casethenthe abilityto treatpainor otherwiseis instructive towards theabilityof theancientEgyptian understanding physician.

97B.Sjorgren, Obstetrics foranxiety 'Reasons in 100pregnant Journal aboutchildbirth of Psychosomatic women', 4 (1997), 266-72. Thefearof painfeatures listof anxieties andGynaecology pending veryhighlyinthesewomen's childbirth. 98The unit of painmeasurement is givenas a dol. Thisis unit of measurement fromthe machinethat produces and measurespainlevels.Mostcancerpainsrateas 0-2 dols.Theaveragepersonseldomgets past5.5 dols throughouttheir lifetime.Yet, somelabourpainsrate at 9- 10.5dols whichis equivalentto a burningcigarette beingheldagainsttheskin.M. Farley,TheConquest of Pain(London,1978),80-1. 99If not normalin termsof functionor chauvinistically consideredas beingthe Iof of womanthenby punishment from God duringthe Creation.'I will increaseyour sorrowin childbearing; birth to you give will sorrow with children',Genesis3,16. b,

29

been have Finallyanalgesics Several be themselves substances will considered. 5-8.Theconsideration will of thesesubstances andtheseformthebasisforChapters selected individual in severalways.Thepharmacological be approached medicinal each of properties Its be in its appearance analgesic. as an will appraised, particular ability substance actual in respectof forinclusion textswillbeconsidered together withinthemedical withitssuitability in Lastly,any significance the statedintentionsof the prescriptions. of its appearance Thatis to consider thefrequency and withothercompounds will be considered. combination effects.This appearance withothercompounds andto consideranycombinedpharmacological

References latterexercise to thepharmacologically analysis. willtaketheformof a prescription knowledge andagainst suitability of substances willbe madeagainstcurrentpharmacological important inclusion ingredient in classicalandmodemherbals.Thelatteris particularly since ratherthannatural engineered modempharmacopoeias willfeaturemodempharmacologically products. It willnotbe possible to directlyassesstheextentof painfromtheEgyptian sources. Thiscanonlybe doneby reference to diseaseandthe extentof thatdiseaseshownto be to painwithinthese present.The levelsof painwill be assessedby modernreferences In otherwordsit willbe assumed diseases. thatactualpainin ancientEgyptwillbe thesame for the samemedicalconditiontoday.Any substances thatwereusedto treatthis painin ancientEgyptwill be assessedeffectiveor otherwiseby referenceto currentreference disease. It is ignore that this the of may socialcontext pharmacopoeias. appreciated approach However, the efficacies of the substances still remainconstantandthusI believesuchan forthepurpose Infact,thenatureof ancientEgyptian approach is sufficient of thecomparison. formulations This is fully may be suchthat they may negateany individualcomparison. intheconclusion to thethesis. explained

30

in sucha fashionshould I believethatthediscussion of pain,diseaseandanalgesics byother a representative expedite appraisal of Egyptian medicine whichwouldnotbepossible

means.

31

CHAPTER2: PAIN 2.1 Concepts

it as'painmatteror morbid Nunnin hisbriefdiscussion describes of thetermwhdwsuccinctly Healsosuggests thatthereareat leastfiveotherwordsforpain,butdoesnottellus principle'. in 100 be fully discussed (The implications its the these terminology are. will what of painand 'Ol nextchapter).

Theconfused situationin respectof manymedicaltermsis notjust a problemwith fromthe Egyptianbut is alsobecauseof intrinsicomissions directtranslation and lackof because, withinthemedicalpapyri.Theseareperhaps elaboration omissions nodoubt,many termswouldhavebeenobviousandunderstood to the originalreader.Thisis perhapsnot lists.As suchtheywould surpfising sincethemainmedicalpapy(iareessentially prescription or theories. serveto provideremedies ratherthandiagnoses Someof the termsusedin the medicalpapydare expanded uponin a footnoteor Edwin gloss.Butthesegenerally applyto termsof a technicalsurgicalnature.Forexample, Smith(4) refersto the treatment of a gapingwound.In it glossA explainsthe meaningof 'splittinghis skull':as for 'splittinghis skullit meansseparating shellfromshellof the skull 102However, whilefragments remainstickingin thefleshof his headanddo notcomeaway'. thesetypesof seriousinjuriesarenotlikelyto represent common generalpracticemedicine. Theadditionof detailedexplanations hereandtheirabsencein generaltextsis perhapsnot surp(ising. Anothermajorproblemis the difficultyin understanding the socialattitudesof the Egyptianstowardspain and, consequently, its appropriateness for treatment.This has implications in translationand in treatment.For example,in modemEnglisha situation described froma situationof acutesocialembarrassment to as 'painful'couldvaryanywhere 100 Nunn,Ancient Egyptian Medicine, 62. 101 in thethesisaremine,exceptwhenstated. Alltranslations 102 Translation takenfromRalston, JEA62,118,9.

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for in Egyptian: injury. distinction A to example, physical apply of actual similar seems one Hanniggivesthe word3,bw as 'Schmerz'(pain)but also'Leiden'(trouble), whilst,Faulkner 103 definesthewordas'pain,misery, trouble,illnessandeveninjury'. translated Thewordmr'04is literallytheverb'to be ill' (kranksein)butit is generally Thus illness. the it degree to that the that of state suffering particular applies of within so definition canbecome widerto includepain,forexample: in (a 'an illness I themedical treat', id. 1, prescriptions). common phrase will which mr fromthe knee', to driveout illness/pain kt nt dr mr (t) m pd, 'another(prescription)

(Eb605).

However, of the complete analysisof the textsis onlypossiblewhenthe symptoms Thisis rarelythecase.Thefirstimpression onegets condition or illnessarefullyunderstood. be It detail. is Egyptian terseness their texts the must of andpaucity of medical whenreading be illustrate that this to that missingserious well may remembered paucityalsoserves we implications withintheoriginal. human in is it Painis unlikeothersymptoms disease that an essential also of a is fear hate. its like Equally, is difficult to subjective. perception or assess emotion pain since definedby reference Conversely to socialsituations andstereotypes. paincanbe objectively However, As suchit is notsurprising to muchanalysis. thatpainhasbeensubjected mostof Whilstwehavemanyhistorical thishasbeenin respectof Greekmedicine. worksonthetheory little have fact, in Greek, 105 have Egyptian. In disease in very we of we and pain none

103Hannig,10. Faulkner,A ConciseDictionaryof Middle Egyptian,3. 104Hannig,344.

105Thereare many.For example:Plutarch,On the ScientificBeliefsof the Philosophers 911A (balancesand disease),Aristotle,OnRespiration 473bl-474a5, MedicalWritingsXVII8-XIX Philolausin AnonymusLondinensis, (onthecauseof disease),translations fromBarnes,EarlyGreekPhilosophy. AristotleandGalen,seebelowpage 35 (reasonsfor pain).

33

fromEgyptandsocautionmustbeexercised theoretical in presuming reflection or anyreliance between thesetwomodels. relationship Theconcept is an important of painanditstreatment aspectin thehistoryof medicine. I wouldsuggestthattherearetwodistinctdivisionsto thediscussion of painas a concept: firstly,therationales thereasonforpainandsuffering of thecauseof painperseandsecondly, in thewider'human condition'. Chomme la douleurestsonmaTtre. EtnulestconnaittantquWna pas estunapprenti, 106

souffert.

It is arguable thatinquiryintothecauseandeventheperception of painis intrinsicto It is partof thelargerattemptof a societyto explaintheillsanddisasters thehumancondition. thatbefallit withintheirparticular state.Indeed,thereasonforunnecessary painandsuffering intheological debatetoday. stilloccupies a primary position Inthissense,paincanbedividedbroadlyintotwotypes:painthatresultsfromoutside influences fromwithin.Manyprimitive believed thatallpain andpainwhichemanates societies camefromoutsidethebody.It couldbe caused'notonlyby thorns,arrows,clubsor fire but 107 Thisprimitive, alsoby evilSpi(ItS'. externalviewof painlater'seemsto developintosome 108 thatpainandphysical to thebody'. concept whichrecognised experiences wereharmful Keeleevensuggests thattheideaof painbeingdueto anoutsideobjectenteringthe bodywas 'prepotent'in all primitivesocieties.Pain inflictedfrom withoutthen becomes to saythataccordingly synonymous withthe termdisease.He continues manydiseasesin by theintrusion intothebodyof objectsrealor primitive communities areheldto be produced

106 Musset, 'SomeFunctions 3-8. quotedin H.Merksey, oftheHistory oftheIdeaofPain,Pain9 (1980), 107 Fairley, TheConcept ofPain,19. 108 K.D.Keele,Histofical Concepts 1962),4. ofPain(London,

34

'whether imaginary: thisintrusion objectis as obviousas anarrowor aselusiveastheshotof an elf,the painwhichresultsis as equallyhardto bear'.109

inflictedbythe TheMesopotamians believed thatpainanddiseasewasa punishment godsuponmenfortheirsins.110

Significant in theideasconcerning at thetimeof Aristotleand changes painoccurred he Aristotlemadedistinction his contemporaries. betweensensation andemotion.However, it as oneof the'passions didnotregardpainas sensation butinsteadclassified of thesoul'. Theintensive experience of of touch,sightor hearingmightgiveriseto painbutonlybecause "' ClearlyAristotledid tookplacein the heart. its internaleffectswhichAristotlepostulated in causingpainandit wouldbehardto suppose of peripheral stimulation realisetheimportance fromhis writingsthathe thoughtthatpaincouldarisewithoutsomeperipheral cause.Both brain in that they the Aristotleandthe Egyptians placed no value on clearly mistaken were by the Egyptians duringthe embalming discarded withinthe painprocess.It wascompletely jars.112 anddidnotwarranta placein thecanopic process Galenin the secondcenturyAD,however, thatthe brainandthe senses concluded werelinkedto differentpartsof thebodyby a networkof nerves.Thesewere'hard'and'soft' sensation. andsoftnervesconveying nerves:thehardnervesbeingmotornerves(movement)

109 Keele,HistoricalConceptsof Pain,4. 110 G. Roux,AncientIraq3rdEd.(London,1992),336.Illnesswas,therefore,a moralcondemnation callingfor a moralcure.Treatmentwasoftenreligiousor magical. M Aristotle,Partsof Animals11647al, 14-20.From, The CompleteWorksof Aristotle.The RevisedOxford Translation, J. Barnes(ed.), (Princeton, 1984). 112The Greekview was that the brain had no sensationwhen touched.In this sense,it was like 'bloodor excrement'.It was presumably considereda discreteorganbut couldhaveno rolein a systemwherepassions werefelt in theheart;ratherit hada placeconcernedwiththe processof sleep- AristotlePartsof Animals11652b, 3-6.

35

InDeUsuPartium: 'Naturehasindeeda tripleendin viewin thedistribution of nerves:shewishesto give to organsof perfection, to organsof locomotion, andto all the sensibility movement theexperience othersthefacultyof recognising of injury.Thethirdaimof Naturein the distribution of nervesis theperceptionof thatwhichcancauseharm'.' 13

In otherwordsGalenis attempting to definepain.Heclearlyrecognised the needfor in the body to makeus awareof the noxioussubstances pain.Forhimpainwasnecessary whichthenneededto be expelledbeforetheycoulddo damage.However,therewasno further

114 Thetheoryof theGreekphilosophers thatpainwas workor developments onGalen'sideas. for sometwothousand a passionof thesoulremained widelyaccepted yearsandwasonly in thelateeighteenth replaced withtheadventof scienceandtheunderstanding of physiology andearlynineteenth century. TheEgyptian 'theoryof whdW withits implications of painand on thetransmission diseasefroma distinctsourcewithinthebodyis a fundamental hypothesis. If correct,it would bothpre-dateandsupersede Greekthought.The understanding of whdw as a conceptin Egyptianmedicine factorswithinthe to explainthe transmission of diseaseandpathological bodyhasbeengenerally 115It accordswiththeideaof thevesselsof thebody,the accepted. thevariousorgansandterminating aroundtheanus,a conceptof anatomy mtw connecting brieflyexplained inthesocalledVesselBook. 116 'to Estesstatesthatthemtwwereconsidered be indispensable to normalbodilyfunction'to the extentthattheirimportance 'is implicitin 'mayyourmtw be everyday ancientwishes:'mayhis mtw be comfortable' or in greetings:

113 Fairley, Concept ofPain,21. 114Hisrefusalto acceptthatthe soulwasimmortal led to the suppression of his workby the fathersof the Christian Church intowhosehands, forthemostpart,thepractice hadpassed. of medicine 115 Fortwoexamples, Surgery factor,seeK. R. Weeks,'Medicine, whereit is accepted as a pathological and PublicHealthin AncientEgypt'in J. M.Sasson East 111, (1995), 1787-98 (ed.), Civilizations Near Ancient the of , 82. Egyptian 1993), andR.K.Ritner,TheMechanics Magical ofAncient Practice (Chicago, 116 Thenumber Bln163,(TheVesselBook). is described of themtw,theiranatomy in Eb854/856, andfunction

36

For further for 117 The the presumptions. connection of wbdw with sound'. mtw allows hygienic be because body (generally to thought the the or of example, practiceof shaving from free the is because the demands)'18 exit of wbdw shavingpermitted probably religious the ' in to travel through hair. 19 The terminated the that mtw and skinor abilityof iKhdw mtw in a clotis 'thefinaldestructive to changethebloodandto culminate resulf.Suchthatthere destructive from body. Worth 'final to the the the connects a need scab remove wasconsidered Intestines' in "Eater Eater' the 'Blood the bdwwith the the of and presenceof element'of w-, Hallof Judgement.In that,he statesthattheirpresence'probablyrepresented a relatedfearof

120 corruption'. corporeal to the original However, it seemsthatEstesis merelyaddinghis ownsuppositions Steuer. It is difficultto imaginethe ancientEgyptian a scabbing of notto perceive proposals bloodclotas theimmediate otherthantheexternalsourcethatcausedthe resultof anything does imply is documented In fact, for the treatment an and not well evidence such wound. (Sm9a, bandaging or application of emollients of urgencyto removescabbing rather one Eb482-509). Food,diet andtheirassociations uponby with healthanddiseasehaveremarked in food anddrinkmaywell havebeenconsidered Egyptians and Greeks.Overindulgence immodest unhealthy or self indulgent,but Estessuggeststhat it was actuallyconsidered becauseof the excessive tractthatwouldfacilitatethe residuesleft in the gastro-intestinal development of whdw.121 122 food Egyptians Herodotus disease that the eaten. alsowrites connected with

117 J. W. Estes,TheMedicalSkillsof AncientEgypt(NewYork,1989),80. 118See,A. M. Blackman,'Purification(Egyptian)',in J. Hastings(ed.), Encyclopaedia of Religionand Ethics10 1918). (Edinburgh, 119 Estes,TheMedicalSkillsof AncientEgypt,85. 120 Estes,TheMedicalSkillsof AncientEgypt,80,83. 121 Estes,TheMedicalSkillsof AncientEgypt,83. 122 in Chapter3.2,below.Healsoblamesdiseaseon changesin theweather. Discussed

37

instruction dernotic in be The perilsof suchoverindulgence to a contained appear teXt: 123

Illnessbefallsa manbecause thefoodharmshim. Hewhoeatstoomuchbreadwillsufferillness. He whodrinkstoomuchwineliesdownin a stupor.

Allkindsofailments of overeating. arein thelimbsbecause Hewhois moderate in hismannerof life,hisfleshis notdisturbed. in food.124 Illnessdoesnotbumhimwhois moderate

in thattheymightoffendthe Thetaboossurrounding somekindsof foodareexplained god with whom they are associatedand 'prompthim to retaliateagainstthe offenderby

is I find 125 I believe The however, of spurious. noevidence can connection, producing %ýW. foodbeingassociated fact,theideaof tfýbdwbeing connected withfoodis not withnbdw.1261n is presumably by Steuerin his originalproposals. This connection made evenpresented diet believed because The Greeks intestinal food that the was of theassociation system. of and 127 factorin goodhealth.Butthiswasviewedas beingpartof a goodlifestyle. an important Eitherthis or it was associated in the 'forces'of the body.In that,those with imbalances 128 diseases byrepletion thataregenerated canbecuredbydepletion. A recenttranslation intoFrenchby Bardinetof somemedicaltermsshouldhopefully haveofferedclarification themainkeytexts of whdwasa medicalterm.Bardinet re-translates it is but 123 Aristotle Thebrainis involved the seessleepas partof thedigestive process process. sleep with theheatcausedbytheintakeandprocessing concerned withdissipatng of food.A personawakesfromsleep is completed. Aristotle, OnSleep458a,10-15.Thus,deepsleepfollows whendigestion overindulgence. 124 Papyrus Insinger'The EighthInstruction', TheLatePeriod, in Lichtheim, 1/1: Volume Ancient Egyptian Literature 190.Thistextdatesfromthe4thcenturyandso couldbe a Greekidea.Thepointis madeby Lloydbuthe it unlikely Book// 1-98, theconcept Lloyd,Herodutus andratherseemsto support considers of foodandwýhdw, 331-2. SkillsofAncient 125 Egypt,84. Estes,TheMedical 126 Aristotle does'connect' foodwithcertainillness:fevers.Thelinkis notwithfoodperse,butwithfever. Actually Infeverthebodyactslikedigestion theheatofthefever,OnSleep4571a,1. producing sleepto assuage 61. 127 GalenofPergamon, Sarton, Diaita,inJ. Wilkins 347. 128 E.Cralk, 'Hippokratic ), FoodinAntiquity 1996), (Exeter, et al (eds.

38

from severalof the medicalpapyri,yet for ipýhdwhe givesno translation and fails to it asthemainpathological factor,ratherviewingit as havingnodirectequivalent acknowledge dangers in contemporary the 129 He the of making of medicalpractice. wiselywarns reader facile interpretations and conclusions on Egyptianmedicinebasedon currentmedical Hisreluctance butfor his in translating knowledge. somedifficulttermsmightbe applauded failureto fullyexplainsomeof his assumptions. He lists wbdw as oneof the four major factorsalongwith ri-r,stt and blood.He seesstt and whdw as of externalorigin pathological comparedwithbloodand ciewhichhe considerselements'normallypresentin the bodyor on 130Heviewswbdwas the in certaincircumstances'. the surfacebutableto becomepathogenic

Opposing factor body. factor is is to blood. Blood the to the the which vital opposing principal joinedto anyoffereddecomposing thisis whdwwhichbecomes material.ndw, amongst (la douleur).The bodyis otherthings,is involvedin the Egyptianideaof 'suffering/pain' in the mtw. He immersed 'gnawedat' (grignot6) in thefleshor evenpiercedby substances buttherehe makestheconnection of Eb193,202, of whdwwiththebloodin histranslation Thisis otherthanits accepted thesignIZ 131 rendering asPs actuallytranslates as wbdw.132 (faeces)and where Eb193,202 are generallythoughtto relate to the treatmentof 133 constipation. Steuerin hislaterstudyon Egyptian thattheconcept andCnidianmedicine suggests is actuallyseminalto thelaterGreekphilosophies on painand of whdwas a morbidprinciple

1341-lowever, I consider illness. thatheoffersnoactualevidence forthisandI willfullydiscuss hisconclusions in thenextchapter.Evenif it is accepted theotherit is thatoneideapreceded

129 Bardinet,Lespapyrusm6dicauxdeI'8gyptepharaonique131. , 130 Bardinet,Lespapyrusm6dicauxde I'8gyptepharaonique, 121.Mytranslation fromtheFrenchintoEnglish. 131 Thesign/Z appearsfrequentlyaloneandin conjunction be faeces the ps, must meant.See with word where Chapter9 below. 132 Bardinet,LesPapyrusm6dicauxde I'tgyptepharaonique, 131,134. 133Westendort, 842.Grundriss VII:6311,2. 134 Steuer,AncientEgyptianandCnidianMedicine.

39

important to appreciate thatthereis noevidence thattheEgyptians about wereascircumspect thehumancondition astheGreeks.

2.2PainRelief Any considerations of painmustbe prefacedwith the caveatthat a 'conceptof pain'

Thisis an importantpointin respectof reliefmayactuallyprecludethe use of painkillers Egyptianmedicine;one that can only be speculatedupon againsta presumedsocial 135Equally Painreliefin any framework. thedefinition of diseaseis definedbysocialreference. andmaynot of painacceptable societyis promoted onlyif thatsocietyfindsthe treatment be in proportion Forexample, 'thealmosttotal of analgesics. necessarily withthe availability from 1000to 1200ADin the westernworldreflectsthe male absenceof painin documentation

136Evenin late dominatedmilitaristicideologythat viewedpain as weakand ferninine'. Europeheadachewas still regardedas a weakness,a eighteenthand early-nineteenth

feminine trait.137 TheEgyptian mayhavebeensimilarbutwasprobably viewof painon thebattlefield 138 differentto theirviewof painin a domesticsituationat homein Thebesor Memphis. in termsof the battlefield However, it wouldseemlogicalto lookafterone'stroopsandso protectthe efficiencyof the army.This protectionwouldpresumably extendto medical if timeallowed. Theuseof analgesics treatment to placateandso wouldhavebeenimportant

135 Whatis normalandwhatis disease? Forexample, 'a patientmayfeelill andin painwithoutnecessarily in termsof a disease 'Concept suchphenomena explaining of HealthandDisease', model',from,H.T. Engelhart, inA.Caplan (ed.), TheConcept (Massachuseus, 1987),37. ofHealthandDisease 136 F.A. Djit6-Bruce, ThePuzzleof Pain(EastRoseville, havebeen 1994),126.Equally, the'pains'of childbirth havebeenconsidered forpainrelief. viewed as'normal' andonlyrecently suitable 137 Quoted Pain,3. byMerksey, 138 in whichsoldiersfeellittlepainappearsto be causedby thephysiological 'Battlefield analgesia' effectsof to be 'gated'or adrenalin overlayof reliefthattheywerenotkilled.Equally, andthepsychological painappears J. Blenkinsopp, 268(2002), 252. bypastexperience. 'Analgesics', Journal ThePharmaceutical modulated

40

139Modernsurgeryhas only developed treatment. to facilitate sincethe properuse of andanaesthetics. analgesics industrial been have Injuriesrequiring of as a result common surgicalattentionmust injuries full lpy Medina The Deir tomb suchas occupational of of at el showsa relief accidents. dislocatedshoulders,footinjuriesandthe removalof foreignbodiesfromthe eyes.140

2.3 Physicians

how do know is Egyptian Anothermajorproblem that physicians not medicine we with It seemsprobable thatsomemedicalactivityoperated or howtheyweredistributed. operated to thetemples, partof whichwerethemselves of Life'attached aroundthepr cAhor'House(s) infrastructure. The importanceof the 'Houseof Life' is mentionedby the overallorganisational

furnishing int them is he their thehighofficialUdjahorresnet al restoration; with charged since formal training 141 It dutieS. that their to any seems unlikely staff and equipment carry with out for documentation' 'centres being or repositories of programme was operatedrather

be thatphysicians 142 information. Bylooking later historical the presumption must models at is This for those i. themselves the those to also services. of operated elite e. able avail Weretheyreserved important in theconsideration of pain-killing substances. of theavailability justfortheelite?Thismayexplaintheapparent whichonemight absence of somesubstances 143Certainly the veryfactthatprescriptions were predictto be presentin the medicalpapyri. 'The C. F. Salazar, 139 Yetfor Greco-Roman that'analgesia timesSalazarsuggests wasnotto be expected'. 21 in I Scarborough (ed.), Studiesin AncientMedicine treatment antiquity', of warwoundsin Greco-Roman (Leiden, 2000),65. in Workmen Necropolis 140 in R. L. Miller,'Paleopathology, Literacy, Treatment Illustrated andMedical amongst Egypt'Medical 35(1991), NewKingdom History 7. , Ancient Lichtheim, 141 Page43.Also,thistaskwasclaimed bytheSaiteofficialPeftuaneith in his'autobiography', Volume Egyptian Literature /11,35. 'The 142 byA. Gardiner, Thereis ampleevidence Houseof Life'withmedicine, to connect'The thisis discussed Houseof Life, JEA 24 (1938),157-9.He firmlytakesthe viewthat therewerenot 'trainingcollegesor However, thisviewis notaccepted byotherswhoconsider it toonarrow universities'. a viewof the'Houseof Life', Lichtheim, Ancient Egyptian Gardiner take the LiteratureVolume /1/,36,41.1 view see,forexample and with agree thata morelikelysystemof medical the training likeothertradesor professions on apprentice/ master operated relationship. 143 SeeChapter 5.2onopium.

41

on waspracticed writtenandcopiedimpliesusageby an elite.It seemslikelythatmedicine differentlevelsbutwithina framework wasfar wider.The of a physician wherethedefinition is modernconcept. Themedicalpractitioner of ancient controlof entryto a medicalprofession Life' 'House Egyptcouldbedrawnfromthe'wellborn, lowbom the theM'144 of or of no among fromtheworkmen's 145 villageat Deirel Medina. Someof the communications writtenduringthe Amarnaperiodillustratethe elitist is shownbytheHittiterequest Thevalueplacedon theEgyptian natureof medicine. physician for a palaceattendant'thatis also a physician.Herethereis no physician'and a requestthat

146However, 'the kingsendan archerandmyrrhfor medication'. it is oneparticular counter He is recorded(on morethanone III that is far moresignificant. requestby Amenhotep 147This occasion) sendingto theMitanniking,Tushratta, a requestfor 'OurLadyof Nineveh'. of his pain. was a statueof the goddessIshtarsent in an attemptto relieveAmenhotep Donadoniin attemptingto justifythe studyof apparentlyisolatedand trivial detailsin Egyptology 'detailsthe likeof whichmay toothache: citesthisveryexample of Amenhotep's indeedlaterproveto havegreatersignificance'. 148 Thefactthattheservices of physicians werenotusedwasnotalwaysdueto economic Thechoicebetweenpainfultreatment, by a or elitistconsiderations. outcome, withuncertain physician anddeliberate neglectwasoftena preferredchoiceof a patientevenin recent history.Jacksondiscusses howin GreeceandRomepatientssoughtthe helpof thegodsin to theuseof doctorsforsuchreasons. 149 InEgypttheinvoking preference of godsthatwereso integralto thedailywayof lifemayalsohaveoftenbeenthefirstchoice.Certainly, aswithall 144 Lichtheim, Ancient Egyptian LiteratureVolume 1/1,40. 145 Afthough Ghaliounghui believed 'fromthestricthierarchy of theirtitles'that'somekindof controlmusthave beenexerted Science, 64-5. (1,82)Ghaliounghui, MagicandMedical ontheirentry.OnthishequotesDiodorus However, I thinkthisis an example thetypeof 'Greekorder'alludedto by of Diodorus supposing andapplying Lloyd,seefootnote, 187. 146 W.L.Moran(ed.), TheAmama Letters, (London, 1992),120EA49,316 EA69. 147 M.Roaf,A Cultural AtlasofMesopotamia andtheNearEast(NewYork,1990),132-40. 148 S. Donadon! (ed.), TheEgyptians (Chicago, 1997),A. Thesignificance is thateffective painreliefappears not tohavebeenavailable in Egypt.Please, toAmenhotep 5.2onopiumforfurthercomment. seeChapter 149 J.Jackson, Doctors in theRoman Empire(London, andDiseases 1988),20.

42

TheEbers otheraspectsof lifetherewereno definitedividesbetweenmagicandmedicine. illustrates Papyrus thispoint.It givesspellsthatareto be recitedwhenthe at thebeginning is drunk, 'really is being the ('traditional') 'words be to medicine remedy used, spokenwhen for int (Eb3). the A thanks times, Amen-Re to al given a million votivestela records excellent; in savingthelifeof a son,'I madeforhimpraisesto hisname,on behalfof latter'sintervention Nakhtamun, 150 justified, thedraftsman wholaysickuntodeath'. The Egyptianwordfor doctorappearsto havebeenstmw: m.

var. 0

.

151

The presenceof the 'arrow'may havearisenwith the development of the doctoras the one

distribution doctors is 152Any baftlefield. the the of understanding of arrows removed on who 153 For hierarchical because titles. the the within of word confused use somewhat of swnw V1,ranksamongst histitlesthatof thevizierMereruka, to Tetiof Dynasty example, son-in-law thistitlewas 'overseer of thetwosidesof theboatof thedoctorof thegreathouse'.Whether it But is difficult know. kudos by to honorary bestowing title academic prowess realor merelyan is equallydifficultto imaginethe son-inlaw of a king actuallypractisingmedicine.The Twenty-seventh Dynasty from Udjahorresnet the gives an statue naophorous of 154He heldverymany autobiographical accountof hisworkfor the PersiankingCambyses. important theseis thetitle uTswnw.Thistitlewasclearlyof great offices,included amongst fromDeirel Medinarecords importance to him.At theotherendof thesocialscaleanostracon 155The 51518). the dailygrainrationspaidto the varioustypesof workers(Cairo,Ostracon

150 Lichtheim, AncientEgyptianLiterature- Volume2,106. 151 Hannig,677.

152 Egyptian 115.Orit couldsimplybephonetic Nunn,Ancient Medicine, 153 A fulllistof suchfitlesis givenbyJonckheere. Theyinclude, int al, 'chiefdoctor,doctorof theroyalpalace, de ltgypte doctorof thestomach LesM6decins F. Jonckheere, andeyes'.Thelasttitleimpliesspecialisation. 1958). (Bruxelles, Pharaonique NearEast.2 volumes 154 A. Kuhrt,TheAncient (London, 1995),663. forthenecropolis 155 Thesearerecords workmen of theRamesside period,albeittheymaynotberepresentative (swnw)forthework-crew of Egyptasa whole.Thephysician seemsto havebeenpoorlypaid:I kharof wheat Cairo,25608)compared to thenormal and%kharof barleypermonth(Ostracon rationof 4 kharand workman's 1Y2kharrespectively. It maybe thatthesewagesmerelysupplemented thebasicwage,butthisis notstated (whereas, detailsof daysoff for sickness by for etc.are).Thiscontrasts the one workman made with payment treatment to an un-named 'private'(outside) doctorof 22debenof copper(P.Turin1880,vs 5.2),(22 medical

43

boy. female bottom list, below is doctor the the that to the and servant of of at rationpaid it is difficult doctor typical the the Whether thisis reflective of a of statusor of workingpractices is It to say. But it seemsunlikelythat theywerefull time 'professional' physicians. more in they the that medicine and performed work-force wereemployed aspartof general probable is 156 the As 'costs' treatment to the notclear. situation again capacity. of medical a secondary Medina from Deir is the for treatments Somelimitedevidence records el available of payments had in Egypt Diodorus that for Ramesside Conversely the people some mentions period. above 157 freecarewhichhasbeendesc(ibedby someas a sortof 'NationalHealthService'.

2.4UseofAnalgesics thehistorical In respect concept of of paintoday,Jaros,in considering of thetreatment decidesthatevenuntilveryrecentlypaincontrolremained somewhat painandits treatment decades... last 'the therapeutic two ineffective. Even the and modalities and within empirical drugswereavailablebut not properlyappliedbecausestudentswerenot taughtthe basic be is that 158Equally accepted must subjective sensation pain a of painmanagement'. p(inciples felt be byothersasbeingwhatever thesufferersaysit is. Oneindividual's might senseof pain 159A by tolerated thesamestimulus of pain another. personcanexperience and easily as mild is Likewise intensity but feel different different that the activity on each. of pain occasions on (awareness) of pain. oftenreduces

History ThefiguresquotedaretakenfromMiller,Medical debenofcopper= 11debenof grain=2 months salary). 35,16-17. 156See abovefootnote. (1,62).Thedescription HealthService' 157 Diodorus is madebyPahorandmust,inthelackof ofa 'National Hefurtheralleges beassumption. thatmanyphysicians bythestate.Thewealthof evidence, weresalaried bythesplendour 'private' canbeevidenced physicians of theirtombs,J. L Pahor,'Ear,NoseandThroatinAncient 106(1992), Egypt,Journal 678.However, thisreliesonthetombtitlesbeingactual ofLaryngology andOtology ones. nothonorary (1991), 194. 58, 158 J.A.Jaros,'History MountSinaiJournal Medicine of Pain:Concepts andTherapy', of havebeenshownto varybetween different those 159 Painthresholds between of sociomenandwomenand Froma reportin theLancet(1971),reported in Fairley,TheConcept of Pain, groupsandoccupations. economic 63.

44

is It Theavailability drugs does directly to their perhaps use. of notnecessarily equate difficultto imagine thatanysocietythatpossessed painkillers wouldnotusethem.Butit cannot be assumed thatjust because an ancientsocietyhadaccessto certainmedicalcompounds Thepointis thatmedical thattheirusemusthavebeenwidespread. areonlyused compounds For a modernexample,in Europeandthe USA,over withinthe prevailingsocialbackground.

Thisis is nowregarded thelasttenyears,painin terminal asunacceptable. conditions medical due to a socialshiftin the perception the painassociated with certain of pain.Previously terminalconditionswas regardedmerelyas partof the illnessi.e. naturalandso somethingto

dosesof be contended the currentpolicyof givingever increasing with. Consequently, in earlierformularies to dyingpatients notonlyredundant morphine makesthedosageregimes 160Equally,narcotics buttotallyinadequate. havebeenfreelyavailable for somecenturies yet the post-1960's pandernicof drug addictionhas only been possiblebecauseof the factorswithinthecurrentsocialclimate. predisposing sociological It mustbeappreciated thata lackof knowledge of thesocialcontextof drugusewillto someextenthindera greateranalysisof the use of analgesicsin ancientEgypt.In of this, I fell one methodof approachmightbe to lookat the actualuse of consideration todayandattemptto find paralleluseswithinancientEgypt.Themodemuseof analgesics intothreebroadareas:the reliefof acute,minor andsedatives analgesics canbe classified discomfort, thetreatment diseaseandthe treatment of painin chronicandincurable of pain

injury. following Thevolumeuseof analgesics It is partof the social todayis for minordiscomfort. expectation withintoday'ssocietythatpharmacy willprovidea 'pillforall ills.' Thirtyyearsago for anxietyand'related'conditions theuseof sedatives is Today this a mere wasenormous. fractionandindeedmanyof thesecompounds havebeenwithdrawn theyarenotnow because 160 Thisis illustrated byofficialmedical to controlpainwas Thedosefor (oral)morphine monographs. sulphate in 1970.In 2000thedosewasgivenas upto 500mg(if required). BritishNational Formulary givenas 10-20mg (London)1970,2000.

45

161 Thisis an exampleof socialattitudes to produce. controlling andexpectations economical It is impossible to imaginethat framework. the useof drugswithina government prescriptive Egypt. 162 treatment thisvolume of painoperated onthesamelevelin ancient todayis in the At thechroniclevelof painthe highestuseof opiatesandnarcotics Cancersarenotwelldocumented in Egyptandthereis goodcauseto treatmentof carcinomas.

in geneticprofiles,livingconditions dueto differences thattheywerenotwidespread consider It is the shorterlife expectancy thatprecludes manyof these anda shorterlifeexpectancy. diseasesof middleandold age. conditionswhichareessentially

Injurywasa problemin Egypt163bothat the militarylevelandthe inclustrial level, duringstoneworking.Thereappearslittleevidence thatanalgesics particularly wereusedat thislevel.Fractures weredealtwithandthe painseemsto havebeenrelievedby the actual facial fractures in limb'64 the the at case of notreatment settingor immobilisation received of or all. 165

166 TheEdwinSmithpapyrusrecordsanddisplaysan understanding of suchinjuries. being is Whilsttheirtreatment be there to no recordof anyanalgesics appeared systematic administered. The understanding in ancientEgypton the useof of any possiblesocialrestraints is limited.Knowledge be limitedby analgesics mustby necessity of the useof analgesics in themedicalpapyri.Whether to theirappearance thisis actuallyrepresentative of reference 161 Thevolumeof usageforsucha widerangeof alleged'psychosomatic' social andthesubsequent complaints (NewYork, See,M. C. Smith,A SocialHistoryof theMinorTranquilizers consequences cannotbe overstated. 1985). Rochepharmaceuticals finallydiscontinued inJanuary 2002. production of Valium 162 Themaindifference between themodels is in theircomplexity. Thesociologist Parsons a 'sickrole'to proposed The'sickactor'is allowpeoplein modern, stressful societyto temporally opt out to recoverandreintegrate. excused workwithoutblameor stigma.Theuseof medicines servesto justifythisrolein, P. Bates,'Is the'sick today?,ThePharmaceutical Joumal269(2002), 246. role'stillrelevant 163 intheareaofthefirstAswandamin 1907produced Theexcavation 6000bodies thatshowed a highincidence totheforearm F. W. Jones, 'Some from particularly offractures, blows andcollar-bone possibly sticks. a result of fromancient fractures' lessons BritishMedical Journal (1908), 455-8. 164 EI-Ansary, MiddleEastJournalOfAnaesthesiology 10,99-105. 165 V.S.Femades 'Thetreatment Portugal 11, (1998), face', Medicine andM.Andrade, the Acta of fractures of 119-126. 166 Sm4,6,7(skull),Sm12(nose),Sm35(clavicle) Forexample: andSm36(humerus).

46

in viewof theeclecticcontents theirusecannevertrulybe known.However, of the medical in proportion to theirneed. papyrionemightexpecttofindanalgesics by I feelthatthe bestapproach for this thesisis to predictthe needfor analgesics lookingat thetypeandincidence within of painas a symptom of diseaseandtheimportance that disease.The incidenceof diseasewill be consideredin Chapter4. On this basis,it is

demandmayemergewhichcanthenbe gaugedagainstthe actual hopedthata quantitative in thisway,thentheir If theneedof analgesics number of specificremedies. canbepredicted, in the medicalpapyriishouldbe significant. appearance actualquantitative

47

CHAPTER3: EGYPTIANTERMINOLOGY

3.1WordsforPain for 'pain'.Whilstthis might In this sectionI proposeto dealwiththe Egyptianterminology it is important initiallyseempedantic to evaluate thewidersignificance of someoftheseterms. ListedbelowaresixwordS167 in Egyptian thatareusedfor 'pain'.Thenumberis not the rangeof meaningof 'pain'.168 surprisingconsidering

mr

141'ft (Eb,H, Berlin,Kahun,London36, Ram111, % IV,Ostr.Cairo.)

mn'-"I'ft (Eb,Berlin,Ram111) i,bw1r'3-11'ft (Eb37) 1: (Eb, Sm22,1) §1 iffir ý,

whdw Stt

(seetextbelow) (seetextbelow)

is (t is It both inside ) that the a a and outside medical papyri. word commonly appears mr to mean'pain'.169It occursas bothverband generictermfor 'illness'andits useis extended in EIJ30 1: nut m cýt nb.t 'suffering/pain in everylimb, P,,t nut a 'severe noun.Forexample, disease', mrt'pains'(Ebl2,13,16,21), mrftp'headache?', (Eb258). frequently bothinthemedical Mn (t) similarly appears andothertexts.It canbebothverband is It to mean'suffering'and'pain'.170For example,tnn.f lb (u) generallyaccepted noun. (Kahun,5), nw.f Iýtnb.t'he suffersin all hislimbs/body',mnt m mwit'pain in 'toothache' (Eb267). theOne (onudnating)', 167 1donotsuggest thatthislistis complete butofferit asa starting Otherwordsexist,for pointto thediscussion. ý (see,Grundriss V11: 856).Thewordnkm with is usedto meanboth'affliction' §n]in Eb252,369 example and depending 'painful' 21. 'A NewLetterto theDead',JEA16(1930), oncontext, seeA.H.Gardiner, 168 Fora modern therearealsosixlistedin German, Dictionary 12tIEd. & English Cassell's comparison German 1975),349. (London, 169Hannig, 344. V11: 365. 170 Hannig, 335,Grundriss

48

t is Irillp. 171 Faulkner Leiden', 'pain, Hannig 'Schmerzen, trouble'. by Mw givesIhw as given

it in literary texts frequently the 'sufferer. '172 The where most as wordappears Such 'deprivation'. in the but 'trouble' to to to of sense appearsnot apply physicalpain more 173In The to Merikareit appearsas: Mw m mw 'shortof water'. that in the Instructions by Lichtheirn Complaints thewordis translated as 'futile',suchas:'it is of Khakheperre-Sonb 174In the sametext tfýhdappearssomefour timesand is futileto answerthe ignorant'. translatedvaryinglyas 'painful,sufferandendure'.175In the Instructions of Ptahhotepit appears with a causative's' as sihw and is translatedby Lichtheimas 'deprived'such that, 'one 176 deprivedbecomesanopponent'.

1ý1 is takenin the medicaltexts dPr'.: => thiswordgenerallymeans'bitteror bittemess'177but

in For the by 'bitter to mean'pain'whenthe symptoms example, source. arecaused some ), d,ýrs m jwff caseof a patientsufferingfroma (tumour?

'it is bitter(pain)in his body',

(Eb868a). in: S'ncn.fr-lb. -gmm.k sw Ar r In thecaseof a Anc(a 'stoppage'), in thestomach (possibly because 'bitter'(pain)fromthestoppage, elt wrt thepatientexperiences of gastric (Eb201). heartburn), the of stomach causing severe reflux important However, thelasttwowordsfrom'thelistof six,' w, more andsu, are _hdw Theyare thansimplywordsfor pain,andtheyhavebeenthe sourceof somediscussion. in have far been implications thatthey terms they since proposed as with wider significant I As disease. Egyptian to the the such, conceptof physiology and aetiology of appearseminal it necessary to dealwiththesein somedetailbelow. consider 171Hannig,10.

Dictionaty 172 Faulkner, A Concise 4. ofMiddleEgyptian, Ancient Egyptian 173 M.Lichtheim, Literature 1975),104. Vol.L TheOldandMiddleKngdom(Berkeley, Ancient Egyptian 174 Lichtheim, Literature, 148. AncientEgyptianLiterature,149 175 Lichtheim, AncientEgyptianLiterature, 176 Lichtheim, 72 177 Biftersein',Hannig,985.

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3.2 whdwU'aViliýi

is 178 Its ndwis a wordthatappears in the appearance papyri. generally medical only bythecontemporary anditssignificance practitioners. notfrequent musthavebeenunderstood Sometermsandconditions in the medicalpapyriaredefinedin moredetail,as footnotes or as a resultof later copyingor perhapsas an aid to teaching. glosses,presumably Unfortunately, definedas 'pain'or thereis nosuchglossfor whdw.It hassincebeenvariously as a termto explainthe Egyptian moresignificantly viewof the aetiology of disease.Nunn brieflydescribesthe problemsassociatedwith the understanding of the term whdw. He

the differentviewson its meaningas lyingbetween'painmatteror summarises succinctly 179 'morbidprinciple'. I consider thisto bewellputandwillusethetermmorbidprinciple whereI discussiqhdwas a pathological factor. fromtheverbjiýbd'tosuffer.180 It appears ndwis generally accepted asoriginating 181 in themedicalpapyrias: whdw, u,-bdwt(apparently ). 1 feminine form) (? a and whdwy includethelatterforcompleteness because Nunnstatesthata personsuffering fromwhdwis form.However, this referredto as a wbdwywithýy' added.Thisis presumably a participle formis notgivenintheGrundriss, norhaveI yetfoundthisin anyof themedicalpapyri.It does however (discussed Sageby Gardiner appearas a singleentryin Admonitions of an Egyptian 182Gardinergives tfýbdas bothverb:'to suffer,bearpatiently'andas a noun,'pain'.183 below).

