In ancient Egypt, as in modern times, hygienic practices, whether good or bad, had a profound effect on the health status of the population. Many aspects of the environment affected the physical and mental well-being of individuals, and the range of evidence available allows an examination of hygiene from both the public and personal aspects.
In the public sphere, climate had a far-reaching effect. During the fifth century BCE, the Greek writer Herodotus, in book II of his Histories, was of the opinion that the health of the Egyptians was due to the lack of variability in their weather. Certainly, the constant sunshine provided the body with vitamin D, yet the intensity of the heat encouraged the rapid breeding of flies and other insects, which spread infections among the population. The Nile River played a central role in the life of the ancient Egyptians, being at once the source of drinking and washing water, a means of travel and transport, and most importantly the provider of the essential irrigation waters, without which agricultural activities could be severely curtailed. The Nile waters were even then unhygienic, harboring the endoparasitic worms that caused much disease. The schistosome worm in the Nile is one of the most prominent health hazards even in present-day Egypt, affecting human physical and mental development, and research has shown that the disease it causes, schistosomiasis, was present in Egypt from at least Predynastic times. Infestation by these worms, which enter the body through the feet of unsuspecting waders in infected waters, often leads to general ill health, increased susceptibilities, and, in extreme cases, death. Infestation by hookworms often leads to anemia—from blood loss—resulting in weakness and debilitation. The guinea worm enters the body in an immature form in drinking water and then matures in the stomach, later burrowing through the abdominal wall to mate.
As with developing societies generally, the ancient Egyptian transition from nomadic food collection into a sedentary agricultural life had its consequences. Nomadic groups periodically move, leaving behind parasite-ridden waste; sedentism, however, results in the accumulation of animal and human fecal and other waste matter, with its consequent effects. Defecation in fields and the use of animal feces as fertilizer meant that parasites, such as hookworms, tapeworms, and roundworms, could complete their life cycles and infect new human hosts through food crops; any fecal waste deposited along the banks of the Nile provided good breeding grounds for flies, which carried the filarial worms responsible for onchocerciasis (“river blindness”). Evidence from tomb paintings seems to suggest that some musicians were blind, possibly as a result of this type of eye disease.
For the ordinary ancient Egyptian, housing may have been overcrowded, with inadequate ventilation and poor sanitation. In many households, animals shared human living quarters. Such conditions favored infectious diseases, such as tuberculosis, and promoted other chest infections. As outlined above, defecation generally took place outdoors—in the fields, in the deserts or near the home—but there is evidence that some of the elite had planned sanitation. Housing representing several levels of society has been excavated at Tell el-Amarna (ancient Akhetaten), an eighteenth dynasty site in Middle Egypt. In some of the better houses there, a stone or wooden seat with a keyhole-shaped opening served as a latrine, with a removable bowl for waste underneath.
Household waste was disposed of, unhygienically, in the vicinity of the home; thus, food remains and other rubbish attracted scavengers, many of them carrying transferable diseases. Permanent housing in villages, towns, and cities enabled fleas and bed bugs to encounter new human hosts. While in most cases these creatures were little more than irritants, they could cause skin diseases. Concern with ridding the household of parasites is evident from “recipes” in the Ebers Papyrus, which suggest smearing infested rooms with a mixture of charcoal and fleabane or utilizing a solution of natron. More seriously, the Xenopsylla cheopsis flea that carried Pasturella pestis, the agent of bubonic plague, could gain access to humans when its host, the black rat, invaded grain storerooms.
Sources suggest that the ancient Egyptians were particularly concerned with cleanliness and grooming. The Greek historian Herodotus wrote that the Egyptians “set cleanliness over seemliness,” and he noted that the Egyptians washed their linen garments frequently. In reality, however, personal cleanliness was not only a means of attaining good health but an indicator of status and rank. Cleanliness meant being Egyptian, for foreigners were believed to be dirty and unkempt. The ancient Egyptians were aware of the need to wash frequently and did so at least once a day: some texts mention washing before and after meals. The priests were required to wash at least twice a day. Some of the wealthier people had private washing facilities. One house at the Amarna site had a bathing area, with stone slabs forming the base and a splashback for a shower; water was poured over the bather from a jug, as the waste water drained away through an outlet in the wall. The majority of the population, however, bathed in the Nile waters, which exposed people to further disease conditions, since the Nile was also used as a sewage-and-waste disposal system. Soap, as we know it, was not used, but the ancient Egyptians employed natron—a naturally occurring salt—as a cleansing agent. Natron came from several areas of Egypt, the most notable being the Wadi Natrum in the Faiyum district.
