Many of the diseases prevalent in Egypt in ancient times still occur there today. The ever-changing pattern of disease in the world is, however, reflected in important differences between pharaonic times and the present. Many conditions well known today were unknown in ancient Egypt: for example, syphilis, leprosy, and bubonic plague probably did not appear until after the pharaonic era, and cancer was very rare. A difficult problem for identification is the incidence of diseases that are today unknown or much modified. Fortunately, the special geography, climate, and literary legacy of Egypt have enabled an unparalleled insight into the state of disease among ancient Egyptians.

Sources of Information.

The study of the pattern of disease in pharaonic times depends on three main sources: human remains, artistic portrayals, and the accounts of disease in the medical papyri. Data from those sources do not greatly overlap, and each has serious limitations.

Human remains.

The locations of tombs and burial grounds, as well as the hot, dry climate of Egypt favored excellent preservation of human remains. Simple burial in hot sand often resulted in desiccation proceeding faster than putrefaction. Then, too, the process of mummification frequently resulted in the good preservation of organs left in the body; however, the brain was sometimes removed and discarded, and the liver, lungs, stomach, and intestines were often removed and placed in canopic jars, where their state of preservation has usually been poor. The overenthusiastic use of resin, pitch, and cosmetic packing in the mummification process tended to cause severe damage to soft tissue, as did the attentions of tomb robbers.

Scientific paleopathology was pioneered by Marc Armand Ruffer, professor of bacteriology in Cairo from 1896 to 1917. Today, the objective has become the extraction of maximal information with minimal destruction of irreplaceable material. Simple radiography has been supplemented with the more informative, computerized tomography, which can be undertaken without opening a mummy cartonnage. Fiber-optic endoscopy allows the sampling of tissues, which can be examined by light microscopy and by electron microscopy, in both the transmission and scanning modes. Studies of antibodies require only very small samples of tissue and have enormous potential for population-based studies.

The recovery and replication of DNA (deoxyribonucleic acid) has provided the possibility of determining individual genetic profiles, sex determinations, kinship studies, genetic diseases, and, perhaps, the identification of ethnic groups. The DNA from bacteria, viruses, and parasites may also be sampled from infected individuals, and skeletal remains are a very important resource for this and for population-based studies.

In ancient Egypt, the average life expectancy was thirty to thirty-six years, although some people lived much longer, even into or beyond their eighties, notably Pepy II and Ramesses II. Known burials for those over the age of sixty are rare, but those that exist show the expected changes of aging, including osteoarthritis, arteriosclerosis, and calcification in major blood vessels. Texts describe the ravages of age in explicit terms.

Representations of the body.

Male tomb owners and important people were usually portrayed in exuberant good health. Women were generally shown as tall, slender, and beautiful, with graceful poise. For servants and occasionally for the tomb owner, the canon of proportions might be set aside in favor of what appears to be realistic portrayal of disability. There are, however, important caveats in the interpretation of such representations. For example, special conventions may have applied to certain conditions or diseases, particularly dwarfism, blindness, and obesity; then, too, the highly atypical artistic style of the Amarna period has created a special problem.

Medical papyri.

Injuries are very well described, particularly in the glosses of the Edwin Smith Papyrus. However, the medical (as opposed to surgical) papyri usually assumed that the diagnosis was already made and merely identified the disease by a name—one usually unknown outside the medical papyri and thus difficult to translate. The medical papyri tell us nothing of the prevalence or the epidemiology of diseases.

Parasitic Diseases.

Parasites enter the human body through the ingestion of water or foods or by contact with the soil, infected people, or substances. Some are acquired through insect bites or the bites of other animals. Undoubtedly, parasitic diseases were prevalent and probably a major cause of ill health and early demise for ancient Egyptians.