Faulkner givestfýbdas theverb'to be painful;suffer,endure;be patientwithsomeone' whilst bothivýhdwand 184 whdalare givenasthenoun'pain'.

178 Except,see3.2(iv)below,howeverstillin a medicalcontext. 179 Nunn,AncientEgyptianMedicine,61. 180Hannig,214.

181 Hanniggivesthewordas w_, bdy, 214. 182 A. H. Gardiner,TheAdmonitions of an EgyptianSagefroma HieraticPapyrusin Leiden(Leipzig,1909),10,12 Gardiner,EgyptianGrammar, 183 562. Faulkner, 184 A ConciseDictionary of MiddleEgyptian,68.

50

fz in both It is notwithoutsignificance is thatthepustuledeterminative seen wbdand - . For kind'. Gardiner this to 'bodily bdw. attributes sign of a morbid growthsor conditions w, found it is in: example, ez R'ZZ,. (Eb,H,RamIV),%%% (Eb,Bin,H,RamIV). Psfaeces EEO

FE; a

"ý3 (Eb871 (Eb561,767, Sm) gftv'to swell'-. - '1ý3 c), -ý! J, dd)'fat' ý z (H,BIM62).

However,in the Old Kingdomit seemsto havebeenusedwithoutany morbid 'ý' It is seenin It instead the anddeterminative. connections.was of sign bothas ideogram 185 lbw'Elephantine'and Vw'be narrow'.

Themorbidprinciple bdwis basedon theideathat wbdwis notpain.It theoryof tfý,, throughthevesselsin thebody,the mayproduce painbutis actuallyan agentwhichspreads 186 The later Greek ideas The is theory being to on medicine. concept claimed as seminal mtw. fromthecloseobservation of wbdwas a morbidprinciple of the bodyduringthe emanates Thedutyof theembalmer the bodyin an attemptto mummification process. wasto preserve It is not surprising that the embalmers achieveimmortality. wouldhavebeenawareof the Theywouldhavenoticedthatit was immediacy duringpreservation. of theputrefaction process decay body from in to the of prevent rapid vitalto quicklyremovetheintestinal contents order thecadaver.Intestinal spillageandfaecalmatterwouldbecomeassociated withputrefaction. Thisideaisthentransposed fromthedeadandextended to theliving. eventually

185 Egyptian Grammar, Gardiner, 539. fromAncient 186 Saunders, TheTransition Egyptian to GreekMedicine, 20-33.

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187 Each levels Herodotus three tellsus thatthe Egyptians of embalming. practised the gearedto the incomeof the client,yet in eachlevelhe still emphasises presumably first They take intestinal importance the to the a crooked cavity: of removal of,andneed clean, take they brain iron it draw the through the cut and make a next andwith out nostrils pieceof ... ... withpalm whichtheycleanse,washingit thoroughly of the abdomen, outthewholecontents 188 frequently infusion again of powdered aromatics. and with an wine

both Theremoval intestines to the the pathologically vital embalming process was of both the Steuer the the that performed embalmer and physician cosmetically. suggests and physical role:onepreventing physicaldecayafterdeaththeotherpreventing sameessential butalsoin bythewordsrwhmeaning to 'embalm' decayduringlife.Thishesaysis confirmed HannigandFaulknergivethe in general.However, a medicalcontextto expresstreatment is to in Certainly 189 the 'to 'treat'. papyri medical well attested as embalm' and wordsduýh srKb in be it treat the in to treat the could mean extended medicalsenseandpresumably mean 190 SteuerstatesthattheEgyptians process. senseof preparing a bodyduringtheembalming of thecorpseat deathandpathological sawbothprocesses as linked:thatis decomposition decayof the livingbodyin disease.Both'as apparentidenticalmanifestations of organic destruction': 'Justas thephysician therapypostpone thedestructive powerof couldby appropriate during life, by itselfa therapeutic the procedure so embalmer mummification, wbdw althoughtranscendentally conceived, couldpreventphysicaldecayof the bodyafter death'.191

187 Lloydthinksthatthisis merelyan example a rigidsystemwherenone of 'theorderlyGreekmindimposing fromLloyd,Herodotus tohaveexisted', Book11,356. appeared 188 Herodotus, Histories 86. 11: 788.AJso,Wb4:368.Giventhesimilarity 189 Hannig, of thewordsandtherarityof sdwbthelettermaybeanerror in copying fromthehieratic and byconfusion caused Hannig, 729.AJsoseeGrundriss V11: 775-8. 190 Egyptian 191 Steuer, Ancient Medicine, 4. andCnidian

52

However, theycontinue Wewillseelaterthattherearedifficulties Steuer's views. with in thattheyproposean Egyptian'conceptof disease' to be quoted.Theyarefundamental limits factor be Equally importantly, to whichequallycontinues cited. wbdwas a pathological is, It the forpainfuldisease texts thepotential the analysis. overall affects so within medical and therefore,importantto reviewtheseviewsandalsothe proposedparallelsandlinkswithGreek

medicine. Steuerseeswhdwasa noxiousagent,something thatis carriedbythevehicleof the faecesand, Whichhadthe potentialon absorptionof causinga greatvarietyof diseasemainly

'In theprodromal wasdirected of thephysician supperative'. stagesof diseaseeveryattention to the elimination and of whdw togetherwith the faecesthroughthe use of purgatives

192 enemas'. body: IndeedHerodotus the importance the of purging stresses fortheir 'Everymonthforthreesuccessive daysthey(theEgyptians) purgethemselves from the belief in health'ssake,withemetics, disease the that comes all andcysters, foodthata maneats.193 This seemsto be supportedby the Eberspapyruswhereabouta quarterof all forthegastro-intestinal areintended remedies system. The so called'VesselBook',a 'description' of the anatomicalsystemand its to the variousconnecting ductsor mtw seemsto reinforcethe conceptof relationship

be 194 to Itappears thought transmission. thattheheartandtheother(mentioned) were organs to themtw all unitingat theanus.Thisis important because sucha systemwould connected 192The connectionof ifýhdwwith the faeceshas even beenusedexplainthe presenceof a latrinein an Old Kingdomtomb(2302)at Saqqara,not simplyfor defecationbut ratherto rid the bodyof tghdw,in Estes,The MedicalSkillsof AncientEgypt,95. 193Herodotus, Histories11: 77. Therectalrouteof drugadministration waspopular.ThepapyrusChesterBeattyVI is solelyconcerned withrectalconditions, seethe briefdiscussionin Lloyd,HerodotusBookl/, 331.However,his implicationherethat the rectalroutewas recognisedas a meansof 'systemic'treatmentcannotbe correct.The dealingwiththeanusratherreflectsthedegreeof sufferingin thatareaof thebody. volumeof prescriptions 194To be calleda 'Book'is an overstatement, as it is little morethan a few collectedheadings,althoughit may haveformedpart of a largertext. It is the only Egyptianequivalentwe have,albeitfar moreskimpy,to Grays Anatomy.

53

for the but faecal intestinal tract flow the wider the allow would of matterwithin not restrict heart the both the found 195 Thus, 'to anusand and refresh' are prescriptions spreadof wbdw. to expelfever(Pap.ChesterBeattyV1,13a). 'The Egyptianconceptthat mostinternaland infectiousdiseaseswererelatedto the

have to in this the wonacceptance seems manner of organicmatter of corruptibility observation in the medicineand biologicalscienceof classicalGreece'.'Whilstthe humoraldoctrine Greek dominate be to Nature Man On the in Hippocratic the said of could work expressed in De Egyptian humoral the fuse theory Galen to the concept: with viewof seems medicine, 196 The fever to 'whoever putrefaction'. prevent cure a must attempts methodomedendi, There in Cnidian is bowels in disease the was medicine. seen also originating conceptof believedto be a normalstateof the faeces- koprosand its pathological counterpart 197 peritoma. logical be faeces the betweenifýhdwandputrefaction Whilsttheconnection may via Greek had influence theories later in be this that of on an cautionmust applied suggesting it is but familiarity between two the disease.Certainly culturesareundeniable'98 contactand disease.AlsoI beliefsto laterGreektheoriesregarding impossible to connectfirmEgyptian in the'normality' thatto associate thinkit shouldberemembered of of theprocess anychanges Greek Egyptian be just is morefundamental defecation'99 or an claimed as and cannot that body There is to are substances regularly expel an essential and normal need concept. irregularity In if simple any certainlyas unpleasant. manysocieties perceived,notas noxious, been has faecal in the this stool, suchasconstipation or a change appearance of with process, here from It in faeces localises 195 Yoyotte the theory that in the the and spreads anus. modifies actually wlidwin bologique des M6decins is Yoyotte, bowel to disease. J. Th6orie frequent 'Une necessary evacuation prevent so tgyptiens', Kemi18(1968), 79-84. TheTransition fromAncient Steuer 31-2. 196 Egyptian ToGreekMedicine, andSaunders, Ancient Egyptian Medicine, Steuer, 21. 197 andCnidian Egypt:TheHellenistic C.A La'da,'Encounters 198 in R.Mathews GreekExperience', andC.Roemer withAncient ), Ancient Perspectives (eds. 2003),71-94. onEgypt(London, is alsoquitesimplypartof a patternof regularhygiene. defecation Thepresence 199Regular of latrinesand involved homes This in Egyptian bathrooms all purification werevitalaspartof theprocess of secularpurification. 4-8. (Egyptan)', bathing, 'Purification Blackman, shaving, ofcleanliness: washing aspects offeet,depilation etc.

54

irrespective andso associated of a viewedasabnormal withillness.Thisis a validassociation in eighteenth England theexamination society.Forexample, particular andnineteenth-century in colouror consistency of faecesandurineforanychanges withphysiological wasassociated 200Remedies for laxativesand changesthat werenot themselves understood. abounded Indeedtheword'physic'wassynonymous 201TheGreeks aperients. withtheword'laxative'. butnotto ridthebodyof putrefaction. Ratherit appears thattheirusewas alsousedlaxatives, intendedto addressthe 'imbalances specifically of forces'withinthe body.202 However,we will see laterthatfaecalmatterwasactuallyusedby the Egyptiansas a

ingredient. Thisapparent prescription paradoxto whdwas a diseasetransmission agentis in theAppendix. fullydiscussed SteueralsostatesthattheancientEgyptian physician viewedthepassage of w-hdwas intrinsic to theageingprocess itself.Thepassage themtwwhenactingupon of wbdwthrough intopus(ryt ).203It is actuallythisassertion the bloodunderwent transformation thatSteuer Egyptian forthis thathisevidence usesasthebasisto connect andGreekthought.(I consider isflawedandwilldiscussthislater. ) Hesuggests to becausedbythe thatoldagewasbelieved inevitable absorption of wbdwleadingthento the physicaldestruction of the body.In facta literature similarparallelis foundin Hippocratic wherethe humours mixwiththe bloodin old if it is accepted thatEgyptian Greekit is important theoryinfluenced to realisethat age.204Even thattheEgyptians thereis noevidence wereascircumspect asthe aboutthehumancondition Greeks.It is unlikelythatthe Egyptians tooksucha philosophical to painandit is approach probableto assumethat they simplyregardedit as connectedwith diseaseand, thus, 200 Inthesamesense, English onecouldclaima linkbetween ancientEgyptandthenineteenth model. century 201Thewordis recorded from1589,OxfordShorterEnglishDictionary, 1575Thefortunesof manyexisting intheproduction fromthisperiod. companies originate pharmaceutical of laxatives z 202 Cralk,inWilkins ), FoodinAntiquity, 348. etal (eds. 203 Steuer Ancient Egyptian Medicine, andSaunders, 31. andCnidian 204De Morb.,1,24. It is merelya pgrallel.Thedifference is thatHippocratic theoryregardsthe humours as It is theirimbalance thatis problematic. thatis in balance. occurring. naturally ndwis nevera natural substance Aristotle Thesourceof lifeis lostwhenthesourceof heat,withwhichit is alsoseesoldageas an imbalance. boundupisnolongertempered bycooling, 4is consumed byftself- OnYouth,OldAge479a,8-10.

55

in Europe letting blood in itself. For be treated that practised was example, something should it logic behind beneficial it believed the Whilst the waspoorly was century. until earlynineteenth 205 by its practitioners. understood the experiences I believethatSteueris possiblyrightin associating However, of the to the But, belief bodily decay. that the the agent specific of with process whdwwas embalmer by is in This is I believe transmission this a recentreviewof supported part uncertain. aid factor they is it Whilst that Kolta Tessenow. take the by they a pathological view and tfýhdw dismissits connectionwith faeces. This is becausethere is 'no connectionor parallel

206 texts'. faeces (as between the be medical andwbdwin appearance should expected) Alsothecloseconnection wouldseem process of ubdwwithpainandthepathological thisviewmightbe one to makeit too widea termfor a specificmedicalcontext.However, terminologies. by is the exact and specific science with of conditioned modern view which in respectof whdw is not entirelyclear.They Theexactpositionof the Grundfiss 207 Sowhilsttheyallowthatit is something dw as 'Schmerzstoffe. translatetfýb, morethanmere intrinsic the idea to that does to the their aetiology view not necessarily subscribe whdwis pain Whilstthismightbe'fencesitting'it maybetheonlyandmostsensible of thediseaseprocess. to takeinviewof actualevidence. position it is necessary to In orderto evaluateifýhdwas a termof morbidprincipleI consider thetwoaspectsof dividethetheoryintotwopartsandthenconsider eachin turn.Essentially, intestinal from disturbed thetheoryarefirstly,oneof observed contents putrefaction resulting travelled to from belief then that that the a specificagentevolved which situation andsecondly, consequences. otherpartsof thebodywithpathological for 205As late as 1840a prominentmemberof the RoyalCollegeof Physiciansstronglyadvocatedblood-letting theprevention andcureof disease.Itseffectsareso strikingandimmediateit is hardlypossibleto over-estimate ... if. Despitethispraisehe admitsthatthereasonsfor its effectsarevaguebutsuggests(aswellhe mightin an age thatit is connected achievement) withthe mechanicalactionof the bloodon the bloodvessels.M. of mechanical 1840). OntheProperAdministration (London, Clutterbuck, Cure the Disease of Blood-letting and of ZAS127,38-52.TheEnglishhereis mytranslation. 206 KoltaandTessenow, VII:207. 207Grundriss

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In respectof the first situation,it seemsperfectlylogicalandquitelikelythat the spillageandwiththe withintestinal of therapiddecayof thebodywasassociated observation have believed Egyptians However, intestinal the the may whilst contents. natureof unpleasant follow it does thatany disease, in theinternaltransmission thatsomeagentwasinvolved not of In to for basis treatment. beliefwaseitherpromulgated the words, other medical as or used by Steuerit is necessary fully acceptthe theorypostulated to acceptthatthis agentwas andgivena name. specified actually in thatit joinsEgyptian Equally, thetheoryis convenient andGreekthought.It fitsboth medicalprowess. andin termsof thelatter'spraisefor theformerssupposed chronologically ButI believea passivebeliefis stillpossiblewithoutspecifyingwbdwas a morbidprinciple. The theory,therefore,hingesaroundthe interpretation of the term wbdw andwhetherit was

Theproblem believed to bea namedmorbidprinciple. of thisterm wehaveis theinterpretation 208 it decide to the to pain. or as whether accept asa morbidprinciple within medicalpapyriand it alsoto mean difficultto reconcile If wbdwis a termfora morbidprinciple thenit is somewhat to meanboth.Thewordsnm andmr are painor suffering, unlessthetermcanbeextended in termsof thelatterbeinga degree bothusedfor'illness'and'pain'butthiscanbeexplained or a conditionof the former.To this extentit is a questionof extendingthe definition It is difficultto envisagew-hdwin the sameterms,withoutconfusion, where semantically. is both fundamental term a with and a symptomof pathological significance wbdw It humanfaeceswereactuallyusedas prescription ingredients. 'straightforward' pain. Equally, factor.Theuseof excrement thisfactif whdwwasa pathological seemsdifficultto reconcile laterin theAppendix. withinthemedical papydis discussed

208 Thisis because Thepossibility (pain)is dismissed byKoltaandTessenow. of wbdwbeinga specific symptom to thatpossibility theyseetheconnection incongruous e.g. s§n of w, withotherwordsin certainphrases as -bdw (pain? ). I disagree in thisrespect, a pool of astheydiscussand withtheirconclusion wbdw wbdw particularly termsin theliterarytexts,ZAS127,39. admitthemetaphorical significance of (medical)

57

Inmyattempt developments later found to re-assess I it the that or all apparent tvýhdw furtherattributes to itssignificance derivedfromSteuer's arethemselves originaldeliberations. it is necessary 1,therefore, thatSteuerputsforward. to lookin detailat theevidence consider faecal Themorbidprincipletheoryof whdw is essentially dependent the of on movement Heclaims matter(withwbdu) aroundthebody,suchthatanyblockage willleadto problems. thatBerlin154illustrates thisandso is seminalto thetheory.Plate3.2(i) givesthecomplete intoEnglishaspresented by Steuerandthisis thendiscussed below.Following translation the discussionon Steuer'sproposalsI will offer other examplesof the appearanceof ivýhdw.

ThesearetakenfromtheLeidenPapyrus, Admonitions Sageandthemedical of an Egyptian

texts.

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PLATE3.2 (i) BERLINPAPYRUS154(XIII,3-7)

is fromSteuer209 Translation TheEnglish fever,(1) Another(prescription) againsta pool(of wbdl+)generating his(thepatient's) bodyis heavy,hisr?lb (cardia? ) is sick, Pylorus? hisheartis hot,it pulsates; hiscoversareheavyonhim, hecannotstandmanycovers; hesufferthirstatnight andhetastes(feels)hisheartoppressed like(thatoo a manwhohaseatenfruitsof thesycamore (?) tree; hisfleshis weaklike(thatooa manwhomtheroadhasfound. in orderto evacuate If hecrouches (then)hisintestines areunderpressure (but)heis notgettingalongwiththeevacuation. Thoushouldst saytohim(i.e.concerning sucha case);(2) Thisis onewhois undera poolof wb-dwin hisbody; hetastes(feels)hisheart,, heis sick(and)I shallact(onhisbehalo. Shouldit arisein himandbecome (3) anocclusion youwillhavetoapply(tohim) to remedies againstwhdw,together withremedies destroytqhdw.

Ancient Egyptian 209 Steuer, Medicine, 37-8. andCnidian

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is headed: Theprescription (1) kt SS'Mbaw

Thisis'translatedby Steuer:'as another(prescription) againsta poolof (vtýhdw the The line. from fever. However, is this the of assumption wordwhdw absent generating 'then (2) is from later: Ptf, drawn dd! krYbrySS'ifýhdwm youwill of presence whdwhere n. body'. in his it is (concerning it), is this arise onewho undera poolof wbdwshould say Berlin154is givenas theexample whichdemonstrates tKbdwas a morbidprinciple. the 'rising'of whdw which causesa blockagethat subsequently One whichdemonstrates by Steuer indicated is The be 'rising (s§ treated. to as of a pool' of wbdw needs n ivýhdu)

'beingthegeneralcauseof fever- thisbeingtheearliestexample of sucha causalassociation 210 andfeverin thehistoryof medicine'. of putrefaction At (1)thewords§ 1`ý,is translated as 'pool'andSteuerseesthisas an additional Hecompares thesimilarity poolsand of stagnant reinforcement of hisargument. metaphorical 211 TheGrundriss theirdisagreeable give of faecalmatter. natureandodourwiththestagnation Faulkner Gardiner (German English) 'Nest' thetranslation and with and whichaccords of ss'as r-=-

ýý ýý 1.212 (1) The 'pool'u 'bird than at symbol pool'ornest' rather asa s§ whogivess§,! as r-. -, 1. birds to asopposed ss' 3m clearlyshows Thewordss' ýý appearsin theLeidenmagicalpapyrus(6R6)whereit is suggested to referto the'takingoverof thebodybya demon;thedemonthoughtto havemadeits 'nest' body.213

in thepatient's

buta Ancient Egyptian Medicine, 210 Steuer, 51.Thisis hisconclusion butit isdifficultto seeanything andCnidian link.A betterpossible linkbetween Egyptian intermsofthecauseof 'fever' andGreekmedicine slimmetaphorical TheEgyptians sawtheworldin termsof opposites mightbe theviewof opposites. andthe balanceof those Thisis forces.Thisviewis alsoseenin Pythagorean hadmedicalapplication. medicine where'Opposition' in thatwhilstfevercomesaboutfroma surfeitor deficiency by Plutarch thecauseof demonstrated of nutriment, between Beliefsof the theheatandcoldin the body- Plutarch, thiswasstillan imbalance Onthe Scientific 991A. Philosophers, 211 Steuer,Bulletinof theHistoryof Medicine10,16.Steuer,AncientEgyptianandCnidianMedicine,39. 212 Hanniggivesint al both'nesfand'swamp','Nest,Sumpf,761. VII:778,9. 213Grundriss

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I wouldsuggest a betterwordmightbe 'cluster'which wouldfit in withssas nestand alsoaccords withtheideaof 'pool'asin 'pooling'or a 'conglomeration'. h3btlw

4 i If il 14 **, rill ý (fOr)ein failsto translatethisterm,the Grundfiss Wreszinski gives:'Einanderes(Heilmittel) for) (remedy (b!jb vonaw- Hitze,whichNunntranslates NestdesUmherziehens as 'another is mostenigmatic andthedirecttranslation a nestof wandering of heat.214Thistranslation from Germanto Englishis not helpful.I would suggestthat the absenceof an acceptable

forthislinehasmerelyaddedto the'enigma' translation of wbdw. by failsto lookat thesymptoms TheGrundfiss exhibited of thepatient.Thesymptoms includes thepatientcertainly oneof 'heat';his'bodyis heavy,hisheartis hot,hiscoversare by a high heavyon him'.The patientseemsclearlyto be in somedistressoccasioned 'Fever'seemsto fit the symptoms: temperature. thirst,quickening and pulse,constipation frombedclothes. 215Steueris correctin considering discomfort this line as 'fever'.I see no conservative reasonwhy'heat'shouldnotbeconstrued as 'fever'.Thecautious andsomewhat to the approachof the Grundfissof sw as heat is reallybecauseof their commitment (seelaterat3.3,in respectof stt). of W as'Umherziehens' rendering SteuerhasIvb (1)as 'send'whichis problematic. hib hereis shownwiththeplough symbd'ý (alsoat H69)whichis morein linewithFaulknersrendering of 'tread'ratherthan

216 In H69,H70it appears 'send'. in theGrundfiss asb3bandis translated undertheheading 'wanderings' (noun). 'Umherziehen' 217 (1) The interpretation depends Mb Grundriss on of beinga nounin directgenitivewith aw, andin H70we actuallysee Wband aw in indirect genitivalform: dr Mb n aw. The Grundrisswouldhavethis as 'the drivingout of the 214 Grundtiss VIA04,Nunn,Ancient Egyptian Medicine, 85 215 in Bln154isdescribed Thecondition intheGrundfiss bymovements occasioned asa 'blockage ofthestomach, I wouldsuggest thatperitonitis is a condition ofdiscomforf. whichmightfit inwellwiththesesymptoms. 216 Faulkner,A ConciseDictionafyof MiddleEgyptian,157. 211GnindrissV11: 563.

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doubt 218 form heat'. This throws to Ub on more and of seems support as a noun wanderings In factthe onlyexampleof the word'send'usedin the medicalpapyri Steuer'srendering. (Lond4). seemsto bein a spellintheLondonPapyrus Grundriss In verbformA?b appearsin EIJ767 Cairo, in both Ostr. the examples and 219 Faulkner 'tread'. translation to the as concur with and give seem

In Eb767it appearsas ft

(in sdm.f form)in whichcontextthe Grundfiss giveas:

dasin das Ohrendringt- thatwhichtreads(pierces*)the ear.(Thisis possiblyinflammation, or

it (ODM 1062) infection), *my in brackets. In Cairo Ostracon inner translation appears ear an 220 (pierces*) (of illness, Krankheit, die die Auge betriff treads the eye). an which von as: I wouldsuggestthatin thesecasesA?b is meantin a moreforcefulsensethanthe as the main symptomsassociated with ear disorders word 'tread'conveys.Particularly is 'pierce' 221 I the Therefore, that a word areof acute,sharppain. wouldsuggest generally translation. moreappropriate OverallI thinkSteuer'stranslation (1) is shaky.Ignoringthe presumed omissionof form being his depends translation hdw Yb a participle of the verbto 'send'of which on w, butone,in a magicalmedical text.Hisassumption thereappears of noothermedical example, is The kt too Grundriss translation metaphorical evidence of as of convenient. ss'n whdw s§ (remedy) fora nestof wandering is non-committal, Mb uw. 'Another which of heat'(Grundriss) for its Inthat,froma 'nest'or cautionmaysupporta spurious commendable although analysis. thespillageandsubsequent 'wandering' anaccumulation of wbdwmayjustbeimplied. TheGrunddss translation to describe maybe technically correctbutis too restrained It is (1) a headingto the prescription the symptoms. andas suchit shouldbe expectedto body I thinkthe word'nest'shouldbe a poolor 'cluster'of the of symptoms. encapsulate 218GrundrissIV:1144. VA06,Faulkner,A ConciseDictionaryof MiddleEgyptian,157. 219Grundriss 220GrundfissIV:60. 221Murtagh,GeneralPractice,463-5.

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(whichin factarelaterdescribed). Theword'heat',I seenoreasonwhythisshould symptoms, (if appropriate) with not be fever,thus'wandering' couldconveythe riseandfall associated feveror thespasms Also,if h;b is takento meantread, of painasanaccompanying symptom. to'pierce'(Eb767), translation thena betterEnglish extended anditsmeaning mightbe: kt s§n Mb aw

(remedy 'another against) a clusterof thespasms(of)fever.

(2) ddin. kr. fhrXsgn whdwmhtf

Steuergivesthislineas:'thenyoushouldsayto him(concerning it) thisis onewhois ainlyhavess'n wbdwwhichwasimpliedby undera poolof whdwin hisbody'.Herewecerl: hasthislineas: thenyouwillsayto him(concerning Steuerat (1)TheGrundriss it)thisis one in hisbody'.222 whois undera nestof 'Schmerzstoffe' The Grundfissuses 'Schmerzstoffe' for the translationof wpdw. WhilstSteuer describes but does English theterm translation, translates theGrundriss not provide an wbdw but vaguelyenoughto allowfor the possibilityof wider connotations. In manyways is a goodword.It is non-committal Schmerzstoffe andit allowsfor a middlepositionbetween dw 'Schmerzstoffe' is English into difficult direct to as either morbid principle or pain. put wb, 'painmatteror'painsubstance'. Inthissenseit is betterforit allowsforthe otherthanperhaps butdoesnotnecessarily theoryof whdwasa morbidprinciple, accepttheideaof tKhdwasa It merelyallowsfortheconnection transmitter substance. or association.

Steuer in s§n wbdwandindicative seesSS'asimportant of of a poolor collection However, I be seeno reasonwhy %ýbdw not appropriate as 'painor suffering' ifýbdw. should in thisline.Thelinecomesaftera longlistof specificsymptoms. it wouldbe logicalfor ss'n

222GrundrissIV:104.

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is him he list, hdw to 'then that that: generically encapsulate say concerning such youwill w, froma nesUcollection ' in hisbody. suffering of pain/sufferings for It Alsohisrendition irregular. theaddition him' is highly f to 'to of allows of r. mean if andsoimpliesanunintended degreeof gravitas tothecondition. thewords'concerning

ir ts.n. f im. fhpr n (fl m gn

'Shouldit arisein himandbecome anocclusion. irbr. kr. fspwnw ný, bdw... Pncspwnwsdt tvýhdwmbt.f

Thisline(3) is important. Steuertranslates andgivesthis as an exampleof whdw occluded at a point,therebycausingillness,withthesubsequent risingin the bodyto become in respectof the at firstsightis quiteconvincing particularly needto driveit out.Thispassage, factthatit is necessary to both'apply'spw'remedies' againstuýbdwandto 'breakup' sdt; thatyoumustfirsttreattheimmediate suggesting symptoms andthendriveit outto complete in that'a the cure.Thus,to substitute the word'pain'for wbdwwouldseemto repetitive, intoEnglish,ignores remedyagainstpainanddrivingout pain. ButSteuer,in histranslation the fact thatthe verb ts is actuallyin the sLd-m. n.f formandso in the pasttense,an unfulfilled

It shouldstrictlybetranslated condition. as'if it hadarisenin himandbecome occluded'. However, the word ts (u)

Steuertranslates this as needsmoreattention.

'rising'in thesenseof upwardmovement. It is certainlybasedupontheverbts to 'raiselift', I. hereit appearswiththe determinative withthe determinative However, of -'I suggestive for the verb ts! withdeterminative including'rising, motion.Hanniggivesvariousmeanings liftingup'whichimplies'raise'in thesenseof erectratherthanmovement. 223In thissenseits is extended to mean'stiffor stiffness'As a nounit appears in Sm3theGrundriss meaning so 223Hannig, 962.

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is it As in 'stiff 'stifF thatfor ts foundin Sm3the Grundfiss the tsw a noun neck. gives word giveas:'erleidetan seenin Sm3in thephrase,mn-f-tswn ntbt. f ThisphrasetheGrundriss 224 in However, in his Nacken', from 'stiffness' Versteifung ('he is neck) an seinem suffering different in thatit cannotbe'stiffness' Eb262itsmeaning appears andseemsmoresimilarto its use at (3) as 'rising',kt nt rd.t wgsshrd tsw n mwit m MY, 'anotherto causea childto

from) has in (one in This body'. the the tsw a suffering example accumulation of urinate urine formof 'rising'as 'accumulation to aid Thisis clearlya prescription participle or massing'. It is thatthe urineis notvoided,it risesor accumulates. micturition. an observation

Sm3and Eb262are usefulin that seemto offeran explanation betweenthe two Eb262 is Whilst 'stiffness (w) ts contradictory apparently meanings of andaccumulation'. InSm3 (w) connected withurine,whichif notvoidedsuccessfully obviously willaccumulate. -ts (of discomfort) is a 'rising'whichbecomes(perceived to a pointthat as) an accumulation becomes erect,stiff.Thiswouldaccordwithall meanings accumulation of ts (w) as 'stiffness, impliesaccumulation and andto beerect'.TheformthatSteuersuggests as a 'rising'certainly (1). However, I seenoreasonwhy'pain'could wouldseemto accordwiththerisingof týýbdw for wbdw. If whdw is takenas 'pain',thenin termsof 'accumulation' it not be substituted in him(i.e. thelocalisation as:'If it shouldaccumulate mightberendered a of pain)andbecome Thisaccords blockage'. fever,spasmodic wellwiththepossibility of thiscondition asperitonitis: perceived asa blockage. painandsuddenlocalisation

224Grundfiss IV:173.

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Bin163) 3.2(ii)TheVesselBook(Eb854/6, throughthemtw Thetheoryof whdwasa 'morbidprinciple' reliesonitstransmission to givethissomeconsideration. thevessels ofthebody,soit is necessary Egyptians Alexandria Manetho BothClement to the somesix possessing allude of and booksconcernedwith medicalmattersone of whichwas concernedwith the anatomyof the

humanbody.Nobookis knownto havesurvivedwithinthissupposed corpusof knowledge. indeed do Papyri Berlin Ebers distracting, However, tantalising the and partsof or whether 854/856 Ebers fragments book. As have been descriptions such which of such a might contain 225 Vessel Book'. have been 'The 163 Berlin to as referred and Thetermmt

English direct has 226is obviously single a wideoneandprobably no

is it 'vessel' the equallya as seem appropdate enough, although would word equivalent; blood in include tendons, Egyptian to in English. It term muscles, appears generic somewhat body. long, ducts thin the of and other various vessels body the TheVesselBookessentially the of part of a specific number assigns mtwto It define function the the the nt at it is may also relative and or contents of mtw. is interesting bytherelevantmtw.- blood,air,mucous, semen,water oftenspecificasto whatis transported 'to hisrightearthebreathof lifeenters' andair,breathof lifeandbreathof death.Forexample, Bin163g). (2mtw)...'to hisleftearthebreathof deathenters'(2 mto, (Eb854f/856g, As to the actualnumberof mtw thereis a difference betweenthe texts.Bln163b 227All are saidto cometo the heart,'they whereasEb856liststwelve. recordstwenty-two, distribute However, to hisnoseandall uniteat hisanus'(Eb163h). Eb854listssomefifty-two Bin 163. Eb856 to distribution independent all of which seem represent and a of systemof mtw Also,it is notclearin Eb854thatall the mtw connectto theheartandunitearoundtheanus.

Egyptian Medicine, 44. 225 Nunn,Ancient 373. 'Hohlgefflss', 226 Hannig, it maybethatthelatteris a scribalerrorfortheformer. 227 Adthough

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is it independent Nunnhassuggested thatEb854mayin fact represent although, view; an 228 fundamentals. have been diversity difficultto imagine accepted onwhatshould is It includes the is laid Eb163h Theanatomical organs. main onewhich scheme outat in One Egyptian be be to that system. anatomical a scheme might predicted partof anoverall important: being Egyptians i. by listed, 'main' the those the as e. perceived are organs whichall to receivelife;the heartis the seatof the emotions Thenoseis important andthe anusis in the logic is However, there to of parts some whilst expel all noxious matter. necessary hadnoclearconceptof thecirculatory VesselBook,it is immediately clearthattheEgyptians For human have Equally, this that they physiology. concept of nooverall could means system. blood to thought to the to those that contain not were seem appropriate arteries example, mtw but to containair.229Also, it is difficult to imaginethat with all the practicalanatomical

knowledge throughtheembalming processthattheycouldbelievethatall the mtw obtained be due to for One in this lead heart the to the might explanation anus. still unite andyet could 'end'. 'anus' 230 both dual the the and as of wordpbWylt with possible meaning confusion be further, but investigate the this Thereis insufficient to notedas should uncertainty evidence to the the is dependent the Steuer'stransmission of on relationship mtw of wbdw partly

231 anus. in thatfromthetwentyknowledge is furtherillustrated TheEgyptian lackof anatomical functions destinations fifty (thirteen) the contents or of of sevenalleged mtw, nearly percent Thoseareasof the bodywherethe functionsarespecifiedarethosethat are notspecified. (duringembalming) andbladderthey e.g. in thecaseof thetesticles wouldbevisuallyapparent Egyptian 228 Nunn,Ancient Medicine, 48. 229 Thisis possiblybecauseafterdeaththeyappearto deflateandarevoidedof blood. 230 Hannig,288.

in Blnl63aspPWY 231 Thewordapparently to include It appears changed spelling aT fromthelate19thDynasty. bothmaybe different in thatWalkerconsiders andin Eb856cas ppww. Thesituationis furtherconfused the terms.Theformerequates to thatgeneral whereas anatomical regionofthebodyi.e.thepelvicareagenerally, latteris specifically termdesignating a 'ratherspecialised withwhichonlypersonshaving an internalstructure Terms Anatomical Walker,Studiesin AncientEgyptian wouldknow,(or usedfor rectum)'. specialknowledge , 227,223-4.

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Herethemtw wouldseemto wererightlysaidto containor passsemenor urinerespectively. to thetwospermatic correspond cordsandtheureters. The lackof a statedfunction/destination for the othermtw mightsuggestsome (and less However, intellectual is in the the reserve. a magicalelement seen conceptof ears obviouslyexplainedfor the shoulders)wherethe breathof life is said to enterthe (ight side

(ear/shoulder) andthe breathof deathto enterthe left. Thisright/leftaspectmayhavea 232 withtheEgyptian concept of opposites. parallel

Eb856a Thisprescription is nodoubt beginswiththefollowing Itspresence prefaceor heading. intendedto aid its efficacythroughthe gravitasof its divineimplication. Anfangvon demBuchdes Umherziehens der Schmerzstoffe desMannes, in allenKörperstellen istin Schriften alsetwas,dasgefunden unterdenFüssen(einerStatue)desAnubisin Letopolis:zur Majestätdes Königsvon Ober-und Unterägypten Usaphals,dem Gerechfertigten, 233 wurdeesgebracht. found Beginning in limbs the of theBookof Wanderings of a manas was of iKbdw all in writingsunderthetwofeetof Anubisin Letopolis, underthemajestyof theKingof UpperandLowerEgyptetc.,(mytranslation fromtheGrundfiss).

In respectof theaboveSteuerstates,'it is notwithoutsignificance thatthetreatiseon found feet Anubis; the allegedly under of a godwithmedicalassociations andthe tKhdwwas

232 Therearemanyexamples. E.g. deities:HorusandSeth(goodandevil),ShuandTefnut(dryandwet),J. G. TheConflict Griffiths, 1960),1-22.'Cosmic in of HonisandSeth(Liverpool, andthebattleforequilibrium', entities DailyLifeof theGods(London, D.MeeksandC.Favard-Meeks, 1997),19-23. 233 Grundfiss IV

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' 'treatise, the 234 be described However hardly Eb856a a as whilst could mummification'. godof heading, atfirstsight,doesseemsignificant. nevertheless As in Bln163previously, the vagueword 'wanderings' appearsin the Grundriss Thistimefromthephrase:hbbb i+ý, bdw translation.

Heretheword

bbbb originatesfromthe verb hb 'to tread,to travel'235 with bbbb as the compoundversion

in 'tread/tread'. 'traverse' the sense of Faulkner (inreference translation Incontrast, to EMMA) givesa different of theword bb,hb (withthe stickdeterminativei)as, 'to driveout (pain)'.236Thusif Faulkneris correctin ,

his interpretation of thisword,Eb856wouldbe a prefaceto the bookfor 'thedrivingout of limbs (pain) in the all of a man'. ifýbdw for the 'destruction' In Ebl03 at 25,8-11we seea prescription of whdw: fir das (tqbdu)in BauchunddasMen derWurzeldes Men derSchmerzstoffe

1237Herethe .....

Theuseof thisphrasemakesit morelikely (death)of wbdwis clearlyindicated. 'destruction' Thisis because for tfýh_dw to be painratherthana morbidprinciple. whenactingas a morbid from be 'led the body. It to in the off subsequently needs physically accumulates agenttiýbdw (killed)in situ. body.Incontrast paincouldbestopped translated TheGrundriss generally givesbothwordsIVbandbbbbas 'Umherziehen' hasthedanger Similarly, intoEnglishas'wanderings'. theword'wanderings' aswithBerlin154, be better. implying translation might something more esoteric perhaps a more prosaic when of In the contextof Eb563the Grundrisstranslatesthe word bbbb as 'betreten, 238 (pierce, Grundriss The is listed tread). hbhb in the glossaryas word also endfingen'

234 Steuer,AncientEgyptianandCnidianMedicine,4. 490. 235Hannig, A ConciseDictionary 236Faulkner, of MiddleEgyptian,158 564. 237Westendorf, 238GrundrissIV:235

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latter 239 the 'to I 'Durchziehen' through'. why specifically cross see no reason or pull interpretation couldnot similarlybe appliedto E856a.Theuseof the stickdeterminativei is 'pulling implied. Thus is being 'wandering' there than a a more vigorous suggests action fromwbdw.ThiswouldalsoagreewithFaulkner's to'driveout'. through'or a release As suchit is possibleto havea'book'whichis concernedwiththe 'expulsion'of w-bdw

book to In this appropriate notthe'wanderings'of case pain seems quite wbdw. iiýbdwas -'a I thinkthisis morelikelysinceE856ais a preface or heading. onefrompain/suffering'. release Onlyoncedoes wbdw appearin E856and in this preface.It maythen representa generic

I king. 'universal by Anubis the a a mentioned cure all', endorsed panacea, andunder reignof to reinforcetiýhdwasa morbidprinciple. seenoparticular connection 3.2(Iii)TheLeidenPapyrus 1,348- Spell13240 Themagicaltextsof theLeidenPapyrus consistof thirty-nine spells.Theseareeither incantations or a combination of incantations with cursoryphysicalremediesfor various Theword tvbdwappearsin Spell13 (butnowhereelse).Spell13 is medicalcomplaints. intendedto preventthe entryof a malicious demonintothe body.Theremedyfor whichis recitedovera 'figureof Redrawnin fish bloodon a pieceof king'slinen'.Thespellis in a to the commonformatwhichincludesan addressto the demonlistingall its evil intentions Thedemondesiresto forciblyenterthe personthroughthe head,'youaresaying individual. thatyouwillstrikewoundsin thishisheadof hisin orderto forceyourentryintothisbrowof his,to smashin thesetemplesof his',(R6,5-7). 241Oncehavinggainedentryto thebodythe demonintendsto unleash listof evil.242 Thespellwillhopefully a comprehensive counterthese.

239Also the Grundrissgivespýr as 'twist,turn' and umherziehen (in respectof stt ) also as and bt and LpLht Grundriss VI 1:283,574,673. umherziehen,

240 Thetranslations TheMagical 1971). Leiden(Leiden, TextsofthePapyrus aretakenfromJ. F.Borghouts, TextsofthePapyrus 241 TheMagical Borghouts, Leiden, 21. 242 Inthispassage thelistof afflictions in thesecondpersonsingular V, suchthattheyaredemon's aresuffixed tothevictim. whichwillbetransferred afflictions

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'Backwards It willwardoff yourstrikingpower,it willdispel enemy,fiendetc...Retire ... yourejaculations, yourseeds,yourharms,yourdigestion-products, youroppressions, heat (ivýhdu),yourafflictions, yourwrongdoings, yourtorments, yourinflammations ' - and andfire,all the badthingsof whichyouhavesaid:'he shallsufferfromthem! accordingto whichyouhavedone(indeed)l(R6,7-8).