Following their ablutions, the Egyptians often rubbed unguents into the skin. These unguents, oils fragranced with frankincense or myrrh, prevented the skin from drying out in the hot, sunny climate. The Egyptians believed that oils prevented wrinkles. The wealthy had access to imported oils, while the ordinary people used castor or linseed oil. Curative recipes in the Ebers Papyrus express the ancient Egyptian concern with body odor, and it is thought that they used douches and genital fumigation for personal freshness. From the earliest times, cosmetic items, palettes, and eye paints were included as important components of funerary equipment, reflecting their importance in daily life. Both males and females paid a great deal of attention to their appearance, and this included the use of eye paint. The most frequently used eye paint was called msdmt and was made from the minerals galena or stibnite; the other type, called wʒḏw, was made from the mineral malachite. Apart from being decorative, the eye paint protected the eyes from the glare of the sun and had some medicinal properties. In some of the medical papyri, msdmt is recommended for eye problems; it may have acted as a disinfectant. In a letter from the nineteenth dynasty, the draftsman Pay begs his son not to neglect him for he “is in darkness” (i.e., blind), and he asks his son to bring him treatment for his eyes in the form of an unguent made from honey, ocher, and galena. Evidence from human remains reveals that henna was used for various cosmetic purposes; an examination of the mummy of Ramesses II revealed that the elderly pharaoh's red hair was achieved through the application of henna. In the British Museum, London, a mummified arm has beautifully manicured nails, colored a rusty red with henna.
Care of the hair was extremely important to the ancient Egyptians. A depiction of the eleventh dynasty queen Kawit on her sarcophagus shows her servant at work dressing her hair. It is suggested that any depictions of individuals with unkempt hair must indicate either a state of mourning or low status—therefore the uncleanliness of the individual concerned. A variety of oils and unguents were used to dress the hair; the examination of the bodies of a group of soldiers or archers from the eleventh dynasty indicated that their thick curls were adorned with grease. From the examination of human remains, the deduction was that some individuals retained their natural hair while others chose to wear wigs. Excavations have revealed a variety of hair colors and qualities, including carefully dressed natural tresses measuring up to 27 centimeters (11 inches) in length, as observed on a body from the Gabati cemetery site in central Sudan, which also yielded wooden combs. Evidence from tomb paintings show a variety of dressed hair styles, many employing pins or flowers as decoration. There is little evidence to suggest how regularly the ancient Egyptians washed their hair. From an examination of statues, it is clear that some of the wealthier preferred to shave their heads and wear wigs. This may have been undertaken for comfort in the hot Egyptian climate, but it may also have been an attempt to be relieved of head lice. There are several reports of lice eggs discovered during the examination of ancient hair—on the hair of the weaver Nakht, during the autopsy of his mummy in Toronto in 1974 for example, and on Nubian bodies dating to the sixth century BCE. The earliest example of lice so far found on ancient Egyptian hair is of Early Dynastic date. Contrary to popular conceptions, nits and their adult form, lice, are not evidence for poor hygiene, but rather the opposite, for head lice cannot travel on dirty hair shafts. Infestation with lice, either on the hair or body, may cause dermatitis from scratching. Lice may also result in the transmission of the more serious typhus and relapsing fevers. It is difficult to determine the prevalence of such diseases in ancient Egypt as no evidence is retained on the skeleton. Whatever the reason for wearing wigs, there is no doubt they constituted an important commercial industry. Research has indicated that most Egyptian wigs were made from human hair, many being of elaborate construction. An exemplary wig at the British Museum, consisting of a mass of light-colored curls atop numerous dark-colored plaits, is constructed from over 120,000 human hairs. Despite the preoccupation with hair care, baldness was evidently a fact of life in ancient Egypt, to judge from the recipes contained in the Ebers Papyrus, one of which recommends a cure, using a mixture of fats from a lion and a hippo.
Herodotus wrote that Egyptian priests shaved their bodies every other day; again, the prevention of lice infestation is postulated, however, the act may have held religious significance as a symbol of purification. Depilatory equipment, metal tweezers, razors, knives, and small whetstones, helped the Egyptians fastidiously pluck and shave unwanted hair. In the Middle Kingdom Story of Sinuhe, Egyptian standards of cleanliness are compared with the lesser hygienic habits of the foreigners that Sinuhe encountered on his travels, when he says: “Years were removed from my body. I was shaved and my hair was combed.” From the nineteenth dynasty onward, priests shaved their heads completely. The history of facial hair can be charted from Predynastic times, when figures of wood or clay suggest that Egyptian men then favored beards. Those Predynastic beards, as evidenced on the Narmer Palette, may have been purely symbolic, however. Certainly, as with the unkempt hairstyles noted above, facial hair eventually became indicative of a low rank in life but, during the Old Kingdom, neat moustaches were very much in vogue among the upper classes, as can be seen on the statue of Prince Rahotep. As with unkempt hair, facial hair may also have indicated a state of mourning. For example, eighteenth dynasty depictions of King Akhenaten in an “unclean” state, with facial stubble, has been interpreted as the king's outward display of grief following the death of one of his daughters. In Egyptian religious concepts, facial hair came to be a divine attribute of the gods, with deities depicted wearing plaited beards and the dead and mummified pharaoh adorned with a false beard, secured by cords. While barbering was probably undertaken within the home, it is possible that there were itinerant barbers.