Microscopic identification of the eggs of schistosomiasis (also called bilharziasis) and the detection of the schistosome's antigen have indicated schistosomiasis in bodies from Predynastic times to the Roman era. Evidence of the disease in the medical papyri is, however, less secure. Recent opinion has veered away from translating the ʿʒʿ-disease as “hematuria (blood in the urine) caused by schistosomiasis.” No text links ʿʒʿ directly to the bladder, and it is not certain that “voiding of much blood” (wsšt snf ʿšʒ) necessarily refers to urine. Perhaps schistosomiasis and hematuria were so common that they were considered normal (as they were later in some locales). A calcified Guinea-worm (Dracunculus medinensis) was found in the abdominal wall of mummy number 1770 of the Manchester Museum Mummy Project. Parts of filarial worms were found in a Leeds Museum mummy, Natsef-Amun. Adult worms of some species can block the lymph system, causing swelling and thickening of the skin (as in elephantiasis). Although in tomb paintings there are many representations of the enlarged male external genitalia of servants, the typical swollen legs of elephantiasis are almost never portrayed. Larval forms of strongyliodiasis have been found in the intestinal wall of the mummy Asru of the Manchester Museum Mummy Project. The ancient Egyptians were probably unaware of their existence, and there is no obvious mention in the medical papyri. A roundworm egg was found in the mummy PUM II, and tapeworm eggs were in the mummy ROM I (Nakht), who was also infected with Trichinella. A hydatid cyst was also found. The papyri contain unequivocal references to intestinal infestation by parasitic worms, with ḥrrt and perhaps ḏdft being general terms for worms; pnd and ḥfʒt probably refer to particular species, but precise identification is difficult. Other Old Egyptian words (ḥsbt, bṯw, sʒ, sp, and fnt) also carrying the worm determinative may have only metaphorical meaning. The Para SightTM-F test for the plasmodial antigen of malaria has demonstrated many cases of malarial infection with Plasmodium falciparum in a series of naturally desiccated bodies from the Predynastic period and embalmed mummies from the New Kingdom, twenty-fifth dynasty, and the Nubian Ballana period (350–550 CE). No gross pathological changes are to be expected in malaria-infected mummies, and the medical papyri are silent on malaria's characteristic recurrent bouts of fever and chills.

Bacterial and Viral Infections.

Bacteria and viruses have not yet been identified in mummies or in ancient skeletons, so we must infer the existence of infections from the appearance of the mummies and DNA studies, with some additional clues from the medical papyri and the tomb illustrations.

Tuberculosis.

Dan Morse and colleagues reviewed thirty-one cases (from the Predynastic to the twenty-first dynasty), mostly with gross pathological appearances highly suggestive of bone tuberculosis, a bacterial infection. The best authenticated case showed classic spinal tuberculosis (Pott's disease), with the collapse of a thoracic vertebra, angular kyphosis (hump back), and tuberculous suppuration tracking downward toward the right groin (apsoas abscess). There are many tomb scenes portraying hump-backed servants, but from them it is difficult to distinguish between Pott's disease, porter's hump, ankylosin spondylitis, and bad posture. Andreas Nerlich and colleagues have detected DNA of Mycobacterium tuberculosis in a New Kingdom mummy's lung with the appearance of tuberculosis. Dan Morse has also described another possible case of pulmonary tuberculosis.

Leprosy.

No unequivocal case of a mummy or skeleton from pharaonic times has presented the appearance of leprosy, a bacterial infection. The earliest case is from a sixth-century CE Coptic Christian burial at el-Bigha in Nubia. It has been suggested that “Khonsu's tumor (ʿʒt nt ḫnsw),” as mentioned in the Ebers Papyrus might be nodular leprosy, but there are alternative interpretations.

Tetanus.

Evidence of tetanus, a bacterial infection, is not to be expected in human remains. Yet Case 7 of the Edwin Smith Papyrus, describes lockjaw and distortion of the face, suggesting tetanus.

Plague.

No mummy has shown signs of bubonic plague, a bacterial infection, and the medical papyri are silent on the subject. There is some evidence, however, that bubonic plague reached Egypt only after the Moslem era began.

Sepsis and abscesses.

Sepsis (a toxic state of infection that enters the bloodstream) must have been common in ancient Egypt, but there is no convincing evidence in mummies. There are, however, highly suggestive descriptions of sepsis and abscesses (pus-filled swellings) in the medical papyri. The words for “pus” (ryt and wḫdw) are strongly supported by context, although wḫdw undoubtedly has other important meanings. A graphic account of an infected wound is given in the Edwin Smith Papyrus, Case 41.

Osteomyelitis.

Nontuberculous osteomyelitis, a bacterial infection, is surprisingly rare in the skeletal remains of ancient Egyptians. There are many healed fractures in which the bone shows no signs of such infection.