Borghouts inflammationS. 243This in is translates that as a rendering quite good wbdw it takes accountof the Grundfissview of wbdw as Schmerzstoffe since the word 'inflammations' thepathological embraces significance of w-bdwand alsoimpliessuffering. I thinkthe importance of Spell 13 is in the 'type'of afflictionsthat are listedin in thatit appearsto includenotonly'physical' conjunction with nýhdw.Thelist is significant for example,'your harms but also harmsconnectedwith 'biologicalimpregnations', Suchthatit seemsthat wbdw mightbe ejaculations, yourseeds,yourdigestiveproducts'. 244 JiSt. to the

biological to add another substance

However,the 'biological'wordsin Spell 13 needcloserexamination sincetheir has the word cic (with') from line R6,6as meaningsare far from specific.Borghouts Thiswordis oftentakenas'seed,semen'butalsoas'illness'. 245 'ejaculations'. The Grundriss 246Dawsonalsotakesthisview,suchan givesthe wordas 'poison'. 'impregnation withsemen'is 'thepointof contactbetweenmedicine andmagic'suchthat,'it thatsomeevilsecretion wasenvisaged wasinjectedintothebodyof thepatientbya godor a demon,anditseffectwasto causesuffering'. 247This intothe toxicsubstance whenintroduced 243 Borghouts, TheMagical TextsofthePapyrus Leiden,100. 244Bodilyfluidsfigurein magicalmedicaltexts.For instance, thereare severalexamples wheregodsare by theirbodilyfluids.In Papyrus Leiden1,343(R25,1,x and2.26)theyareinvoked: 'Thisis your confronted blood(sni) Horus!Thisis yourefflux(pus? Seth! ' In These (Pwia) Seth!... etc. other are your putrefactions -rji) (mm) andbitterstuffs(4w4 of casesthefluidsofthegodarequotedasthreats. e.g. the'fluid(mwm),poisons FromBorghouts, Seth,Shu,Wepwawet'. TheMagical Textsof thePapyrus 99. Leiden, 245 Wb1:168,167.Theintrinsic forother or seminal natureof thewordas'semen'maybetherootof themeaning determinatives for irrigation, I. e. ) is connected wordssuchthatthewordciet(withappropriate withreservoirs togivelife(Wb1:166). essential 246 129-133. VI11: Grundriss 247 JEA21,39-30. Dawson,

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bothwith It required treatment bodywasconsidered to bethecauseof a varietyof diseases. 'traditional' andwithincantations. remedies in Spell is impregnation by It maywellbethattheintroduction toxin envisaged of some 13. Butequallythe term c3ccan be usedwherethereappearsto be no external(malign) forceS. 248

Alsoit shouldberemembered thattheactof impregnation upona victimcanbeseen in Parkinson, Horus. Seth in battle between humiliation. This is the and witnessed as anactof in ancientEgypt,discussesthe act of malesexual his considerations of homosexuality 249 to thinkthat I aminclined in termsof degradation penetration ratherthansexualgratification. in a widelist of general Spell13 mightbe just suchan exampleof physicalhumiliation degradations. Theexpression 'yourseeds'appearat R6,7butthesameis seenlaterat R6,8butthis bythewordmm- inthephrase,cic- mtwtsuchthattheword'poison'maybe timefollowed hereinstead appropdate of 'seed'(alsoBedin58). It also (Pwi) is aninteresting hereasdigestion-products Thewordtranslated proposal. in Eb296,858f of priorto theproduction appears whereit is takento mean'decay'(verfaulen) worms. 250

in Spell13is notentirelyclear. In summary, I wouldsuggestthatthelistof afflictions Theiruseseemsto be in termsof abuseor threatratherthanof 'actualbiological assault'. (unlessperhaps 218 thiswasthecauseof the Bln58is a casewhereric is drivenfroman alreadydeadbody. death).To addmoreconfusion Steuerviews1*3c to the meaning, of schistosomiasis, as the mainsymptom (bloodin theurine) that'comes haematuria fromthe(infecting) 1VT"'(worm).Theconnection of thiswormwith Egyptian Steuer, Ancient is 'remarkable thesymptoms thesizeof theinfecting andcondition parasite', considering Medicine, 2. Remarkable indeedconsidering thatit is invisible to thenakedeyeandthatthelifecycle andCnidian Bardinet cleto be considers wasnotdemonstrated untilthelatenineteenth of theparasite century.In contrast, factor is factorsbutconsiders It the that it asa factor'normally in body. the oneof themajorpathological present' forkilling (remedy) for thisotherthanin Eb99,'another givesriseto w-bdw.Buthegivesno evidence actually doI'8gypte Lespapyrus m6dicaux whdwanddrivingoutof ciefromthebodyof a manor a woman'Bardinet, 113. pharoanique, 249 'Homosexual R.B.Parkinson, 'DesireandMiddleKingdom 56-76. Ulterature', JEA81(1995), 250 VI:108.I thinkthattheallusion See Gnindriss to wormsmayindicate thefinality(seriousness) of a condition. laterin thetext.A translation yourseverit(ofintent), mydiscussion withthisin mindmight'fit'thelist:yourharms, youroppressions.

72

ndw appearstowardstheendof a list whichis associated or shortcomings withpersonal 'pain' The translation torments. as e. g. your of afflictions wrongdoings, your spiritual tvýh-dw inthetextto makesensein context, suchthat: couldstillbesubstituted I youroppressions, yourwrongdoing, yoursufferings, yourpLins,hate yourtorments, ' andfire andall the badthings...

3.2 (iv) Admonitions of an EgyptianSage In Admonitions of an EgyptianSagetranslatedby Gardiner251we are presentedwith

twoclearexamples of wbdwwhichseemto supportitsuseas'pain'or'forbearance'. formof wbdw It appearsin theformof wbdwywhichNunnstatesto be a participle I do not thinkNunnhassufficientlyconsideredhis inclusionof i.e. onesufferingfrom wbdW252

this term.It is the only exampleand also contradicts the completetranslation givenby Gardiner. hdýVW253 sA?thb ........... týý, rnm. f, hcw,f

'remember to immerse himwhois in pain(?) whenheis ill in hislimbsI ...... 254It is obviously thb is takenby Gardinerto mean'soak,immerse,dip, irrigate. relevantto the medicaltreatmentof the patienthere,the onewhois in pain.

foundwith this sense(i.e. soaketc.) in the medical The word thb is commonly (Eb,H, Kah,Bin).Itsuseis typicallyillustrated literature in Eb32wherea liquid(drugremedy) is appliedto produce (qbb)of theaffected reliefbyirrigation pad. Steueradmitsthat whdyw in Admonitions is 'problematic'. To overcomethis he that'if the lacunaaftert, is ignored'thenit wouldbecomea participleto read, suggests -hb

TheAdmonitions 251 A. H.Gardiner, Sagefroma Hieratic (Leipzig, 1909). inLeiden, ofanEgyptian Papyrus Egyptian Medicine, 61. 252 Nunn,Ancient Gardinergiveswbday as thesingularparticiplefromtheverb wbdto suffer singularto accordwithmn.f 253 254 AlsoHannig,939.

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bdwY. 2551 think it is more likely that the lacuna 'those (the one) immersedare called ivý,

by is that (like the the applied actually tbb) substance of nameof obscures otherexamples to relievethe'onewhois in pain'-the wbdwy. soaking

In lines13-14(105)we see uý, bdw as painin the sense'to bearor endure'.It is difficult

In thefollowingvvýbdw hdwas Schmerzstoffe hereto envisagew-, appears asan or otherwise. formfollowing infinitive týh: tgndjbjýh tfýbdw k?iry. 1stn

ZT. f

Itp.1swmdwtnt (mcir) drindmal

'WouldthatI hada heartableto suffer Then/ wouldrestuponit ) I wouldloadit withwordsof (misery? I

256

wouldwardofffromit mymalady'.

Entriesfor "dw. 3.2 (v) OtherPrescHption

intowhichit is difficultto fit the morbidprinciplemodelof Theseare prescriptions in I (or 'pain' be the the bdw which consider would as more)appropriate. and use of word w,

Ebl3l The 'spell' in thatit is an 'incantation' Eb131is interesting §nt againstabdw,, oýhdw. is to berepeated whenandif: in whdwprm bkn

Egyptian Ancient Medicine, 255 Steuer, 40. andCnidian Admonitions Sage,105. 256 Gardiner, ofanEgyptian

74

in respectof theterm If the 'm'here is takenas a 'stateof being',or is concomitant ) 257 it thenmightimplysomelocalised infection. Thenwbdwas'pain' (painful) bý-n,(swelling? 2

fit, theswelling to suchthat:'it is painwhichcomesfrom/duflng wouldseem .

Eb336,741 Theseareheaded: krtrrdt'-"'r

for is done be 'what to ntwhdwmsnfmlrw4,

blood in (both)eyes'. rdtnt whdwwith 258-a tumourof The Grundrisstranslatesthis phraseas G5wachvon Schmerzstoffe In theirrecentappraisalof wbdwKolta andTessenowcitethis as an example Schmerzstoffe.

thatthewordis associated withinthephrasesuch of wbdwasa morbidfactor.Theymaintain that it preludesthe meaningof tqbdwas a specificsymptom(pain).Theyarguethatthe be Thus be in lexical the a must condition noun must combination with preceding rdt whdw. result of iiýbdwitself. 259

I However, is thattheyaccepttheGrundriss theproblem translation withoutcomment. thinkthatthe interpretation of the wordrdt needsfurtherattention.It appearsonlyin this (one) in but Nunn the the a not medical context. prescription gives meaning of wordasgrowth tUMOUr. 260The

'synonymous with

to derivefromthecommonly wordappears usedverbrdl'to

261Inthissense,its useequatesmetaphodcally As thesamein Egyptian grow'. andin English. 262 Onlyif to prosper(financially) suchit meansto 'flourish, andevento overgrowwithweeds'. its meaningis viewedin a medicalcontextcanit be supposed to meana (tissue)growthor in thisprescription to suggestthatit is a turnour.In fact,it tumour.Butthereis no evidence Theonlyactual as a turnoursinceno exactlocationis specified. seemsdifficultto envisage

568,Bardinet'foyer Lespapyrus 257 Westendorf, 262. deI'tgyptepharoanique, putride', m6dicaux V:79,Westendorf, 609. 258 Grundriss ZAS,127,44. 259 KoltaandTessenow, 260Nunn,AncientEgyptianMedicine,224. Hannig,462. 261

Dictionary A Concise 262 Faulkner, 154. ofMiddleEgyptian,

75

head be likely to the is in both is indication This blood a of result more eyes. of symptom an these Importantly, injuryor eyecondition. anyinternaltumourof theheadwhichmightproduce

is 'growth' tumour The identifiable. be be a a as a of view couldnot seenandsonot symptoms it I from that wasa concept suggest analysis. concept only experienced post mottem modern 263 beviewedsimilarlyby the ancientEgyptians. thatwouldnot necessarily It is easierto see rdt in termsof 'non medical'growthand ratherto viewit in a more

be The in phraserdtn ifýhdwwould could a symptom. case way which conventional wbdw thatis 'thegrowth(increaselgetting thenimplya growthof w, worse)of painresultingwith -hdw,

bloodin theeyes'.

Eb858

QTX 264 The prescription is headed:a remedy(§s3tofor btihnt bprt br wdt n because has ' the that bdw, of ivýhdw movement of -. occurred an abscess w, Here,theimportant phraseis, hnhntl!

l!

266 of Mcer/abscess/boil wbdW265 Z'Snt

iqbdw'. hasapparently Heretheboilor abscess or displacement arisendueto themovement has the This face it implies fluid that the that caused agent phrase, on a of of whdw. whdwis in is here E858, However, but the the used also word phraseonlyappears at abscess. wdt is clearer.Sm43is concerned Sm43,whereits useas 'movemenf with'puttingback'a joint thathasbeendisplaced a 'jolting'or 'movement' andin thiscontextthewordseemsto indicate in terms bdw 267 This this to to the of of mightalsoapply symptom n,, required achieve effect.

in England. The from 1847 263 Theword'growth'to meana morbidformation have to been onlyseems used 1978,897 English Dictionary Shorter Oxford Pfinciples 1972).Revised 3rded.2 volumes. (London, onHistorical VI:234,Vertagerung 264 Grundfiss shifting'. -'displacement, 265 Thisis another oftheappearance see example of wbdwina relatedphrasethatKoltaandTessenow itsuseasa symptom ZAS127,49. ofdisease, precluding 266Grundriss VII:609 for settinga dislocated Ancient Egyptian Medicine, technique 267 It is a recognised Nunn, illustrated in shoulder, 179.

76

1.

.ngpain'.However, I do concedethatthe indirectgenitiverelationship of wdtwith w, 1016 -hdw Butthelinkcouldstillbeoneof description to thisproposal. or causeto couldbe problematic from describe theprodromal symptoms of the boil,'a boilcausedby pain'or 'a boilresulting pain'

Bin75 Theinterpretation difficulties. It concerns thetreatment of of thisprescription presents a patientwhois saidto be:bry Pn i+,-bdw.

1" HereP appears asl

269 The Grundriss ZahnsmerZ translates this as word 1.268

Westendorf 'toothache' because 'toothache suchthatthephrasebecomes of Schmerntoffe'. 270'crampof the translatesthe worddifferentlyas the somewhatvaguetermKaumuskelkraMpf

Thisphraseis problematic in thatit seemsthatthe to wbdwas a symptom smallmuscles'? is a resultof the wbdw.It seemsunlikelythe toothache (pain)is a resultof the toothache itself. bdw(pain) w, However, in theKahunPapyrus theworddi alsoappears at Kahun5. Itsentryhereis puzzlingand so throwssomedoubton its meaningat Bln 75. The KahunPapyrusis a treatise.It hasa commonformatwhichgenerally gynaecological startswiththe expression: fora womanwhosuffersfrom'followed 'instructions bya description affecting of.thesymptoms thefemalereproductive the'teeth'and'gums'areclearly organs.Yetin Kahun5 surprisingly for a womanwhosuffers mentioned usingthe termtA Kahun5 is headed,'a prescription (mn.s ) in her teeth and gums and cannotopen her mouth'.This is followedwith a ddbrkr. s arpwpmt2T'thenyouwillsayconcerning uponthecondition, pronouncement her/it,'it is 0 of thewomb'.Clearlythiscannotbe'toothache Nunn translates this the of womb'.

268 It appears to bea falserendering of to.

\-jj

1.

Westendorf, 168.

269GrundrissIV:67 168. 270Westendorf,

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271Westendoff to the as 'acutepain'. use the wordKaumuskelkrampf whichis appropriate Icramp'type of painexperienced It may be that the word tR is with uterineconditions. in Kahun5 the However, to describe thetypeof painas beingsimilarto toothache. attempting is reconciling thismetaphorical problem connection withthewombandwiththeprefacewhich describesa womanwho 'suffersin her teeth',(the word jbpw clearlybeingused).It makes

littlesenseof whdwtobea pathological agentasfarasteethareconcerned sinceit is difficult 272 area. inthis

itsaccumulation to visualise

H4,26,29,30,41-7 Thetermiiýbdwappears in allof theaboveprescriptions fromtheHearstPapyrus. 1-14: for the expulsionof whdw from pbrtpt drrlmw" nw whdwppwy. Thisis a prescription the anus. There is some uncertaintyover the meaningof rlmwe

J the term ZJ, ra 01

The Grunddss fails to translatethisterm.Leakehasthislineas:'to expel proceeding wpdw. 273Westendorf ) (base/basis? hasit as 'theexpulsion gripingpainfromtheanUS'. of theStOtzen of

274 I anUS'. from for local it is important H4 is the think to that a prescription remember whdw

(direct)application to theanus.Inthecircumstances, it wouldseemlikelyto bea preparation to by Leake soothepainratherthanexpelsomemorbidprinciple.In thiscase,the translation the painseemsappropriate. Theincidence wherethe termrlmw-ris takenas describing of in particular in Chapter 4. painandanaldiscomfort willbeconsidered

Egyptian Medicine, 271 Nunn,Ancient 34.It appears alsoin Sm7where(dental) painseemsto bea clearerfeature. Thisinvolves aninjurytotheskullwhichisfollowsbyfeverand63whichaffectsthemouth. KoltaandTessenow 272 for wlidwratherthanSchmerzstoffe. It is quiteappropriate usethewordLeidensmacher However forBIn75. theyalsosubscribe to wbdwasa transitory 127,45-8. ZAS feature, pathological 273Leake,TheOldEgyptianMedicalPapyri,62. 338. 274Westendorf,

78

H26:

pb,tt nt sd uýhdwmht H29: pba nt sd whdwm ht Boththeaboveprescriptions 'to breakup' wbdwfromthe bodywhich aredesigned 275 Leakegivesasto 'breakuppainsinthebody'.

H30 dr ifbdwm gnbt

Thisis morespecificin thatit is to 'expel',or'breakup' wbdwintheAnbt-LY'. BothWreszinski translates the andLeaketranslatethiswordas 'skin',276whilstWestendorf 277 wordas'breast'. Theword'skin'wouldbe significant herebecauseit wouldbe difficultto conceive being 'accumulate' in There is dw direct the to the of as able skin. no connection mtwwith uýh, the skin.Also,anydisturbance of the skinwouldbe a localdisturbance andso likelyto be painful. The overallnon specificpainof arthritisis perceived via the skin.Leake,in fact, thisrangeof Hearstprescriptions for arthritis.If so, thenas considers arefor the treatment mentioned otherpartsof thebodyarepreviously skinmightbe predicted at H30to complete buttheprescription ingredients sucha list.Thisis a logicalassumption, arenotspecificenough andat H30the wordappearsas an intemalremedy.Also,the word§nbtas breastis well I Wreszinski think that theerror.It appearsin waswrongandthatLeakeperpetuated attested. Eb187asanalmostexactcopyof H30:ktntbsAvýhdWms'nbt,'another to driveaway(repel) breast'. However, in the wbdwaspainis stillappropriate. vvýhdw

275 Leake,TheOldEgyptianMedicalPapyri,80. DerGrosseMedizinische 276 W.Wreszinski, PapyrusdesBerlinerMuseums(Leipiig,1909),7. Leake,above. 552.AJsoWalker,Studiesin EgyptianAnatomicalTerminology, 2" Westendorf, 276.

79

H41.42,46,47 H41(E584): bdw nhpm I'tnbt nt s pba nt dr i+, H42:pbrtntsm? whdwm ctnbt H46:spwnwsn2iwbdwm rtnbt H47:pbdntsni? wbdwmht All the aboveareto 'expelor deaden'ifýhdwin anypart(limb)of the body.Leake (42-46)'todeadenpainsin anylimb'.278 theseasa groupof prescriptions translates -

11.

H41is interestingsinceit has wbdw qualifiedby nhp roA The Grundrissgivesthis 279Leakegives it as 'throbbing'.Thus, we have a 'throbbingof as, 'schneiden,springen'.

have ' It is difficult Leake 'throbbing to dw. to pain'. and as pain: not agree with iKhdw mh, it is difficultto envisage Conversely, Leake's a throbbing' morbidprinciple. viewof thisrangeof E41 does to treatment sincethe as arthritis seem particularly appropriate prescriptions bandaged 'throbbing to theaffectedlimb.Again,this pain'is treatedbyanexternalapplication forremoval is inappropriate of an'internal' element.

278Leake,TheOldEgyptianMedicalPapyti,81. 409. 279GnindrissV11:

80

3.2(vi)TheConnections of whdwwithGreekMedicine I believethis to have Sincethe theoryof uýhdwhas generallywon acceptance, in Greek the idea Egyptian to to the areaof connections and some extent, provided, of support bySteuerandSaunders. asproposed medicine Thelink betweenthe EgyptianandGreekmodelsis describedin the following:'wbdw

althoughof greatimportance schoolof thoughtbasedon the represents onlyoneparticular to is theabilityof ivýh_dw formation ofpusandthecorruption of theblood.Thecommon element 280 convettthebloodintopusto CoagUlate. into 'Asto thecoagulation of itýh_dw effectof wbdwupontheblood- theconversion /

of pusin theblood)as the pus Iryy wasbelievedto producea stateof pyaemia(presence ---A

281 stageofbloodcoagulation'. preliminary Accordingto Steuerand Saundersit is 'pus' that linksthe two models.Aristotle hdw Egyptian idea 282 In digestion. the the the model associates of sepsiswith processof tvý, is Greek (sepsis) in the that the the sepsis of coagulation produces pus coagulates, model 283 byabnormalities inthedigestion produced process. However, is that thereare no textsthat the seriousproblemwith theseproposals to be noconnection with connectwbdwto thecoagulation of theblood.In factthereappears 'plus blood In Bardinet the this grave,on chercherait at all. and respect of point writes: whdw le du de manlerenonequivoque pus par sang en vainunpassagedecrivait cettecoagulation 284InfactSteuerhimselfseemto concede danslesvassauxl. theabsence of evidence repandu

280It is interesting to notethatare nowtoldthat w, Irepresents onlyoneschool'of thoughtwithoutbeing -hdw informed be. Steuer, the Ancient Egyptian 7,26. Medicine, of othersmight andCnidian 281 Steuer, Bulletin 10,26. oftheHistory ofMedicine 282 381b,12-13. kistotle,Meteorology 283Heeithermisquotes Aristotleon thispoint.kistotleis writingin Meteorology or misunderstands aboutthe loss typesof heatonthedryingprocess. the Hegivesdigestion effectsof different of gradual of example an as lower down (381b, I that intestine 13). the drying the is that'excretion surfacemoisture so putrefies' effect such theunpleasant thinkthisisto explain it is notpus. change ofthenatureoffoodintoexcreta. 284 Lespapyrus Bardinet, de1'8gypte 130. m6dicaux pharoanique,

81

the hdw (sic) in hisoriginalwork'concerning the upon of specificaction týý, particularments of information is offeredby themedical 285 blood,nodidactic papyril. However, he latertriesto supplywhatis missingby histranslation of thewordts as 286 Thewordts'ýIlu appearsin themedicaltextsandseemsto bea derivative 'coagulation'. r. =

of the verb ts -"ý

to knot.287Steuerstatesthat 'the specialmeaningin medicaltermsof ts

288He bloodcoagulation (is)usedto designate tissues'. the and solidification of cartilaginous offersnoexamples. Withinthe medicaltexts the word appearsin a few examplesonly. The examples

latter (Sm) (Eb, H), 'internal' the specific surgical concernsome cases andsome cases albeit to bethesamecase.In Sm5,1weseea casewiththeinstructions: allrepresent whatappears 'youmustlift (thebandage) ,

recoII6)289

totheshellofhisskull'.

In Sm5,19w6have:'youmustcleantheinteriorof histwonostrilswithtwolinenstrips Gloss in theinteriorof histwonostrils'. soasto removeallof thebloodwhichts (isattached/li6) 12 for the aboveexplainswhatis meantby the expression 'all the bloodwhichis ts to the interiorof thetwonostrils,'it is bloodwhichis tfh (baked)in theinteriorof thetwonostrils'. Theseareclearlycaseswherebloodis 'boundin thesenseof being(attached, fixed)'clotted' ona wound.Thereis noimpliedmorbidpathology.

285Steuer,Bulletinof the Historyof Medicine10,15. 286Steuer,Ancient Egyptianand CnidianMedicine,47. 287Wb 5:396.

288Steuer,AncientEgyptianandCnidianMedicine,47. Lespapyrusm6dicauxde 1'8gypte 289Bardinet'recolW, 130. pharoanique,

82

Theothercasesarelessclearsincetheyareinternal'caseswhichconcerna 'poolof is unableto ts (bind): blood'which snfpwSS'n tstf (Ebl98a),

s§n snfn tst.f (H143) s9n snfn ts.n.f (Eb593) All are prefacedwiththe description tautnessof the of a 'blockage of the stomach, skin',withthe subsequent pronouncement of 'a poolof bloodwhichcannotbind'.It is very difficultto envisage becauseof this 'pool'would whatis meanthere.A blockageoccurring thatsomething, suggest evenblood,wasin factlodgedorfixedratherthantheopposite. He Bardinet in a reviewof Steuer'sproposals forthesepassages. makessuggestions /6 takesthis as illustrative of the powerof bloodas the mainlife force.71fautcomprendre encorequele r6ledu sang,quiestde fierlessubstances se trouvant6 soncontact,ne peut

290 Bardinet's s'exercee. suggestion of bloodbeingbound andsodeprived of its lifegiving is plausible, butthesepassages capability offered.Also,he givesno are the onlyevidence indication thebloodwasthoughtto reactwith. of whatsubstances If thewordts in Ebl98aetc.is takento mean'coagulate' bySteuer(i.e. a asproposed reactionwith wbdu), then we would have a blockagecaused by the blood unable to

becoming coagulate, yetstillpresumably pusin orderto produceillness.Thisis notthesame Steuer's 'coagulation'of unobservable pathological process. I thinktheconnection bdwis unproven. theorywithuý, of Egyptian andGreekmedicine between Whilstinfluence GreeceandEgyptcannotbedenieditsextentin thisrespectis oneof In the absenceof specificEgyptianphilosophical texts,anysuchlinksbetween assumption. Greekand Egyptianthoughtmustremainsupposition. The situationhas beenexacerbated because thattheirownphilosophy of theassumption of theGreeksthemselves wasbasedon

290Bardinet,131,above.

83

Egyptianthought.However, the provenparallelsare veryfew andon analysissurprisingly It is impossible imprecise. 291 inthisarea. tofinda singlecaseof influence

3.2(vii)Conclusions on Mdw. On balancethe ideaof ivý, bdwas a morbidprincipleis unproven.

is unsound Steuer'sworkis basedon his interpretation of Berlin154.Histranslation idea it likely he it fit his I that the to this to think of appears use make and assumed model. duringtheembalming substance observed with noxious process wasin somewayassociated It is not diseasein the living.However, I thinkany link is moresupposed thanschematic. factor. to believein someconnection andalsoto needa namedpathological necessary is difficult Equally, theuseof humanandanimalexcrement ingredients as prescription factor. to reconcile withitsbeinga carrieror generator of a pathological KoltaandTessenow haverecentlylistedand appraised the possiblemeanings of TheydismissSteuer'sviewthatit is a pathological processor specificagent,butstill tvýhdw. suggestit to be a causeof illnessor a pathological way'.They agencyin a 'ratherunspecified 292(causeof suffering- mytranslation). In thissense as: Leidensmacher rendera definition theyseeit as a possible causeof diseaseanddismissthe possibility a specific of it meaning (pain).However, theirreasoning symptom of themedicaltextsis basedupontheinterpretation Whilsttheypresenta validsummary of theGrundriss. of thepossible meanings of whdwtheir donotfullyconsider thefactthatwbdwcanbeunderstood conclusions as'pain'. I thinkthatanattemptto seeka singlespecificmoderndefinition of uýhdwforthesake

isa mistake. terminology Whilstconvenient it restricts thepossibilities ofsatisfying of meaning; In its this suchthatthe termLeidensmacher restrictsthe possibility as a symptom. of use

15,38. 291Barnes,TheEariyGreekPhilosophers, ZAS117,52. 292 KoltaandTessenow,

84

is to It Schmetzstoffe is definition. better it for term perhaps wise a since allows a wider respect leavethetermun-translated. I amnotproposing thatthewordpaincan that whdwjustmeant'pain',noradvocate intotheexamples I havegiven.WhatI dosuggestis thatin manycases simplybesubstituted juxtaposition Themetaphorical theword'pain'fits as easilyas otherinterpretations. of words Also,in manycasesthereis a betweenliteraryand medicalcontextsis underestimated. 293 to cometo themedical textswithmodernanalogies tendency of meaning. It wasobviously termwhichin someinstances animportant mayhavehadsignificance beyondsuffering per se.Thefactthatit appearsonlyin the medicaltextsseemsto support ButI thinkSteuer's this.294 pursuit arewrongandhavebeenseminalto erroneous conclusions of theterm. justoneof semantics. I thinktheproblem is probably ndw maywellhavehadmore in thatit mightbe a generictermfor illness(evenfrommorbidassociation) thanonemeaning (ill) be 'sick' in is Such English, 'pain'. that the can specificity one still retain an of example, yet is difference be In the 'sick' 'vomit. the to to absenceof context alsomeansspecifically yet impossible to detect.Themedicalpapyriarenotdetailedenoughto providedefinitive evidence Grundriss in has the the this cautious view of respect createdan additional,and perhaps and

'pain' illusion Overall the there word of mystery. where appearmoreexamples unnecessary, for ifýhdw. a translation wouldbeasappropriate Asfaras I cansee,therearenoexamples and rendering where'pain'is nota possible therefore noneedto lookfurther.

isonesuchword,seediscussion m Theword'growth' 3.2(v),page73. onEb336, aboveChapter In legaldocuments m Compare the 16thCenturyuseof the Englishword'possession' it in differing contexts. byanevilforcebutto be thesewouldmeannotonlydomination yetoutside wouldmeanactualor legalownership in'possession Historicalftciples,1635. English Dictionaryon ofa condition'i. e. anillness,ShorterOxford

85

2, 3.3sttT, %"%3% Thistermlike whdwhasbeenthe subjectof discussion. firstsuggested Wreszinski 295Later,it wasdescribed by Dawson to thatthetermstt appliedto 'swelling(boil)or tumour'. mean 'shootingor acute pain' and has since been translatedby the Grundrissas 296Thelatterinterpretation 'Schleimstoffe'. is important becauseit impliesa conceptual term, partof the Egyptianviewof the aetiologyof disease.Thismakesit necessaryto reviewit in this

thesiscn pain. ý"? ' The derivation 'to shoot, of stt as 'shootingpain'comesfromthe verb st! (arrow/person), to impregnate ) and to stare (to shoota stare?a female(ejaculate? )'.297However, it alsoappearsin phoneticform,unrelated to the abovein stt 'ground' glare? and styw'Asiatics'.Withthe waterdeterminative the verb st! meansto 'pouror flow'.As

suchit appears at Eb9l,768,207d. The W6rterbuch summarises all thesetranslations whenit givesstt as: 'swelling, featureof disease 298 turnour, ofthehead,neck,chest,bodyandotherwise'. There are essentiallytwo positionson the meaningof the word stt.- firstly, Schleimstoffe factorand therathervague'featureof disease'or pathological whichembraces theviewof Dawson type'. secondly wherestt is regarded aspainof an'acuteshooting TheGrundriss bythewater fromtheverbstj to 'flow',evidenced seesstt asoriginating determinative' 'Es sindalsoStoffe,die in K6rperumherziehen'. 'It is alsoa substance 299Thisideathatstt is a substance thatwanders whichtravels,wandersthroughthe body'. throughthebodyderivesfromTheVesselBookat Eb856fwherethereis briefmention of stt in to be connection withthe mtw. Thus,we haveanothertermthatwasoriginallyconsidered 295Wreszinski, DerGrosse Medizinische Papyrus desBerliner Museums, 131. 296Dawson,JEA20,185. GrundnssVI:813,for bothformsof stt with bothpustulefZ andwatercleterminatives 297 Hannig,778.Wb4:330. 298

Wb4:333. 2wWestendorf, 343.

86

'pain'butlater,like w, is presented andwhich significance as a featurewithpathological -hdw, travelsthebodyviathecirculatory system. If whdwis a featurethatunderlies it seemsdifficult thecauseandspreadof diseases Steuerdoesnot to imagine theneedfora secondfeaturewhichmayoperateinsimilarfashion. considerstt in his considerations of wbdw and the embalming process.Likewise,the Grundrissis non-committal as to anysignificance of sawithinthe pathological process.

It maybethateach'factor'wasthoughtresponsible fordifferent of disease categories or withindifferentpartsof thebody.At firstsightstt seemsto be orientedaroundthe upper body,particularly 300 However, as Schleimstoffe with seemsconnected withcoughandcatarrh. it is difficultto imaginewhytwo different an anatomical systemall thoughtto interconnect between them. agentsarerequired pathological andwhythereis nointeraction In fact, Bardinetconsiderssuch interactions as part of the diseaseprocess.He includesstt (alongwith whdw) asoneof the'fourmajorpathological factors'andof extemal he failsto explainits 'externalorigin'andgiveslittleevidence to supporthis origin.However, Hemerelysuggests for stt as a 'livingsubstance'. thatEb296givestheevidence conclusions. Hereasons that,sincestt is derivedfromtheverbsti'to flow,pour',thena connection withstt 'flowing'throughthe mtwis made.301

It is necessary to lookcloselyat the examples of stt as theyappearin the medical papyri.

300Eb52,298.

Lespapyrus deI'89yPte 301 Bardinet, m6dicaux 121,125. pharaonique,

87

(1)E296 k hr ir n231. y stt m nk w(t) Abth t.Jýbr.s

HereDawsonseesstt as a symptomof 'somestomachtrouble,whichmakesthe abdomen rigid'.Hestatesthat'themeaning of (theword)ný-w(t) A

(whichfollowsstt)

is unknownto me'.302The Grundrissalso suggeststhat thesesymptomsarisefrom'tightness'

of thestomach It (alsoSchmerzen). The Grundriss translatesthe wordntw (t ) as 'Schneiden is givenas, hereandBerlin94,alsoat Eb`102 (var.ný-w). Thetranslation appears Schmerzen', 'Wenndueienen(Mann)betrachtest undschneidenden mitSchleiffistoffe 303 fromSchlebstoffe i.e. 'if youexamine (aman)whois suffefing anbcuttingpain'.... However, the Grundfiss translation seemsto ignorethe W betweenstt andn*w andso separatesstt from the symptomof 'cuttingpain. If the W is treatedas an W of is In 'stt this then a concomitance, would pain'. sense read: withcutting it stt notnecessarily disease feature,but,couldbe'shooting painwithcuttingpain'. However, laterwesee:tum stt.fm ht.fn gm n.s witntprtn grt witpny-SIM.f 1sttis in hisstomach it cannotfinda wayout,alsothereis nowaythatit couldgoout'. in hisstomach, 'if it putrefies It continues, it cannotescapeand(finally)becomes worms.It will better. wormsif it dies.Then,it separates notbecome outandhequicklybecomes Thispassageis curiousandat first sightmightimplythe presence of someactive factor.It differsfrom vKbdwin that it appearsto be a factorthatcannotbe (pathological) 304 oUt'. butseemsto haveto 'separate It is this expelled

thatBardinet givesas passage

for stt as a pathological factor.Thefollowing is mytranslation evidence of therelevantsection (fromtheFrench): of Bardinet

302Dawson, JEA20,185. 303 Westendorf, 602.

discussed later,wheresucanbedrivenoutandexpelled However, 304 intheurine. see131043,

88

Wnnsttmht. fngmn. s witntprtngrt

hnti. im. f_phw.; ihnrsm if' witpny. s

'If youexamine fromstt withpainin theinteriorof hisbody a manwhois suffering the stt whichis thecausecannotfinda wayout.Thereis no wayfor it to leavehim Then,it mustdecayintheinteriorof hisbody(always) withoutbeingableto leave'. The importantpart is that underlinedabove.Bardinettranslatesthis specificallyas it must

de lint6rieur dans decaynotmaydecay:'Alors,ils devront(--nepourront d6composer que)se is it (toujours)'. decay because decay He then that a soncorps not might reasons stt must (whichby definition 'livingsubstance' mustdie anddecay)andwhichwhendeadtransforms 305 into worms.He statesthat Eb296showsthe urgentneedto avoidits accumulation. is hypothetical. However, between It relieson theconnection theanalysisby Bardinet stt and However, 'worms'andthatthelatteris actuallypartof thediseaseprocess. stt andwormscan occurseparately. in thatthe stt Theconditionin Eb296seemsto be concerned withan 'obstruction' fromthestomach. However, I thinkthattheimplication may cannotbe relieved of putrefaction In otherwordsthe to conveytheseriousness wellbe allegorical andintended of thecondition. mightbefatalunlessthesymptoms condition pass.In thiscaseit allowsfor stt applyingas a i.e. 'pain'. symptom Thewordusedhereat Eb296forwormis bsbt Thereareseveralotherwordswiththe I determinative foundin themedicaltextsfor example,ILtw(B205), si, sp (Eb671) worm in viewof thesupposed is highincidence andAt (H196).However, of parasitic worminfections 306It is thereare onlytwo thatcan be actuallyrelatedto someknowncondition. surprising logicalto assume therewouldhavebeenrecognition (andso possibly connection) a perceived betweenthe apparentspontaneous appearanteof maggotsafterdeathanddufingcertain

Lespapyrus 305 Bardinet, deltgypte,125,6. m6dicaux 306 ThetwowordsareLiVelandpndwhichappearto correspond to roundwormandtapewormrespectively, see Egyptian Medicine, 72. Nunn,Ancient

89

(infected) For instancethe actualpresence medicalconditions. of maggotsin gangrenous in Eb296 described If thecondition woundsis an almostcertainpreludeto fatalsepticaemia. to be a seriousor fataloneunlesstreatedthenthemention wasequallyconsidered of worms mightbeincluded assuchanindicator.

(2)Eb297(52,7-10),Bin 136

Eb297 ktntdrsttm, ht

'another (prescription) to driveoutstt fromthestomach'. Berlin136 pbd nt dr stt mht m ctnbt

'a prescription to driveoutsttfromthestomach andallpartsof thebody. Essentially thesearevariantson Eb296buttheydifferin thattheyshowthatstt can indeedbedrivenoutof thestomach andall (other)partsof thebody. In BIn136suis notlocalised, it is desc(ibed asbeingm ctnbt'in allpartsof thebody'. Thisseemsto correspond feature betterwithit meaning 'pain'asopposed to somepathological thatneedsto 'collect'andthenturnto worms.Eb297,'another(prescription) to driveout stt fromthestomach'. Eb300is similarbutaddsto thetitle'of a manor a woman',kt nt dr stt m ht nt s st r-pw.

Dawsonseesthe aboveconditions as 'colicor someotherformof acutestomach307However, if the mentionof wormsis an allusionto theseriousness ache'. of thecasethen 'colic'is hardlyappropriate. Butsome'formof stomachache'(dueto constipation? ) is implied to an extentby theformulaof theremedyin Eb297.Thisconsistsof an internaldoseof figs, curninandcarminatives whichwouldhaveanaperient effect.

307Dawson, JEA20,185.

90

(H35) (3)Eb294(51,15-19). ý In H35,stt is shownas,withboltV 'and a 'woman'determinative,in Eb294as 'z a pustule. sttwith In theseprescriptions Thisexcludes the possibility the lowerbodyis affected. of stt being a factor confinedsolely to the upper body. pAtt nt sW (yt) At m npPw. It is a

is 308 Aftertreatment 'prescription to causeto godownstt fromthe'pelvis'or 'groin'. stt saidto (subside)ep-ýsA?.t! Pr -rwy.It is thisprescription the 'godownimmediately' whichprompted Sucha swelling translation thegroinareacouldbea boilor a hernia,and of sttas a 'swelling'. down'(the to'cause U to come swelling) wouldseemto appropriate. rd!, Leakeagreeswiththisreasoning 'tocauseanabscess andgivesH35asa prescription butthe most 309However, thismightbe convincing, or swellingin the pubicareato subside'. is wellattestedin themedicaltextsas Owt common wordfor 'swelling'

A

It doesnot

found It is here. It Eb556,553,558-560,562,563,583-5,589-91. also appearsat occur frequentlyas a verb gfw in Eb871c,561,767, Sm4l etc. It frequentlyappearsin Dawson dr,§fwtm hff (Eb556). accompaniment withtheverbdr'to driveout',forexample, translates pain'i.e. releasefrom(shooting) rd! 19stt as,'tocauseto comedownof (shooting)

310 pain'. I thinkit important to consider theareaof thebodyin whichthepainoccurs,thegroin describes is 'shooting he because that the or pelvis.Dawson groin or acutepain' reasons stt as ) pain.However,I think that Dawson's not an appropriate areafor rheumatictype (dull? is flawed.A painin thegroinis morelikelyto be theresultof an abscess reasoning or evena hernia(thelatterbeingparticularly for a hernia Thetypeof painexpected welldocumented). felton movement, wouldbe dullpaingenerally whilstthe painof an abscesswouldbe acute 308GrundrissIV:140,Dawson,JEA20,185.Walkergivesthe word'groin,inguinallymphnodes',AncientEgyptian 270. AnatomicalTerminology, 309Leake,TheOldEgyptianMedicalPapyri,80, 310Dawson,JEA20,186.

91

but,generally Whist'pain'mightbeanappropriate translation onlyfeltoncontact. of stt in this I amlesssurethat'shooting' If the in viewof thelikelycondition. example, painis convincing thenpelvicpainmightsuggestarthriticpainof thehip.Also,suchpainwould pelvisis involved to have Equally, tendto bedullratherthansharpor shooting. thereseemsto benoevidence a pathological agent. sttas 'Schleimstoffe',

(4)Eb295(51,12-19) Inthisprescription the'neck'is clearlyaffected: k s stt m Wt. f ir n2i3.

Jw.fmn. f "ty n npbt.f iw. fmn. f tp.f

iwlswnnhbtfn, ht iwnpbtf wdn.tin bpr.n n.fdgtn btf

iw tsn r.f dd M'.kbrysttmntbt. f 'If youexamine a manwithstt in hisneck,hesuffersin thebase?aoint)311 of hisneck, hisheadhurts,thevertebrae of hisneckarestiff,hisneckfeelsheavy,he is unableto turnit (lookat hisbody),it is painfullawkward, youmustsayit is onewithsit in hisneck.' Thesymptoms in thisexampleareclearerthanthosein (1).Thepatientis suffering from stt of his neck,312which is desc(ibedas painfulwhen an attemptis madeto inclineit

describes 313He towardsthebody.Dawson thiscondition as a caseof 'fibrositis or stiffneck'. butit seemsreasonable doesnotelaborate to suggestthatthestt is 'shooting pain'produced

byanyattempt atmovement. boil does swelling as or notseemappropriate stt agent. nordoesstt asa pathological Studies inAncient Egyptian 311 Walker, Anatomical Terminology, 266. 312 TheVesselBookdescribestwospecificmtw to theneckalthoughtheircontentsarenotspecified. 313Dawson,JEA20,186-7.