The examination of Egyptian mummies undertaken so far seems to indicate that most Egyptian males were circumcised. The practice may certainly relate to a state of ritual purity, but there can be little doubt that hygiene was an important motivating factor. The surgical procedure of circumcision is not mentioned in the extant medical texts and is depicted on only two occasions. The better known scene is that from the sixth dynasty tomb of Ankhmahor at Saqqara, which seems to show two young men being circumcised; it has been suggested, however, that this is an initiation scene, showing the shaving, preparation, and circumcision of a ḥm-kʒ priest. The second circumcision scene, now very badly damaged, is in the temple of Muten-Asheru at Karnak. During the Old and Middle Kingdom, Egyptian boys were probably circumcised between the ages of six and twelve years, although Weha, an eleventh dynasty man from Naga ed-Deir, reports being circumcised with 120 other “men.” Perhaps only royal personages, the nobility, and priests were routinely circumcised during these periods, but in later periods the procedure may have become routine for all Egyptian males. It is not clear whether the procedure involved the actual removal of the foreskin or merely a ritualistic “cut.” From at least the Late period, priests had to be circumcised in order to attain the state of purity deemed necessary for the execution of their duties in the temple. Again, foreigners who were not circumcised were looked down upon by the Egyptians and were regarded as unclean. Despite the fact that full female circumcision (as practiced in modern Sudan) is known as “pharaonic circumcision,” there is no direct evidence for it in ancient Egypt. Nevertheless, the Classical author Strabo believed that the Egyptians circumcised their daughters, for he wrote; “the Egyptians circumcise the males and excise the females.” It is difficult to assess mummified female bodies, distorted by the mummification process, for evidence of the excision procedure.
As in many other ancient societies, Egypt had a high infant mortality rate. Poor standards of hygiene led to dysentery, diarrhea, and gastric disorders resulting in infant deaths. Puerperal fever and other complications of giving birth, exacerbated by a lack of hygiene, contributed to maternal mortalities. Excavations at the Gabati cemetery in Central Sudan have revealed the burials of several adult females with a fetus or newborn baby, a testament to the hazards of childbirth in ancient times. Women were regarded as “unclean” after giving birth, and the event was followed by a period of cleansing or purification. Evidence from the Westcar Papyrus suggests that the new mother underwent a period of seclusion from her family for up to fourteen days to attain a state of purification. Women were also regarded as “unclean” during their times of menstruation; it is not clear, however, whether it was the woman herself or the menstrual flow that was regarded with disfavor. Generally, there is little information about menstruation from ancient Egyptian sources, as texts were written by men. Notably, the Middle Kingdom Satire of the Trades regarded as unfortunate the washerman who must clean women's bloodstained clothing.
Dental health was very much influenced by hygiene practices or the lack of them. Inadequate oral hygiene is implicated in the two main forms of dental disease: periodontal disease and dental caries (cavities). Both conditions are related to the formation of plaque, a sticky film in which bacteria proliferate on the teeth. Plaque irritates the gums, causing gingivitis, the first stage of periodontal disease. Left unchecked, this inflammation travels into the gum, destroying the fibers holding the tooth in its socket; eventually the tooth may fall out. The molars are most commonly affected, since they are less readily cleansed by the action of the tongue and saliva. Tooth decay, if left untreated, can also lead to the loss of an affected tooth, through the formation of a dental abscess. Amenhotpe III and Ramesses II feature dental abscesses as part of their dental health profile. Sometimes unremoved plaque calcifies to form calculus (or tartar), which creates gum pockets wherein decay can intensify. Diet is another important causative factor in the development of periodontal disease and dental decay, since certain foodstuffs promote the rapid growth of plaque. Roman historians suggested that the ancient Egyptians used a type of “toothpaste” made from the roots of plants. It is possible that, as now used in parts of Africa, twigs and sticks served as rudimentary but effective toothbrushes. Rags may also have been used to clean the teeth. Then, as now, people were concerned with halitosis, or bad breath, and several medical papyri recommend chewing pellets of aromatic spices and honey to improve the situation. It is possible that cinnamon, having mildy astringent properties, was used as an antiseptic mouthwash. Ritual evidence suggests that the king's oral hygiene also included natron, to purify his mouth, as part of his morning toilette.
- Filer, J. Disease. London, 1995. Surveys the health status of the ancient Egyptians and Nubians.
- Filer, J. M. “The SARS excavations at Gabati, Central Sudan, 1994–5: C: The Skeletal remains.” The Sudan Archaeological Research Society Newsletter 8 (1995), 23–27.
- Filer, Joyce. “Revealing Hermione's Secrets.” Egyptian Archaeology 11 (1997), 32–34. Presents the findings from a new examination of this well-known mummy.
- Filer, Joyce. “The Gabati Cemetery. An Ancient Nubian Population Revealed.” Minerva 10.2 (1999), 31–34.
- Fletcher, J. A. “A Tale of Hair, Wigs and Lice.” Egyptian Archaeology 5 (1994), 31–33. Explores hair and hygiene in ancient Egypt.
- Nunn, J. Ancient Egyptian Medicine. London, 1996. Offers an excellent overview of medical practices and practitioners in ancient Egypt.
Joyce M. Filer