Poliomyelitis.

Evidence for this viral infection comes largely from the Stela of Roma, where a man is portrayed with a grossly wasted and shortened leg, strongly suggesting poliomyelitis contracted in childhood, before the completion of the growth of his leg bones; an equinus deformity of the foot thereby compensates for the shortened leg. An alternative diagnosis would be an equinus variety of club foot. The mummy of the nineteenth dynasty pharaoh Siptah, usually diagnosed as suffering from club foot, has other abnormalities—actually suggesting the possibility of poliomyelitis. No mention of this disease exists in the medical papyri.

Smallpox.

Diagnosis of this viral infection rests upon the appearance of the skin of well-preserved mummies. If correct, the most distinguished victim would be Ramesses V. Nothing in the medical papyri can be related to smallpox.

Cancer and Other Tumors.

Untreated cancer often produces large tumors before death, which would be conspicuous in mummies. Yet tumors are extremely rare in both mummies and skeletons of pharaonic times. In part, this may be due to relatively early deaths, but an additional factor might be low levels of carcinogens.

The malignant tumors known from ancient Egypt include multiple erosions of a skull from the Old Kingdom, attributed to carcinoma of the nasopharynx, with widely scattered secondaries. Benign tumors include the celebrated osteochondroma of the femur in a skeleton from the fifth dynasty found in Giza; the cystadenoma of the ovary in the Granville mummy (Irty-senu), now in the British Museum; and the usual skeletal reaction to meningiomata in two skulls, one from the twentieth and one from the twenty-first dynasty. In the medical papyri, evidence of cancer is very uncertain. Khonsu's tumors were mentioned above, in relation to leprosy, and they might refer as well to cancer. The Ebers Papyrus, paragraph 813, refers to an “eating” (wnmt) of the uterus, which might also be construed as cancer.

Diseases of Internal Organs.

There are major difficulties in the detection and identification of most diseases of the internal organs. The problems arise in both paleopathology and in the interpretation of the medical papyri.

Cardiovascular system.

Atherosclerosis and the calcification of large arteries are common in the mummies of older persons, including the kings. Otherwise, our limited knowledge of their circulatory disorders must be gleaned from the medical papyri. The Ebers Papyrus, paragraph 855, is largely composed of a series of misplaced glosses, explaining terms used to describe pathological states of the heart. The link between the heart and the peripheral pulse was apparently understood, and heart failure may be the subject of a misplaced gloss (Ebers, paragraph 855e):

"As to: “the heart (ἰb) weakens (ʿmd),” it means the heart (ḥʒty) does not speak, or it means the vessels (mtw) of the heart (ḥʒty) are dumb."

Elsewhere in the Ebers Papyrus, there are hints of congestive cardiac failure, disordered rhythms of the heart, and possibly ischemic heart disease, with anginal pain radiating into the arm.

Lungs.

Sand pneumoconiosis was found in the course of the Manchester Museum Mummy Project. Evidence for pulmonary tuberculosis is considered above. Paragraph 305 of the Ebers Papyrus announces the “Beginning of the remedies to drive out cough (sryt),” and paragraph 190 of the Ebers Papyrus describes what may be production of purulent sputum.

Gastrointestinal system.

Paleopathology has shed little light on ancient diseases of the stomach and bowels. Although there remains uncertainty in the translation of r-ἰb as “stomach” (as in the Ebers Papyrus, paragraphs 188–208), much attention was devoted to its obstruction (šnʿ). The ancient Greek historian Herodotus noted that the Egyptians were obsessed with their bowels, and much of their pharmacopeia was devoted to facilitating bowel movements, with aperients “to drive out feces (ḥs)” and “to evacuate (fgn or wsš),” often with the unmistakable ideogram for defecation.

There are also many remedies to “cool or refresh (sḳb) the anus (pḥwt)” and to “drive out heat (ṯʒw),” suggesting an infection, possibly fungal or one related to schistosomiasis. The Ebers Papyrus, paragraph 161, specifically refers to “the vessels (mtw) of the anus,” which may mean hemorrhoids.

Urinary system.