92

(5)Eb298(52,10-13) for be done is to (prescription), ktirftn smn.fhntm tp.fsttmnPbt. f, 'another what

his his head suffersbntin and a manwho sttin neck'. HereDawson translates thisaspain(stt) in 'thefrontof theheadandtheneck',which diagnosesas 'neuralgiaor similar'.(The symptomsmightsuggest he not unreasonably is but, to 'shooting appearelsewhereas gs seems certainly a pain' migraine which migraine ---1314

315 to bnt in take Westendorf differ boththe Grundfiss that they However, not and instead but 'catarrh'. to 'front' mean mean 6. in theoriginalwiththenosedeterminative 'Wenner anSnupfen/kattarh It appears 316 in Nacken leidet, indem Schleimstoffe Kopf sind'. seinem an seinem

'm 'impliesthatLmtis in theheadandthatstt is in theneck.That Theconnecting -bnt in is head 'front' the in head to the be the to shown of as opposed something actually seems Eb391:ktDt drbDt m tp m msdrwyanotherto driveout hntfromtheheadandears'and Sm22,8,drbntpwmtpwherebnt is drivenoutof thehead.In Eb36:ktntdrbntmjrly, 'todriveouthnt in theeyes'.Andin Eb4l8:ktntdrLmtm fnd, 'to driveoutbnt in thenose'. 6 Sincebnt affectsthe head,noseandeyesandappearswiththedeterminative it seems likelyto becatarrh. in Eb298bnt m tp.fstt m nbbt.f if Pntis catarrh,thenwehavecatarrhin However, does But in this the the theheadwhichcouldsuggestthepresence not cause. of stt neckas precludeit beinganothersymptomand 'shootingpain'or 'pain'wouldseemappropriate

4,1-9wherethesymptoms SeeEb250andPap.BeattyVRs. 314 areclearer. ofgs-tpasmigraine Egyptian Walker Anatomical 315 Terminology, 272. gives'frontofface,head',Ancient Stoffe for is to 602.Thespecialcharacter Schleim(slime,mucous, 316Westendorf, appended which viscosity) following for Such is 'reserved that the to relationship of otherwise'. completeness stt catarrhandcoughandnot Westendorf, 344. Berlin48weseea coughremedy,

93

suchthat'hesuffersfromcatarrhin theheadandpainin hisneck'.If notthenstt must enough; factor. betakentoqualifythecauseof bntthecatarrh,suggestive of somepathological

(6)Eb856f(103,11-12) iwmtw2 jm. fnVb. firmn. f*1j2. fd? dcbw.f in.kr. s sttpw -dd

'Thereare2 vesselsin theupperarm.If hisshoulder suffersandhisfingerstremble thenyouwillsayit is sti. The aboveprescription is from the 'VesselBook'whichwas discussedearlierin Chapter3.2 (ii).In thisprescription we aretoldthatthereare'twovesselsto the upperarm' (gib)andthatthesymptoms to stt.Asthemtw areviewedasvessels arecollectively ascribed Eb856fsuggests factor bythesemtw. transmitted a of transmission sttas Here(6) Dawsonhasstt'shootingor acutepain'as the collective description of the 'painin the arm and tremblingof the fingers'.He suggeststhat this maybe symptoms:

317Wreszinski translates thislineas,'if hisarmssufferandhisfingersare paralysis agitans. 'if hisshoulder sore,thenyouwillsayit is the(stt) condition.Westendorf andthe Grundfiss: 318 suffersandhisfingerstremblethenyouwillsay:it is Schleimstoffel. Thesymptoms (rnn) in the shoulders aredescribed andfingerswhichthengetsthe (stt). To havesuas shooting havebeen of thecondition response painswhenthesymptoms described In thiscasestt mightbe thoughta previously as painfulmayappearas duplication. termof widersignificance. Howeverthereis no reasonthat stt shouldnot be 'shootingpain'.Thesufferingin fingers is described is not and shoulder andsummarised as stt'shootingpain'.Suchrepetition in themedical texts. uncommon 317

JEA20,185. Dawson, DerGrosse Medizinische 318 Wreszinski, Papyrus 698.Grundriss desBerliner IVA Museums, 134.Westendorf,

94

forthecondition is givenin: Theremedy iInt r.s sbR.fmt7n w Pr M-t PrLYs b. f Im fpr db bddw-k3 c cý wr sn w. i wf(w) r-pw it by to vomit- Erbrechen) 'Whatis to bedoneforit. Hewillbecausedto expel(caused 319 be in fish beer (plant? ) to well'. order or meat etc., with with meansof

It is atfirstsightdifficult Thisline'causedto expelit or causedto vomit'is problematic. Thewordsb,§(t) to explain.

*as 'tovomit'seems in Eb85,16b It appears attested. well

It determinative. Eb696 suggests as sb§yUEýO*1'O'jA and with an additional,clearer and

thephysical withthestopping needto removesttfromthebodyandseemsdifficultto reconcile 'action' indicate the be in to be However, this that used verb might explained of pain. sb9could I ). (from i. like the see no pain a release vomiting, quickandviolent remedy,e. stt of M betweenthisapproach difference to its meaningandthatof theverbdr' whichis well to meanbothphysically'drive out'andto'd(iveout pain. attested It is Eb856fwhichhasbeenputforwardto implythatthecontents of thevessels(rntO the is it that is But this to theuppershoulder merely connection notactuallystated, weresa. difficultif the It alsomakestheassociation twotermsappeartogether. withcatarrhsomewhat involved. are shoulders It is possibleto equatestt witha definitesymptom of catarrhonlyif stt is generally to mean'mucousor fluid'.In thissensestt couldbe bothcatarrhand morewidelyconstrued it However, the rathervaguer'fluid'passingthroughthe mtw withpathological significance. (upperarm). to bespecificto thedestination seemsunusual

319Westendorf, 699.

95

(7)Berlin48 drsttm fy gw(t)y. abitnt

forthe'drivingoutof stt inthetwosidesof Hereweseea prescription

I hisbody

.

Thiscontradicts thesuggestion containstt. at (6)thatthemtw to theshoulder

(8)Berlin138 pbit nt rdit, &y stt nbt mvw ftt

m iwfn s

'Prescription to causeto bringdownall the sawhichcomesandgoes?(bLht)in the bodyof a man'.Dawson translates thisas a remedyfor'sttwhichcomesandgoesin a man's flesh.' It is an internalremedyfor 'shooting seesthisasa or intermittent pains'.TheGrunddss 320 This body down 'wanders' in 'to bring the to the man'. of a cause all prescription stt, which

down down'.Or,it couldequallyimply:the'bringing impliesthatstt mustbephysically 'brought or removal of allpainswhichwanderin thebodyof a man'.

(9)Berlin139 Dh,ttntdrsttmnt. smS'Mwmprtm .

rtnb

in summer Thisis a prescription to 'driveoutsUwhichcausessuffering andwinterin all thatstt is significant thepartsof thebody'.Themention of winterandsummer sinceit suggests Thisseemsto implya permanent is notseasonally affected. pain.In fact,Berlin140hasthe ). Under but differs in heading is for (rheumatics, that the specified sciatica? same winter stt it easierto viewstt as 'pain'.It is difficultto imaginea 'pathological factor' thesecircumstances fluctuation. to seasonal beingsubjected

320Dawson,JEA20,187.GrundrissIV:159.

96

(10)Berlin142 pb,rtntdrsttm

mnt(y).sprbrymnd wnmyilbyr-pw

left breast. 'A prescription the to driveoutstt whichcauses or suffering under right Dawson translates for stt whichgives'painundertherightor leftbreast' thisas a prescription The Grundfissgivesthis a prescription for the 'drivingout of sawhichcausesdiscomfortin the

321 (ightor leftbreast'. here, Schleimstoffe. is to to there appropriate pain nothing suggest sttseems sttas

(11)Berlin143

kt nt,§dstt m WSS' 'Another(prescription) to removestt in/from(m ) the urine'.This prescriptionDawson

hasas a remedyfor 'shootingpain'in the bladderor urethra(painfulmicturition), 'perhaps theGrundriss someinflammation of the of theprostate gland'.However, givesit asanexample 322 durchAusscheiden. needto expelstt via theurine:fOrdasFoifnehmen vonSchleimstoffe 'fortheremoval of sttby/through excretion'. -

I,.. Thedifference between hingesaroundthewordws.§ thetwotranslations

r-ID

I

is mistaken herein takingthiswordto mean'bladder. 323 thinkDawson Thus,histranslation as 'painin the bladder.The Grundfiss translatesthis as 'urine',hencethe drivingout of stt (through) theAne. Therearemanyexamples of ws.§ as One (Eb24,26,262,Bin154,1871 195etc.). DespiteDawson's in histranslation I believeit is logicalthatsushouldbepain. mistake It is necessary to consider thepossible Thereappears to be someproblem medicalcondition. A prostateproblemor a urinaryinfectionwouldproduceshootingpainwhilst withmicturition. 321Dawson,JEA20,187.GrundfissIV:159. 322GrundrissIV:159.

323 Walkerdoesnotcitethiswordin hisextensive listsbutrathergivesthewordspw for bladder, anatomical Anatomical Egyptian Ancient Terminology, 276.

97

to urinate.Thefactthatstt is expelledthroughthe urineor duringurination goes attempting is Equally,the routeof transmission againstthe conceptof stt 'pooling'or 'wandering'. intheVesselBook. withthemtwas suggested unconnected

(12)Berlin201 ktpbrt nt stt m msdr my

for stt intheears'.It wouldappearto referto 'earache'. 'Thisis anotherprescription

(13)EdwinSmithPapyrus

WhilsttheEbersandHearstpapyrimayappearto bedisorganised, andan repetitive in contrast, orderedand appears eclecticmixof medicine andmagictheEdwinSmithpapyrus, It is primarilya surgicaltreatisedevoidof theoriesandmagic(exceptin a single pragmatic. SM9). 324The

case,

treatments toinjurywithanequally tendto bea logical candid approach

injury.In fourteenof the fifty-twocasesno assessment of the abilityto treatthatparticular is recommended to treatthem. dueto theseverity treatment andtheinability of theconditions For example,a case of a splinteredbreakof the shoulderwhichis ominously by bloodfrom the nostrils,ears and mouth,is statedas 'an illnesswhichone accompanied

1-7).Whilsta'hole'in theshoulder illnesswhichI willtreat' becomes'an cannottreat' (Sm17,7 14-17). (Sm15,6 difference Thesignificant betweeninjuryanddiseaseis that in injurythe causeis factors. usuallyknown.In thissensethereis no needfor a systemof explanatory pathological As a surgicaltext EdwinSmithconcentrates designedto stabilisethe on first-aidtreatment

324 Thiscaseinvolvesa seriouswoundto theskull.The'primary'treatmentis surgicalwitha charmfor the 'additional'protectionof Isis.

98

325 However, factorit is unlikelyto appearin EdwinSmith. injury.If stt is a pathological wefindit in at leasttwoexamples: Sm43(14,22-15,6) Thiscaseconcerns to haveproduced somestrainonthe a chestinjurywhichappears if 'If for It is headed: the 'Treatment the the you chest'. rib cage. of ribs of a centre imh

a manwitha umbin theribsof hischestandyoufindtheribsof hischestraised? examine flushedin hisfaceQp) andalsohesufferssttin bothhissides'. 326. The word wnh is definedin GlossA and takento mean'dislocation/separation'.

Thetypeof injuryis furtherdefined(in GlossB) in thatthe injuryhascausedthe patientto hereis that'both'sidesare 'sufferstt in bothhissides',jrmn. fsttm§wty. fy. Theimportance

diagnosis be from injury. The to the to of confirm seems necessary a central gloss affected Thiswouldresultin a 'referred', sharppainbeihgfelton both chestmuscles. pulledor strained in ratherthanfromthe centralinjuryitself.In thiscaseit sidesof the chestwhenbreathing 'pain'.stt as Schleimstoffe seemsthatstt cannotbe anything otherthanreferred(shooting) seemsinappropriate.

Sm47(16,1817.1-2) for a gaping/spewing? Thisis headed:'Treatment (,*) woundto hisshoulder(ktt4'. Thiscaseinvolvesa woundto theshoulder whichappearsto be causinga problemwiththe f, he suffersstt in his scapula shoulderbone,thescapula.Mn.f stt (m ) mgc4ct. underlying Hereagainstt as 'pain'seemsmostappropriate to explaintheseverityof thewound.It has gonedeeplyenoughto affectthe lowerboneand so mightproducea radiating(sharp, pain. shooting) I thinkit unlikelyin Edwin 325Theideathatinjurycouldbe complicated by pathologycannotbe totallydiscounted. Smithsincethe treatmentsare first-lineones directedtowardsphysicalinjury.Complications or prognosis(of treatable)casesarenotdiscussed 731. 326In Sm3l GlossA, Westendorf,

99

factoris not In briefsummary, I believethatthe evidence for stt as a pathological Theconcept proven.Themedicalpapyrimightimplythisbutdo notsupplyanyfirmevidence. in from the the as a pathological and of of stt agentarises spuriousassociation mtw stt Eb856f.Whilstthe Gnindriss in Eb52rightlytranslateshnt as catarrh,theythenassumea directconnection withthisandstt andunnecessarily attributeit (in othersituations)withsimilar propertiesi.e. Schleim.Theremay well be some connectionbut on balancethere appears

it 'shooting in to translate the examples where equalopportunity as or sharp pain' most of stt appears.Thosein the EdwinSmithpapyrusI considerare clearexamplesof this. The It canbeexplained connection as a withwormsin termsof stt is a widerallusion. problematic to thesedousness allusion metaphorical of thecondition.

Terminology 3.4Adaptive in thischapterI havediscussed Previously someEgyptian medicaltermswhichhave beenclaimedto be integralto the aetiologyof disease.I havehopefully demonstrated that bytheirrelationship thesecanassimplybeexplained to thesymptom of pain.327 Thesetermshavederivedfromtheadaptation usedto of theoriginalword(adjective) is describethe typeof pain.I intendto call this adaptiveterminology. Adaptiveterminology To of the diseaseandfor its nomenclature. usefulsinceit providesbothfor a description to a diseasein termsof painis logical;sincethetypeandextentof painis important consider In somecasesthe thepatientin termsof sufferingandto theclinicianin termsof diagnosis. of the type of pain may then havebecomeadaptedto describethe originaldescription itself.Thismethodwouldprovidefor a systemof nomenclature for painfuldiseases, condition to be lacking.I do notproposethisto be a regulated onethatappears systembutmerelyone The 'adaptive that may have developedon an ad hoc basis in some circumstances. English 327"dw, stt etc.Invernacular The examples andcondition. arecommon e.g. the'gripes'-symptom, $pox'anda (cursed) condition. symptom 100

that terminology' approach conditions mayhelpto explainsomeof themany'unknown' medical appearacrossthemedical papyri. To this end, I havemadea selectionof someof the morefrequentlyappearing 'unknown' to classiýthoseunder(therespective) medical conditions parts andhaveattempted of the body.I do notproposeto evaluatetheirtreatmentsbut ratherto considerthe nameof the

fromthe typeof pain.I do not suggestthatthe list is conditionas a possibleadaptation butmerelyrepresentative. complete

(1)TheEve Thefollowingareconditions whichaffectthe eye.Theyareall listedby Nunn328as 'unidentified' conditions:ným,Chn,bid pdst, Prw

(a)Atfl Thistermappears to derivefromtheadjective varies np andits variants.Itsmeaning 330 between dangerous 'wild,neglected, terrible329, andinfected'. restless, AsthewordnM -t-IJ3

it is usedasanadjective to described (withvariants) a type

) or ) or with'rough'(wild? of wound(Sm4,23-4)- presumably onethatwas'severe'(terrible? Thismayreferto the'rough'feelof unevenedges?In Eb874ait describes a typeof swelling. (restless) In Eb197bit describesa the skinor movement of the swellingon examination. stomach condition, presumably onewithpainfuland'restless' symptoms. It appearsas an eye conditionin Eb346,350,383.All of theseprescriptions are to theeyesdesigned thatthese to 'ddveout'nlvt. It hasbeensuggested externalapplications

328Nunn,Ancient EgyptianMedicine,Appendix13:217 329Wb 2:290

330 L. H. LeskoandB. SwitalskiLesko(eds.), A Dictionaryof LateEgyptian.5 Volumes(Providence, RI, 19821990),ii:25.

101

is 331 is disease that This trachoma. to the trachomatis a conditionchlamydia corresponds throughhumancontactand flies and is especiallyrife in crowdeddomestic transmitted blindness in form hygiene. in the It the of conditions associated most common withpoor results The Egypt. It in large today. untreated ancient was presumably also a problem scale world is lashes, by lid, in-turned the cornealulcersand characterised scarring of eye condition blindness.332

is Egypt it in Inviewof thefactthatthecondition have been ancient would widespread 333Thewordnlytwould seemappropriate: logicalto expectthe conditionto havebeennamed.

(neglected) disruption being'thetroubled (terrible? ) eye'andalsoimplying physical widespread to theeye.

, 2, (b)tbnEDm. Nunngivesthecondition Thiscondition in Eb349,381,337 as a andRam111. appears doesin factsuggestan 'thn injury'of theeye.334In Eb337(kt nt r t1mm irt) thetreatment ) (split, injuryto theeye.Westendoff be 'Ritzung' its to etc. caused scratch a considers nature bya foreignbody.335 in Ram111, However, A21the verb'driveout' (dr) is usedsuchthatthe remedyis intended 'todriveoutthfif dr thnpw. Thisimpliesthatthnis actuallyan'external' attachment, , is described as being ratherthanan injury.Eb349seemsto confirmthissincethe condition

byEbbell, 331 Thiswasoriginally VIA72. proposed seeGrundfiss 2nd 332J. General Practice Ed.,(Roseville, Murtagh, 471. NSW,1998), Some in theNileDeltatoday.Overhalfof pre-school 333 haveactivetrachoma. It is stillhyper-endemic children See,P. 90%of residents, scarring. over25 yearsof age,havebeenshownto displaysubstantial conjunctival forthefuturein the Courtright in theNileDelta:currentpatterns andblindness et al.,'Trachoma andprojections BritishJournalof Ophthalmology 73 (1989),536-40.The problemseemsto be ruralEgyptianpopulation', familygroupsandtheabsence Theseconditions withcloselyclustered musthave connected of properlatrines. in inflammatory factor alwaysexistedin this region,P. Courtright et. al., 'Latrineownership protective a as in Egypt',BritishJournal trachoma 75(1991), 321. of Ophthalmology 334Nunn,AncientEgyptianMedicine,225. 609. 335Westendorf,

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tsw.f i.e. whichis bound/attachedto the eye.Againin Eb381the problemseemsto be orwithanexternal causesinceis described asbeingPr(upon)theeye. external 336 But it Faulkner 'injure to the the tbn appears eye'. gives word as a verbmeaning it is morelikelya nouni.e. theinjuryitself,asa resultof something fromtheevidence actually it is Although determinative the the the eye. with word striking arm sometimes appears entering

todirectlyrelatethecondition to anyknowncausative verb. notpossible

blAtZ

Thistermappears in Eb368,385. Eb368is to 'driveout(dr) bid in (m) theeyes'.As for the same it is unlikelyto be an injury.Eb385is an incantation botheyesare mentioned butmentions 'watering' of theeyes. condition:

Ko" "(d)p dst Thistermappears in connection in Eb355,430 withtheeye.Theverbmeansto 'stamp

inconnection fromthewordfor'foot'pd It alsoappears toderive orflatten'337and appears is by the drugs (mortar ). The term the the given of compounding of and with pestle? meaning 338 Inthissensetheytakeit to referto a 'sty'.However, Grundriss thereis no asa 'smallpellet'. in respectof for thisotherthana commitment to a particular evidence aspectof its meaning in (pelleting), drugpreparation I thinkit as probable to thesymptoms thatthetermis referring beating) termsof 'stamp,flattenetc.' Inthiscase,it couldreferto thetypeof pain(flattening, or thestateof theeye,flattened, perhaps closed.Thelattersymptom wouldbea typicalsymptom (infected, closedeyelid). of blepharitis

3x Faulkner,A ConciseDictionatyof MiddleEgyptian,301. 337Hannig,299.

302. The reasoningseemsto basedon the fact that grounddrugs,in their preparation,are 3n GrundrissV11: reducedto a smallpellet.

103

(e),ýirtv for ',§inv in both eyes'.The This conditionappearsin Eb351as a prescription Fresh liver liver hereincludes to the thelocalapplication treatment contains eyes. ox of roasted including of vitaminA canresult a highsourceof fat solublevitamins vitaminA. Thedeficiency in the impairmentof visionin dim light or night blindness.It is this fact that has led to the

betweenthe treatment in that93, has withliverin Eb351andnightblindness, association rw 339However, impaired beentakento meannightblindness. nightvision(orindeednight)is not Thestorageof fat solublevitaminsin the liveris a comparatively recent mentionedin Eb351.340

Also,any discovery to theancientEgyptians. andit wouldbewrongto ascribethisknowledge bycooking. Equallyabsorption throughtheskin contentin theliverwouldberemoved vitamins limited. wouldbeseverely Whilstthiscondition a treatment appliesto theeyesit cannotbeconsidered obviously fornightblindness. AlsoI cansuggest nolexicalconnection withpain.

(2)TheSkin lkw4 Pw3w,Psk

(a)lkwt

Thisconditionis described by Nunnas an 'unidentified diseaseor manifestation of 341 I consider However, it to morespecifically disease'. referto a condition of theskin.It appears Thesearepartof a runof prescriptions in Eb543,544,545. to fromEb537whichareintended

339Both Ebbelland Westendorfhave committedthemselvesto this conclusion;see Nunn,AncientEgyptian Medicine,200.Thisconnectionis oftenquotedas an exampleof Egyptianmedicalprowessin the recognition of See, for treatment. example,G. Wolf, 'A historicalnoteon the modeof the administration of vitaminA in vitamin AmericanJournalof ClinicalNutrition31, (1978),290-2. nightblindness', for Prwof theeyesin BMEA 10059,22-24. 340It appearsas an incantation 341Nunn,AncientEgyptianMedicine,217.As doesthe GrundrissVII(l):13

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(eczema, Hautblase be to treat skin wounds.Westendorf the skin considers condition

342 vesicles). Thecondition is likelyto havebeenonewithsymptoms anditching'. of 'irritation

WMýi (b)Pwlw Thiscondition designed to drive onlyappearsin Eb123.It is an externalpreparation 343 Westendorf considers outpainfromthepatientwitha 'skincondition andwithitt andhWIW. 344 Cerl: thatalsocauses'trembling thisasa skincondition andshivering'. ainly,some'motion'of to cometo a tellsus thatit willcausethecondition thebodyis impliedsincetheprescription both However 'halt'.It is difficultto envisage a skincondition complete withallthesesymptoms. thelattertermsarelikelyto bevariations onthesymptoms of theindexcondition. ThewordPwiw appearsto derivefromPwc meaning'foul,offensive, putrefaction' etC.345

'worry InLateEgyptian tohavebeenextended tomean theuseofthewordseems or itt

346 fromtheverb At seems toderive vexation'.

347 to

'flyup'.Thecombination of

), theseseemsto implya foul skin condition(infected)that is 'flared-up'(sore,inflamed? ). agitated andrestless(itching?

0ýý; 1M (3)Psk '-*-, 348 Nunngivesthis wordto meana 'diseasedemon(especially cutting)'. It clearly derivesfromtheverb'to cutoff,clip,deprive'etc.349It appears to beactingasthenameof the

641.Eb546usedthetermkikal similarly 342 Westendorf, translated. 343 Westendorf 567. SchOttelfrost? Westendorf, trembling, givesthetranslation asZittem? shivering. 34Thereis nomention offeverorheatwhichmighthavemadea diagnosis easier. 345 Wb3:50-1 346 LeskoandLesko,Dictionary ii:104. ofLateEgyptian, VI1:111 347 Wb3:50,5Grundfiss 348 Egyptian Medicine, Nunn,Ancient 221. 349 Wb3:168

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demon,in thatit is 'theonewhodepriveS1350(of inflictsdisease.It is health)andconsequently bothdescriptive It appears in Eb854e the'capture' andaetiological. of theair whereit explains in Eb360 Thetermappears to theearsviatheconnecting whichis ordinarily supplied vessels. in an incantation for an eye condition. 351The conditionmay be one wherethe sightis 'cutoff or 'deprived' i.e. a condition impairment temporarily of associated withthetemporary thevision.

U

(4)Mgpnt

Thiscondition in Hearst 9,10, Papyrus H 160-6 in London the appears at and mgpnt 16,and25 (in demonicform).Leakeconsiders for the thattheseareexternalpreparations 352This treatment is because theyall includemild,alkaline, of 'bone,jointor muscledisorders'. in a fatty basewhichare obviouslyintendedfor external astringentagentsincorporated

353However, Westendorf thisto be an actualskincondition massage. considers as does Bardinet it asan'eczema' 354 whospecifies and'eruptive' condition.

(5)NsytandpW Boththe Grundfiss andNunnconsiderthetermnsyt'ý'W6P-appliesto an unknown diseasethatis causedby a 'disease-demon'. 355 Thisis essentially because of theappearance of the termin London5 andLondon25 bothof whichare spellsintendedto exorcisethe condition.

350

VI1:635 Grundriss 351 Lefebvre thought thewordbskapplied it appropriate to migraine. Hegavenoreason, butpresumably thought tothesymptom isgs-tp, GnindissVII: 636. believed to haveapplied of'cutting' painThetermnowgenerally 352 Leake,TheOldEgyptian Medical Papyri, 322. m Theskinseemsto beinvolved in BMEA10059,6.'...WhichcomesupfromHeliopolis whichpenetrates and from Isisstands,laments, has C. Leitz, from Magical (? ) ' Translation the emerges after she raised and up skin! ... PapyrioftheNewKingdom Medical (London, 2000). 239.T. Bardinet, 354 Westendorf, 'Remarques 21-3.Inthisarticlehe dela peau'Rdt 39(1988), surlesmaladies showsthatthereareclosesimilarities withCopticterms. 355 VII:480.Nunn,Ancient Grundfiss Egyptian Medicine, 223.

106

sntntnsyt (Lond5)

InLondon 25it appears tmyt, additionally withtheunknown condition 'm A

gntntnsyt tmy0-M

356 25). (Lond

In London5 and London25 both of the aboveconditionsare clearlyintendedto be

curedby magic,but this doesnot automatically are causedby meanthat the conditions Theterm demonicpossession. in conventional Boththetermsappearelsewhere treatments. in H206-11 disease Grundfiss be the to the term appears a of some where considers nsyt nsj4

357 Leake 'internal 'fever, thinks these to organ'. mightrefer although givesnoreason. However, in connection thismakesit difficultto reconcile withthe withits usein Eb751whereit appears eyes,to 'driveoutnsjlfrom botheyes'. Equally, thetermtmytis seenin a 'traditional' contextin H168, drive 'prescription dr to tmyt, outtmyt. a pbit nt it Thus,whilstboththeseconditions in somecasesmayinvolvedemonicinfluence doesnotpreclude theirappearance elsewhere. Boththesetermsmightbe explainedif theywereconsidered in termsof adaptive Forinstance: javelin derive from flame terminology. bum, might etc. or = = nsyt nsywt nsr 358 (?sharp,quick,stabbing), hiUifrorntheverbtmtto beat,powderetc. Thus,whatstartsout to describethe typeof paineventually becomesadaptedto by eithera describe thecondition, so thatnsyt couldbe a diseaseor condition characterised ) or 'stabbing' 'burning'(fever,Leake? pain.ThetermhW wouldbe anotherpainfulcondition beinga painsimilarto 'beating' ). (palpitations? themainsymptom or'pummelling'

39Thistermis alsoanunknown illness,Wb5:306, described medical condition asa 'demonic whichis similarly V11: 952. Grundriss, 357 Medical Leake,TheOldEgyptian Papyri, 58 W Wb2:335-6fornsr etc.,Faulkner, for A Concise 139 Grundriss VI:954 Dictionary Middle Egyptian, ns of andWb5:09for tmt

107

Suchconditions as such.This wouldbe by definitionpainfulandrequiretreatment explanation wouldfit inwithH209andEb751,inwhichcasetheremedies wouldbeanalgesics. It wouldalsoallowforthecondition influences to becausedbydemonic suchasin Lond5and Lond25.

(6)VerbsandPain Egyptian In thissectionI havetakena smallselectionof commonly verbs occurring actionswhichcouldbeusedto relateto or to describe whichdescribe pain.I havethenlooked for into in if 'adapted' terms their texts to the at occurrence within medical order see anyare painfulmedical conditions. Thefollowingverbswereselected: cý 'fa X

359 to 'crush,beat,pound,pulvedse.

Q9 ----j

x, m var. ng

Ill'i ppd x, Adr

TI

xi

k-j

360 ' to 'break,force.

oll"I 361 var. x to'break,smash,sevee. to 'grip, grasp, seize'.362

ýx-W-363. 'break, to smash'. sd ýO-Ul 364 'crush, bruisel. to pinch, sPm

Hannig,940. 359'Zerstossen', M'Aufbrechen',Hannig,438.Grundriss VII:487. Hannig,290.Grundriss 361 'Trennen,aufschneiden', VI1:962. VII:499. 362 'Zimmern',Hannig,450.Grundiss 363'Brechen',Hannig,787.Grundriss VI1:827. 3"'Zerstosssen,zerquetschen, Hannig,736. zerstampfen',

108

NO 365It onlyappearsto be usedin Thisverbmeansto 'crush,beat,pound,bruise,etC. drUgS. 366 the connection with preparation of

ng

It is usedin thecontextof Theverbmeansto 'break,force,reduce,anddisintegrate. in drugs is the in breaking. It to the state manageable contextof reducing a also medical stone It is notseenin connection withmedical conditions. ofdispensing medicines. process

(C)pPd (pAd This verb meansto 'beat, sever split, crack etc'.367This is also only seen in the

Bin26). preparation of drugsin themedical context,(Eb875c,

(d)ndr Thisverbmeansto'grasp,seize'.Thewordis usedin thecontextof wounds.It is used (draw (4dr) i. 'to in Sml4 (6,8), 26 (8). Here instructions to e. grasp' are given as a verb it is alsousedas a nounwhichis descriptive thewoundpriorto closure.However, together) of ) (mn disease in Sm22,11 is described disease the of or state,e.g. as a suffering condition a (m) This in be the to type the seizing. of pain:grasping, anus. appears an adaptation of n&-u4 Thisseemsappropriate to describeanalpainwhichwouldproducean involuntary seizingor (pain) in theanus. grasping

VII:785. Grundriss A ConciseDictionary 365Faulkner, of MiddleEgyptian,300,GrundfissVil: 962,'Verstossen'. W As is the verb bbk'to beatup, grind'(EbI1,21).But it appearsonly as nounoutsidethe medicaltexts,for example,'the thud(bbk) of thy shaft (spear),in A. M. Blackmanand H. W. Fairman'Mythof Horusat Edfu11', JEA29 (1943),6. VII:2811 367Grundriss

109

(e) sd (sLd)

Thisverbmeansto 'break,smash.It is useda verbin thesenseto 'breakup'(dispel) in i. body (eliminate) the 'break' disease to e. pains up or paine.g. sd wbdwtosmash pain,or (Eb,BIn,H). In PapyrusSmiththe wordis usedin to get rid of, to act as an analgesic, as a sd withfractures of thebone(a break).Suchthatin Sm5(glossA) it appears connection fracture'.In Sm34it is usedin connection with of theskull.Herethewordmeansa 'smashed i. 'fractured (wbnw) Pr thedescription or e. a of a woundsuchthatit is usedadjectivally s sid in connection wound'.It alsoappears withthe'knitting'together of boneswhichhave smashed (broken) (H 13,15). beensmashed f sid

MSPM ' Thewordalsoappears in themedicaltextsas a Thismeansto 'crush,pinch,pound. in Thetermcouldbe describing thetypeof (crushing) pain.Forexample, medicalcondition. Suchthattheprescription Eb553ulcerated is intended to 'driveout teeth(gums)areinvolved. 2 is (stm Beatty Chester (the ing/pounding teeth' jbPw). crush pain) of ulcerated nw spm ),368'a crushing(sensation) the withsbm n (anus? concerned of the anus'.Sm33concerns (sensation) in thevertebrae neck:spmm is n 4bt, 'a crushing of theneck.

213. Westendorf, 3w 110

CHAPTER 4: DISEASE Sources Studies Previous 4.1Back-qround in Egypt in disease is Thepurpose this to the anattempt ancient of chapter examine patternof themajorcategories to identify of illness. Earlytwentieth diseaseinvolved theexamination centurystudieson ancientEgyptian valuablerepresentative of humanspecimens whichshouldhaveprovided of largenumbers initial 369 bone disease, the However, in degenerative conclusions of some respectof evidence. becauseof the availability from thesestudieshavebeenre-appraised of later scientific Laterstudieshavemostlybeenon a muchsmallerscaleandhavetendedtowards techniques. 370 esotedC. debateasto whether Forinstance, therehasbeenconsiderable thespecificor the

dentalprofession thatwhena existedin ancientEgypt.Suchwasthepreoccupation a separate that in a tooth,it wassuggested femaleskullwasfoundat TellDuwair,witha metalfragment inserted been filing had be dental initially It to thought thisprovided which a suchevidence.was intotheocclusal showed examination a laterdetailed surfaceof a lowermolartooth.However,

deathandwhichhad fragment thathadbeenbittenonbefore tobea smallmetallic thismerely 371 itself. failedto displace

the As for examples regarding of the esotericthereis a continuum of publications Kingdom Burddge New In latest body king Akhenaten. these the the of shape of unusual frommyotonic 372 Marfan's thatAkhenaten syndrome andCattaino suffered suggests suggests

369The principalworkwas carriedout by the anatomists ElliotSmith,WoodJonesand Derryworkingin Fora biography of the excavations conjunction withthe extensive carriedout by Reisnerbetween1907-10. fromNubia:The 'players' 'TheStudyof HumanRemains andtheirrelationships withReisner see,A. Waldron, 363-388. 44(2000), ElliotSmithandhisColleagues History Contribution Medical to Paleopathology, of Grafton 370 Notsurprisingly bythebackground subjects chosenfordiscussion asopposed of theresearchers aredictated tothemoregeneral earlieroverallstudies. 371 'Dida dentalprofession P.Ghaliounghui, Histoty15(1971),92-4.F. F. Leek, existin ancientEgypt?Medical DentalOperation, EarlyEgyptian (eds. ), in 'Reputed T. Sandison Diseases A. in D. Brothwell anAppraisal', and 1967), (Springfield, 702-9. Antiquity Warfansyndrome 372 A. L. Burridge, research andthe 18thdynastyroyalfamilyof ancientEgypt.Preliminary News111(2000), 8-11. reporf, Paleopathology

373Abretson fromwhichresultedin diagnoses dystrophy. disorder,thedisability an endocrine fromthe family.Thisexclusion, his exclusion coupledwitha lackof 'maternalaffection'is 374I mentionthesewithout for his later'turn'to monotheism. arguedto be the explanation but,I wouldpointoutthattheseareall fairlyrare on thevalidityof anyconclusions comment Suchspecificattentioncandistractandgivea falseperspective medicalconditions. on the overalllevelandtypeof disease.Manypublications on diseasein Egyptdrawfromthesame for example, popularpictorialsourcessuchthatthe readermightbe leftwiththeimpression, that dwarfism was common or that blindness was a prerequisitefor a musician.375Equally,

thereis a presentand.sometimes tendency to matchexamples misleading of knownmedical Forexample, diseases withancientpictorial conditions representations. anarticleonendocrine bytwowellrespected in antiquity Theypresentan illustration researchers strainscredibility. of a potteryvasefromthe Mochicaperiodof Peru.Theysuggestthatthe staringeyesof the intended 376 humanfigureonthevase'werepossible to portraythyrotoxicosis'. Thesamearticle claimsthattherepresentations of Cleopatra at Dendera showsher'witha full neckthatcould begoitrous.However, anexamination of Mochica potsshowthatthestareis presentonthem fromthyroidproblems; all whichsuggests eitherthewholepopulation wassuffering or, more Asto Cleopatra's 'goitre',thesameshaped wasjustanexample obviously of artisticstylisation! neckis presenton thegoddessIsisandotherfemaleson templesat KomOmboandPhilae simplythePtolemaic andis I suggest styleof representation ratherthangoitre. I believeit is necessary to takea moreprosaicapproach to disease.In this respect thatafflictedthewiderpopulation. attention willbedrawntowardsthemoregeneralconditions Fromsucha list the relevance in an andextentof painas a symptom will be considered A recentLondonsymposium attemptto drawconclusions asto theneedforpainkillers. on pain 373 G.Cattaino 'Myotonic dystrophy 41(1999), inAncient Neurology 59-63. Egypt,European andL.Vicario, &C.Abretson, 374C. SAbretson 'Akhenaten 119(1999), Laege/bran, 1115-8. heretic', Nor Tidsskr. and -pharaoh ( London, 375 J. Filer,Disease 1995)53-66. 376 C. Sandison ), (eds. Diseases in diseases', Antiquily, in Brothwell andA. T. Wells,'Endocrine Sandison and 522.

112

theeffectivetreatment thatthosesocieties thatpromoted of pain concluded and'demanded' 377 not. thanthosethatdid

(paincontrol) hada bettersystemof medicine

duty is The for 'Patients a prime of pain onlyconsultphysicians painor anxiety. reliefof 378 a doctoe. Thus,if thelevelof painfuldiseaseis highit shouldprovidean impetusto treatment. Theabilityto treatandcontrolpainshouldbe proportional to theoverallabilityof theEgyptian physician. Onthefaceof it, theevidence fordiseasein ancientEgyptcompared withotherearly societiesis wide and abundant.Evidenceis availablefrom threemainsources:human remains,representations of disease(bothpictoriallyand withinthe literarytexts)and the But naturally,thereare problemswith the interpretation of the medicaltextsthemselves. in theirremitsufferedfromthe lackof modern Manyearlystudieswhilstambitious evidence. It mustalsobe remembered thatevenareasof scientific scientific equipment andtechniques. fashion. For influenced historical driven by the or example, are perspective and study current the originsof venerealdiseaseandin particularsyphilishavelongbeenthe subjectof a 379 Newor OldWorlddebate. Aroundthebeginning of thelastcenturysyphiliswasa continuing with its majorincurabledisease.Consequently, were well experienced most physicians So, it is Thisalsoappliedto tuberculosis common condition. symptoms. was also a very which in a studyof humanremains thepresence thatFouquet of bothsyphilis reported notsurprising

377 Reported in TheTimes, July7 2000. 378 Arthritis P.McCarthy, IstEd.(Philadelphia 40. 1985), andAlliedConditions 379 Researchers thatbonydeformities at theUniversity of Bradford of syphilishadbeen reported characteristic foundonremains in Hullandwhichdatedbackto 1300-1450; it of theNewWorld.However, priortothediscovery thatthosedatesaresuspect nowappears thathighfishdiets(oftheHullresidents) sinceit hasbeendiscovered determination 266(2001), Journal 768. spurious mayproduce radiocarbon ofage,reportin ThePharmaceutical

113

380However, Smithlaterattributed the bonecondition as dueto the post andtuberculosis. 381 beetles. motlemeffectsof burrowing its Evennowtheidentification disease the withpostmortem and confusion process of 382Pseudo-pathology Thisis the effectthatthe is a problem. aftefactsremainsproblemafiC. surroundingenvironmentcan have on humanremains.A numberof factorscan produce changesto thoseremainswhichovertimecan mimicthe signsof disease.Forexample,the sheerweightof soil abovea samplecan producepost mortemskull defectsthat mimic 383Mouldscan form that simulateleucocyteswhich can give rise to the false disease. impression lesions.Problemscan arisefromthe physicalchangesoccurring of inflammatory

dueto the natureof the embalming of an processitself.Forexample, an initialdiagnosis in an elderlyfemalemummywaslatershownon closerexamination to bethe arterialaneurysm

384 for the it wasnotuncommon Alsoto addconfusion, resultof a tearduringmummification. 385As in the mummy to includepartsof differentbodiesor animalremains embalmers pack. importantly, it mustbe remembered factorscanproduce thatmight thatpostmortem changes In this respectthe incidence obscurethe presence of diseaseactually of 'true'pathology. perceivedin humanremainscouldbe lowerthatthat recordedandso neverfullyquantifiable. However,at the sub-physical levelidentifiabletissuechangesare lesssusceptible to artefact in remainsafter3000 changes.A recentpapersuggeststhatan arteriallesionis stillidentifiable At a chemicalleveltissue today.386 yearsandalsoillustrates a typeof diseasestillencountered

380D. Fouquet,'Observations in I de Morgan,Recherches pathologiques', sur les ofiginesde I'tgytpe (Pads, 1904),350-373. 381G. ElliotSmith,'Reporton the HumanRemains',TheArchaeological Surveyof Nubia.Reportfor 1907-8, (Cairo,1910). MIE. Buikstraet al,'WhatdiseasesplaguedtheancientEgyptians', in W.V. DaviesandR.Walker(eds.), Biological Anthropology andtheStudyof AncientEgypt(London1993),27. 383 P. H. K Gray,'Calcinosis Invertebralis Foundin Mummies to SimilarChanges of withSpecialReference AncientEgyprin Brothwell Diseases in Antiquity, 2 andSandison, 384 H.Hankeet al.,'Thediscovery Acta Chir BeIg of thepaleo-physiological revied, aspectof athersclerosis -a 101(2001),162. 3n El MahdyC., Mummies,Mythsand Magicin AncientEgypt(London,1995).96. lkrarnand Dodson,'The Mummyin AncientEgypt,118-129. 386 R. Magee,'ArterialDiseases in Antiquity,MedicalJoumalof Australia169(1998),663-6.

114

in the mummification inositols from have been isolated tannin the used still phenolicacidand

fragments bone from Egyptian 387 Equally, identifiable has been DNA recovered processes. in half-lives DNA the to 388 5400 However, some yearsold. a morerecentstudy measure is higherthanpreviously remainshasshownthatresidualDNAregression ancientEgyptian believed.Thisprovidesan indirectargumentagainstthe reliabilityof claimsaboutthe recovery 389 andboneremains. of activeDNAfromEgyptianmummies

in privatetombscenesand Representations of diseaseare foundmoregenerally 390 The formal They to be to stylisation. royal statuary. appear candidandcontrastparticularly

(JE51281). statueof Senebthedwaffandhisfamilyis a famouspiecein theCairoMuseum His physicalstatureseemsnot to havebeenregardedas sociallyunacceptable or even 391 The 'abnormal'and may have representedan elementof noveltyor enterl: ainment.

Autobiography the evidentfascination, albeitof a youngboy,shown of Harkhufillustrates 392A woodenfigurinefromthe FifthDynastyappearswith a humpedback towardspygmies. deformityof the chestwhichmightbe a possiblecaseof Pott'sdisease and corresponding (CairoMuseum, JE 52081). 393 A scenefromthetombof Mehuof the SixthDynastyat Saqqara have been five fishermen shows eitherwithenlargedumbilicusand/orenlargedscrotumswhich

387P. Mejanelleet al., 'Identification of phenolicacidsand inositolsin balmsand tissuesfrom an Egyptian 767(1997),177-86. mummy,Journalof Chromatography 388E. Crubezyet al, 'Identification DNAin an EgyptianPott'sdiseaseof 5,400yearsold, CR of Mycobacterium Academy Science1//321(1998),941-51. 389 1.Morotaet al.,' DNAdecayratesin papyriandhumanremainsfromEgyptian sites',American archaeological Journalof Anthropology 117(2002),310-8. 3wAkhenaten Otherwise is theexception if we areto believethathe wasaccurately signsof disease presented. in represented wereexcludedfromroyal'portraits'.Forexample,the conditiontalipes(clubfoot)wascommonly (SeeNunn,AncientEgyptianMedicine,79).Yet the NewKngdompharaohSiptahescapessuch non-royals. despitesharingthisobviousdefect Rowlingsuggeststhatthe reasonfor suchexclusions maybe representation foundin the sixty-ninth chapterof the Bookof the Dead:1 havebecomea spirit I havebeenjudged...I have destroyedthe sicknessand sufferingwhichwas there! This passageimpliesthat the diseasefromwhichthe is demonstrated deceased diedwasnotreproduced in thehereafter. Thecareto restorethemummyto perfection J. T. Rowling, by thefactthatthebedsores of Nesi-Tet-Nab-Taris werecoveredby gazelleskinat mummification, 'HemiaIn Egypt!in Brothwell Sandison, Diseases in Antiquity;35-6. and , 391 Theyappearto havehada specificplace.Theywereregarded as Tullhumansor perhapslife-longchildrenas themanifestation of thesungodReandof Horus',V. Dasen,Dwarfsin AncientEgyptandGreece(Oxford,1993), 51. 392 Lichtheim, AncientEgyptian LiteratureVolume1,23-7. m Filer,Disease, 70.