Stones in the kidney or bladder are very rare in mummies. The urinary section of the Ebers Papyrus (paragraphs 261–283) includes consideration of urine that is “plentiful” or “frequent” (ʿšʒ). The former interpretation might refer to diabetes (with polyuria) and the latter to cystitis (with frequency of micturition). Paragraph 265 is “another [remedy] to eliminate obstruction (šnʿ) of heat (ṯʒw) in the bladder, when he suffers retention (ḥdbw) of urine.” Since heat suggests inflammation, obstruction and retention must mean outflow obstruction, caused perhaps by urethral stricture or an enlarged prostate gland. Reference has been made above to the difficulty in translating ʿʒʿ as hematuria, the cardinal sign of schistosomiasis.

Disease. Table 1. Important Medical Papyri



Title Location Approximate date of copy Contents
Kahun (gynecology) University College, London 1820 BCE gynecological
Ramesseum III, IV, V* Oxford 1700 BCE gynecological, ophthalmic and pediatric
Edwin Smith New York 1550 BCE surgical, mainly trauma
Ebers Leipzig 1500 BCE general, mainly medical
Hearst* California 1450 BCE general medical
London* British Museum 1300 BCE mainly magical
Carlsberg VIII Copenhagen 1300 BCE gynecological
Chester Beatty VI* British Museum 1200 BCE rectal diseases
Berlin* Berlin 1200 BCE general medical
Brooklyn snake* Brooklyn Museum 300 BCE snake bite
London British Museum 250 CE general medical
and Leiden Leiden 250 CE and magical
Crocodilopolis Vienna 150 CE general

Nervous system.

Although the ancient Egyptians did not understand the function of the brain, there are excellent descriptions of the neurological consequences of spinal injuries, as in the Edwin Smith Papyrus, Cases 31–33. There is also a possible reference to facial-nerve paralysis (Bell's palsy) in the Berlin Papyrus, paragraph 76. The Ebers Papyrus, paragraph 250, probably refers to migraine:

"Another [remedy] for suffering (mrt) in half the head (gs-tp). The skull of a catfish (nʿr), fried in oil. Anoint the head therewith."

Diseases of Women.

There is disappointingly little mention of gynecological disorders in the Kahun Papyrus, the so-called gynecological papyrus, which is much concerned with pregnancy tests and contraception. The Ebers Papyrus, paragraphs 783–839, contains a wide range of prescriptions for diseases of women.

Problems relating to birth.

Prolapse of the uterus is known from human remains, and the Ebers Papyrus, paragraph 789, relates, “to cause the uterus (mwt rmṯ) of a woman to go down () to its place (st).” The Kahun Papyrus, Case 34, refers to “a woman whose urine is in an irksome (ḳsn) place (st),” suggesting a fistula between the bladder and the vagina, which has also been observed in human remains.

Other pathology.

The ovarian cyst of the Granville mummy was mentioned above. Amenorrhea was clearly defined in the Ebers Papyrus, paragraph 833, as “a woman who has spent many years without her menstruation (ḥsmn) coming.” Excessive bleeding (menorrhagia) was not clearly defined, but there were remedies mentioned “to draw out (itḥ) the blood of a woman.” The ḫʒʿw of the uterus (in the Kahun Papyrus, Cases 3, 7, and 10) has been variously translated as “discharges,” “excrementa,” and “defluxations.” The context and the treatment gave no clues to the meaning. There were many remedies for “cooling the uterus” and “driving out heat,” but the pathology remains unclear.

The breast.

Remedies for the breast are embedded within the gynecological section of the Ebers Papyrus. Paragraph 808 mentions “the beginning of remedies to prevent the breasts going down,” presumably referring to sagging. Reference to more serious disorders, such as tumors or those related to lactation, are difficult to discern.

Disorders of Other Parts of the Body

Hernias and hydroceles.

The mummy of Ramesses V (of the twentieth dynasty) has a bulky but empty scrotum, which might indicate an inguinal hernia or possibly a hydrocele. Several tomb paintings and reliefs show servants with protuberances that resemble umbilical hernias. A marsh fowler in the tomb of Ankh-ma-hor shows a scrotal swelling that might be a large inguinal hernia or a hydrocele. An abdominal swelling (ʿʒt) “which comes forth when he coughs” was described in paragraph 864 of the Ebers Papyrus.

Locomotor system.

Skeletal remains show many fractures, often well united. The bony changes of wear and tear have also been widely reported. Ankylosing spondylitis (fusion of the spine) has been well documented from Predynastic to Coptic times. A series of remedies to strengthen, soften, relieve pain, and soothe the mtw which seems to refer to the “muscular system,” was described in paragraph 627–694 of the Ebers Papyrus. There has been a remarkable lack of reports on nontuberculous infections, on gout, and on rickets.

Eye diseases.

There is virtually no paleopathological evidence of eye disease, but there are many representations of blindness in ancient Egypt, particularly of harpists. The best source of information is from the papyri, particularly paragraphs 336–431 of the Ebers Papyrus. The Egyptian word for “blindness” (špt) is well attested, but most of the causes remain unclear. The šʒrw disease of the eyes was treated with liver, suggesting the possibility of night blindness. Although cooked or even raw liver, applied locally, would be ineffective for a condition caused by vitamin A deficiency, the Kahun Papyrus, Case 1, recommends raw liver by mouth for “a woman who cannot see.”

The Ebers Papyrus refers to a wide range of eye diseases that cannot be identified with any certainty, but kkw (“darkness”) and ḥʒty (“cloudiness”) might refer either to opacities in the cornea or in the lens (cataract); ḏfḏft (“drip”) may well mean excessive tearing (lacrymation), from a variety of causes. Perhaps nḥʒt (in paragraphs 350, 383, and 407) is “trachoma,” since the adjective nḥʒ has various meanings, including “uneven” and “terrible.” Paragraph 424 describes troublesome eyelashes, growing inward to irritate the cornea, and pdst (“pellet”) of the eye might be either a sty or a Meibomian cyst in paragraph 355.

Ears and nose.

Deafness was well understood. The mummy PUM II had a perforated eardrum, suggesting a middle ear infection. Rather unclear diseases of the ears were also mentioned in paragraphs 764–770 of the Ebers Papyrus and in the Berlin Papyrus, paragraphs 70–71 and 200–203. Remedies for the nose are offered in paragraphs 761 and 418 of the Ebers Papyrus; and ḥnt are thought to mean “coryza” or “catarrh.” Paragraph 762 provides a remedy for the unknown nἰʒ-disease of the nose.

Skin.

Mummies have shown a few examples of skin diseases (as reviewed in Brothwell and Sandison, 1967), but paragraphs 708–721 of the Ebers Papyrus, paragraphs 150–154 of the Hearst Papyrus, and the verso of the Edwin Smith Papyrus (Cases 21, 3–8) list remedies for skin complaints that are difficult to identify and which may belong to the realm of beauty care. Concerns about skin problems are remarkable for the omissions rather than for the discussions.

Teeth.

The wearing down of teeth (called attrition) was almost universal—caused by the chewing of hard particulate matter in food. Attrition resulted partly from the grinding of grain with stones and partly from the contamination of grains with wind-blown sand after the harvest and during its processing to separate grains from chaff. There was gradual improvement in these matters in the Late period. Caries (cavities) were extremely rare until the first millennium BCE, probably from the absence of sugars in the diet; their incidence increased during the Ptolemaic era, as attrition declined. Caries reached high levels in the early Christian era, probably owing to dietary changes. Dental abscesses were quite common, arising from caries or through the tooth pulp that became exposed by attrition. Periodontal (gum) disease was widespread, as well, leading to loss of alveolar supporting bone, thus loosening the teeth.

See also DEFORMITY; MAGIC, ARTICLE ON MAGIC AND MEDICINE; and MEDICINE.