115

394Scenes blind to hernia,signsof gynaecomastia variously ascribed of andschistosomiasis. harpists from forexample, Paatenhemheb tomb the the appearfrequently; of of on wallrelief Dynasty(Rijksmuseuem, Leiden,AMT 1-35).The stelaof Romaof the the Eighteenth Dynastyshowshim with a severelywastedright lower leg (Copenhagen Eighteenth AE.I.N.13Y).Theproblemis to understand howrepresentative thesedepictionsactuallywere. In the casesof RomaandSenebtheir'deformities' wereobviouslyimportantfeaturesof their persona.In other casessuch featuresmay have beendeliberatelyselectedto add some variationandcontrastto otherwise repetitivestylisation. Other sourcesof the evidencefor diseaseare the medicalpapyri themselves.

However, butdefinitive. Thereareproblems theseareanything of withtheactualidentification itselfcan Terminology medicalconditionswhichwerediscussedin Chapter3 on terminology.

iscommonly theGreekwordTE1TCTCI translated alsochange withtime.Forinstance, as'leprosy', butintheclassical periodincluded suchaspsoriasis, never skindisease eczema andprobably In medieval trueleprosy. to includeleprosyandmayhavealso usageitsrangewasextended 395 syphiliS. for to Inrespect textstherehasbeenmoreconcern referred ofthestudyof Egyptian

specificsto the extentthat it has effectivelylimitedprogresson an holisticand an effective the analysis.Also, there is 'an underlyingfascinationwith and delightin demonstrating thesebiasesarein partdueto thenatureof available precociousness of Egyptiancivilisation... data,but are ultimatelysymptomatic of the historicalandefite-centred emphases of traditional Egyptology'. 396

However,settingasidethe problemsof identification, it is difficultto ascertainthe actualincidenceof specificdiseasesfromthe medicaltexts.Fora modemanalogy,fromthe

it wouldbe difficultto picturethe examination of thecontents of anycurrentpharmacopoeia 394 C. Reeves,Egyptian Medicine (PrincesRisborough, 1992),34 395 P. H.K Gray,Pseudopathology, in Brothwell Diseases in Antiquil)ý17. andSandison, 3%G.J. Armelagos in Daviesand andJ. Mills,'Paleopathology as Science:thecontributions of Egyptology, Walker,Biological Anthropology, 5

116

instance, health For level that at of and medical sufferings community. overall within particular 397 UK in 12% for the the all prescriptionS. prescribing of present of analgesics accounts some highin eitherpatients' Thisfiguretellsusthatpainfeatures prioritybutdoesnot or prescribers' intheHearstPapyrus indicate thatpain.Ofthe260prescriptions whichdiseases areproducing ten (H144-149,155-158) areto 'improve'the hairrepresenting some4%of thetotalnumber,yet

dental (H8,9) lessthanonepercentof the to to two prescriptions problems, appear relate only total. 398.Statistically thistells

fivetimesgreater thandental usthathair'problems' werealmost

Yet,it is a conclusion fromothermodelstellsuscannotbe disease. thatlogicandexperience possible. for life are generallyacceptedto be food,waterand Thefundamentals necessary shelter.In thisrespectthe Nilevalleyseemsto haveamplyprovidedall. Barleyandemmer Shelterwas by fowl,fish andvegetables. andsupplemented wheatwerereadilycultivated bya favourable throughtheuseof mudbricks.All of thiswassupplemented climate. available Underthesecircumstances it is notsurprising thatthe PapyrusInsinger, albeitoptimistically, 399Actualstatistics in respectof modalityhave tellsus thattheideallifespanwas100years. centuryand then oftenonly for European only beenavailablesincethe mid-nineteenth The low life duringthisperiodin Europewasdirectlydueto thespreadof expectancy countries. diseases infectious livingconditions. Incontrast associated withindustrialised onemightexpect the non-industrialisation of ancientEgyptto haveprovideda healthierlivingenvironment. for pharaonic However, Egyptappearsnotto havebeenhigh.It has averagelifeexpectancy beenestimatedas 39 yearsfor men and some34-36yearsfor women. 400It shouldbe 'Theuseoforalanalgesics 1. 397 Department 11(2000), in primary Bulletin of Health, care',MeReC Medical Papyd, 63 398 Leake,TheOldEgyptian Egyptian Ancient Literature 399 Lichtheim, Volume /, 199. W.B. Harer'Healthin Pharaonic Egypt,in DaviesandWalker,Biological 400 Anthology andtheStudyofAncient Egypt,20.Thesefigurescanonlybe estimates. Theyarebasedon actual,modemfiguresfor maternal-related lossin ThirdWorldcountries. Similarfigureswereobtained fromtheexamination andneonatal of actualremains (709skullsshowedanaverage fromtheTurincemetery B. Chiarelli 36 collections, death of years). et al., at age 'Ricerche dell'Instituto 53, di Torino',Rivdi Antroplogia, antropologiche sullecollezione di Antropologia egiziane (1996),61-9.Theaverage diseases. In RomanEgypt ageat deathincreases aftertheinitialperiodof childhood

117

be figures that these should not and average whether correct only an or notare remembered increased has in isolation. The 1900 in England life and expectancy of womensince viewed in disease 401 is because This that pattern or change of some reversal not nowexceeds of men. It is to butsimplybecause expect reasonable of the reduction mortality. of maternity related thatwomenin Egyptwhoescapedmedicalincidentduringtheirchild-bearing ageweremore longerthanmen. likelyto liveaslong,or perhaps, to completely Thischapteris writtenwith the awareness that it will be impossible is thetypeandincidence of diseasein ancientEgypt.WhatI hopeto demonstrate conclude thatthereis evidencethatthereweresufficienttypesof commondiseasesthat presented suchasto requiretreatment. painfulsymptoms Mostof theworkon ancientEgyptian diseasewasdoneearlyduringthefirstthirtyor of X raysin 1895allowedthe non-destructive so yearsof the lastcentury.Thedevelopment Petrieusedradiography to examineEgyptianremainsas earlyas of mummies. examination birth its initial 1898.It is the technique the X-rays that of novelty probablyspawned of and histological Muchearlyworkwasdoneby Rufferwhoundertook considerable paleopathology. 402 Theinitialdiagnoses tissue. of diseaseallcomefromthisearlyperiod of mummified analysis andhavebeencollatedin Table4.2.Thislist, althoughearly,still includesall of the main isolatedto datefromhumanremains. Inthissenseit is a representative of diseases categories it hasto be assumed This list.However, thattheremainsthemselves arealsorepresentative. from is be But, it the that they probable cannot statedwithcertainty. aresince remainscome different regionsandacrossmosttimeperiods. Thereareproblems identifying infectious Certainly in diseasefromevidential remains. diseases forthelargenumber recenthistoryinfectious wereresponsible of youngdeathswhich lifeexpectancy from300census in 10year (maleandfemale) returns, wascalculated at23.9yearsyet,increased to 34.5-37.5 years.R. S. BagnallandB. W. Frier,TheDemography oldfemales of RomanEgypt(Cambridge, 1994). Statistics OfficeEnglish 401 Central LifeTableNo7-Population 2000 Trends99Spring 402 M.A.Ruffer,'Histological 3 deI'tgypt 6 (1911), M6moires studies onEgyptian Institute mummies,

118

drastically lifeexpectancy infectious disease Western reduced values.Inpre-antibiotic societies I for the baselineof illness;today,withits eradication this positionis occupiedby accounted

degenerative diseases. Thedifficulty leave its is do diagnosis that always not with pathogens lesionsontheskinor bones.Somecancausechanges distinctive to theouterlayerof bonebut However, maybe no morethanjustan indicator of infection or inflammation. someinfectious diseases at laterstagescausedegenerative changesto theskeletonmakingthisan indicator Forexample thisis oftenthecasewithleprosy, tuberculosis of theirpresence andsyphilis. Since these early diagnosesscientifictechniquesand methodshave radically improved initialspecificdiagnoses have suchthatin thosecasesthathavebeenre-evaluated 403Often later work has been to correlateskeletalevidenceof often been challenged. pathologies anddiseasein themedicalpapyribut,onlyto verifyor refutethetextsratherthan in a widersocialcontext. to putdisease However, the evidenceof diseasesfoundpresentis still evidencethat that those diseases Table4.2liststhosediseases forwhichscientific has wereactuallypresent. evidence beenfoundfromhumanremains.It is presently in roughlyhistorical orderandwithoutinitial the maincategodes comment as to its veracity.Thelist still represents of diseasethathave fromhumanremains beenisolated to date.Table4.2willbetakenasa startingpointto discuss someof the actualdiseasesin detail.Thelist accordswiththegeneralacceptedpatternof diseasefor ancientEgyptas described by Nunn,DavidandMiller. 404FromTable4.2,1would intobroad,genericheadings for suggestthatit is possibleto placeall thechronicconditions detailed discussion. Thisexcludes infectious because conditions of theproblem of identification for analgesic treatment. is excluded for the Arteriosclerosis andbecause of theirunsuitability samereasons.Thesebroadcategories wouldthenbe carcinomas, arthritisandotherbone 403See,Buikastra, in DaviesandWalker(eds. ), Biological Anthropology, 24-53.Otherexamples arediscussed belowinthetext. 404 Nunn,AncientEgyptian Medicine, 64-95.A. R. David,'Disease thecontribution in Egyptian mummies: of new Lancet349(1997),1760-1763. technologies', Miller,Medical History35,1-24.

119

TothelistI wouldaddparasitic anddentaldisease. andrespiratory conditions worminfections disease inthetextbelow. withanexplanation

120

TABLE4.2 MedicalConditionsandFirstIdentifications MedicalCondition

FirstIdentification

cancer(ovarian)

Granville 1825

rectalandvaginalprolapse

Jones1908

osteoarthritis

Smith& Jones1908,Ruffer& Rietti1912,Ruffer 1918,Smith& Dawson 1924

infection mastoid

Smith& Jones1908,Derry1909,Smith& Dawson 1924

arteriosclerosis (others) carcinomas

Shattock 1909,Ruffer1910

(Pott'sdisease) tuberculosis

Smith& Ruffer1910

schistosomiasis

Ruffer1910

pneumonia leprosy

Ruffer1910

Derry1909,Smith& Dawson 1910

Smith& Derry1910,Smith& Dawson 1924 Ruffer& Ferguson 1911,Smith1912,Ruffer1914

smallpox scrotalhernia

Smith1912

tuberculosis

Smith& Jones1918

dentalcaries,abscesses

Ruffer1918,

gallstones

Smith& Dawson 1924

gout

Smith& Dawson 1924

Referencesfor table: B. Granville,'An essayon EgyptianMummieswith observations on the art of embalming Philosophical Transactions amongtheancientEgyptians', of the RoyalSociety115(1825),269-319.F. W. Jones, Report',Archaeological Surveyof Nubia,Bulletin2 (1908).G. E. Smith& F. W. Jones,The 'The Pathological Surveyof Nubia:Reportfor 1907-1908, Archaeological (Cairo,1910).M.A. Ruffer& A. Rietti,'Onosseouslesions Journalof Pathology in ancientEgyptians', 26,(1912),439.A. M.Ruffer,'Arthritisdeformansand andBacteriology spondylitisin AncientEgypt',Journalof Pathologyand Bacteriology22 (1918),335-82.G. E. Smith,W. R. Dawson,EgyptianMummies(London1924).D. E. Derry,'AnatomicalReporf,Archaeological Surveyof Nubia, Bulletin3 (1909).G. E. Smith& W. R. Dawson,EgyptianMummies(London,1924).G. S. Shattock,'A reportupon the pathologicalconditionsof the aorta of King Memeptah',Proceedingsof the Royal Societyof Medicine (PathologicalSection)2 (1909),122-7.M. A. Ruffer,Remarkson the histologyand pathologyof Egyptian mummies',Cairo ScientificJournal4, (1910). G. E. Smith & D. E. Derry, 'Pott'scheKrankheitan einer AegyptischenMumie aus der Zeit der 21 Dynastie,in K. Sudhoff (ed.), Zur historischenBiologie der Heft3, (Leipzig,1910).G. E. Smith& D. E. Derry,'Anatomical Krankheitseffeger, Survey report', Archaeological thatof variolain the skin of Nubia.Bulletin6 (Cairo,1910).M.A. Ruffer& A. R. Ferguson,'Aneruptionresembling 26 (1911),1-3.G. E. of a mummyof theTwentiethDynasty(1200-10BC)',Journalof PathologyandBactedology Smith,The RoyalMummies(Cairo,1912).G. E. Smith& F. W. Jones,TheArchaeological Reportfor Nubia: Reportfor 1907-8,(Cairo,1910).

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4.3Carcinomas Surprisingly the situationregardingthe presenceof cancersin ancientEgyptian to assumethatthosechronicmedicalconditions remainsis notclear.It is notunreasonable for todaycouldalsohavebeenpresentin ancientEgypt.However, generallyencountered Theriskof cancerincreases carcinomas manyof thecausalfactorsarenotcomparable. with age such that in populationswith low life expectancylower levels of cancerswould be

But thoseenteringold agewouldprobablybe at equalrisk.Alsomanyof the anticipated. moderncancersarethe resultof industrialisation andthe subsequent changesin livingand 405 Theincrease in presentdaymalignant hasbeenascribed turnours to an ecological patterns. increasein life expectancy factorse.g. air and the enhancedinfluenceof environmental A recentstudyshowedthat pollutionand the nutritionalintakeof potentialcarcinogens. inherited is geneticfactorshaveonlya minorrolein causingcancerbutthattheenvironment 406Lungcancer,untilrecentlya majorcauseof the maincontributor to the majorityof cases. in smoking. Conversely, maledeath,is nowlowerin Western societybecause of thereduction dueto the fashionof sun bathingandthe increasein radiation skincancersare increasing due to ozonedepletion. for A highincidence exposure of skincancersmightbe predicted 407 ancientEgyptbecause of theclimate. Certaintypesof cancersif untreated are insidiousby natureandcan producelarge tumoursbeforedeath.Thechangesthatthesecausedirectlyto associated boneandtissue

408 Evidence disease. canoftenbe seenin skeletal remains andso provide of of evidence

405By moderncancersI meanthosecausedby industrial chemicals cancerfromsoot,bladder e.g. testicular fromorgano-chemicals. cancers 406 N.Spector, 'Cancer NewEngland 343(2000),1494. Journal genesandtheenvironment, ofMedicine 407 Thereis highfrequency in Egypttodaycompared Some60%of theseare Europe. of skincancers to Western directlyattributable to exposure to thesun.J. E. Cleaveret al., 'Xeroderma fromEgypt: patients pigmentosurn Preliminary correlations of epidemiology, biology,Journalof Investigative clinicalsymptoms and molecular 77(1981), Dermatology 96-101. F.el Khwsky et al.,'Riskfactorsfornon-melanomatous skincancerinAlexandria, Journalof Cancer56 (1994),375-8.A. S Pappo,'Melanoma Egypf,International in childrenandadolescents', Journalof Cancer18(2003),2651-61. European Thesymptoms aresuchthattheyaredifficultto of skincancers identify intheancient texts. medical 408 Egyptian Medicine, Nunn,Ancient 81.

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been have in 409 However, human in these since remains was reported early studies. cancers in 1967andMicozziin 1991whosuggestthattheserepresent putintoquestionby Brothwell 410Equally,Rowling(1961)dismissesSmithand benigngrowthnot malignanttumours. left from (1924)diagnosis (malignant Dawson's the of a examination of osteosarcoma growth) 411Thedistinction (benigngrowth). femur,ratherconcludingit to be a caseof osteochondroma

because is themostcommon is important formof benignbonetumours.It is osteochondroma 412 theagesof 10-25). andoccursprimarilyin youngerpatients(between oftenasymptomatic in termsof lifeexpectancy Statistically, thisgroupis morelikelyto be represented andthus between thetwoconditions willleadto anomalies of frequency. misdiagnoses

Thelargestinvestigation wascarriedout by the Nubian of diseasein humanremains Surveyin 1907priorto the buildingof the firstAswandam.Morethan6000 Archaeological havingaccounted for exceptionally bodieswereexamined; well soil andclimaticconditions for Those then pathology preserved remains. were retained museum withexternalsignsof by its disrupted is It that this were subsequently and records collection. unfortunate collection A re-appraisal in 1941,whilstattheRoyalCollegeof Surgeons. bombdamage of thecollection workwascarriedout by Smith value.Theoriginalanatomical wouldhavebeenof enormous fromCemetery 7.413 reported notumours exceptforonepossible whosurprisingly metastasis For ancientEgyptgenerallyNunnreportsthatthe incidence of tumoursin skeletal (tumourof the remains'seemsfew'.Thosehe citesarea skeletalreactionto meningiomata femur the of the brain)reportedby Hussein(1949-50), of membrane an osteo-chondroma

in 1962andcarcinomas by Rowling in 1961 by by Wells the and repofted of naso-pharynx 409Table 4.2.

410D. Brothwell,in Brothwelland Sandison(eds.), Diseasesin Antiquity,430.M. S. Micoz; ei,'Diseasein antiquity, thecaseof cancer',Archivesof Pathology Medicine115(1991),838-44. of Laboratory. 411 T. J. Rowling,Proceedings of theRoyalSocietyof Medicine54 (1961),409-14. Paleopathological 412R.T. Steinbock, Diagnosis BoneDiseasesin AncientHumanPopulations andInterpretation. 1976),319. (Springfield, 413 T. Molleson,'TheNubianPathological Collectionin the NaturalHistoryMuseum,London',in Daviesand Anthropology, Walker(eds.), Biological 141.

123

twenty-six Ghaliounghui for in 1980.414 the Sandison that only studied case ever reports all 415 Strouhal harvest'. 'is a meagre knowncasesof tumourareknownin total,whichhesuggests 416 fact to is in figure by total that the improves this nearer sixtycases. suggesting number on (25adults)onlyonetumourwas fromsomethirtymummies Ina studyof thefragments foundon the heelof a separatedfoot.417Strouhalin 1976reporteda caseof naso-pharyngeal

by Sixth in Dynasty the overlooked whichwasapparently carcinoma a middleagedwomanof 418 SmithandJonesin their1910excavation. bothradiologically in the TurinMuseum A studyof somethreemummies examined in the 419 Equally the bone of mummies collection or otherpathology. andexternallyshowedno

420 Museum Manchester of cancers. showsa notableabsence Theevidence, of so far, doesnot seemto supporta strongcasefor the presence (325 individuals 415 in However, in Egypt. study of some a morerecent carcinoma ancient the tumours Thebannecropolis affecting somefourcasesof malignant adults)fromthewestern 4045 female (a 20-5 identified. In two years) and a aged agedyears were cases male skeleton These from thereweremixedbonelesionssuggesting were carcinomas. metastases multiple (40-50 In breast the two testicular the cases others cancersrespectively. and possibly resultof that 50-60 there symptoms of were signs of sex unknown and a male years age) age yearsof 421 thevertebra, hadaffected skull of suggestive myeloma. Fromthistheresearchers pelvisand factors tumourswere findings indicated important that their that malignant affecting concluded for in historic Statistically figures these age and sex adjusted populations. effectiveeven

Medicine, Egyptian 81. 414 Nunn,Ancient Egyptian 81. byNunn,Ancient Medicine, 415 Reported inAncient Egypt,Paleopathology 1-6. 'Tumors Newsletter 416 E.Strouhal, 85(1994), 117(1981), 364histiocytoma 'A possible in a anEgyptian 417 M.Zimmerman, Archives mummy', of Dermatology 5. intheremains 45(1976), 613'Tumors Anthropology 418 E.Strouhal, American Journal ofanEgyptian', ofPhysical 20. in Turin E.,'Radiological Museum', the M.GallinoandSantmaria 419 mummies andskeletal-anatomical of study 11,503-6 18(1995), Medicine. Minerva Nosample 420 David,Lancet349,1761. sizegiven. Tumors 19(1999), inAncient 4273-8. Egyptian J. Zinketal.'Malignant Research. 421 Populations', Anticancer

124

between indicated tumourwithboneinfectionhigherthanthatof England a rateof malignant lowerthanthe present 1901and1905.Thatis an expected frequency of 0.95-1.74, although incomplete frequency 13.57-16.68.422 day- expected Thefactthatmanyof theskeletons were higherresults. thatcomplete samples suggests mayhaveproduced

Entdes Prescription Thereappearsto be no directevidenceof cancerin the medicalpapyri.However, Ebbell423hassuggestedthatEb8l3 is a caseof uterinecancer:

for a womanwhosewombis eaten/consumed Eb8l3 'Another(prescription) andin whosevulva(9ds) ulcersarepresent'(mytranslation). indicates ThewordthatEbbellsuggests canceris wnm (t) fromthefirstline:kt nt 424 The Grundriss 'to is translates The the idt. verb eat'. well attested as word imm wvmtm 425 formas immo this as fressen'to consume, corrodeandgnaw'. It appearsin participle 'devourer', flame'. 426 meaning asin 'devouring However, Theword'eating'427 Eb813is buta singleexample. appearsto be a good description However, (modem) of a cancerandin thiscasethewombjdt is clearlymentioned. it is unlikelythatthisinternaleffect(of cancer)wouldhavebeenappreciated by the ancient Egyptians. The actualcancerwouldbe occult.It is morelikelyto referto the symptom by patient.Theideathatmany'specific'anatomical termsareintended to describe perceived 428Therefore, by Walker. it seemsmore thatareaof thebodynottheorganitselfis discussed likelythat imm wouldapplyto thesymptoms of a gnawing, consuming, eatingtypeof painor

422 biomarkers A.Waldron, 'Editorial: Intemational 6 (1996)324-5. Joumalof Osteoarchaeology ofdisease', 423Ebbell,ThePapyrus Ebers,130. 424 Faulkner,A ConciseDictionary of MiddleEgyptian,81. 425Grundriss VI1:185.

Dictionary A Concise 426 Faulkner, 62. of MiddleEgyptian, haslongbeenusedin theEnglish 427 Theword'consume(d)' language tomeanbothto'eat'andto be'consumed Oxford Shorter (eatenup)withdisease'. English Dictionary 409-10. Principles, onHistorical Studies inAncient 428 J. H.Walker, Egyptian Anatomical 1996). Terminology, (Warminster

125

in the areaof the lowerabdomen. discomfort Thus,it is as likely,for exampleto simplybe 429 irritation. describing dysmenorrhoea infection: discharge, and or a candidal vaginal ulceration

Eb874,877refersto citntbnsw 'swelling Thishasbeentakento mean of Khonsu'. leprosyby Ebbellin 1937andby Lecain tubercular

1988.430.

Millerhasan entirelydifferent

in Eb875.Herehe seesthe swellingof Khonsuto referto thatswelling pnsw c3t of view nt by the presence produced of the parasitic guineawormunderthesurfaceof theskin:'it is a do notdo anything knownswelling thefulltranslation aboutit'.431However, of thesepassages isdifficultandit mayrelatetocancer,bubonic 432 plagueor evenneurofibomatosis.

4.4BoneandJointDiseases butrathera genericheading Thisheading is notintended to bea specificclassification includearthritis,rheumatism to collectively spinaltuberculosis and othermuscular-skeletal Specificindividualisation forthepurposes problems. necessary of diseasewasnotconsidered it is appreciated thatthereareproblems of thischapterandbecause withspecificidentifications Rather,it is considered sufficient at thispointto acceptthatthesetypesof withinthiscategory. diseasewerea problem forpainrelief.Forexample, in theHearst andsopresented a potential Papyrus, forthetreatment thatcanbeclassified of thoseconditions of bone,jointor muscular disorders 433 veryfewareactually specific- apartfromfractures. in ancientEgyptthosethatsurvivedintoold agemightbe Withlow life expectancy to sufferthesamemaladies determinative thatafflictmodemman.Thehieroglyphic expected M foroldisdepicted bya hunched manleaningona staff.

429 P.J. ReesandD.G.Williams (eds. ), Principles 717. Medicine 1995), (London of Clinical tgyptienne Ebers,127.A. P.Leca,LaM6decine 430 Ebbell,ThePapyrus (Paris, Pharaons, 1938). des Temps au 431 R.L.Miller,'Dqr,Spinning 251. andthetreatment of theguineawormin P.Ebers875',JEA75(1989), Egyptian Medicine, 432 Nunn,Ancient 75. 433 Medical Leake,TheOldEgyptian Papyri, 62.

126

IntheInstruction ofPtahhotep wearetoldthat: Age is here, old age arrived eyes are dim; ears deaLthe bones ache .. throughoutpainfularestanding 434 and sitting. ..

Tuberculosis is statedby Nunn as beingwell documented. 435The remainsof Nesparehan, Dynasty priestof theTwenty-first clearlyshowsa deformity of thespinewhichis 436Derryreportson somenineknown characteristic of Pott'sdisease(spinaltuberculosis). cases of tuberculosisfrom remainsexcavatedprior to 1938.437

Zimmerman considersthe socialconditionsthat wouldfavoursuchconditionsas 438A largefamilywas consideredprestigious.Householdsseemto have been tuberculoSiS.

families.In turntheseresultedin crowdedhousingand of large,multi-generational composed 439. Such disposalof wastes. periodicepisodesof undernutritionand in the rudimentary Zimmerman wereidealto sustaintuberculosis conditions andotherconditions. reportsonsuch 440 a childhood casefromthetombof Nebwennef. The clinical diagnosisof skeletal tuberculosisis not simple. Single dried, bonespecimens Onlyif thespineis involved archaeological cancompound anyconfusion. will be morecertain. 441Many otherconditions a diagnosis canbeconfused withtuberculosis such arthritiS. 442

astraumatic arthritis, crushfractureandrheumatoid

Buikstrain an extensive thattuberculosis studyof tuberculosis andsyphilissuggests diagnoses beingother andthatprevious wasnotextensive arenotconclusive moreprobably Egyptian 434 Ancient Literature Volume Lichtheim, 1,62-3. Egyptian 435 Nunn,Ancient Medicine, 73. Egyptian 436 Medicine, Nunn,Ancient 73-4. 437 D.E.Derry,'PotfsDisease inAncient Egypt',Medical PressandCircular 197(1938),196-9. JARCE 14,33-6 438 Zimmerman, 439 J Dixon,'TheDisposal House-hold of CertainPersonal, andTownwastesin AncientEgypt,in PJ Ucko,et al ), ManSettlement (eds. (London, 1972),647-50. andUrbanism, 440Zimmerman, JARCE 14,34. 441 'Tuberculosis', in Brothwell B.Morse, (eds. ), Diseases 249. inAntiquity, andSandison Paleopathological Diagnosis 442 Steinbock, Human Populations, BoneDiseases inAncient andInterpretation. 321.

127

have DNA 443 involving boneconditionS. However, degenerative suggested morerecentstudies in ancientEgypt444andof Pott'sdiseasein a pre-dynastic findingsof tuberculosis thepositive in 25 has 445 tuberculosis Most DNA technique of some present shown recently a new skeleton. 446 85humanmummy tested. samples Arthritishasbeenfoundin a largenumberof casesfromancientEgypt.Ofsomeeight degeneration in 1961, in British Museum, the was arthritic examined radiologically mummies foundin

four. 447

Ptolemaic from Late RemainsfoundnearAlexandria the and of soldiers

feet bone the degenerative disease, have of arthriticcondition particularly shown periods the 448 in Miller due to the noted necropolis workmen a study on marching. stress of presumably injudesand work practicesthat led to extensivearthritisand chronicskeleto-muscular 449A computertomography(CT) scan of a Twenty-secondDynastymummy deformities.

the (herniation the from Schmod's have it to of surfaces articular on nodes suffered showed from 450 A 64 heavy This lifting the mummies objects. studyof vertebrae). waspossibly resultof This to the Romanperiodsshowedsome18 casesof disc calcification. the pre-dynastic from is far 28.12% higher than that the expected modernstatistical of sample, which represents occurTence- 0.0001%. 451

in thefossilised Jointdiseaseis a veryoldproblem. Infactit hasevenbeendiagnosed hazard be 452This to disease dinosaur. that the of a assumed suggests a whilst remainsof joint fact is is in Osteo-arthritis lifestyle the common a much older most problem. modern in Brothwell Biological Anthropology, 45-6. Buikstra, 443 7, ERES(Arqueologia) diagnosis lesionsin historictissues', A. Nerlich, 444 of tumourus et al.,Differental skeletal 87-100. (1997), DNAin an Egyptian PottsDisease 445 E.Crubezy of mycobacteriurn et al.,'Identification of 5,400yearsold',CR 1I (1998), 941-51. Sciience. Acedemy. by DNA'sfromEgyptian 446 A. R.Zinket al,'Characterization tuberculosis mummies of Mycobacteriurn complex Journal Microbiology 41(2002), 359-67. Spoligotyping', of Clinical Medicine, 41. Egyptian Reeves, 447 Bodies 1964),65. Evidence in EarlyMan(London, C.Wells,Bones, 448 andDisease: of Disease andAbnormality History 35,21. Miller,Medical 449 450Filer,Disease, 50. (eds. ), Diseases Gray,in Brothwell in Antiquity, 451 22.However, thiswaslatershownto bedueto andSandison in thepre-Dynastic (absent thepostmortem absorption of natronusedin theembalming sampleaswere process thepresence of 'degeneration'). intheJurassic', 1454. Lancet360(2002), 452 B.Rothschild etal.,'Spondyloarthropathy

128

icallyhumangroUpS. 453Thetombof Ukhhotep diseaseseenin archaeolog at Meir(Twelfth leaningon a Heis depicted Dynasty) showsa nakedpotbelliedmantalkingto a shipwright. be knees to bow His himself the the swollenandthe appear on of ship. stickandsupporting It appears to bea representation of arthritis. of thelowerlegseemto beemaciated. muscles Rheumatoid arthritiswasreportedin the handof mummyfromtheThirdDynastyby in in a FifthDynasty Rufferin 1918,454also exampleby KarshandMcCarthy

1960.455

In 1975

456 degenerative joints in Old Kingdom Weizshowed the of spineand MUMMy. osteo-arthritis an 457 In 1999Rothschild inearlyNubianpopulations. thepresence reported of spondylarthopathy fromthe'Tombsof theNobles' A morerecentstudyof theremainsof 273individuals The in up to 60%of examined vertebra. of spondylosis at Luxorshowedint al the presence in oneof themainnecropoles thatthelivingconditions concluded was'quitepoor researchers highstandard of the of thesociallyhigherpopulation andin contrastto the'usuallyassumed capitalof

458 Egypf.

Feldtkeller in reviewingthe availableradiological evidencefrom pharaohsof the Eighteenthand NineteenthDynastiesconcludedthat at least three had ankylosing 459 spondylitis. A recentmajorstudyexamined the humanremainsof 211MiddleKingdom and273 fromtheThebanNecropolis. NewKingdom to LatePeriodindividuals Bothgroupsshoweda boneconditions. highlevelof tuberculosis Thoseof the MiddleKingdom anddegenerative

453

Rothschild, above. Journal 454 Ruffer, 22,152-196. ofPathology andBacteriology. 455 R.S.Karsch Wchaeology (1960), 640-664. Medicine 105 Archive Intemal andJ. D.McCarthy, andArthritis', of W.Wenzet al.,'Viewofthepast:Roentgenography 456 45-9. 15(1975), ' Radiologie ofanEgyptian mummy', 457B. M. Rothschild, identified American et al.,'Spondylarthropathy as theetiologyof Nubianerosivearthritis', Anthropology 109(1990)259-67. JoumalofPhysical 458 A. Nerlichet al.,'Anthropological fromthree'Tombsof andpaleopathologicall analysis of thehumanremains thenecropolis 321-43. theNobles'of ofThebes-west, Anz.58(2000), upperEgypt,Anthropol. 459E. Feldtkeler in pharaohs Interriational 23 et al., 'Ankylosing spondylitis of ancientEgypt',Rheurnatology Amenhotep 1-5.Theyinclude 11, Ramesses (2003), 11andMerenptah.

129

the typically disorders manifestations, showed evidence of metabolic osseous with particularly 460 scurvy and anaemia. resultof Jointdiseaseis a majorreportedproblemtoday.Some25%of peoplein theUKvisit 65 joint 461 51% disease. In Spanish theirdoctorbecause aged of patients of a studysome pain, arthritic or rheumatic symptoms andof thesesome82%reported yearsor morereported 462 andmoderate. some23%asfrequent in the Therathervagueconditions of 'painsandsicknessin the limbs'as described Hearstpapyrusmaybe textualevidenceto supportthe presenceof joint conditionsin ancient

(27%)mayindicateconditions 463Leakeconsiders Egypt. thatat least69 prescriptions of joint, is givencredencein that the majorityof these boneor muscledisease.His suggestion to designed 'rubbing or compounds' are non-quantitative external preparations as preparations He considers be appliedby bandages. that H33,34,37,41-6,125-130mayall represent 464 to arthriticdeformity. treatment of arthdtictypeconditions withH123,124actuallyaddressed But,whilstthis maywellbe the casethe symptoms are vagueandthe actualprescription ingredients arenotallrecognisable.

460 Egyptian A.Nedich Investigations etal.,'Paleopathology ofancient ontheoccurrence mummies andskeletons. duringvarioustimeperiodin thenecropolis Pathologie 23 of specificdiseases andfrequency of Thebes-West, 379-85. (2002), 461Roberts 1999: 100 disorders impact',Clinical M.Espalliaques 462 in theelderly:anapproach to theirpopulation at al.,'Osteoarticular ) 106(1996), 601-16. (Barcelona. Medicine Medical Papyri, 61. 463 Leake,TheOldEgyptian Medical Papyri, 62. 464 Leake,TheOldEgyptian

130

Entries Prescription Manyof theseprescriptions intheEberspapyrus. appearasequivalents

H33(Eb3Ol)kt pbrt nt srw mrwt m I'ivt nbt n s, 'anotherprescription to fromthe limbsof a man'(mytranslation). remove/banish sickness/pains

H34dr stem -rwtnbtto driveout ste

C, A-A

(aneffect)fromall the limbsof the

body'(mytranslation).

H33is vagueenoughto applyto arthritictypepaini.e. 'to driveout painfromthe 4651n H34thewordsteis difficult.Leaketranslates bothH33,34thesame,astheyfollow limbs'. eachother.TheGrundfiss givesthemeaning of thewordst-ras Einwirkung an effect466such Westendorf, thatH34is to 'driveout the effectsof the condition' or to curethe symptoms. forces. 467However, however, thatthe'effect'is dueto demonic thiscanonlybe an considers to explainan otherwiseopen term. It seemsunlikelysince the preceding assumption H33mentions in thelimbs,notdemonic suffering presc(iption possession. H37 irrt r nhp m cwt 'whatis doneagainst'nhp / jumping'in the limbs(my 468.Westendorfgives this as an exampleof the translation')(nbp = schneiden,springen).

(of Schmetzstoffe)' i.e. 'the rapidmovement (of Schmerzstoffe) 'Umherschnellen aroundthe 469 Butthisis because factor(seeChapter limbS'. to tvýhdw of hiscommitment asa pathological 3 ). I thinkit farsimplerandmorelikelythatLeakeis rightin givingnhpto meanjumpingin the 470 'Throbbing' limbs. wouldbea bettertranslation a prescription of nhpsuchthatH37becomes

465Leake,TheOldEgyptianMedicalPapyri,80. 466GrundrissIV:264. 467 Westendorf, 367.

319. GrundrissVI 1:469,Westendorf, 468 319. 469Westendorf,

Medical Papyri, 470 Leake,TheOldEgyptian 81.

131

in thelimbs.In thiscasearthritisor rheumatics to curethrobbing wouldseeman appropriate forH37. explanation

fromany H41,(EME drtKhdwnhpm cainbtnts'to driveoutpainandthrobbing limbof a man'.

H42(Bln 161)pbrt sm?wbdwm lul nbta prescription to remove painfromanylimb'. H43-5'anothee. H41is anexternal Theprescriptions thatfollow: application of excrements appliedbybandage. differinthattheyareinternalpreparations. H42-45

N-RA )a H123 (Eb654).H124(H655)'another(prescription) to causeto soften/relax(sgnn

jointin anylimb' H123is a remedy forrubbingin whilstH124is appliedbybandages. Leakehasthisas forarthriticdeformity. 471 Whilstthiscanonlybe assumed, I nevertheless thinkthat a treatment thisrepresents goodevidence of anarthritictypecondition.

H160-6, H168,169 Leakesuggests is for'muscular thatthissequence or subcutaneous in a fatty base. 472 soreness'sincethey are localapplications of mild alkalineastringents r--"

-

hefailsto translate However, theconditions herems'pnt-1 on c3(H160-6)and thatappears .u

-w%cl. TheGrundfiss it to tmYrz. andWestendort suggesting givems'pntasHaufflechte473 butoffernotranslation besomekindof skincondition for tMyt.

474

Therearealsoprescriptions H94-122 deal andH228-238, which withvariousafflictions to themtw. Theseinclude'cooling'of themtw (1-195), to give'reliefto themtw (H96,Eb627), Medical Papyri, 471 Leake,TheOldEgyptian 62. Medical Papyri, 472 Leake,TheOldEgyptian 63. VI: 398.Westendorf, 839. Grundriss 473 474 Theyappear tobeskinconditions, seepages71-2.

132

'stiff'(H110, for a mtw which'throbs'in any limb(H99,Eb644),for a mtw thatbecomes in Eb694)andto 'soften'a mtw (H114,Eb659,Bln49).Thewordmtw hasbeendiscussed body internal the 3.2 (ii). length Whilst it is the taken to of vessels aboveat represent some include framework it to in its be taken and muscles sense an anatomical can also generic within implied. In 475In thisrunof prescriptions be to this thelattermeaning tendonS. of mtw seems be designed it to give these that seem appropriate some could well would of presc(iptions case typeconditions. reliefto arthritic Inaddition, I wouldsuggest thatthereareotherinstances mightbe whereprescriptions for the treatmentof arthriticconditions.I offer a few examples:Eb603-5 appropriate for 476 EIJ295,298 knee' (ointments) for knee, the the and or region of applications nvst'the 'painin the neck.'

4.5DentalDisease Theteeth,compared to otherpartsof thehumanbody,aremorelikelyto disintegrate been fact have duringlifeyetafterdeathhavegreattenacityagainstdecay.Because this we of fromwhichto assessthelevelof dentaldiseasein ancient dentalevidence leftwithabundant 477Ruffer Egypt.It is generally thatthe levelof dentalhealthwaspoor. accepted notedthat in everyskeletalcollection fromEgyptandNubia.Healsoreported dentalabscesses appeared 478He thisto thetypeof food of thoseteethexamined. attributed severeattritionin themajority lentils,artichokes, to breadbutalsoto the consumption of rawvegetables: eaten,principally beans,asparagus andcabbage.In an extensivestudyof some3000dry ancientEgyptian bygoodcalcification mostof theteethwerecharactefised and skullsLeekfoundthat,although These included enamel,mostexhibiteda greatvarietyof non-pathological abnormalities. 475Nunn,AncientEgyptianMedicine,222.Westendorf, 839. 224. Westendorf, 476, 477Filer,Disease,94-102.Reeves,AncientEgyptianMedicine,16. 478M. Ruffer,Studiesin Pathology of Egypt(Chicago,1921),228.

133

of oneor moreteeth,varieties andun-erupted absence of non-pathological cystsandimpacted teeth.Theseproblems werefoundto be the resultof attritionto the cuspsof the teethwith 479 damage in infection to thesurrounding abscesses. softgumtissueresulting andsubsequent in bread,theprincipal It appears thatthecauseof thisdentalattritionwasdueto contaminates food.An analysisof ancientsamplesof breadhasrevealedthe presence of extensive and 480Theseparticlesappearto havederivedfromwindblownsand damaging mineralparticles. both from brick These have the the surface caused of mud silos. contaminates would and dentalattritionanddirectdamageto the gums.Thisis supportedin anotherextensivestudyon

fromAbydoswhichshoweda highincidence humanremains of abscesses andseveredental in 481 Extensive dental in the theexposure of thepulp present older adUltS. wear results attrition 482Roseandhisteamfoundthat abscessing. of thetoothto infection andsubsequent chamber fromcemetery of over50%of allsamples examined sitesin Nubiashowedextreme onaverage 4831n1999Lovellreported highpatterns dentalwear. of dentalenameldefectsin allof some88 fromMencles. FirstIntermediate individuals, Theserangefromthe OldKingdom, andGreco484 Romanperiods. Modemnon-invasive havenow allowedmummiesin museum medicaltechniques be to A CTscanof thecollection withoutdamage. of mummies at Leipzig collections examined dentalattrition. 485 AnotherCTscanof anancientEgyptian extensive mummy showedit showed Ofthe28 teethpresentin themouthsome24wereshownto to exhibitseveredentaldisease. haveextensive exposure of the dentalpulp,'thiswouldhaveresultedin considerable pain,

479F. F. Leek,'TeethandBreadin AncientEgypt'JEA58(1972),126-32. , 480Leek,JEA58,130.