Bibliography

  • Breasted, James H. The Edwin Smith Surgical Papyrus. 2 vols. Chicago, 1930. Facsimile reproduction, hieroglyphic transcription, English translation, and exhaustive analysis of the Edwin Smith Papyrus; an outstanding work, essential for the understanding of ancient Egyptian expertise in the management of trauma.
  • Brothwell, Don R., and B. Chiarelli, eds. Population Biology of the Ancient Egyptians. London, 1973. A collection of thirty-four papers, many from a symposium held in 1969 and published in the first two volumes of the Journal of Human Evolution. The work is a valuable source of information on the general health of the ancient Egyptians.
  • Brothwell, Don R., and A. T. Sandison, eds. Diseases in Antiquity. Springfield, 1967. A collection of fifty-seven papers, dealing with a very wide range of diseases in antiquity; particularly useful for comparing Egypt with other ancient civilizations.
  • Cockburn, Aidan, and Eve Cockburn, eds. Mummies, Disease, and Ancient Cultures. Cambridge, 1980. A collection of twenty papers, focused on findings in mummies that are mainly but not exclusively from Egypt.
  • Cockburn, Aidan, et al. “Autopsy of an Egyptian Mummy.” Science 187 (1975), 1115–1160. A multidisciplinary account of the examination of the mummy PUM II.
  • David, A. Rosalie, ed. The Manchester Museum Mummy Project: Multidisciplinary Research on Ancient Egyptian Mummified Remains. Manchester, 1979. A multidisciplinary paleopathological investigation of a group of seventeen mummies, from the Middle Kingdom to Greco-Roman times.
  • David, A. Rosalie, ed. Science in Egyptology. Manchester, 1986. Fifty-six papers from symposia held in 1979 and 1984; mainly concerned with new noninvasive technology in the study of ancient Egyptian human remains.
  • David, A. Rosalie, and E. Tapp, eds. The Mummy's Tale: The Scientific and Medical Investigation of Natsef-Amun, Priest in the Temple of Karnak. London, 1992. An account of the exhaustive study of the Leeds Mummy.
  • Davies, Vivian W., and Roxie Walker, eds. Biological Anthropology and the Study of Ancient Egypt. London, 1993. Twenty illustrated papers relating to biology and disease in ancient Egypt, based on a symposium held in 1990.
  • Deelder, A. M., et al. “Detection of Schistosome Antigen in Mummies.” Lancet 335 (1990), 724–725. Reports the presence of schistosome circulating anodic antigen in two mummies of the Predynastic period (BM 32753) and the New Kingdom (Nakht—Rom I).
  • Filer, Joyce. Disease. London, 1995. Although constrained in length, this book contains much valuable information and new insight, based on the author's extensive fieldwork experience.
  • Grapow, Hermann, H. von Deines, and W. Westendorf. Grundriss der Medizin der alten Ägypter. 9 vols. Berlin, 1954–1973. A comprehensive study of ancient Egyptian medicine, including hieroglyphic transcription, translation into German, and detailed analysis of the medical papyri, with an Egyptian-German dictionary; essential source material for the serious student.
  • Miller, Robert L., et al. “Diagnosis of ‘Plasmodium falciparum’ Infections in Mummies Using the Rapid Manual ParaSight™-F Test.” Transactions of the Royal Society of Tropical Medicine and Hygiene 88 (1994), 31–32. A valuable account of a new approach to the epidemiology of malaria in ancient Egypt.
  • Millet, N. B., et al. “Autopsy of an Egyptian Mummy (Nakht—Rom I).” Canadian Medical Association Journal 117 (1977), 461–476. A multidisciplinary collection of nine articles on various aspects of the detailed examination of Nakht (Middle Kingdom).
  • Morse, Dan, D. R. Brothwell, and P. J. Ucko. “Tuberculosis in Ancient Egypt.” American Review of Respiratory Diseases 90 (1964), 524–541. A critical review of sixteen previously reported and fifteen new cases that resemble tuberculosis, from ancient Egypt's Predynastic to Late periods.
  • Nerlich, Andreas G., C. J. Hass, A. Zink, U. Szeimies, and H. G. Hagedorn. “Molecular Evidence for Tuberculosis in an Ancient Egyptian Mummy.” Lancet 350 (1997), 1404. The first detection in an Egyptian mummy of DNA from the bacterium causing pulmonary tuberculosis.
  • Nunn, John F. Ancient Egyptian Medicine. London, 1996. A systematic account of medical papyri, medical science, disease, rational and magical treatment, and the medical profession—with three hundred references, including many relevant to this encyclopedia article.
  • Sauneron, Serge. Un traité égyptien d'ophiologie. Cairo, 1989. The first translation and analysis of a new papyrus concerned with snake bite and its rational treatment.
  • Smith, Grafton E. The Royal Mummies. Cairo, 1912. The classical and most comprehensive account of the autopsy of fifty royal mummies.
  • Westendorf, Wolfhart. Erwachen der Heilkunst: die Medizin im alten Ägypten. Zurich, 1992. An excellent but concise overview of ancient Egyptian medicine.

John F. Nunn