Anthropology 481B. J. Baker,'Contributions to theUnderstanding of Biological andNubian of AncientEgyptian Anthropology Societies', andEgypt(1995),111. J. C.Roseet al.,'DentalAnthropology 482 ), Biological Anthropology of theNileValley',in DaviesandWalker(eds. Egypt,64. andtheStudyofAncient 483Rose, above,63. N.C.Lovelland1.Whyte,'Patterns 484 in Egypt,American Journal of dentalenameldefectsat ancientMendes of 110(1999), 69-80. Anthropology. Physical T. Nickol,et al.,'Anexamination CT: 485 by to of thedentalstateof anEgyptian of a contribution means mummy Journal 43(1995),105-12. dentistry', of Dentistry oftheHistory

134

Udja Lady the 486 A CT distress the of remains andmalaise'. recent scanof mummified personal in 487 Nerlich lower a recentstudyof molars. attritionandextracted alsoshowedextensive dental degree high being dental humanremains Egyptian of a with poor as reports conditions 488 and abscesses. abrasion debateof incidenceof dentaldiseasehasleadto the yet unresolved Theconsiderable

is to There Egypt. in dental support no evidence ancient profession existed a separate whether 489 However, Nubia. from Egypt human large the dental and of remains numbers workon any in in that dental be to to several thereappears profession someevidence supporta separate

has titles Niankhsekhmet the For dental the titles ones. example, uT medical accompany cases Palace Physicians), (Chief the Physician), andRTjbPypr-c3 of wrs%nwpr-c3 stmw(Chief (Chief bp is iry ! In Khouy the title Palace). the (Chiefof theDentists also given addition Wr of incidence high further. However, the discuss 4901t is to this thesis this Dentists). whilst outside of in be dental disease dental applied caution must some profession, mightsupposea of 'dental these There is by demonstrated titles. this where are other examples such suggesting thattheymightmerelyrefer titles'appearwithoutanyaccompanying medicaltitlessuggesting 491 to someofficeof stateor markof prestige. Theredoesnotappearto be anyknownrepresentation or dental of dentaltreatment dental incidence high in the At firstsight,thisis perhaps disease. of surprising viewof apparent

tomography 486A. H. Melcheret al., 'Non-invasive of the reconstruction computer andthe three-dimensional Egyptianmummyexhibitingextremedentaldisease',Journalof Physical dentitionof a 2,800-year-old 329-40. 103(1997), Anthropology American OrthoJournal 487J. K. Thekkaniyil of et al., 'Dentalandskeletalfindingsin an Egyptian mummy', 117(1)(2000),10-14. Orthopology Dentotacial Ariz58,340. Anthropology Nerlich, 488 Medicine, 202 Egyptian Nunn,Ancient 489 History15,171. Medical Ghaliounghui, 490 History16,404.Udjahorresnet Leek,Medical 491 andformernavalcommander a highofficialof the27thDynasty titleof 'chiefphysician' king. theobviously bythePersian administrative wasawarded

135

disease dental level England 492By contrastin nineteenth the disease. was of when century 493 in high, toothache caricatures. represented wereprominently equally painand

Evidence Presdiption is is Prescription typically not surprisingly vague present,although evidence although 0.78% total the Hearst has The two of only references, only possible papyrus extensive. firm' 'make dumbpalm to H8 is Prescription a remedyof gumand numberof prescriptions. to 'treatbloodin (smn)a tooththatis aboutto fallout.H9is lessclearin thatit is a mouthwash to a dentalproblemas it followsH8 andits is a possiblya reference '494This the (mouth)? formulais thatof Eb742where'teeth'arementioned. dentaltreatments thepossible In theEberspapyrus arealsolessthanonepercentof RIS bnulJ drshm teeth to Eb553/4 to or gums: thetotalnumber. ulcerated appear refer )', (gums? flesh in the to ) tooth (*abscesses? drive the P lbp and strengthen out srdt -rw'to m (Eb554). E739-41referto the 'strengthening' or the 'affixing'of a toothPct--rm pbrt nt smn is is that (Eb739). tooth Eb742 to treat tooth' to beginning 'the a jbp, of a prescription affixa being'eatenaway'.Kt nt srwhlbp ws'cwrrP -rw,'anotherto treata tooththatis beingeaten ! bleeding is ktpbrt Eb749 tooth flesh to treat the in the a my snfm of mouth'. nt srwb away ' Eb122(Bln3Qis to 'drive to treatbloodin thetooth/ableeding tooth? jbp'anotherprescription for (r) ' in is toothache. (pain) the mouth/teeth? and a possible remedy out ;ýbdw

inwhatcontextit might beargued thatdentaldisease is difficulttodepictanddifficult to imagine Itcouldequally 492 inadequacy the health. The to emphasises of pictorial point evidence as a guide appear. Imagesof Pharmacy (London, 1989).Thesecaricatures 493M.knold-Foster, wereby definition andMedicine Equally, features features. Egyptian 'odd' the those many perhaps of medical of representations are exaggerations for their (and novelty exaggerated) value. selected havebeenshowneffective Theformula of mulberry, aniseed as 494 consists andotherherbs.Suchherbalformulas J. M. Kaim herbal 'An in investigation activity of the an et mouthwash. al., antimicrobial vitro antimicrobial of an Clinical Dentistry 9 (1998), Journal 46-8. of mouthwash',

136

495 been have to Dentaldiseaseseemswellevidenced present. widely andappears in ancientEgyptcanbesurnmadsed: Thestateandextentof dentaldisease there Ofthemanycollections remains of Egyptian andNubianskeletalandmummified 496 doesnotappeartobeanywithoutat leastoneexample of dentalabsCeSS. Painofvaryingdegreemusthavebeena continual presence.

Worms 4.6Parasitic The terrestrialhabitatandthe changeto an omnivorousdiet exposedearlymanto a

bythedomestication Thiswouldhavebeenexacerbated infection. highdegreeof helminthic of infection by The have worm elimination of parasitic contact. would encouraged which animals WorldWardevelopment. in modernWestern infections societyhasonlybeena post-Second the biological life the the Thishasbeendueto a combination of cycles of understanding of importantly in living the availabilityof effective and conditions improvement parasites, in ancientEgyptshouldbe Therefore, the presence treatments. of parasiticworminfections thern. 497

Indeed theearlyclassical obvious., writersreporton considered

The Nilewasa focalpointin Egyptianlife whichprovideddrinkingwater,washing for parasiticinfection. facilities,the meansof travel and transportand an opportunity 498Indeed,parasitic infection in ancientEgypt. Schistosomiasis seemsto havebeena common 50% in Egypt Rowling the infections today. of some are still a problem estimated worm

beenshownthatpoororalhealthis linkedto increased Lungfunction 495 lungdisease. It hasrecently wasshown lossincreased. F. Scannapieco to diminish of gum-aftachment astheamount et al.,'PoorOralHealthandLung Joumalof Periodontology 72 (2001),50. Thiswouldhaveexacerbated the healthproblems Disease', of the Egyptians. ancient 496Filer,Disease, 98. Carus(11 Plinyreports BC)describes 497 of tapeworm onthefrequency andLucretius elephantiasis asa stcentury Reported by A. T. Sandison, ), (eds. Diseases in disease. Sandison 'Parasitic Diseases', in Brothwell and common 180. Antiquity, 'AncientParasites 938.J. T. Rowling, 'Urology in 498 A. Cockburn, on theWestBankof theNile'Lancet(1981), Diseases in Antiquity, Egypt,in Brothwell 530. andSandison,

137

Health World In 1993 in 1963.499 the populationwere affectedwith schistosomiasis Organisation to beaffected withschistosomiasis. estimated some12%of theworldpopulation between is causedbya parasitic Thecondition wormwhichhasa lifecyclealternating in theportalveinof The itshumanhostanda particular worms pair species of watersnail. adult in thehumanhostandthenceto theveinsof thebladderandrectum.Theeggsaredeposited thebladderwheretheycauseulceration andthepassingof bloodin theurine(alongwiththe This of thecondition. symptom eggs).Thepassingof bloodin theurineis the characteristic by Napoleon's land dubbed Egypt 'the the troops occupying of army of as noticed who was 500 men'. menstruating

Theparasitein the courseof its cycletravelsalongthe portalsystemto the liver. from Thecomplications Because of interference withliverfunction. of this,thereis a possibility It is becauseof this that Ghaliounghui this can give rise to gynaecomastia. suggested for the strangeshapeof Akhenaten. Loebl infectionas a possiblediagnosis schistosomiasis forBak,Akhenaten's 501 thispossibility asa diagnosis chiefsculptor. alsoconsiders It is doubtful if theEgyptians TheBookof wereawareof thecauseof schistosomiasis. thenegative 'I havenotwadedin thewater.Nunncitestheview theDeadincludes confession: in themistaken beliefthat thatpenilesheathsmayhavebeenusedto preventschistosomiasis i. But, the infection. 502 the the the of parasite was e. same via penis route symptom as of entry in theBookof The in viewof theextensive andsomewhat vaguerangeof negative statements Also, Deadandthefactthatmanysocieties usepenilesheaths anyconnection seemsdoubtful. as the wormis too smallto be viewedby the nakedeye we mustassumethattheywere ofthecause. unaware

499Rowling,'Urologyin Egypfin BrothwellandSandison(eds.), Diseasesin Antiquity,534. Nunn,AncientEgyptianMedicine,69. 500 Citedby Nunnin AncientEgyptianMedicine,82. 501 Nunn,AncientEgyptianDisease,69. 502

138

bythefindingof calcified Thepresence hasbeenconfirmed ovaby of schistosomiasis Rufferandin the remainsof Nahktby Miller. 503El Mahdysuggests thatthiswasa problem It is logical 504 far in by but discernible royal mummies. many ordinary mummies not so shared 'higherorder'.Theyarenot thatschistosomiasis maynothavebeenpresentin the Egyptian likely to have the samedirect level of contactwith Nile water as ordinarypeople.Reeves

VI havinga largeeviscerated however, scrotalsacimplying reportstheremains of Ramesses fromlivercomplications However, I consider 505 to schistosomiasis. thatthisresulted secondary this conclusionsomewhatsuspect.Thesymptomsare too remotefromthe indexdisease.The

is thatit wassimplya caseof aninguinal hernia. likelihood Otherparasitic Theguineawormor anddocumented. wormhavealsobeenidentified Calcifiedremains dracunculus medinensis appearsto havebeenanothercommoninfection. 1770at Manchester. Thiswormmanifests itselfin theankleregion havebeenfoundin Mummy by can be performed of its humanhosts.Removalthroughthe skin,althoughdangerous, excisingthe wormthenwindingit carefularounda stick.Millersuggeststhatthis surgically have been is in Ebers 875.506 Other to very parasitic worm appear proposed conditions method Amongst in theLeedsMUMMy), 507 thoserecorded arefilariasis(TappandWildsmith common. (Tapp in Manchester tapeworM508 509 the mummies), androundworms. strongyloidiasis is a parasiticwormthatblocksthe lymphatic Filariasis systemcausingcharacteristic (elephantiasis). thickening Strongyloidiasis is a wormthatentersthe the of and skin swelling humanbodyviathefeetandthenceto thelungsviathevascular systemproducing symptoms intestinal Tapeworms are worms,sometimes of cough. of greatlengthbutpresentfewoutward otherthanlossofweight. symptoms Egyptian CitedbyNunninAncient Disease,69. 503 Mummies MythandMagicinAncientEgypt(London, C.el Mahdy, 504 1995),. Medicine, 34. Egyptian Reeves, 505 506Miller, JEA75,249-54. Egyptian Disease, CitedbyNunninAncient 71. 507 in theManchester w8E.Tapp,inA. R.David(ed.), Disease (Manchester, Mummies in Science andEgyptology 1979). (eds. ), Mummies, 509 A.Cockburn 1981). Disease (Cambridge, andE.Cockburn andAncientCultures

139

Theoldestparasite forwhichthereis evidence is enterobius or pinworm. vemicularis 510 Recently,faecalsamplesfrom RomanEgypthaveshownthe presenceof pinworms. Pinworms today.Theyareverycommonin arestill a problemevenin the UnitedKingdom is spreadfromfingerscontaminated in theanus)to childrenandinfection witheggs(hatched by intenseanal otherhumansorally.It is a fairlyinnocuous conditionbut is characterised living irritation, thatthrivesincramped particularly at nightwhentheeggshatch.It is a condition conditionsandmusthaveverycommonin ancientEgypt.511 There are several pictorialrepresentationsthat are alleged to show individuals

from They are mentioned here for completeness but such parasiticconditions. suffering diagnoses Thecuriousfigureof theQueenof Punt arefarfromclearandremainspeculative. is represented fromthetempleof Hatshepsut withapparently severalfoldsof skinonherlimbs. include but otherexplanations This has beensuggested as an exampleof elephantiasis, dystrophy, disease. fluid 512 Theretention achondroplasia muscular andDercrum's of abdominal is a common symptom of schistosomiasis andthisapparently shownin a groupof fishermen in the tombsceneof Mehuat Saqqara. 513Thisswellingresultsfromhepatic represented impairment andis a symptom of Symmers' syndrome.

Entries Prescription References to wormsdo appearin the medicaltexts but their identification and is The ideathattheirmentionmaybesymbolic obscure. significance andrepresents a concern is considered in theabovechapteron Terminology. Ebbell of a condition asto theseriousness 0ý

1ý -1

CC the (blood in the the considered word I _u - r----to meanhaematuria urine) mainsymptom -

510P. D. Horne,'Firstevidencefor in ancientEgypt',Journalof Parasitology 88 (2002),1019-21. JARCE24,33-36.Therearemanyprescriptions Zimmerman 511 designedto'cooltheanus',e.g. Ebl 38-64. knowledge 512K. R. Weeks,'Theanatomical of the ancientEgyptiansandtherepresentation of the humanfigure in Egyptianarf, Ph.D. Thesis(Yale,1970). 33. Reeves,EgyptianMedicine, 513

140

Thisviewis alsoacceptedby Steuer. 514However,the problemis thatthere of schistosomiasis.

areno textsthatconnectc?cwiththe bladder.Dawsonviewedell'as a typeof pathological factorrepresenting 515Sothatin Berlin to causedisease. anevilinfluence whichwasbelieved 58:pbrt nt dr c1cn ntr nftt'a prescription The to driveout cicof a godand/orgoddess'. Grundfisstaketheviewthatthewordmeanssemenor Giftstoffe-'poisonoussubstance'. 516In

byanevilspirit theimpregnation thissensew represents of a victim,generally whilstsleeping, of whichcausesdisease. withits poisonoussemen,theconsequence Berlin'165,1-118, Eb49, Bln187 are possiblecandidatesfor prescriptionsagainst

They of bloodintheurine:pbrtnts wsgfmsnf c93, schistosomiasis. referto theelimination a for a manwho'voids'muchblood'.Theverb wss'ý=' 'prescription

is generally takento

517It is non-specific ausscheiden'. suchthatit maymeaneither meanto 'expel,to eliminate, Nunnsuggests thatin thiscaseit maybe describing the passingof or defecation. urination bloodin thefaecesandsomaybea caseof bleeding haemorrhoidS. I 518However, on balance the passingof bloodin the urine.Haernorrhoids thinkit morelikelyto be descdbing can heavybleeding justspotsof blood.Thewordc,§iis usedto indicate or morecommonly produce thevolumeof bloodandwouldseemto implya largevolumeof bloodyurine. Eb875is givenaspossible to dracunculiasis (guinea-worm). 519 Thisrefersto reference 'comes and goes'whichwouldbe consistent which swelling with the femalewormbeing 2' is madeto treatment presentunderthe skin.Reference witha knife.Theworddýr

is

520Miller withthetreatment whichthe Grundfiss usedin connection givesas 'to cling,press'. 'to spin'.521Thisaccordswithits surgicalremovalby cutting thealternative meaning suggests

Steuer,AncientEgyptianandCnidianMedicine,3. 514 515Dawson,JEA21,39. 516Grundriss VI1:129.

837.Grundriss VII:2119. 517Westendorf, Nunn,AncientEgyptianMedicine,91. 518 Nunn,AncientEgyptianMedicine,70. 519 VI 1,991. Grundriss 520 521Miller, JEA75,249-51.

141

it arounda stick. theskinto releasethewormandthengradually windingit outor 'spinning' to be a resultof havebeensuggested Themissinglowerlegsof Mummy1770at Manchester breakingoff of the wormresultingin havinggonewrongwiththe premature thistechnique

522 infection. secondary

Disease 4.7Respiratory thatold agebrings,amongst In TheInstructions other we areinformed of Ptahhotep breath: of shortness problems,

whatoldagedoestopeopleis badin everyrespect Thenose,clogged, cannotbreathe, 523

Painfularestanding andsitting.

his from Deir Medina A limestone mouth with el shows an elderly workman ostracon 524 laboured breathing. in manner which suggests a open jar in lungs Duringthe embalming the canopic wereremovedandplaced a process Most the Children Horus'. figure Hapi, 'Four headed the the the of of of one care of ape under 525 before dried found and were collapsed wrapping. parcels clearly and aresmall specimens In manycaseshoweverre-hydration in a poorstateof preservation. Mostare,therefore, and has been histological Ruffer two suchcasesof examination possible. examined subsequent In 526 lung hepatisation Dynasty the the Twentieth origin:onewith of and otherwithpneumonia. themummy thelungsshowing 1938Shawexamined of anelderlyman,a singer,yetreported (carbon have been deposits) The former a and anthracosis pneumonia. condition must extreme

Filer,Disease,12. 522 AncientEgyptianLiteratureVolume1,63. Lichtheirn, 523 J. JanssenandR.Janssen,Gettingoldin AncientEgypt(London,1996). 524 Diseasein Egypt,in BrothwellandSandison(eds.), Diseasesin Antiquity,489. J. T. Rowling,'Respiratory 525 Ruffer;Memoires 526 surItgypte: InstitutdEgypte6,3.

142

fromoil lampsandopenfires.Infact of livingconditions, product presumably smokeinhalation disease 527 suchrespiratory seemsto havebeenfairlycommon. Studieson town planningshowcramped,intimatelypackedhousing. 528Evenat Amarna,a 'greenfield' site, the workmen'svillageseemedto havefollowedthe same 529Largefamilieswereprestigious tendedto be multi-generation pattern. andhouseholds with Thisenvironmental subdivision consequential of housingandcrampedconditions. pollution fromclosecontactin cramped conditions overopenfiresandoil lampsmusthaveproduced The presence problems. of carbonpigmentsin lungtissuehas beenfoundby respiratory

530 Zimmerman. Whilstsandcontamination in breadcausedone problem,sandinhalation seemsto havepresented in a male another.In 1910Murrayfoundevidence of sandpneumoconiosis 531A malemummyKharyexaminedas pad of the Manchester MummyProject MUMMy. exhibited pulmonary adhesion causedby sandpneumoconiosis whichwasso severethatthe chestcavitywasdividedinto threesections.Davidreportsthatsandpneumoconiosis and 532An investigation problemsfromenvironmental associated pollutionwerewidespread. of datingfromtheMiddleKingdom humanremains to theRomanperiodat Abydosshowedhigh 533Thisseemsto havebeena resultof irondeficient levelsof nutritional stressandanaemia. dueto parasites childhood nutrition,malabsorption grain,insufficient or a combination of all thesefactors.All thiscombined diseasewouldsuggesta withthe latereffectsof respiratory witha marginal stateof health. population

in Brothwell (eds. Rowling, ), Diseases 527 inAntiquity, andSandison 492. JARCE 24,34. Zimmerman, 528 Workmen's Villagein retrospect', B.J. Kemp,'TheAmarna 529 JEA73(1987), 21-50. 24,35. JARCE Zimmerman, 530 Egyptian Medicine, CitedbyReeves, 33. 531 David,Lancet349,1761. 532 Anthropology Baker, 533 andEgypt,111.

143

In Papyrus Westcar theprince,on meeting theonehundred andtenyearoldmagician Djedi,compliments him: Yourcondition is likethatof onewholivesaboveage- for ageis thetimeof death, enwrapping, andburial- onewhosleepstilldaytime andfreeof illness,withouthackin gpUqh.534

Thephrase'withouthacking cough'is givenbythephrasenn kWt sryt.It is notinsignificant I&h thatthewordfor 'cough'is linkedlinguistically the k with word

535

536 old'. 'to be meaning

This impliesthat a hackingcoughmightbe an inevitableproductof old age. Blackmanstates

that'eventoday'thissymptom was'typicalandsymptomatic of the congestion amongstold 537 menofthepeasant class'.

Certainly disorderis welldocumented in the medical coughas a resultof respiratory papyd I U19 Eb305t3t--rm pba nt dr sryt 'startof the prescriptions to stop(driveout) cough'. EW06-320 ktanother Eb321ktbrwcndrsrytmht, 'another to instantly driveoutcoughin thebody'. Eb322-5 kt'another. H61,pbrt nt dr sryt withBin29pPft nt dr sryt m brd'a remedyto stop Bln29,31, coughin a child'.

Ancient Egyptian Literature Lichtheim, Volume 534 1,218. Thelinkissurelyalsoonomatopoeic. 535 536Hannig, 888. 'SomePhilological Notes',JEA13(1927),187-91 A. M.Blackman, 537

144

4.8Accidents andIniuries important to it In additionto the abovecategodes I disease think considerother of be list to intend I do that exhaustive such any not of pain. conditions mightpresentsymptoms but ratherto illustratethat suchconditionswere common.TheseadditionalcategoriesI bites. insect be from industrial injury, bums trauma to and snake accident or and consider foranything Intermsof surgicaltreatment thereappears to be noevidence otherthan far Of 'surgical' the so examined noneshowanysignsof all remains procedures. verysimple from Grecois instruments 538AIso, the there an abundance of surgical scars. whilst operation RomanperiodstherearenoneknownfromearlierEgypt.539

Thereis a highincidence of fracturesin Egyptianhumanremains.Jonesin 1908 incidence high Aswan 6000 bodies that of a surprisingly at showed examined reported of some Therecordednumbers fractures. of fracturesto the forearmwere31.25%andto the collar bone13.75% of thetotal.540It seemsthatmanyof theseinjurieswerepossiblytheresultof a by Bakerfromthe investigation blowfroma stick.541A similarscenariois laterdescribed of 542She reportsa high incidenceof, humanremainsacrossseveralperiodsfromAbydos. blunt injuries), fractures forearm by likely have been (amongst to the to small, caused other objects.TheAbydossamplealsoshowedmanyinjuriesthat appearto havebeenactivity Osteoarthritis trauma. induced. wascommon andaccorded withwearto thejointsbyrepetitive foodand Thispatternof wearaccords carrying withthetypicaltombscenesthatshowservants 312-9. 63(1989), 'Theriseanddecline in dynastic Egypt,Antiquity 538 J.T. Rowling, of surgery Medicine, 163.Therearerepresentations Nunn,AncientEgyptian 539 and surgicalinstruments of manydifferent on theoutertemplewallat KomOmbo.Theseappearto includehooks,probes,forceps, otheraccoutrements (Adthough, Ghaliounghui disagreesand ratherconsiders themto be toolsand other sawsand catheters. MagicandMedicalScience,101-3).No surgicalinstruments featurein the earlier Ghaliounghui, appliances, Herethe texts.Eb866-877 to whatpresumably containreferences procedure. medical mustbea simplesurgical X ýý' isusedwhichtheGrundriss 1000.Eb866involves V11: Grundriss translates wordjweL: as'knife-treatment, oftherntwwhichistodealtwithby'knife-treatment. a swelling fromancient 455-8. fractures', 540 F.W.Jones,'SomeLessons (1908), BritishMedical Joumal Egyptian Medicine, 177. 541 CitedbyNunn,Ancient Anthropology 542 Baker, andEgypt,111.

145

suspended on polesthataresupported on offerings acrosstheshoulders or carriedin baskets due fractures topof thehead.Therewereseveralexamples of compound of thewristpossible from hazards to falls.Manyothershadmultipleinjurieswhichsuggests or accidents ordinary Onefemaleaged30-35yearstypically associated withanoccupation. showedmultiplehealed fractures anda laterwoundacrosstheP and6thribsthatwasthelikelycauseof death. Miller1991in a studyon necropolis workmenof the NewKingdomreportsa high incidence 543However, the evidenceof carein of failureto reportto workdueto sickness. providingfor the welfareof these workmenis high. There would appearto have been a

to losethis workingpopulation The reluctance pragmatic at higherratesthannecessary. in Egyptaretheproductof Greekauthors. of neglectandharshworkingconditions suggestion Thetombsceneof lpy fromThebesillustrates an activeindustrialbuildingsite.It showsa industrial including thedroppingof malletsandinjuriesto theeye.It also of range accidents to beanattempt 544 to removea foreignbodyfromtheeyeof a worker. showswhatappears A recentstudyshowedthatwork-related bonedamagewasfoundin all the human fromtheMiddleKingdom, NewKingdom examined remains andtheLatePeriod.Surprisingly, fromtheLatePeriodshoweda considerably higherlevelof damageconsistent thoseremains levels This of greater work. contrasts with withwhatmightbe expected, particularly sincethe NewKingdom buildingperiod. 545 periodwasanextensive Thedomestic homesandtheircrowding arrangements of ancientEgyptian musthave for accidental A studyon opportunity adequate presented scaldingandburningof individuals. healthanddiseasein contemporary primitivesocietiesshowsthatthe incidentof accidental burnsis highdueto domesticarrangements andthe closeproximity of sleepingnearopen

Miller,MedicalHistory.35,60. 543 P4Miller,MedicalHistory35,7. 23,380. Nerlich,Pathologie 545

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today, 547Even been have bums 546Nunn fires. that without common. andscaldsmust reports fire, burns, USA through In high. is the burns fires, to the youngchildren very numberof open The less. 5 in deaths 17.3% deaths for those the numberof or aged years of all of account than families in fold factor those bums increases by one more with a of six childrensuffering have been child. 548 It is, however, burns to to that must children reasonable assume accidental highin ancientEgypt.

EntHes Prescription

In termsof medicalpapyri,the EdwinSmithPapyrusprovidesa textfor the surgical treatmentof vadoustraumasto the upper body.549Eb863-77concernthe treatmentsof

Eb51O-41 intervention. turnours are concerned cit, surgical some with or possible swellings body. from blows to the treatment the of woundsresulting with non-surgical for burnsappearat Eb482-509 Themedicalpapyriprescriptions e.g. Eb482hit-c m Ram-11,1 111, B5, 46-61, Ram 15-21, Lond Lond for burn', Istart of prescriptions a pbrtnt wbd4 ' 'a H39-40 (Eb537,538) N11andpossibly weeping wound/burn? at

Insectandsnakebitesmusthavebeena commonproblemin ancientEgypt.These The fatal. in intense in proved eventually cases could painand some andspreading result an BrooklynPapyrusis concerned sometwenty-one withsnakebites.It namesanddescribes by local, herbal bites treatment; their the or products either andappropriate snakes, severityof 550 incantations. magical

Antiquity, 69in Diseases in Primitive Societies', Sandison, 'HealthandDisease in Brothwell 1.V.Polnin, 546 and 98. Medicine, Egyptian 182. 547 Nunn,Ancient Pediatrics 101(1998), El 2. 548 R.Scholer et al.,'Burnsinchildren', 15(1999), 281System 'TheEdwinSmithSurgical Papyrus,ChildsNervous R.P.Feldmen 549 andJ. L.Goodrich, 4. hippopotamus, 550In fact,it alsodealswiththetreatment pig,dogetc. of humanandanimalbites- crocodile, 249-78. haveexactequivalents in theEbersandHearstpapyri.Westendorf, Manyofthetreatments

147

in Scorpion stingsmustalsohavebeena painfulproblem yetthereareno remedies Papyri.In termsof painEb200compares froma stomach theBrooklyn thesuffering condition 551Bin78 alonegivesa remedyfor a scorpionbite, withthatlikeonebittenby a scorpion. 552 usingthelessusualwordpYmryforscorpion. although The cippusof Horuswas a formof stelapopularin the first millennium. Its form Horusas childstanding featured andotherdangerous on a crocodile whilstholdingscorpions forces. TheMetternich their assuaging excellent example and so stelais a particularly animals for is Isis, Horus the texts the engraved with story of and seven scorpions and magical which

animals.Itstextsandincantations canbe recitedfor againstthebitesof poisonous protection 553 relief. bothprevention Protection againstbiteswas alsoprovidedby the wearingof and

amulets. protective

4.9Summarv In summary themaincategories to haveafflictedtheancient of diseasethatappeared Egyptiansare: boneand joint disease,parasiticworminfections,dentaland respiratory disease.Withinthe categoryof 'boneandjoint'diseaseshouldbe includedinjuriesto the fromdiseasebutfromindustrial In addition bonesandjointsnotresultant andsocialsituations. butpainfulconditions to thislistshouldbe addednon-diseased suchas burnsandinsectand but stressedthat I do not considerthis list to be exhaustive snakebites.I havepreviously it to berepresentative 554 Astheaim of thebulkof possible episodes. ratherto consider medical

551Westendorf, 582.

278.Nunn,Ancient Egyptian Westendorf, Medicine, 552 190. Museum 553Metropolitan of Art, NewYork(MMA50.85).Othersmallerversionscan be seenin the British Nunn,Ancient (EA36250). Egyptian Museum Medicine, 108. 1acceptthatanylistwillbelimited.Forinstance It 554 fevermusthavebeena problem of infection. asa symptom heresinceI amdealing is excluded it generally leavesnorecordon humanremains. withpainandalsobecause to testfor malariafromsuitabledesiccated/ L it is nowpossible R. Milleret al, However remains. mummified falciparum infectionsin mummiesusingthe rapidmanualParasight 'Diagnosis test', of Plasmodium -F Medicine Transactions 31-2.Thereis 'surprisingly 88(1994), of Tropical of theRoyalSociety a total andHygiene for the Greco-Roman of febrifuges' of WarWoundsin Grecoabsence period,C. F. Salazar,'TheTreatment inJ. Scarborough (ed.), Studies Antiquity', Roman inAncient 59. Medicine 21(2000),

148

to is todemonstrate thatpainwaswidelypresentin ancientEgyptit is necessary of thischapter brieflylookatthelevelsof painwithinthesemedical categories. Painis complexandwithmanymedicalconditions the disabilitythatpainbringsis thepainis thanthepainperse.Forinstance, sometimes moreimportant withboneconditions These to localtissueandbecomes oftenradiated referredpainor causesnervecompression. is hot deep from to pain which oppressive painor evenred stabbing canrange ache conditions levels bearing. between 555 There differences of pain are on movement or weight accentuated in differentenvironmental Thosewherea patientis forcedto workand situations. perceived familyunitof ancient Presumably the largemulti-generational thosewhererestis allowable. In fact,it Egyptwouldallowelderlypatientsin painrespitefromworkandso reducesuffering. on seemsthatchronicpainin onememberof a familygroupnotonlymakesan impression has inter-relationships level itself. Richards but the that that of affect pain group othermembers fact, it 556 In family trigger that seemsthat accentuate pain. processes or chronic can shown difficultlivingconditions. 557The thosesuffering cramped worsepainwerethosein experiencing irrespective livingconditions musthaveaddedto of theancientEgyptians of anyfamilybonding thelevelsof paininchronicconditions. Boneandjointdiseasecanbepainfulto theextentthatit caninterfere withthenormal England wherephysicallabouris no longerthe norm processof living.Evenin contemporary 558In arthriticconditions to befrom'backpain'. themajority of theworkload of GPsis reported however, themainsymptoms areswellingandstiffness of jointswithlimitedmovement painis 559It seems themostfrequentsymptom andthe onefor whichpatientsconsulttheirdoctors.

(London,1986),100. C. S. B. Galasko,SkeletalMetastases 555 Aspectsof pain,Pain8, (1979),355-66. 556 M.B. Richardset al., Psycho-social BackPain(London,1989) M.Humphrey, 557 W DSSReport,Sicknessandlorincapacitybenefit. HMSO(London,1990). - Spellsof CertifiedIncapacity 559Reesand Williams,Pfinciplesof ClinicalMedicine,557. P. Macarthy,Arthritisand Allied ConditionsIst Ed., 1985),40. (Philadelphia,

149

Thisis bomoutby a comparison thatboneandjointdiseasehasalwaysbeena problem. of 560 today. earlierfiguresfromEngland whichshowa similarlevelof suffering been have Painassociated be This particularly withdentalconditions severe. must can Thesemayalsohave so in Egyptwheredentalattritionresultedin painfulgumabscesses. interfered withthe normalfunctions of eatingandspeech.Onthe 'dol'painscale(1-10)the Equallyit is thelevelof painthateventually painof toothache rateswithcancers andbackache. 561 patientto finallysuccumb. causesa 'dentistresistant' insectandsnakebitesseemto have Painis alsothemajorfeatures of burns.Equally, beenparticularly treatment. common scopeforanalgesic andwouldalsohaveprovided The remaining and respiratory on the 'list' are parasiticworminfections conditions Schistosomiasis fever),urinary,colonic is generally of fourtypes:acute(Katayana conditions. ('swimmers itchy dermatitis fever localised hepatic Katayana starts with schistosomiasis. and itch')aftercontactwith the waterand leadsto fever,bronchospasm and gastrointestinal Theotherformsaffecttheu(inarysystem(haematuria thecolon symptoms. andproteinuda), The (Symmers' 562 (withbloodyand intermitted diahorrea) hepatic and system syndrome). inappropriate However, for analgesic treatment. of theseconditions symptoms areconsidered worm(pinworm) certaintypesof parasitic willresultin analirritation whichmightberelievedby theapplication of localanalgesics. Respiratory diseaseagainis not consideredappropriate for analgesictreatment. is characterised by symptoms Tuberculosis 563SiliCoSiS of weightloss,feverandnightsweats. leadingto breathlessness, will resultin a reduction andanthracosis of respiratory efficiency

560Figuresfrom 1921showthat 'lumbagoand arthritis'(87.6cases/1000) weresecondonly to 'bronchitisand bronchialcatarrh'(231/1000).Onthe Stateof PublicHealth;AnnualReportof the ChiefMedicalOfficer,HIVISO (London,1990). W Fairley,TheConquest of Pain,16. A. Cook,ParasiticDiseasesin ClinicalPractice(London,1990),127-8. 562 ReesandWilliams,Principlesof ClinicalMedicine,302. 563

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in important is However, I that the tiredness respectof cough. consider symptom of cough and 5.2. inChapter Thiswillbeconsidered theavailability of opium(acoughsuppressant).

Thiscoupled Painmusthavebeeneverpresentin ancientEgyptian withthose society. healthinthe in thischaptermusthaveproduced discussed diseases a situation of marginalised generalpopulation.

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CHAPTER 5: MEDICINAL PAINKILLING SUBSTANCES 5.1Introduction Following thechapterson pain,terminology anddisease,I nowproposeto lookin detailat in ancient thathavebeenallegedto havebeenusedas analgesics substances or sedatives Egypt.I usethewordallegedsinceI believethatin somecasesexamination of theevidence mightactuallyrefuteeithertheir presenceor the exploitation of their pharmacological properties. I haveselectedthe substancesthat appearin the followingchapterson the following

basis: (i) By an examination that appearin the medicaltextsand by of the substances selectingthosethat appearin prescriptions whichare eitherspecificallystatedto be for pain

for thoseprescriptions thatdealwithconditions or control painful.HereI whichareobviously includechronicarthritic-type typically conditions. (ii)To selectothersubstances thatappearin themedicaltextsandwhichhavebeen bymodemauthors Here,I includesubstances to havebeenusedaspainkillers. such proposed asopiumandthelotusflower. (iii)InadditionI includealcoholandsurfaceanalgesics bothof whichwerepresentand inthemedical theyarenotrecorded texts. canbeusedto controlpainalthough

The aboveare broadreasonsfor inclusion;specificdetailsfor inclusionare given texts.It wasnotpossible to to producethelistby matching withintheappropriate prescription Thisis becausethe to prescription. ratherit wasdoneby matchingsubstance substance; intendedfor the wouldhave involvedthe collationof all thoseprescriptions alternative treatment the'active'substances MostEgyptian fromeachprescription. of pain,thenextracting prescriptionscontain multipleingredientswhich often have confusingor conflicting

152

(Thisalsoignoresthe fact that manyplantsubstances remain properties. pharmacological impossible) In it is difficult (and to recognise other words, perhaps sometimes unrecognised). Thesignificance theindexingredient withina prescription. of thisis notmerelyin termsof ex but that it must also have presentedproblemsto the original post facto identification It may well have hinderedthe recognitionof individualpharmacological practitioners. If, in fact,thiswasthesituation it wouldactas a 'brake'to anydynamic of effective properties. Thisaspectof treatment hasnotbeenconsidered by previous treatment. researchers medical by mein Chapter9. Thiswill be achieved butwill be considered 'prescription by pefforming fromthosesubstances in mylistof painkillers. Withthisendin mind,I thinkit less analyses' Thisis oneof the important thatthe list mightbe incomplete ratherthatit is representative. chosenas the basisof this thesis.Painis the most reasonswhy 'pain'was deliberately by the important in disease, treatment theonethatprompts symptom whichcanbe assessed Thusanylistof analgesics, of the patient. albeitincomplete, shouldstillbemorerepresentative thana listof othertypesof medicines. overallsystemof treatment herethemethods It is appropriate to brieflymention thathavebeenusedbyothersto fromthe Egyptianmedicaltexts.Identification identifymedicinal hasessentially substances from CoptiC564), following by linguistic beenbythe (demotic, Greek,and methods: association,

Dioscorides theeffectsof knownsubstances to symptoms andby matching withinthemedical

texts. The GreekHerbalof Dioscorides has beenthe majorsourcein Egyptianplant 565It givesfull descriptions identification. of the physicaland pharmacological properties of herbs alongwithvines,wines,dairyproducts roots, plants, etc.acrossfiveBooks.Mostof the It quotesRoman,Greekand areaccurate as aretheirmedicinal plantdescriptions properties. 5u Copticmedicinewas essentiallyGreek,althoughsome Egyptianremedieswere used, W. C. Till, Die derKopter(Berlin,1951). Arzneikunde 565The Englishtranslationby J. Goodyeardatesfrom 1655.Dioscorides was a Greekworkingfor the Romans (c.60-8BC).Theoriginaltextdatesfromthe secondcenturyandso thatthe Egyptiannamesmightwellhavebeen lateradditions.

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(often)Egyptian 566Muchof theearlyworkon thelatterarenotreallyhelpful. namesalthough Egyptian identification by Dawson between descriptions the plant reliesoncrossreferencing of 567 textsandDioscorides. In termsof moderntexts, the GrundrissVolumeVI (1959)providesthe only (1981)568

(Egyptian/German) 'pharmacopoeia' whereasthe magnumopusof Charpentier

'dictionary' sourcesand provides a wider(Egyptian/French) whichadditionally givescomplete historyof identification. Aufr6rehas morerecentlypublisheda seriesof reviewson Egyptianplantsubstances

(1984-7). Theseare concerned on the basisof withthe re-appraisal of theiridentifications lexicalconnections 569Most recentlyMannichehas and reconciliation with Dioscorides. Herbal(1999).

herAncientEgyptian published

570

is from Grundriss Thelistof obviouspossible the the small.Thelist painkillers pagesof I havechosenis somewhat larger.Thisis becauseI haveincluded substances of candidates thathavebeenmorerecently analgesic shownto possess activity. My list includes:opium,cocaine,cannabisand tobacco,wild lettuce,celeryfruit, lotus,dill, juniper,willow,henbane,myrrh,alcoholand surfaceanalgesics. I mandrake, forthepurposes In terms thatthislistis representative consider of a laterprescription analysis. therehasbeennonewlexicographical beyondthatwhichI givein the of identification analysis text. I do not intendthat my discussions but rather of identification will be re-appraisals fortheirpainkilling Thisis donein anoverallattemptto of thesubstances appraisals properties. to theancientEgyptians. effective whether painreliefwasavailable consider

566 theEgyptian Forexample, isgenerally AnAncientEgyptian to bePw (Manniche, wordforcoriander accepted 516.Whilstthisis wellattested 94,Westendorf, Herbal, in Egyptian Dioscorides word givestheEgyptian sources 71) asochion(Book111: Forexample, 567 6.1. seehisdiscussion oftheplant1ft,in Chapter 8pigraphiques Mat6daux Recueil Charpentier, 568 Relatifs Antique. Ala Botanique de1'tgypte 84(1984),1-21,BIFAO BIFAO 569 Aufr6re, 86(1986),1-32,BIFAO87(1987), 21-44. An AncientEgyptianHerbal.The detailof othersis lackingand she doesnot attemptany 570Manniche, Itdoes,however, independent re-appraisal. generally represent a summary ofthelatestviews.

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5.2Opium Manyof the modemmedicaland historicaltexts presume,often withoutany is notat asclear 571 Thesituation thepresence elaboration, anduseof opiumin ancientEgypt. is history imply. known from Greek Whilst be there to these early writers opium appears well as fromEgypt. a distinctlackof evidence 572The Greeks Homerrefersto it as the drugthat 'quietsall painsand quarrels'. However, believed 573 to be thisappears opiumto havederivedfroma plantthatgrewin Egypt. andonewhichhasfuelledthe anecdotalstatusof Egyptian an exampleof Greekmisperception

knowledge 574 andprowess. medical Theexactoriginof theopiumpoppyandthebeginnings of theactualuseof opiumasa 575The

arenotclear. narcotic

is nowthought toAsia to havebeenindigenous opium poppy

It is probable Mesopotamia. Minorandnorthern theopiumpoppythenspreadfromAsiaMinor foropiumuse intotheGreekworld.It hasbeensuggested thattheopiumpoppywascultivated bythe beginning of the lateBronzeAge.576At somelatertimeopium on theGreekmainland It haseven seemsto havespreadfromthe Greekworldintothe restof the Mediterranean. thatthissituation in Greco-Roman beenproposed timeswhentheLuxor wasactuallyreversed 571Bern6thin a extensivestudyof opiumstatesthat the opiumpoppywas knownto the ancientEgyptianswell beforeRomantimes.However,his referencesto this are the findingsfromthe tombof Khaandthe allegedentry of opiumin Eb782.J. Bern6th,Poppy:The GenusPapaver(London,1998),2. This is similarlyaffirmedby L. Kapoor,OpiumPoppy,Botany,Chemistryand Pharmacology, (New York, 1995),2. Boothalso quotesthe informsus that opiumis includedin some700 remediesin the EbersPapyrus, referenceto Khaandadditionally M. Booth,Opium,A History,(London,1996),16. This is remarkablesincethere are only 877 prescriptions recordedin total! 572Odysseyiv: 220,230 573 Thiswasalsobelievedby the Romansin thatGalen(c 130-200AD)tellsus thatThothtaughtthe mortalsabout thepreparation of opium. 574'Madein Egypt'carriedmuchmedicinalweightin Homersday.R. PorterandM.Teich,(eds.), Drugsand 1995),4. in History,(Cambridge, Narcotics 575W. C. Evans,Treaseand EvansPharmacognosy 4thEd. (hereafter,Trease& Evans)(London,1998),368. Somewritersreportthatopiumwasfirstusedby the Sumerians.Forinstance,see Kapoor,OpiumPoppy,2 and Bern6th,Poppy,TheGenusPapaver,2, but,whoofferno evidence.Thompsonappearsto identifyboththe poppy and opiumfrom the Assyrianmedicaltexts. However,identificationis far from clear since there are many in the textswhichpresenta confusedpicture.Themedicalconditionsthat he matches andbye-names synonyms withthe useof opiumare tenuousin the extreme.For example:ýarriýamumarru,the bitterdrug...a narcoticor SA, enemyof the muscles may refer to the narcoticpowersof the opium.J. Thompson,A poison,gama-a-ba ... Dictionaryof AssyrianMedicine(London,1949),224-9.Moreimportantlythereis no mentionof the hypnoticor by the Greekwriters. sedativepropertiesof opiumwhichis emphasised R.knott, 'DiseaseandHealingin theAegeanBronzeAge, in Studiesin AncientMedicine(Leiden,1988),41. 576

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islands Greek to the for became and opium an area growingpoppiesand exporting area 577 theMediterranean. throughout its usewas. in Egyptandhowwidespread It is notclearwhenopiumfirstappeared is essentially Theideathatit waswidelyusedduringthe NewKingdom centredaroundthe Greece between based his Merrillees the trade and of opium assertionsregarding on workof Egypt.578

It hypnotic Opiumis a powedulanalgesic, also suppressant. and cough sedative, in important drugs the is It the activity. of most anti-diarrhoeal perhaps one powerful possesses historyof medicine.It is importantnotonlyin termsof its efficacyandwidemedicalapplications

579 itsusehaswidersocialsignificance. butbecause Sincethe patternof diseasein ancientEgyptshowsa highlevelof chronicpainful have dental the would of opium properties conditions pharmacological andrespiratory medical, 580Bothits availability impacton the levelof suffering. hada tremendous andthe abilityto Egyptian to its therefore, to medicine ancient significant properties are, and exploit appreciate andsociety. four fromtheopiumpoppypapaversomniferum there Opiumis produced are of which Theredor cornpoppypapaverrhoeas,although containing a numberof varieties. cultivated in 581 I believe been the has has that there confusion some alkaloids, no narcoticactivity.

intheLightof FourHundred (NewYork,1941),117. Years'in MarchofMedicine 'Paraceisus 577 A.Sigerest, ' Antiquity36 (1962),287-92;'Opiumagainin 'Opiumtradein the BronzeAge Levant, 578R. S. Merrillees, 68(1971),167-71. Levant antiquity', for butevengovernment 579 Notjustin termsof addiction, policies, economic crimelevelsandsocialdependence 926. Warsofthe1840's. Seearticlein,ThePharmaceutical 267(2000), Joumal, theOpium example for diarrhoea (principally treatment Opiumis alsoa highlyeffective dueto thecodeinecontent).I havenot 580 dueto in mychapter it wasa considerable butpresume discussed theincidence problem of diarrhoea ondisease, Again,onemightexpectto seesomemention infected worminfections. of theuseof opiumfor waterandparasitic In fact,it is difficultto evenfinda wordfordiarrhoea. thewordwsg,which Nunnbrieflydiscusses thiscondition. in Eb44-8, Nunn,AncientEgyptian 90.Theverbws§is usedmore Medicine, as a possible candidate. appears (Bothversions Hannig, 217. The determinative), appearwiththedischarging oftenastheverbto 'urinate'. phallus Grundriss i.e. 'evacuations' thereby, of allowingfor the possibility as 'ausscheiden', givesthewidertranslation the formulations i.e. remedies Eb44-8beingfor the treatment to 'stop ws§,.However, of diarrhoea. contain as anti-diarrhoeal variouslyfruits,dates,resins,and honey.Theydo not particularly suggestthemselves formulations. Pharmacognosy, 368. 581 TreaseandEvans,

156

between the inability thetypeof poppyflowersandto distinguish of somewritersto appreciate useof poppyseedsandopiumitself. in severalnewKingdomtombsceneswhereit is The poppyfloweris represented 582 in flowers, the mandrake. and principally cornflower shown combination withother generally Sincethe poppy betweenthe speciesin suchrepresentations. It is impossible to distinguish for field it likely flowers that they simply picked were seems arecommon, andcornflower wild, theircolourcombinations ratherthananyotherproperties. The opiumpoppyis currentlyfound growingwild throughoutEuropeand the Near East.583opium is the white juice or latex that is naturallyexudedfrom the plant pod. In

incising 584 it is by the unripepoppycapsuleof papaver careful produced cultivated species Thelatexobtained is thendriedbya combination and evaporation of spontaneous somnifenim. by artificialheat.The correctdryingprocessis vital to the conservation of the morphine

in It be dried 585 then to orderto prevent out with air and stored of contact content. needs is into 'bricks' latex 'cakes' loss. In the each or moulded modem production morphine from It is leaves for this in then the export. of place of odgin and wrapped poppy characteristic driedstatethatotherformsof preparation aremade. The opiumso producedis a complexof somethirtyalkaloids,the six principal 587 being: 586 thebaine, codeine, papavefine. morphine, noscapine, narceineand constituents

Medicine, 130. Sucha scenefroma Theban tombis illustrated in Manniche, Ancient 582 Egyptian 367-8.Itspresent it is by law,although 583 TreaseandEvans,Pharmacognosy, in Egyptis prohibited cultivation insomeregions from'oldgardenplants',Boulos, Plantsof NorthAfdca,140. Medicinal naturalised reported Rainwindanddew 584 It needsto bedonein theafternoon andtheexudates arethenscraped offin themorning. 4thEd.,(London, 439. 1960), ofPharmacognosy willspoilit.T. E.Wallis,A Textbook in thelatexareonlypresent 585 Theactivealkaloids forabouttendays.If notharvested theywillbreakdowninto inactive compounds. in theBritishPharmacopoeia Thelastentryformorphine 586 contentin opiumto be statestheminimum morphine 10%. 587 Thesealkaloids is thattheirpresence appearto beof nousetheplant.Onerecentsuggestion wasa random bytheplantschemical for theyevolved Oncetheywerefoundusefulto humans produced processes. mutation Sturgess, it. R. 'Christmas thepoppy'ssurvivalby virtueof thefactthatmanthereafter plantedandnurtured Journal Pharmaceutical 267(2001), 927. Miscellany',

157

ingredient, its principal Essentially albeittheonsetof opiumhasthesameeffectsas morphine, theformeris slower. Dioscorides aboutopiumandwasclearlycognisant wroteextensively andaccurately latex between its importance he distinguished the the of correctpreparation since of oposand 588The thewholeplantmekonion. significance of hiswritingson opiumis thattheimportance in termsof its potencywere of the poppyspeciesandthe needfor its carefulpreparation in his by him 589The dangers noted opium poisoning were also associated with clearlyrealised.

is 591 It Egyptian is in known texts. 590 There to nosimilar mention any writers. referencesearlier 592 thatlendsitselfto ritualyetnoneis recorded of preparation or illustrated. a method Certainlyopiumwaswellknownto the Romansandso its use mustbe assumed 593It is theperiodbetween duringtheiroccupation thesetwoeventsi.e. opiumin the of Egypt. This in EgyptduringtheRomanoccupation thatis lessclear.594 Greekworldandits presence

'gap'hasbeenfilledby Merdllees thattheimportation of opiumintoEgypt whosuggests BasefromtheAegeanduringthe NewKingdom. 595This occurred wasimportedin Cypriote Ringjugletswhichweremodelledon the shapeof a poppyhead.This was in orderto the contents(seePlate5.2 (i), overleaý.Thesejugletsthenreducedin number 'advertise' duringtheXVIlthDynastywhichhe stateswasbecausetheopiumpoppythenbeganto be grownin

itself. 596 Egypt To furtherdemonstrate

a presence of opiumin the NewKingdom

588Dioscorides IV:64,6.

IV:64,65. thesameEgyptian 589 Yet,hereports nameforboththewildandopiumpoppy, nanti.Dioscorides (c.40013C) (21713C). toDiagoras Herefersspecifically 590 andAndreas that scenesof vomitingand prostration 591It is interesting (seemingly to not of wine) are an excess -due in banquet included SeeMu-Chou infrequently Poo,WineandWineOffelingin theReligion scenes. of Ancient 1995). Egypt(London, Scenes 592 tombscenes. Perhaps andtending ofagriculture ofgrapesarecommon ofa sucha'ritualin respect if theywerepresent? coloured opiumpoppies mightbepredicted cropofbrightly byGalenandPliny.Thelattermentions 593 It ismentioned thatit wasknowntotheEgyptians. 594 1do notimplythattherewasa complete thetwoevents.Thepresence of Greeksduringthe voidbetween theirknowledge Greekruleof Egyptpre-supposes anduseof opium. Thischaracteristic 'OpiumAlkaloids in a 595 shapehasbeenfoundin Egypt,Gaza,UgaritandSyria.K. Koschel, 159. BaseRing1Vessel Cypriote Age',AgypteundLevante 6 (1996), of theMiddleBronze 36,290.Later'disruption' Antiquity Merrillees, in theareamightequallyprovidea reason.AftertheAmarna 596 of tradein general.Onecausemaybe seenin the ArnarnaLettersin the periodtherewas a diminution

158

Merrillees thatthepoppyshapedmotiffirstappeared and suggests at thistimein handicrafts Eighteenth from Tell Amama the beads. It be in typically of el can seen pieces necklace in thattheywent 597 It is allegedthatthesedemonstrate Dynasty. thepre-occupation opium with beyond thepowerful of opium'. mereornaments and'symbolised andprotective properties Fromthishe concludesthatopiumplayed:

in households 'a vi.talpartin everyday lifeandmusthavebeenindispensable asaspirin jS today'.598

Karageorghis hasalsostudiedthedistribution shapedjugsandjuglets of distinctively liquid.The theLevantandshownthatsomeappearto havecontained throughout anexclusive 599This networkof Cypriotoneshavingthe widestcirculation throughthe Mediterranean. distribution seemsto havebrokendownafterthe Hyksosperiod.Thesewereeitherthe Red Lustrous Wheelmade BaseRingJuglettype.It is theformerthathaveusually wareor Cypriote beenfoundin tombsin Egypt.The deceasedin thesetombswereusually,althoughnot 600 head. Certainly the found have been female the jars the near usually exclusively, and long in Cyprus. He have been that the these to containers states exclusive must products I thinkit aslikelythatthe ' However, of theproduct. narrowneckservedas'a tradeidentification

IIIwhentheformercomplains of thekingofAlasiatoAmenhotep of theattacks onhiscountryby correspondence byepidemics. (London, W.L. Moran,TheAmama 1992),17-21. Letters andthatit wasravaged pirates beenre'poppy'shaped beenfoundin Mycenae. Buttheyhavemorerecently 597SiMilarly objectshaveallegedly 1984),199M. D. Merlin,OntheTrailof theAncientPoppy(Rutherford, as partsof a 'pomegranate'. assessed beadpendants froma necklace 201.Equally, foundat Amarna thevariform a andstatedbyAldredto represent G. T. Martin,TheRoyalTombat el Amama1; The 'poppy'havealsobeenre-assessed as a 'pomegranate', (London, 1974).1wouldagreethatit is difficultto visualise Objects manyof theseAmarnaitemsas poppies. However, fruits,doesshowwhatappears faience oneparticular necklace, madeupof concentric rowsofcoloured However, fortheircolouraspartoftheoveralldecorative theyarepresent tobepoppyflowers. effect- notfortheir See,Fig111, Amama- KeyPiecesfromthePetrieCollection (London1974). page64in J. Samson, symbolism. , 36,292.Thisfactseemsto haveescaped Antiquity, 598 Merrillees, IIIperhaps themostunhealthiest Amenhotep of Hesuffered fromobesity, thepharaohs. teethwithabscesses thatmusthavegivenhimconstant appalling pain. havingreliefonhand,in theformof opium,heis recorded (onmorethanone Yetdespitesupposedly assending kingTushratta for OurLadyof Nineveh to theMitanni Ishtar. Roaf, A Cultural the occasion) goddess of statue -a AtlasofMesopotamia andtheNearEast,132-140. between 'Relations V.Karageorghis, Cyprus Dynasty', 599 PeriodandXV111th Intermediate andEgypt.Second Agypte 5 (1995), 74. undLevante AgypteundLevante 600 5,75. Karageorghis,

159

601 Such, that i. indicative the use. controlled andsorequiring of producte. expensive shapewas 602 their to be to the wastage. theshapemightsimply either aidpouringof contents or prevent that the by Merrillees, The contentswerecertainlyexclusivebut the assumption, such of the copy alabaster of an analysis chemical on original opium relies contained contents the director Kha Kha Deir Medina. of from tomb jar the several under of works was el of at a Dynastykingsand is believedto havediedabout1405BC.603His tombwas Eighteenth by an Italianteamworkingunder intactcomplete discovered withits funeraryaccoutrements Part in Turin. Museum Egyptian to the in 1903. All of the Schiaparelli wereremoved contents in thirteen his Merit Kha some oils the funeraryequipment of a provision was and wife of Some (ii), (Plate 5.2 different wereclosedandsealed overleaf). capacities vasesof alabaster Another fully in finely been six had sealed. was which casket made cedar wood placed a and tomb. the less hermetically about scattered were sealed whichwerealsomoreor Samplesof thesejars were sent to the Universityof Genoafor analysisin 1925.A the jars by Muzio intact the then at alabaster of performedon one chemicalanalysiswas Instituteof ExperimentalPharmacology.Her report concludedthat the contentswere a Egyptians by the 604 'probably those that ancient of were recognised a mixture vegetableoil: found to 605 In linseed the containa was addition mixture and palmoilS'. castor,sesame, to 606 This iron. then standard subjected substance was of amount considerable

Ormaybea combination to be'fixed'in oilsat thisperiod 601 Oilor perfume needed perhaps? of both?Perfumes duetotheabsence alcohol. ofdistilled Botharesmall bottlesandproprietary bottlesof opiumtincture 602 Bothmodem aresimilarin thisrespect. perfume be Such there for that 50ml have less than might pouring. and a restrictive or cap neck controlled andgenerally between labels. thetwowithout indistinguishing difficulty 203. H.R.Hall,'Tombof Kha',JEA14(1928), 603 in thehot,dryclimateof Egypt.Theremains Oilsandfatswereimportant 604 of sucharefrequently cosmetics A. Lucas, fragrance. foundin tombs.Oftenperfumed additives wereincludedto givethema morepleasing inAncient Egypt',JEA16,(1930), Perfumes 44-7. 'Cosmetics, andIncense dellatombdi Cha',AttideflaSociet& di Scienze Lingustica, 1.Muzio,'Sudi unoliomedicato 605 e Lettere4 (1925), 41,Appendix. isfromtheoriginalItalian,in Bissett, English translation Journal 249-53. ofEthnopharmacology It musthavebeenaddedat fromthecontainer. Thisis difficultto explainsinceit cannothavebeenabsorbed 606 Harris, Ancient Egyptian & (Lucas Ferrous kohl. not uncommon salts were as constituents of paints and source. 235).Buta separate basketcontaining (all)of Merit'scosmetics Materials werefoundin thetomb. andIndustries, Surprisingly, of Bissettdidnotreporton thepresence Whyironsaltsshouldbeincluded withopiumis puzzling. iron!

160

in into laboratory involved These injection the tests. the animals of substance pharmacological frog into injected The to anda a any physiological changes. substance when order observe followed i. have to withmorphinee. excitation produced resultsconsistent mousewasalleged in lowerdoses.Muzioreported: 'fromthepsychological bydeath- sleepbeingproduced effects isolated both frog infer by it the to the that the was alkaloid and mouse was easy exhibited 607

morphine'.

This then testedchemically positivefor morphinewith Fr6hdesReagent,copper 608In summary, the samplewasreportedas andwithferrouschlodde. sulphatein ammonia 609 a vegetable oil also'medicato conferToe conoppio'. containing Since1925theresultsof thisanalysis haseffectively theonlyevidence of the provided of opiumin ancientEgypt.However,in 1994samplesfromthe tombwererepresence tested by Bissettat KingsCollegeLondon.Theseincludednotonlythe previously analysed Turinsamplebutanotherfivefromtheoriginalcache.Thesewereanalysed notby chemical layer in but by thin the tests, of as methods original using modem specific reagents 610 These (TLC), (GLC) immunoassay. layered and gas chromatography chromatography methodsare veryaccurateand unlikethe chemicalmethodsof analysisare specificand Theresultsfoundthatnoneof thesamples 611 showedanytracesof morphine. quantitative.

607 A morespecifictestis the Straubreaction.Thissensitivetestis the observation of an erecttail on injectionwith morphine.It wasnotreportedby Muzio. 608Thesetestsare not specificto a substancebut merelyrelyon colouror otherchangesbroughtaboutby the reactionof the chemicalsto that substance.In this sense,anothersubstance(unrelatedto opium)mightprove positivewiththesametest. w9Muzio,AttidellaSociet6Lingusticadi Scienzee Lettere4,253. Onemustaskwhyopium,whichis a sedative, wouldbe includedin the goodsrequiredfor the afterlife.Oilsare generallyusedto revitaliseor awakethe dead. The Openingof theMouthCeremony setsoutthis rite.Koschelseesopiumhereas providinga euphoriceffector for its 'problemsolving'action,AgypteundLevante6,162. However,I thinkthishis commentmoreappropriate to history! than therapy ancient modern 610 Thesensitivityof thismethodis high.It candetectvaluesas low as 0.024ngof morphinein a 0.1ml sample,J. D. Milleret al., 'The dispositionof cocaineand opiatesin hair and fingernailsof humans',Journalof Analytical 24,(2000),496-508. Toxicology 611N. Bissettet al, 'Wasopiumknownin 18thdynastyancientEgypt?An examination of the materialsfromthe tombof the chiefroyalarchitectKha',Journalof Ethnopharmacology 41, (1996),196.It mightbe due to the fact that some sixty-sevenyears have elapsedsince the analysisby MuAo.However,the originalanalysiswas conductedsome twenty-fouryears after the removalfrom the tomb and storageconditionswere museum controlledbetweentheseperiods,such that any chemicaldegradationis unlikely(EgyptianMuseum,Turin-

161

thatopium thepossibility It shouldbesaidthatthefindingsby Bissettdo notpreclude does it However, time. formed the the have mean of vaseat some partof originalcontents may thatopiumwasknownat fromthetombof Khacannotbegivenasevidence thatthecontents thispedod. in type found later have However, the to a similar of opium presence a analysis alleged in 1996thathehadfoundpositiveevidence by Koschel jar.It wasreported of opiumin a Base Thepresence RingjugletfromtheEgyptian of opium of WOrzburg. collection at theUniversity This immunoassay. by TLC, GLC, demonstrated the and radio of mass spectrograph use was been important had discovery been the have the worthless. of vessel provenance an not would

Egypt in dealer from long been 'a having time It is reported an antiquities ago as purchased froma privatecollector mostly ceramics, as partof a lot of thirteenpiecesof Telel Yehudiyah lack Yet, despite the 612 this Egyptian Also types'. the of and vesselwasnotsealed. of genuine is If 3500 the this being the old. years some reported as contents were properprovenance, It the have degraded through then the air. with contact andoxidised mostof sample would case have been the be latter that original could not addition and any opium present must a suggests

613 contents.

temperatureand humiditycontrolled).'Factorsin the storagedeteriorationof drugs' in Trease and Evans, 1004. Phartnacognosy,

AgypteundLevante, 161. Koschel, 612

in an analysisof severalmummiesdeliberatelylookingfor the presenceof drugsdoesnot report 613Balabanova the presenceof opium. B. S. Balabanova,et al., 'First identificationof drugs in Egyptianmummies', 79 (1992). Naturwissenschaften

162

PLATE5.2(i)

CYPRIOTE BASERINGJUGLET shownalonqsidean invertedseedpod for comparison of Papaverum somniferum (Takenfrom Nunn,AncientEgypfianMedicine,1996)

PLATE5.2(ii)

"AX

"Fff

b-1-

VESSELSand STANDSfrom the TOMB of KHA Thevaseon the right is sfill sealed. Exhibitsat theEgyptianMuseum Turin Egizio,Torino1996) (Takenfroma museumphotograph in Roved,Museo,

A

Entries Prescription to applyto In termsof the medicaltextsthereis onewordthathasbeenforwarded "; opiumThisis thewordApn o

ý.. 614It

internal for an entry onceas a single onlyappears

Eb782 because here been to Opium has being Eb782. this suggested apply at preparation, hypnotic to intended be to to pacifya cryingchild. or act as sedative a remedy appears Eb782: "'I pbrtntdrcg3wt

i

'child it in that is to who the a means, where meaningof e9m elaboratedupon a gloss explain

SothatEb782is a presdiption: is screaming. (excessive 'forthedrivingoutof screaming crying)in a child'. (from flies the the §pnn §pn Theprescription of and excrement of consistsof a combination nw,

for four days. It (mix), in thing stopsatonce% and mash use wall),make one is difficult It just 'fly'. formula to in the Fly'excreta'is specifically asopposed mentioned That fly. for 'dead' it is It be here. that is to envisage a a colloquialism may exactlywhat meant the be intended to then is one'swatted'on thewall.Thespeedof its despatch parallel may its flies ingesting 615 One the the with of mustalsoquestion wisdom speedof efficacyof remedy. 616 (isks. health associated 11111 11-1 spnn nw spn 0 -0

has beentakento meanpoppyseeds.617This

Mohnk6rmer? is 618 by Grundriss. Where hesitantly the 9pnn is somewhat as given reported (poppyseeds)andApnasMohn?(the'opium'plant).

La Botanique de ltgypte, 1094. 614 Charpentier, 615SeeChapter9, page

Onepresumes 616 It wouldnothavebeensafeandwouldhaveintroduced thepossibility of allsortsof infections. thatthiswouldhaveknownsincefliescongregate aroundfaecalwaste.Yet,it is strangethatfly excretais here(Eb782) innocuous pathological as associated sincew, andfaeceshavebeensuggested considered -bdw indicators. (Paris1956). de 116poque G. Lef6bvre,Essaisurla m6decine6gyptienne 617 pharaonique, 618GrundfissIV:292.

165

Thereis littledoubtthatopiumwouldprovidean excellentsedativefor a cryingor base)provided (tincture distressed such child.Theuseof laudanum of opiumin an alcoholic 619 in nineteenth to mothers centuryEngland. reliefandemancipation it nevertheless, Sincethepoppyappears, context, albeitin decorative andhorticultural it does indeed However, had be have this this specify not a nameands'pncould name. must in is to 620 The importance the the vital order of poppy correct species poppy. of gpýUM as found. it is but in Eb782 One to this not effect effect. mightexpecta gloss achievea sedative Theheadingto Eb782impliesthatthe prescriptionis intendedto achievea sedativeeffect,i.e.

to driveout the screaming are actually of a child (to pacify).Whereas,the instructions is This be immediate. in its if included the not would remedy effect since opiumwas ambiguous is it treatment the tell that the the after willcease which us with wordsof prescription consistent 'four Whilst I the that for four days of use ewy(r= accept extending over). used rk-w4tmýT formulaic that 'it willstopafterfourdays'is nota good days'is somewhat theannouncement importantly, More the poppyseedsof whatever consistent effects of opium. nor with remedy 621 have effect. no morphine and so no sedative contain variety

foranexternalapplication in a remedy 9pnis alsoseenat Eb440,443 asaningredient forexternal application. andin Eb445(Sm4114,6,Sm4616,12)in a powder In Eb440/3 gpnis combined withvariousothersubstances andmadeintoanointment forthe'removal' intended to beappliedto theskin.It is listedundera 'run'of remedies of (the Revolution. by thedomestic 619Itsusewasaccelerated overcrowding of therapidurbanisation of theIndustrial themotherandreleased herforotherroleswithintheindustrialised Theavailability social of opiumemancipated V Thenumber for children framework. of proprietary products withoutrestriction, waslargeandwidelyavailable 1996),24.in ancientEgypttheworkinfrastructure Berridge also andJ. Evans,OpiumandthePeople(London, by the allthemembers participation on of thefamily.This'abilityof opiumwouldsurelyhavebeenin great relied demand. L. Boulas in Egypttodayis thepricklypoppyor argemone 620 Theonlywildpoppyreported asgrowing mexicana, etal.,TheWeedFloraofEgypt(Cairo,1984),137. 621Poppyseedscontainsome50-55% of paleyellowfixedoil.Thisis usedtodayfor culinarypurposes andby Theabsence of anyrecords of thisin Egyptandindeedfromlaterpaintanalyses artistsforfixingpaintpigments. its be Materials A. Lucas Egyptian J. R. Harris, of non-availability. Ancient reflective andIndustries also and might 1962),351. 4thEd.,(London,

166

Mrin App, 'bnsit (illness) in head'. Eb440 term) the equal parts, contains, vague somewhat into ), date honey, (fruit) (mineral? then gnft a massandapplied syrup, which are made spdw into incorporated inr-spdw Apn to thehead.Thisremedyrelieson anypotential and effectsof honey the honey date be inert base It and remedy; of and syrup. wouldessentially a sticky an designed to holdtheactiveingredients datesyruppresumably together and(unlikeanointment for massaging intotheskin.622Thisis important forthereleaseof anyactive base)unsuitable Theeffectof massaging ingredients andefficacyof thesgpn present. andsoto thesignificance In into favour ingredient. this the case skin release of any contained active will an ointment best, be, benefit 9p. the at of would of massage, any narcotic or other effects without Sn Eb443 be that §pn the minimal. any effects of would via skin, such released marginally fat in (burnt? ) hippopotamus )623, gpn, equalparts. carob? of and skin contains LWt(colocynth,

from be 'soothing' Eb430/3 the Anytherapeutic effectsof theapplication of could only effects properties. viaitsemollient forexternal InEb445s9pnn is usedincombination andpowdered withotheringredients (mineral, (myrrh) Art (mineral), The inr-spdw, Apnn, cntyw and are: application. ingredients )624. Boththemyrrhandthesktseem to havebeenusedhereto aidthe fossilised resin,gUM? 625 antiseptiC. former is It is difficultto ascribeanyparticular the alsoan although pulverisation,

therapeutic effectsof thispowderbeyondthatof its form.It wouldno doubtbe soothingand have However, drying the may anynarcoticeffects some and well aided of wounds. antiseptic be discounted. §pn should of

byDioscorides 622 A remedy IV:64,forthetreatment roseoilandopiumlatexis described containing of headache. theabsorptive A liniment opiumwaslistedin theBritishPharmacopoeia containing effectof until1949,although See,ExtraPharmacopoeia, 1967),802. Martindale 25thEd,(London, theopiumis nowdiscounted. Medicine, 154. Egyptian 623 Nunn,Ancient 733. VI:458,Hannig, Grundriss 624 6251amnotsurethatthe Egyptians wereactuallyawareof all the medicinal of myrrhsinceits use properties imply to this.Thiswillbeconsidered does later. seem not generally

167

Summary fortheuseof opiumin ancient In summary, I wouldsuggestthatthereis noevidence in have had in is that Egypt.The'negative the would opium evidence' significant viewof value Egypt.I believethatthiswouldhaveledto widespread usewhichwouldhaveleft pain-ridden Otherwise, it is a glaringomission fromthemedical texts. someevidence. being It is a drugthat is uniquein that its effectsgo beyondthe pharmaceutical be fabric Again to detectable there the no suchevidence of a society. appears within social fromancientEgypt.TheGreeksand Romanswrotefrequently aboutits effectsandsocial 626 the particulady pedIs of addiction. consequences, It is important to considerthe formsof opium,i.e. the actualfinalpreparation of the of opiumfrom Greeceto Egyptmighthavealso of the importation product.Proponents This latex. form block is in The the this of a of of export method considered aspect. modem allowsit to then madeinto otherformse.g. allowsfor easeof handlingand importantly for in Greek form dissolved 627 If tinctures,lozenges, the oil wassupposedly mixtures etc. it wouldrestrictitsabilityto beusedin otherforms.Thismightsuggest a Greekdesireto exporl: disguiseor protecttheirsource.Butit seemsunlikelythateventheywouldwishto restrictits itsformin thisway. useandsalebyrestricting

626 IV:64.Diagoras, Andreas, Mnesidimus Dioscorides theseauthors and arereported andNicander of Colophon, ), in PorterandTeich(eds. Medicine', byJ. Scarborough, 'TheOpiumPoppyin Hellenistic discussed andRoman in AncientHistory, 4-22.Marcus honourby Galenof being Aurelius DrugsandNarcotics wasgiventhedubious to cause firstrecorded drugaddicts.Yet,thedosestakenwereactuallylowerthannecessary oneof history's in the propersensei.e. a needto keepincreasing the samelevelof the dosagelevelto maintain addiction Thereis a needto cautiously historical andactual viewandto separate euphoria. modelsintostatesof euphoria Thisis because of opium.This of thelackof a full appreciation of thecapabilities of opiumaddiction. evidence by Hamarneh aftersometwo whocitesthe misuseof bothopiumandcannabis occurring viewis supported Islamandthe in Medieval hundred to pre-Islamic Arabia.S. Hamarneh, 'Pharmacy yearsof theirintroduction Medical History16(1972), History 226-237. of DrugAddiction', Englishhistory,fromat leastthesixteenth Throughout of opiumaddiction, century,therehasbeendiscussion It appearsto haveeitherbeentreatedas a subjectof interestas in The notalwayscondemnation. although, History dramatist ofamusement ofAleppoorasa subject andaddictThomas e.g.thebehaviour of theRestoration Indeed Act1868,(and Standwell thecontrolof opiumwasonlyfirstrestricted bythePharmacy waswellreported. thenfordebateable reasons). 627TheRomans lozenges, tinctures, formsof opiumincluding werewellacquainted withnumerous mixtures, in PorterandTeich(eds. 4-22. History, ), DrugsandNarcotics inAncient etc.,Scarborough, ointments

168

is because It mightbearguedthatthenon-appearance in texts the of medical of opium 628 Thisseemsunlikelyif it someexclusive restriction eitherto aneliteor forreligious purposes. Greekproduct.As to its restriction amongstan elite,outsidethe werealreadyan exclusive texts,I thinkthatthedemands wouldhavemadeit difficultto on its medicalproperties medical keepsecret. Also,it is necessary to considerthe preparation of opiumfromthe poppyflowerand is an art whichtends Thecollection theextentof its cultivation. of the latexandpreparation itselfto ritualisation.FromEgyptiansocietysomeremnantsof this ritualisationmightwell be

featuredon tomb Whilstagricultural yetwehavenoevidence. scenesarefrequently recorded 629Thepoppy as decoration. of the poppybeyondits appearance wallswe seeno evidence fieldis distinctive yetthereareno andwouldsurelyhavemeritedsomeattention or comments, 630 textsor representationS. If indeedthe useof opiumin Egyptwasas commonas aspirinis today631thenthe In an attemptto presenceof cultivatedopiumpoppieswouldnot havebeeninsignificant. figures to been I have have demonstrate howsignificant thatpresence some collated would for cultivation: Table5.2 (i) showsthesefigures.I producethis showthe landrequirements forEngland I amawarethatthefigureswhilstaccurate tablefullyawareof itscaveats. canonly for Egypt,nordo I propose be estimates thatthetwoareinterchangeable usagemodels.I do that thesebeingtotallycorrector scientifically themto illustrate notadvocate validbutproduce Thetableshowsthataccording to estimated a poppycropwouldnothavebeeninsignificant. levelfor the NewKingdomsome11,523acresof poppyfieldswouldhaveto be population E.g. 'Theearly 628 Onecanfindseveralreferences to this,butall appearto be anecdotal andwithoutreference. privilege of cuffs...theknowledge useof opiumwascloselyrelatedto religious of thedrugwastheexclusive fromB.Dai,'OpiumAddiction 1937). PhDThesis(Shanghai, in Chicago', orwarTiors'cited magicians priests, 6-19 Anylargescaleproduction in fields.Vinesareshownin Egypt.Compare those of opiumrequires cultivation is prominent, it becomes wherewineproduction regions socialfabricandthefolkloree.g. the partof therecorded Aquitaine French in medieval tapestries. wherethegrapeishighlyprominent for 630 Therehavebeenmanyliteraryandsymbolic itsuseto the the example ages, connections with poppyover those'fallen'during'theGreatWar. represent 36,292. Antiquity, 631 Merrillees,

169

These England. demand to to that century satisfy a comparable of mid-nineteenth cultivated largeonthetotallandusageof Egyptarelargeenoughnotto go figures,whilstnotnecessarily for land the The in Egypt. infrastructure the within usage, records agricultural of unnoticed for New Kingdom the fairly the period at structure, are well economic recorded overall for int Medina Thebes. There Deir a/ crops, el at western are records workmen'svillageat

632As importantly, (fuel) but dung or no mention of opium poppies. oils, water and vegetables, 633 basiswithinsmallvillages. theholdingof landevenat laterperiodswason a smallholding foodin thefirstinstance to otheremployment. Thislandwasvitalto provide or asa supplement in verysmallparcelsandthese Themajorityof landseemsto havebeenheldby individuals for fully basicitems. have been utilised smallplotswould

In from texts. the In summary, thereseemsto be a glaringabsence medical opium of importation lacking. As its is to the of of presence also evidence additionanycircumstantial impossible do I this from Greece during New Kingdom the not consider period,whilst opium be discounted. its level that trade the must usewaswidespread of anysuggestion given

Commodity PricesfortheRamesside 632 J. J.Janssen, Thecommodities Period(Leiden, 1989). andlistsareso Theomission significant. of an'important' wideasto vergeonthemundane. cropistherefore (2-3.33 S. 633 FortheRamesside 3-5 between periodsome48%of all thesmallholdings acres), auroras were in theRamesside LandTenure Period,(London, Katary, 1989),309.Thesamepatterndoesnotalterwithtime. LaterfortheHermopolite nome,albeitin theRomanPeriodsome50%of allthelandwasownedbyonly3.36%of themajority (c.6 acres)of landor less, thetotalowners, whereas of theowners(almost50%)heldonly9 arouras LandOwners J. Rowlandson, in RomanEgypt(Oxford, andTenants 1996).

170

TABLE5.2 (iii) COMPARISON OFOPIUMUSAGEIN ENGLAND ANDANCIENTEGYPTANDTHEAMOUNT LANDREQUIRED OF GROWING Anaverage ThefiguresforEngland was perannumconsumption aretakenfromHomeOfficestatistics. 1849-1859, takenforthetenyearperiodbetween to berepresentative of thetotal whichis considered figuresavailable. Theaverageconsumption 59,180lb. / p.a.634 of opiumfor thatperiodwasfoundto be This figure was then adjustedfor populationto give a consumptionof 3.421b.per 1000 population

If the sameconsumption figureis assumed635for ancientEgyptthen for differingpopulation following tablecanbeproduced: estimates636the The Cakulated Opium use in Ancient Eqvpt and Land Required for that Volume Population Size

Amount consumed p.a.

Land required in acres

5 million 3 million 1.5million

001b. 17,11 10,2601b. 5,1301b.

19,214 11,528 5,765

figureof 8-15kg/ Thefigurefor land requiredwas obtainedas follows.The modemproduction farminginidealgrowing intensive hectare637 conditions andwithfull wasused.Thisfigureisformodem, Thefigurefor ancientEgyptwouldbe far lower.Thesoilconditions are notideal, useof pesticides. over-watering candestroya cropandthe controlof irrigation wasa realproblem.Equallymodem levels.All thisconsidered techniques collection ensureoptimum collection andlookingat figuresfor or 0.89lb/acre. othercropsI wouldestimate at best,to benohigherthan1kg/hectare production,

634 intoEngland imported During fromEgypt,at thisperiodopiumimportation Yet,thepercentage wasat itsheight. 4.46%of thistotal.i.e.some2639lbs. thattime,stillonlyaveraged p.a. 635 Thisis notideal.However, thoughtheseconsumption figuresarehigherthanpresentday,thisis although InthissenseI think because treatments. of nonrestriction andbecause of thecurrentavailability of morespecific forthisexercise. thetwomodels arecomparable 636 Thesecanbenomorethananestimate figures 1815. These sincethefirstpopulation are not until was census They takenfromButzerwhogives1.5MfortheOldKingdom, 3MfortheNewKingdom and5MfortheIstcentury. in linewithotherwriters,(although forthe themsufficient aregenerally methods ofcalculation vary)andI consider K.W.Butzer, Eailyhydraulic (Chicago, in Egypta studyin culturalecology, of thisexercise. purpose civilization 'Thepopulation 1976).J. C.Russell, Egypt, ' JARCE5 (1966), 69-82.Bagnall of medieval andFriergivea slightly forRoman Egypt,(basedoncensusreturns) lesslowerestimate, of andFrier,TheDemography of 4.5M.Bagnall Egypt,91. Roman 637 TheseweretakenfromV. Burridge 1991),13.andBooth, (London OpiumandthePeople, andG. Edwards, 6. opium,a History(1996),

171

5.3Cannabisin Egypt

In this sectionI haveincludedcannabis,cocaineand tobaccoundera collective Egypt in Thisis because is being heading. andthis ancient available cannabis evidenced as human Egyptian is found in having been tobacco together reported ancient and as withcocaine 638 byBalabanova andherteam. remains

Cannabis cannabis sativaor hempis a tall,annualshrubandis usedfor its oil,seed plant,from andfruitytopsof thepistolate andfibrewhichis madeintorope.Thedriedflowering is usedto produce thewellknownnarcotic component. whichtheresinhasnotbeenremoved, The Egyptianwordfor hempappearsto havebeenS'MS'Mt Piecesof hemparereported to havebeenfoundin thetombofAkhenaten atAmamaandplant of pollenonthemummy

11.640 Ramesses

Hempis actuallythefibrouspartof the plantandhasno narcoticvalue.Hempwas butthisfactdoessupportany usedas rope,mattingandforwovenfabricsW bytheEgyptians knowledge of thenarcotic of theplant. properties fibreandtheotherbothfibreand Therearetwovarieties of cannabis: oneproduces in whichtheplantlivesdictatesits abilityto thattheenvironment thenarcoticresin.It appears but is 642 fibre-producing The European not narcotic variety narcotic resin. naturalnorth produce in Egypt few to the andconversely grown resin-producing a years varietyafter when willrevert

Naturwissenschaften, 6a Balabanova, 9.

La Botanique 639 Charpentier, de ItgypteAntique,1114.In Arabic,thecloselysounding, kn.§mis thewordfor However, in ancientEgyptis wellattested theuseof sesame butforinternalusewhereasftgmt only sesame. ke--dical in non-oral See,W. R. Dawson, Texts',JEA20 (1934),44-5.The 'Studiesin the preparations. appears in thePyramid Texts(514)andis described wordappears as a plantfromwhichropeis made.Itscommercial froma loannotein whichhempis usedas theinterestrepayment of a valuein thisrespectis demonstrated loan.A.C.Johnson 1949),190. Egypt.Economic (Princeton, Studies andL.C.West,Byzantine monetary Egyptian 640 Ancient Medicine, Manniche, 82. AncientEgyptian 641 Medicine, Manniche, 82.LucasandHarris,AncientEgyptian 136, Materials andIndustries, 149. 642Thishas madeif difficultto producea realisticlegaldefinition Trease drug, the and Evans, narcotic of 527. Pharmacognosy,

172

hemp 643 that the This fail to temperate to of means climates will produceresin. whenremoved is This the have been Egypt a resin resin. of producing narcotic wouldcertainly capable ancient brown, amorphoussemi-solidcomplex containingsome sixty alkaloid compounds Thesecompounds (cannabinoids). andwhensmoked. areeffective orally644 in earlyHinduandChineseworks.It is thoughtto have As a drugit is mentioned been having 645 is It into Arab Persia from China the through as reported world. and spread Wars Holy during Crusaders the into Hashishan the by of the sectwhocame conflictwith used Equally,it attracted the attention theeleventhandtwelfthcenturies. at the of the Europeans Egyptian timeof Napoleon's expedition. the by Dioscorides It is brieflymentioned name.Hedescribes whogivesno Egyptian 'juiced'seedasgoodfor'painsof

646 ear. the

been it has In the Themedicinal usedas an past of cannabisare wide. properties 647 is therapeutically It hypnotic, as not anti-tussive. and anxioylitic analgesic, anti-convulsant, its because Western in displaced been has of medicine somewhat versatileas opiumand abuse. recreational it during is important Correctstorageof thesubstance rapidly ordinary conditions since 648Since,the fresh drug is importantone mightexpecta glossto t is losesnarcoticactivity.

implies This this was not appreciated Egyptian texts. in the and absence medicinal effect drug. in intrinsic lack knowledge the of of respect an suggests

(1992), 947. 6A3J. E.Pittsetal., THC,THCAincannabis sativa',Joumalof Pharmacology44 1923givessomefiveoralpreparations. w TheBritishPharmacopoeia, 527. 645 TreaseandEvans,Pharmacognosy, 165 111: 646 Dioscorides

beenusedto control Drug,it hasrecently 647 Although, mostwidelyknownnowasa 'recreational' albeitControlled Effects Cannabis 'Therapeutic in to in AIDS Robson, P. of and cancer patients stimulate appetite patents. nausea British Joumal Psychiatry 178(2001), Cannabinoids', 98. of and to that fromthePittRiversMuseum (1896-1903) rA8Yetanalysis oxford appeared show of somedriedsamples at in dried the D. J. Harvey, 'Stability samples cannabinoid original content of cannabinoids was still of present, most 117. from 1896-1905', (1990), dating Journal 28 Ethnopharmacology around of ofcannabis

173

Entdes Prescdotion gmgmtappearsin the medicaltextsat Eb618,Eb821,BIn59,Bln8l, RamIII A26 . r-= ChesterBeatty13b. However,none of these formulations are either oral or inhaled thatthemedicinal whichsuggest properties of theplantwerenotappreciated. preparations

Eb6l8 to a Thisis partof a 'run'of presc(iptions to beappliedbybandage whichareintended formula butEb618containshemp.It is a quantitative toenail.Theyvaryslightlyin ingredients in hemp (resin), (plant), honey. However, if thiswas the Adw ! bw even yellowochreand with in theformof resinanynarcotic of absorption wouldbe minimalbythisroute.Thisis because for thethickness of theskinandthesmallsurfacearea.It is unusualto seeseveralremedies to It is that this a might refer condition possible an apparently obscure condition. appears what damaged sinceshoes a commonoccurrence or stubbedtoe (lossof toe nail?), presumably for here is intended It be to the that a perhaps act as poultice worn. medication may werenot (or ingrown) from damaged toenail. infection a an

Eb821 Its intended Thisis a gynaecological 'to the preparation cool womb'. ratherobscurely Theeffectis formulaconsistsof Ams'mt per vaginum. groundwithhoneyandis administered is 'this a contraction', as: stated

I'N

11313649 .

in thisprescription, It is difficultto speculate otherthanto say ontheintended condition 650As to anynarcoticeffectof thehempwe arenot thatthewombis 'thought'to be involved.

V:484. 649Grundriss 650Thewordidt is usedherefor 'womb'.Medicalterminology in respectof a 'specifically' namedpartof the body intendsto referthe generalarea.See,Walker,Studiesin AncientEgyptianAnatomicalTerminology, sometimes 259-60.In this casethe conditionmightactuallybe one affectingthe lowerstomachi.e. painin the 'area'of the they womb.It is unlikelythat the ancientEgyptianscoulddiagnosean occultuterinecondition.Nevertheless, is to'think'the concernedsincethe remedyis per vaginum. uterus appear

174

toldwhichpadof theplantis used:fibreor resin.In theabsence onemight of anyelaboration assumethe formerand henceno narcoticactivitycouldhavebeenderivedfrom Eb821. fromthevagina if theresinhadbeenusedthenabsorption However, of anyactiveingredient 651 thantheoralroute. andquicker wouldbeeffective

Bln59 from Thisis 'another(remedy) dueto impregnation to driveoutdemonicpossession the'semen(?)' and'poison'of a god.It featureswithsomeotherfivecompounds andunlike is designedto be usedby fumigation. it is difficultto However, the previouspreparations imagine foranynarcotic to thattheingredients wereselected activityunlesstheywereintended of hempwasto aidthe burningof the sedatethedemon.It is morelikelythatthe inclusion to theprocess otheringredients andasanancillary of exorcism.

Bln8l, This is a prescriptionfor the driving out of fever or inflammationk2mt -1ý11141

652 .

It is anointment leaf(kBw n gmftt) contained in a fattybase.It consisting of s'ms'mt is intended fever,sinceno particular to treata generalised seemsthattheointment partof the However,absorption bodyis mentioned. throughthe skin will be of any activeingredient to otherroutesof administration. Dawson thinksthereasonfortheinclusion compared minimal in thisprescription is becauseit punswiththeword§M§M. 6531thinkthisdoubtful of S'MS'Mt (Bln80-88 in a runof prescriptions sinceBln81seemsmerelyan inclusion and againstS'MS'M R303,304). 651Boththe vaginaland rectalroutesproviderapidabsorptionof activecompoundsand also avoidmanyside withtheoralroute.It is routepreferredin continentalEuropefor manysystemicproducts. effectsassociated 652GnindrissVII:854.Thewordappearsto be usedfor bothfeverand 'Jocalised' heatsincethe latteris seenin withwounds,e.g. Sm4l. connection Dawson,JE4 20,44. 653

175

A26 Ram111, Thisis a preparation to 'cool/refresh'theeyes.It consistsof celerynvtt andhemp information than in The is the more offers no morning. prescription and usedas an eyewash foranalgesic it is significant thatit is clearlynotintended this.However, relief.

Btl3b Amgmt, Thisis a combination emmer(mymy), and*bw of severalitemsincluding (plant).Theseitemsaredescribed asmwnw... andhencetheyappearto betheresultof the ), Lim of in water.In additionthe formulacontainspulp(date? dissolved 'active'ingredients intended is then lotusandgoosefat.Theresulting either rectum, presumably mixture usedper to soothethe rectumor morelikelyto aid evacuation of the bowels,(sincewe are told ). No (constipation? his is blockage 'it 13a that: dns of rectum' a at previously pw n pPyff, hemp it be likely from be this to since nor would prescription expected actionseems analgesic in is not soluble water. resin

thattheEgyptians I wouldsuggest thatthereis noevidence wereawareof thenarcotic fail to No The demonstrate the hemp. plant of otherwise. part above prescriptions of properties The inhalation is specifiedandall are for externalpreparations. of hemp- the mostusual 654 demonic fumigation. is for administration not specified one case of of save method -

Herbal, thattheAssyrians 654 Manniche to 'dispelsorrowor grier,AncientEgyptian records usedit in fumigation to theentriesfor butcarefulattention 82.1thinksheis misled.It seemsto havebeenknownto theAssyrians, thatthattheyhavelessknowledge hempsuggests thanis supposed. Fordepression of spiritswe see'eatand i,59.Butin thecaseof fumigation drinkwitha meal',KAR203 for'thepoisonof allfimbeAM91,1,10 it is intended 4. Herodotus describes thefumigation of hempseedsby the Scythians. andfor the'Handof Ghost,AM.99,3r. by thevapourtheyshout theresultant Thompson becausetransported wronglydescribes effectsto intoxication A Dictionary because Assyrian Thompson, Botany, thisvapour 220. However, of aloud they shout aloud'. only Histories bath; for instead IV:74-5. they them by bodies as water their with water, never serves anychancewash

176

Mummies Cocaine Munich 5.4Cannabis, andTobacco -The I havestatedpreviously thattheuseof drugswithina societycanbe reflective of that With this behaviour. into insight their same social studymaygive a valuable societyand in hallucinogenic in investigation into the ancient substances use of sentiment mind,an from involved in 1992. This the by Balabanova team analyses and canied out was societies determine Munich in the possiblepresence the to of museum at some mummies remainsof (c. 1070 Period Intermediate dated from between Third 655These the drugsubstances. remains BC)andthe Ptolemaic/RomanPeflod(endingc.395AD).Thesamplestestedweretakenfrom

to analysisby radio-immunoassay bone,softtissueandhair.Theywerethensubjected and (GC/MS). massspectrometry gaschromatography/ in thatthepresence Theresultsproduced and of cocaine,cannabis wereastonishing fact that the As the found in tested the concentrations surprising was samples. all was nicotine levels be to In fact, high to high. these comparable enough very substances weregenerally of 656 individuals in modern foundin addicted societieS. If theresultsfromthesesocalled,'MunichMummies' arecorrectthenthreeimmediate be drugs from Firstly, the flow discovery. this that to can of presence seem consequences detectedin ancientremainsaftera considerable periodof time,in thisinstancealmostsome to 3000years.Secondly, thatthelevelsof drugsdetectedsuggests a levelof useamounting World be New Thirdly, believed to tobacco, that products, cocaine and which are addiction. to theancientEgyptians. appearto havebeenavailable is Balabanova by in that Whatis surprising the andperhaps ominous report somewhat If true, it wouldopenup the was expressed aboutthis last implication. no astonishment possibilityof trade routesbetweenthe Americasand the Old Worldand consequently

Ulm. Medicine toxicologist 655 Balabanova Forensic asa forensic at wasworking attheInstitute of Forensic in thehairof drugabusers', 656 E.J. Coneet al.,'Theoccurrence of cocaine andheroinandmetabolites 63(1993), 55-68. International Science

177

found have to 657 history Balabanova team the the appear of and re-writing period. necessitate ignore thismerelyto facie find, to historical that yetseem represents a major evidence prima in detected be drug it discovery is important in that their that that even use can shows comment

658 societieS. ancient teaM659

In 1993thesame

mummies, reported similarfindingsfromsome72 Peruvian

(see German Bell Culture human from ten twoSudanese remains south mummies some and Whatis surprising fromthe 1993resultsis thatcannabis Table5.4(i).660 wasnowshownto be (the in Peruvian Whilst the the coca plant sourceof cocaine)and tobacco mummies. present

Asian be is American to of accepted a plant generally products; cannabis sativa native are find This in South America Old World hence this period. at an productandnotpresent origin be indeed links. The to the trade of cannabis would of presence appears reinforce possibility logicalif suchlinkswerepresentbetweenEgyptand SouthAmericabut this significance, byBalabanova. again,seemsto beignored directly to Surprisingly therehasbeenno-follow attempts reproduce or or connected up Balabanova's resultsfromtheMunichmummies. compare I considerthis 'situation'to be one of scientificinputinto an historicalmodelthe by many implicationsof which are consideredtoo remotefor further consideration However, it is important Egyptologists. thatthiswholemattershouldbe properlyresolved and beingleft It is an exampleof 'external'inputinto Egyptology or dismissed. eitherexplained It canonlyberesolved byfurtherscientific analysis. unanswered. China Silkhasbeenfoundpresent fromDeirel Medina. 657 femalemummy as a hairribbonon a NewKingdom tradethroughPersia. Theearliestprevious example wasfound wastheonlysourceat thistimeandsosuggests A.D.J. Lubecet al.,'Useof Silkin Ancient southof AbuSimbelanddatedto aboutthefourthcentury at Quastal, 362(1993), 25. Nature, Egypt', Naturwissenschaften, 358Theystatethatcluesto ancientsocialbehaviour 658Balabanova, areexpectewith from 'regardto childcare'Theythenreportthat'ourresultsarein excellent withrecommendations agreement justin Pap.Ebers(Eb782)whichshouldcalmcryingbabies'I wouldsaywithcare'generallynotnecessarily betweenthis andtheirresults.Seemy previous respectof children.Anyhow,I fail to see any connection discussion of Eb782. Societies, F.Parsche 659 Lancet432(1993), 503. etal.,'DrugsinAncient tonotethattheircomparative 660 It isinteresting figuresnowshowthattheMunich number mummies elevennot intheirpaperfrom1992. theninepreviously reported

178

I consider thefindingsof cocaineandtobaccoin ancientEgyptian remainsdifficultto Narcotics in far beyond drugs The the affectand medicinal. societies oftengoes accept. useof inconceivable that It beyond leaving the their seems patient. a society, mark within arereflected have in importantly, themselves those trade could products such products or, more route a is it Egyptian indeed had then leaving If they records escaped anyevidence. existedwithout theGreeksandRomans. thattheyalsoescaped almostimpossible foundaddto thedifficultyof beingableto accept Thehighlevelsof drugsreportedly thesefindings.Thismightbe explainedif thereweresomefaultsat the scientificlevel.Possible

faulty be for level the methods, contamination, might spurious at scientific results reasons (e. fault themselves the g. possible or some with remains withsimilarcompounds confusion been have inapplicable fakes). Many these since similar results seem arguments of modern by Balabanovain other samplesfrom other situations.Any possible demonstrated in hair drug 661 The is in technique. the and of presence point whole contaminationeliminated Anydrug tissueis thatanydrugcontactpostmortemwouldnotresultin intratissuepresence. individual. lifetime ingested during the have been the of must sorecorded Theoriginalmethodof thedetection of cocainein hairwasreportedby Balabanova herselfusingGC/MC.662It hassincebeenreportedon by manyotherworkersas a reliable 663It usedto detectand quantifythe presenceof simultaneous opiates,cocaine, method. hair. 664 in andothernarcotics postmortem cannabinoids

(Pipe 661 Samples contamination. arewashedpriorto testto removed of hairfor example external anypossible in thepast!) Washing Egyptologists werenotinfrequent reducethelevelsof detectable canhowever smoking (active THC ingredient drugs.Inthecaseof cocaine againstunwashed and of cannabis) -5% -36%wasrecorded 'Effects in humanhair,International R.J. Zortlein, UltraCleanondrugconcentrations hairsample. of theshampoo 113(2000),102-6.ThismeansthattheMunich Joumalof LegalMedicine, mayhavehadevenNghe examples initiallevels 662 S. Balabanova and J. Homoki, 'Detection of cocaine in human hair by gas chromatography/ mass spectrometry',ZeitschriftRechstnedizin,98 (1987), 235-40. 663Y. Nakaharaet al, 'Hair analysisfor drugs of abuse', Archive of Toxicology66 (1992),659-74. 664Dependingon hair length it can provide a quantitativehistory of the narcoticingestion of an individual from twelve months prior to death. A. M. Tsatsakis et al., 'Evaluation of the addictionhistory of a dead woman after exhumationand sectionalhair testing',AmericanJournal of ForensicMedicalPathology22 (2001), 73-7.

179

Alsorecentstudieshaveshownthatnicotineis evenpresentin thehairof neonates of 665 in known those of non-smokers. who are smokers whilst negative mothers In 1995Kintzstatedthattheuseof GC/MSfor the analysis a wide of hair:'provides information the detection from to concerning provides and ranging of months years window druguse.' Indeed,theGC/MCmethodis nowgenerally severityandpatternof an individual's drug between the being to amount of accurateenough providecorrelation acceptedas in in drug It is known ingested. be detected that to centres addiction a methodwidelyused and 666 before the theUnitedStates.Suchtestsareregularly courts. evidence usedasscientific The In othercircumstances thefindingsby Balabanova controversy. no wouldcause Substances be by to Balabanova, therefore, attested. soundandwell appears methodused is specific tothatcompound. theprofileproduced testedcanbeaccurately recognised, thesamealkaloids Thechanceof otherplantsin ancientEgyptcontaining as cocaine have have to did 667 if they Also, is botanically tobacco exist would similarplants remote. and beenplantsthatwereusedextensively, profilesto cocaineandtobacco, withexactchemical feasible. does This disappear. to theirusenotrecorded then seem at all not and levels body by the the The breakdown of and ultimate of abusivesubstances deposition on age,stateof healthandother will varybetweenindividuals andis dependent drug breakdown ingested. 668 Howevdr, long time of some over period of a substances levels drug imply 669 the is Thus, that to their this probable. would metabolites substance by Balabanova discovered almost mayhavebeenhigherat the timeof deathsuggesting in Egyptian the specimens. addiction certain Journalof Forensic 665P. Kintzet al.,'Nicofine in neonates' to tobacco', hairfor measuring analysis exposure 38,(1995),119-123. Science M.C W It hasbeenusedin Italyto checkthatformerdrugaddictsare'clean'priorto re-issue of drivinglicences. forDriving Licence Ricossa in Cocaine study,Forensic et al.,'HairAnalysis andHeroinUsers.AnEpidemiological 107(2000), 301-8. International Science TheMystery Channel FourTelevision 667 Knapp, Equinox), Mummies', (hereafter, citedin 'Equinox, of theCocaine 8. 1996), Script(London, 668 G.G.Gibson to DnigMetabolism 1994). (Glasgow, andP.Skett,AnIntroduction 1994). 669 R.J. GreenandN.D.Harris,Pathology (London, forPharmacists andTherapeutics

180

No information regardingthe socialstatusor provenance of the mummieswas 670It is in an anthropological study. supplied(orstatedas unavailable); an important omission extremelydifficultto envisagethat any drug addictionat this apparentlevel couldgo in anycontemporary documentation andwouldnotbenotedor reported undetected or medical 671 Thepresence dueto thepossibility papyri. of thesesubstances or necroof necro-chemical is highlyunlikely. biological Asdiscussed GC/MCanalysis is easilyableto distinguish changes betweenparentdrugand metabolite and alsoany anomalies wouldhavebeenpreviously forensic by toxicologists. witnessed

Oneotherinitialexplanation mayhave of the resultswasthatthe Munichmummies beenlatefakes,something thatwasnotuncommon whenmuseums wereanxiousto establish in thenineteenth 672David hasexamined theprovenance collections century. andpronounced 673Sincethe 'Munich'and1993analysesthere the realthing'. of the mummies as 'probably havebeenlaterfindsof similarsubstances in othermummies. In 1996Balabanova reported findsof nicotine in prehistoric Chinese 674 remains. Davidis reported as findingnicotinein 'twoof thetissuesamplesandoneof thehair fromManchester; It is, again,interesting to notethatneithercocainenorcannabis samples' wasfound.Shedoesnot sayhowor howmanysamplesweretestedandher resultsappearto

675 beunpublished.

670 Thenine'mummies' femaleandoneincomplete aremerelydescribed as:sevenheads,onecomplete male Naturwissenschaften, 358.However, Balabanova, the femaleis allegedby Davidto be fromthe Twenty-first 8. David,Equinox, in possession Dynasty of the'Ladyof theTwoLands'segarately sarcophagus of themuseum. is notfroma knownexcavation butbypurchase froma'privatecollector' in 1845 However, theprovenance 671 in respect Please seemyearliercomments of addiction. by European 672Thedesirefor mummies duringthe earlynineteenth collectors centurywas andmuseums Consequently it wasnotunusual forrecently deadbodiesto bemummified T. G. insatiable. tosatisfythisdemand. ForgedEgyptian Antiquities (London, Science, Wakeling, 1912),H. Pringle,TheMummyCongress. Obsession, Dead(London, 2001),171-8,190-2. andtheEverlasting 673 ThisI wouldventureis stillonlyanopinionsinceall werepurchased dealers. throughantiquities or acquired tohavebeencircumstantial Her'examination' appears sincetheactualremains werenotmadeavailable. 674 S. Balabanova Anthropology et al.,'Detection of nicotinein prehistorical of SouthChinese', skeletalremains 341-352. Anz54(1996), in Equinox, 8. Unpublished 675 David,reported to date.

181

1993 Springfield high. for her Balabanova's Peruvian using also seem samples results GC/MSon samplesof Peruvianhairfrom 1000ADreportslevelsof cocainebelowthat of found by Balabanova far below (< 800ng/g). His figures those are modemcocaineabusers thepresence Table5.4(i).Thisis verysurprising natureof cocaine andendemic considering A recent hedoesnotreportthepresence of nicotine or cannabinoids. usein Peru.Interestingly in from from hair sites archaeological somenineteenancientspecimens samples studyof 676 Chile deliberately tested traces or cannabis. no revealed of cocaine,opiates and northern

lack is Balabanova's that they Themainscientific team the any with resultsof problem human include 677 have Control to remainsof attempted other groupsshould controlgroupS.

for from have This tested the same any possible museum. would origin non-Egyptian did is team from It that the not surprising museum storage. or mix-uparising contamination, to These from two to groups unlikely are young children and animals. examine material seek haveingested thedrugsinquestion.

I havecollatedthefindingsof Balabanova andherteamin Table5.4(i). Theresults Sudanese, fromherteamareshownfortheEgyptian, Peruvian together andBellCultures with bymeformodern drugabusers. figuresprovided basisit is difficultto justifythefindingsfor theEgyptianmummies. Ona comparative FortheEgyptian thevaluesshownforcocainearewellwithintherangefor modern mummies livingdrugaddicts.Thefiguresfor nicotinein the Egyptian mummies arewithinthe rangefor

Chemical Science 676 H.Baezet al.,'Drugsin Prehistory: Hair, ' Forensic International Analysis of AncientHuman 108,(2000),173-9. 6T7 Controls Theyserveto highlight arevitalin scientific experimentation. problems withinthescientific possible Thisis donebyselecting andalsoto showupanypossible neutralsamples whichwilltest contamination. method fromthesamestorageenvironment. M. Uhl,'Determination andby selecting samples negative of drugsin hair Forensic Science International 84(1997). 281-94. usingGC/MS',

182

Egyptian the for data living The shows cannabis cigarettesmokers. comparative modem be higher to thanthemodemsamples of a concentration samples mummies difficult is Egyptian in Thehighpresence the these more even samples of substances to explainin viewof theprobability post of thesesubstances of a breakdown nota potentiation

mortem. In summary,we are left with resultsvia an established methodand from an difficult to is distinguished It difficult team. to their and as contradict results and experienced faked.However, despitetheapparent imaginethatthesehavebeendeliberately of accuracy I consider thattheresultsmustbeviewedwith'some thescientific cautionuntilthere methods, is someindependent mummies. resultsonotherEgyptian andsimilarindependent re-testing However, findingswithouthaving theirapparentlackof surpriseat theircontinued is 678 There first the no samplespromotes scepticism. on somecontrolexperiments attempted Thesearesubstances asto theuseof tobacco or cocaineby theancientEgyptians. evidence In Peru become the to beyond of social structure. part palliatives go mere chemical which North In America it is depicted in its tobacco is integral lifestyle, smoking art. cocaine with became society.It is extremely unlikelythatit wouldnothavehada a ritualwithinindigenous societyandalsoescaped similarimpactwithinEgyptian recordin artandiconography. forspecialor exclusive is thatsuchsubstances A possible explanation werereserved in presumably theirapparentblanketappearance whatmustbe a random use.However, this. 679

in theMunichMuseum of mummies precludes collection

678It mightbe arguedthatthis is just scientificignoranceof history.However,the historicalsignificance wassoon pointed out: 'I got a pile of letters that were almost threatening,insuffingletters saying that it was becauseit wasprovedthat beforeColumbusthesePlantswerenot foundanywherein the world nonsense ...... Americas, the from,Equinox,2. personalquoteby Balabanova outside in respectof the supposedexclusivityof opium. 679Seemyearliercomments

183

TABLE5.4 M Summaryof the concentrations (nq/q)of the alkaloidsreportedby Balabanova et al. Belowthesefiguresfor comparison are showntypicalvaluesfor moderndrugabusersandsmokers(summarised fromCone(1993),Kintz(1993)andJurado(1995)680 (Thenumberof samplestakenis shownin parenthesis).

COCAINE

NICOTINE

CANNABIS

24-200(4) 70-442(8) 25-110(6)

140-900(4) 125-1045(10) 45-1050(11)

800-4100(4) 59-2875(10) 36-2800(10)

220-13900 (12) 43-1371(10) 26-326(16)

28-1400(12) 57-1997(6) 39-557(26)

50-1700(17) 49-2795(8) 14-276(20)

0(10)

56-142(8)

0(10)

0(2)

87-93(2)

0(2)

4-760(1W), (17)

nottested

0.06-3.87 (100), (17)

nottested

0.37-63.50 (100), (40)

nottested

Egyptian mummies(Munich) Hair softtissue Bone Peruvian Mummies Hair softtissue Bone Bell culture Bone Sudan Bone

Modern abusers

drug

Hair

Modernsmokers Hair

date 250OBC. BellCulture stated as Sudan- datesstatedas5000-400OBC and400-1400AD.

Science International, 680 Cone,Forensic 55-68.lKintz,Journalof Forensic 119-123. C. Juradoet al., Science, 'Simultaneous ScienceInternational 70 quantification of opiates,cocaineandcannabinoids in haie,Forensic (1995),165-174.

184

LOTUS CHAPTER 6: LETTUCE, CELERY FRUIT,MANDRAKE, 6.1Lettuce

Lactuca sativaebw?

1'4

681 cB Lactuca virosaeft,var.

Thereare two speciesof lettucebothof whichwerenativeto ancientEgypt.Theseare L. is domestic lettuce known is the widelyeatenas a and which commonly as most which sativa leffuce. L. lesser known the the variety virusa or wild rarer and saladvegetable682 its cultivation lettucewaswellknownto the ancientEgyptians; Thedomestic canbe 684 Min. be 683 It in to to the illustrated tomb considered sacred god was also scenes. seen

leffuce: been theseare cbw have to that TherearetwoEgyptian offered mean words lettuce domestic the to Manniche the wild eft, and suggestscorrespond which and

686 It likely (domestic) lettuce. 685The the bwis seems , accepted as generally respectively. word thatsincethe nameof the lettucewasobviously wellknownin domesticandmythological it from distinguish its be to then wildandmedically some other name would reserved contexts Dawson Only in However, the the texts. eft reasons only appears variety. word medical useful lettucewaswellknownthenthewordeftmustrepresent thatsincethewordforthe(domestic)

86,(1986), 6. BIFAO Aufr6re, 681 D. Breweret al., lettucecultivation, the earliestareasof domestic 682Egyptseemsto havebeenamongst The Egyptian Ofigins PlantsandAnimals (Warminster, 1995), 74. Domestic 683 Thecultivation tombof Niankhkhum of wildlettuceis shownin theOldKingdom at Saqqara, andKhumhotep Herbal,113.Thechapelof Senusret AnAncientEgyptian I at Karnakshowshimofferingmilkto the Manniche, 1:176,'anoffering totheithyphallic whoareshownthreelettuceplants.VVb godMinandAmun. godMinbehind Thisassociation between 684 themilkyjuiceof thelettuceandthesemen seemsto havearisenfromthesimilarity alsoexistswithotherdeities.InonemythSethissaidto become pregnant aftereating ofthegodsTheconnection lettucethathasbeenimpregnated withthe semenof Horus.J. G. Griffiths,TheConflictof HonisandSeth 41-6. 1960), (Liverpool, Egyptian AnAncient Egypt,113. Manniche, 685 to as a 'plant,Wb1:176,Wb 686 TheWorterbUch givesebwas 'lettuce'whilsteB var. eft is merelyreferred 1:182.

185

plant. 687

someother

This he takesto applyto mefflot(mefflotus officinalis) or the sweet

688 is by The because to the the connection made melilot clover. of properties ascribed DioscorideS689 whichDawsonsees as directlycorresponding with the usesof eft in the Egyptian texts.Dioscorides medical wordsforboththeseplants,butneither givestheEgyptian lexical Mefflot hegivesasheamith any connections. andforL sativahegivesembrosi. provides butnotgivenanEgyptian 690 Thewildlettuceisdescribed name.

In the Egyptian to combat medicaltextsthe plant cft seemsto havebeenintended between usesthisfactto makethissameconnection pain.Dawson mefilotandeft. Itsuseasa painkiller is principally in externalpreparations internally it is also whereas Theuseas a coughremedyre-enforces usedint al to treatcoughandto actas a vermifuge. Dawson's 'melilota kindof viewthatsomesoothingtypeof herbmusthavebeenintended, 691 cloverwhichsecretes muchhoney'. Theviewof Dawson 692 BUt thattheplanteftwasthemefflothasbeenwidelyaccepted. forthepharmacological thisrelieson theclaimsgivenby Dioscorides properties of thernefflot. I thinkthe choiceis somewhat However, randomandthatthe minorityviewof Aufr6reand Manniche that -rftrepresents thewildleffucedeserves furtherconsideration.

failstoconsider (orwasprobably 687 He,however, notawareof)thewildlettuceasa possibility. in theMedical 'Studies 6NW.R.Dawson, Texts',JEA20(1934), 41. 689Didscotides 111: 48. 166.Hedescribesit as being'soporificandfor theeasingof pain.' 11: 690 Dioscorides 691Dawson,JEA19,41.

by mostfromDawsonto Charpentier. 692Thisviewhas beenaccepted Receuddo mat6daux Charpentier, deI'8gyPte 6pigraphiques 240.Theyelaborate However, relatifs6 la botanique antique, nofurtherthanDawson. is the'wildlettuce'.Hisargument Aufr6retakestheviewthatthissubstance is basedon thereasoning thatthe the significance sincedomesticlettucedoesnot appearin the medicaltextsandconsidering of lettucean Aufr6re, BIFAO86,1-32. wouldbepredicted. appearance

186

6.1 (i) PrescOption entdesof cft in the EgyptianMedicalTexts

EMO ktntdrmrtmgsn,

bt

(prescription) 'another in thesideof thebelly' to driveoutillness/pain (tostoppainin theabdomen Dawson). Theremedyfor thiscondition consistsof cft withdatejuice,boiledin fat or oil. It is to beapplieddirectlyto theskin. a poultice essentially andassuchis intended Thewordmrt is usedandI agreewithDawsonthat'pain'is a morelikelytranslation than'illness'.The sideof the bellyis clearlyindicatedand morelikelyto be describing a 'symptom' whichmustbe pain.In the absence of moredetailsit is difficultto speculate as to is likelyto be. whattheactualcondition However, it is significant thattheremedyintended to assuage thepainis an external ratherthananinternalone.Thisis oddbecauseeft(eitheras mefflotor wildleffuce)wouldbe minimallyabsorbedfrom a poulticecomparedto its oral administration, so reducingany benefit.Thisimpliesthattheproperties painkilling of cftwereeithernotappreciated or that cft otherthanleffuceor melilot. wassomesubstance H42 bdwm ITnbt pbrt nt smi ivý, 'a prescription todeadenpainin allthelimbs', forthedeathof Schmerzstoffe 'a prescription in allthelimbs',693 'tostoppainin anypart'(Dawson). 694 Thisremedyconsistsof a complexmixtureof ingredients whichincludeseft in beer is intended be drunkovera periodof fourdays.UnlikeEb40thisprescription to is for which and internaluse, but the combination of "A with severalother unknownplantsmakesa 693Grundfiss IV:11.

hasthiswrongly listedasanexternal 694 Dawson preparation!

187

the be impossible. If to thought per se cftwas painkiller an effective prognosis pharmacological it if be This was not explained seemssuperfluous: might presenceof othercompounds ingredient. to betheprimary considered to combatpain.It is However, it seemsfairlycertainthatthisprescription wasintended Leake in Hearst Papyrus (H33,34,37,41-46,125-30) 'run' the which of prescriptions partof a

695 areto treatarthritis. considers

Eb608 kt nt sgnnml ct

(prescription) 'another theknees', to soften/soothe 'tostoppainin thelegs'(Dawson). Thisan externalpreparation of eftwithhoney,datesandfat whichis madeintoa consisting in to 'mass'andthenappliedto theknees.Thisis presumably a remedy combatstiffness the jointsandpresumably theknees. wouldaffordsomereliefasanaidto massage

Eb86 pbd nt sd uýhdwmht 'a prescription to breakuppainin/fromthebelly', 696 'a prescription in thestomach'. to breakupSchmerzstoffe juniperberries,fresh Theformulaconsistsof eft, cRh(cowfiesh), 697sktr (incense), breadandsweetbeerwhichis strainedanddrunkfor fourdays.Dawson thisis for considers 'purging'suggesting thattheformulais laxative,nota painkiller, whichratherrunscontraryto The pain may indeedbe from constipation his argument. but, any laxativeactionis not bytheformula. supported 695Leake,TheOldEgyptianMedicalPapyri,62. 696GrundrissIV:104. 697GrundfissIV:104.

188

Eb751dr nsyt m irly'to driveout nsyt in the eyes'.Its formulaconsistsof Ift, bsbs

drunk. be is intended beer. It to (fruit) (plant), (plant/fruit), jPw andsweet LYs I think their does but Dawson these significance. on elaborate not prescriptions quotes is intendedto hereis somesortof painfulillnessandthatthisprescription thatthecondition relief. giveanalgesic

Eb640 'anothee(presdiption)-from Eb637nwdtntsgnnbtnbt,

'ointmentto soften/soothe

'all (Eb656 (Dawson). has joints ' 'for things, andmuscles' stiff Abu nbt stiffness, anypart/all ) intended here. perhaps This is an externalpreparationcontainingsome 15 differentingredients:eft, w.§bt ), pm (plant),698red ochre,copperoxide,sludge?(apt s-dr), (mineral),ssk; (fruit/mineral? (fresh (pod/husk), )699, (colocynth? fat, donkey drrt ibex tp3w enb partof excreta, psýd natron, has Dawson this into is then bone fat. This 700 ), and applied. a mass all made andwhite plant? However, the is I for'stiff joints assumption. unreasonable not an which andmuscles as remedy

formulais odd sincethe additionof donkeyexcretadosesnot fit with the usualsoothing, it formulas This that as a agents. wasusedmorespecifically of rubbing suggests aromatic for joints 'universal for localised than or muscles. rather stiff application a rub' poultice It is interesting to notethatlikefly excretain Eb782,the additionof donkey'excreta' Thatis stubbornand persistent heremaywell be allegoricto the natureof the condition. (pain). 701 (donkey-like) symptoms

656 698 Acacia?,Westendorf, 699Nunn,AncientEgyptianMedicine,164. 656. 700 Juniper?,Westendorf, 701 Thecharacteristics of animalsare frequentlyusedin Egyptianliteratureto describehumantraits.In 'Warnings to an idlescribe'fromthe PapyrusKoller:'Thyear is deaf,thouart likean assin takingbeatings(stubbom).Thou art like an antelopein fleeing',translationfrom A. H. Gardiner,EgyptianHieraticTexts1, (1964),39. In 'Be a scribe,for a soldierslot is a hardone'fromPapyrusAnastasiV: I... areyouan ass?Onewillmasteryou!Thereis (1954),235.Thereare many sensein your body',translationfrom R. A. Caminos,Late EgyptianMiscellanies,

189

Bln20l. kt pbrt nt stt m msdr wy

in both for'shooting 'another ears', pains' prescription 702 in both for Schleimstoffe 'another ears', prescription (Dawson). 'forearache' ... in is ) (ointment? 1br used which Theformulaof thisprescription with consistsof cficombined hadsome It presumably forthetreatment theears.It seemsthatthiswasintended of earache. However, base. by in the the any active ointment emollient ear virtueof soothingeffect ingredient release wouldbelimited.

Bln36 kt nt sgr R sryt

'another(prescription) to soothea cough'. for is be fat taken beer, to including ingredients Thisconsists eft, oil and and sweet of several intended to havea soothing fourdays.It is presumably cough. effectona non-productive

Eb64 ktdrpftmbt to driveoutPt1wormin/fromthebelly'. 'another(prescription) 'eaten'. then (plant), (fermented juice) together Psi Thisconsists and eft, cm plant combined of 703 is designed thetypeof wormis unknown. Thisprescription asa vermifuge, although

Ankhsheshonq, Texts', for Instructions in 'Instruction The in Papyrus the Insinger of example: and moreexamples AncientEgyptianLiterature111,159-217. in Uchtheim, 702GrundrissIV:63. 703Despitethe severityandthe highincidenceof parasiticinfectionsin ancientEgyptthereappearto be onlytwo to the by in the texts. Ebbell these that correspond roundworm medical name mentioned worms suggests specific being former. tft the Ebbell,ThePapyrusEbers,130. tapeworm respectively, and

190

its it is impossible to saywhether ingredients in thisprescription Inviewof theunknown for the Pi? treatments However, therearesomeseventeen formulawouldbe effective. other wormin Ebersalone!

Eb530 bt ssnb nbt mnt sm

704 Sa

better,whena mansuffersa sore'. 'tomakeeverything Thisremedyconsists of eft,andsaltmixedin oil or fat whichis thenapplied.It is presumably ingredient The difficult healing type to heala soreor perhaps designed active of wound. some benefit. have be to antiseptic afforded some presumably appears saltwhichwould

WOW 705Its formulais an external is intendedto preventhair JOSS. This prescription imagine formula is It difficult that this to 'chopped' eft. wouldwork. containing preparation Sufficeto say that supposed'hair restorers'havebeenon offer acrossmedicalhistory. 706 times. Effective modern are a product of very ones essentially Takingalltheaboveprescriptions a farwiderrange as a wholetheyactuallyrepresent implied by Dawson. The than essentially presenta prescriptions are actually conditions of internal by both is that capable curing pain external and means,curingcough, of substance An hair to soothing sores acting restorer. attempt matchany a and as a as vermifuge, acting impossible be to evenwith modern substance sucha widevarietyof useswould almost Dawson (eitherconsciously Insuchcircumstances, or not)hasconcentrated onthe medicines.

704 TheGrundriss Grundriss VII:820. givesthisasSAM (eineWunde), is Eb465.Itsformulais rathereclecticandtheingredients Aninteresting 705 alternative musthavebeendifficultto lion fat, hippopotamus fat,crocodile fat,catfat,snakefatandibexfat! of consisting obtain: hasbeenaneternalproblem. (butlimited)products Hairlossanditstreatment 706 In the1980'sthe'first'effective following the intended for thetreatment observed sideeffectsof minoxidd of marketed originally were a product hypertension.

191

his However for approach. broadusesof cft painandcoughs,perhapsnotan unreasonable the fits to properties the actual of that 'R examination closer needs uses ascribed mefflot view Dioscorides. former than the a reliance on rather of

6.1(ii) Melilot for mefflothavinganypainkilling Thereis no published properties. scientific evidence

It does alkaloidS708which Itsmainconstituents notcontain aromatic oil. coumarinS707and are herbal European feature in does It some mightprovideanalgesicor sedativeproperties. is limited but its nota painkiller. andcarminative emollient asanaromatic, use medicines to combatpainandstiffnessof swollenjointswas Its useas an externalpreparation, But 709 this Gerard. for by the Galen it by monk medieval poultice swelling and useasa reported The fact that the is becauseof its aromaticratherthan any pharmacological properties. to in its inclusion is particularly applications, soothing wouldpromote substance sweet-smelling However, the its ingredients by releaseof anyspecificpain properties. aromatic counterother fromtheplantshouldbediscounted. killingsubstance

6.1(iii)WildLettuce thanthemefflotandso Thisplantcontainsmorepharmacologically activesubstances lettuce The texts. for in the the likely contains eft wild uses of medical candidate seemsa more It is to flavenoids, terpeniods contain alkaloids. and alsosaid citricacid,oxalicacid,cournarins, is saidto possessmildsedativeandanalgesic andhas beenusedfor insomnia, properties 710 and afticular pain. cough,muscular

Thesepossessbloodanticoagulant 707 properties. 167. 708 TreaseandEvans,Pharmacognosy, 709 Reportedin M. Grieve,A ModemHerbal,www.botanical. com.,(March,2003). it is not clearwhichconstituents 710Whilstthe chemistryof wild lettuceis well documented representthe active by disputed J. Huang the been Early hyoscyamine. has This suggest et al., presence reports of component.

192

herbalusesedative information Whilstthereis no published to supportits traditional in animalstudies.It hasalsobeennotedto produce and effectshavebeenreported mydriasis in animalstudies. 711 of motorcapacity a reduction It seemsthatthewildlettuceratherthanthemefflotwouldmoreappropriately accord with the medicalconditionsdescribedfor the eft plant. However,I do not state this as a

certaintybut ratheras a choicebetweenthe two substances as 'candidates. suggested I am concerned However, thatthe appearance withothersubstances of eft in combination Thisaspectpresents primaryingredient. mightmeanthatit wasnottheintended a problemin inclusion impliesthatanymedicinal Random termsof identification. werenotactually properties If -rftwasconsidered to be an effectivepainkiller onemustquestionthe needto recognised. Egyptian in more polypharmacy addotheringredients. andits implications willbe considered detailin theconcluding chapters of thisthesis.

Joumalof Pharmaceutical 'Studies Sciences 71 (1982),270-1.C.A. Newellet al.,Herbal on HerbalRemedies', Professionals, Medicines, (London, 1996),266.(Hereafter, HerbalRemedies). a GuideforHealthcare 711Butthissuggests somealkaloidactivity,F GonzAlex-Lima pharmacological effectsof a et al., 'Depressant fromlettuce', isolated International Joumalof CrudeDrugResearch 24(1986),154-6. component

193

6.2(i) CeleryFruit Mgt712

ApfiFructus

Celeryfruits are the dried ripe fruits of the cultivatedplant Apium graveolenswhich are

The Levant. Europe the from Europe, into Western imported and southern mainly currently 713 in Egypt. have been to ancient present plantappears fruit the Theplantstemappearsnotto possesspharmacological contains activitywhilst

in featured It has 714 fixed two to threeper cent of volatileoil, oil, proteinand mucilage. in longer been has fairly timeS715 used widely traditional much and recently medicineuntil has been tonic, folk It andasa u(inaryantiseptic used as a sedative, medicine. and alternative 716Indeed,it stillfeaturesin the currentBritishHerbal for arthritisandrheumatism. domestic in feature the This celery Pharmacopoeia active constituents of asananti-rheumatic. particular in it have disease fruitfor paincontrolin muscular compound useful made a would skeletal incidence high In the Egyptian one might of such complaints of view medicine. ancient 717 in the papy(I. entries medical corresponding appropriately anticipate

Theplantnamedm?tt hasbeentakento meancelery(celeryfruit).Thiswasoriginally is 718 This detailed the Loret by now generallyaccepted after some consideration. proposed

712Aufr6re, 86,9. BIFAO

Agypten, Floradespharaonischen (MainzamRheinj985),137. R.Germer, 713 Thephthalate 714 properties anditsother andantispasmodic contentof theoil hasbeenshownto havesedative 65. Medicines, Herbal demonstrated in Newall, tests. have ant-inflammatory activity animal extracts 28thEd.,1015. in theBPCuntil1949.Martindale Itwasusedforitsanti-arthritic 715 properties andappeared A. H.AdaandA. havebeendemonstrated inin vivoanimalstudies, 716 Itspain-killing, properties anfi-inflammatory 'Anti-nociceptive AJkofahi, andanti-inflammatory medicalplantextracts',Jourrialof effectsof someJordanian 60(1998),117-124. Ethnopharmacology intheChapter Discussed 717 onDisease, pages126,132. 16. Loret,LaFiorePharaonique, 718

194

by Manniche, 719Dioscorides Nunn,Charpentier, viewandis supported andthe Grundriss. Egyptian for the name celeryasmithwhichalsoaccords gives withtheCopticwordMIT.720

6.2(ii) Dawson andM3tt Thedissenting voicefor thetranslation of the plantnvtt as celerywasDawsonwho plant. 721 SinceDawson

an alternative proposed meaning, namelythemandrake

stillcontinues

to be quotedin the areaof EgyptianmedicineI considerit necessary to lookat Dawson's beforeattempting to evaluate themedicalpapyri.(Themandrake proposals willbedealtwithin

a latersection). Dawson'sreasoning is, at first sight,quiteconvincing andfor that alonedeserves furtherconsideration. Hisasseaion is basedonananatomical connection withintheLeidenMagicalPapyrus (1,348lines5.8,6.1) whichstate: hisphallusis Bebo, tt n2; histesticles fruits the of are

(Inswy.fy m prt mitt)

histhighsareIsisandNepthys etc.

TheLeidenMagicalPapytusis an exampleof a commonformof 'anatomical list' in whichpartsof thehumanbodyarerelatedto a deity.Dawsonstatesthatthe nameof a fruit 'shouldrankas equalto a divinityonewithoutstanding 722He presumably magicalstructure'. He alsotakesthe word wasthinkingof the supposed magicalproperties of the mandrake. 719Manniche,An AncientEgyptianHerbal,76. Nunn,AncientEgyptianMedicine,154.GrundrissVI:214.These authorsconcordwithoutcomment.Charpentierlists all the referencesin support,Charpentier,Receuilde relatifs6 la botaniquede ltgypte antique,501. matbriaux6pigraphiques 75. 111: 720 Dioscorides, 721Dawson,JEA19,133-5. 722Dawson,JEA 19,134. But I think he is supposingmagical'structure'becauseof his belief that it is the (M-U-ChlateLr) with plant mysticalassociation. mandrake -a

195

the testicles because he the to the to shapeof with of shape associates mandrake equate n9tt flowers.TothisendhequotesBudgein sayingthat,aftertheflowersof thisroot themandrake 0

havedriedthereremain:'two littleballswhichare like the testiclesof a man (mandrake) . hecitestheArabnameforthemandrake Equally as'thedevil'stesticles'. in themedicalpapyri:a Additionally, thereseemsto betwospeciesof nvtt mentioned deltaanda foreignvarietywhichDawsonmaintains plantandthat equateto the indigenous fromtheLevant. imported presumably I agreethatthe allusionto the shapeof the testicleswiththe mandrake plantin the 723 conteXt. thanceleryfruitin thesame Leidentextis initiallytemptingandmoreappropriate

I thinkthatthemention However anatomical of thenameof a plantin theLeiden(andDendera) listsis glaringly outof place. In the LeidenMagicalPapynistherearetwenty-five entriesof bodilyparts(although i. deity: threeareunclearin termsof theactualpartsof thebody)andeachis identified e. witha deity the belly is Nut deity directly 'my the acting up gods' or with raises with a e. g. who either is the is /eft the Atum bodily 'my Protector Lord that eye eye eye of my parte.g. right or of as In Dendera lists Horus'. the thereare thirtyrelationships anatomical againmosty in of eye listsis thattheyarewritten directassociation witha deity.The'basicrule'of theseanatomical in a 'form'or patternof alliancebetween thebodilypartandthedeity.If othersuchanatomical thenthe samepatternis found:in papyrusGenevaMAH15274,'your listsare considered 724In Litanyof the Sun,'histesticlesarethe TwoHidden testiclesaretheprotection of Seth'. (InMWy), 725in theBook

Ones'

Ch172,'histesticle 726and inThe oftheDead, areNephthyS!

). CoffinTextsSp.945,'histesticles aresp3'(Sepa?

to havemisseda similarentrythatmightwellhavestrengthened Dawson 723 thiscase.Thesameentry appears lists'at Dendera, in i.e. 1nswy. the'anatomical fymprtmjtt. appears inAncient Studies Egyptian Anatomical Walker, Ter7ninlogy, 724 325. inAncient Egyptian Studies Anatomical Walker, Terminology, 725 314. inAncient Egyptian Anatomical WalkerStudies Terminology, 726 311.

196

listsin whichall of thebodilypartsare Infact,thereareat leasttwenty-six anatomical deity. Nowhere is the to directlyrelatedto or indirectly of a protection or attribute related some body. This 'rule' is human to the brokennoris thereanyinclusion that'pattern' of a plantallied in respectof thetesticles. brokenonlybytheexample givenbyDawson Thelineinswy.fy m prt mitt is givenby Dawson:as: 'N ,\

by in thesequence thenthiscouldbeprovided thata deityshouldbeexpected If oneassumes line: the making C4 W. --

LJ n

'm -.

57 Z3

ý by female determinative the and wherenytt carries