How were nobles chosen in ancient Egypt



Among the areas of knowledge of the early advanced civilization of Egypt, medicine probably enjoyed particular respect. At least that's what Greek writers and scholars have been reporting since Homer, that is, since the 8th century BC. In the fourth song of the "Odyssey" it says (in the translation by Johann Heinrich Voss): "There everyone is a doctor and exceeds all people in experience." The Greeks even compared an Egyptian mortal - Imhotep, vizier, architect and astrologer to Pharaoh Djoser, the builder of the step pyramid of Saqqara - with their own god of medicine, Asclepius or Aesculapius. Two millennia after his death, he was also given divine veneration in his own country, and the sick made pilgrimages to the Imhotep temples in Memphis and on the island of Philae. So it is not surprising that in antiquity aristocrats from the Near East and the Mediterranean traveled to the Nile for consultations and that Egyptian doctors often worked at foreign royal courts.

Your work can be derived from written evidence. Several papyri give detailed instructions on how to treat a variety of diseases. Surprisingly, however, it hardly describes any surgical techniques. There are also no contemporary references from other sources. The Greek chronicler Herodotus wrote (after 490-425 BC): "Every doctor treats only one disease ... there are ophthalmologists, ear specialists, dentists, gastric specialists and doctors for certain internal diseases." But he didn't include surgeons on that list of specialists! So it is not surprising that until recently archaeologists doubted that there had been any major and planned operations at all. However, we have found clear indications in mummies that indicate a well-considered and experience-based approach.

Honey on the wound

But let us first consider the references in the medical writings of the time. The Smith Papyrus describes injuries from the head to about the middle of the body and their consequences as well as appropriate countermeasures. Since the text breaks off abruptly, it is likely that it was part of a textbook that systematically dealt with injuries to the human organism from top to bottom. The often very clear, easily comprehensible recommendations are still impressive today, especially since some even correspond to modern treatment guidelines.

This is the instruction for a skull fracture that did not expose the brain, it can be treated with a bandage to immobilize and stop bleeding. Honey is often mentioned as a medically effective substance, whose bactericidal effect should have served well. In contrast, a head trauma with an exposed brain ("when you see the brain pulsing") was no longer treatable.

Case 36 of the work describes a closed fracture of the humerus, that is without spit through the soft tissues. It seemed to be locked with wooden split pins. The anatomist Elliot Smith, who lives in Cairo, actually found such aids in two mummies in 1908. However, the patients had probably not survived their injuries - an upper arm or a thigh fracture - for long, because no new bone growth could be detected at the fracture edges. Smith interpreted discoloration of the surrounding soft tissues as bleeding remnants - an indication that the break actually occurred during his lifetime and was not inflicted on the corpse. It is noteworthy that a similar but open fracture follows with Case 37 and is classified as an "injury that you should not treat": until well into modern times, such a fracture resulted in fatal wound fever. The Egyptian doctors were of course not aware of the bacterial infection of the fracture site that was responsible for this.

Occasionally, medical documents on other topics provide indirect information on surgical measures. In particular, there are some examples of interventions in other diseases in the Ebers papyrus. For example, "swellings", which presumably mean abscesses or water bubbles, are caused by cutting with the hememto open the mentioned knife. Of course, it remains unclear to what extent this instruction also applies to swellings, which can be recognized as circumscribed swellings - for example tumors - in various pictorial representations. Nor is there any indication of the success rate.

Circumcision should not be missing from the list of indications for surgical measures. It was not carried out until puberty, that is, probably in connection with initiation (although the Greek chronicler Herodotus reported that it was customary "for the sake of cleanliness"). It is mentioned several times in texts, and a relief in the grave of the doctor Ankhmahor in the necropolis of Saqqara from the time of the 6th Dynasty (2290-2157 BC) shows the procedure in great detail: In the first scene there is a boy, his raised Hands a helper posted behind him, in front of a crouching priest or doctor who treats the limb with an object - perhaps a sponge. However, the accompanying inscription "rub vigorously so that it is effective" does not indicate whether it was just a cleaning or a local anesthetic. In the second scene the surgeon applies a knife to the boy's foreskin. The picture also does not reveal whether a doctor or a priest went to work there. According to the findings on mummies so far, almost all adult Egyptians were circumcised in antiquity; the intervention, although originally perhaps motivated by hygienic precaution, was probably not primarily used for medical purposes such as the elimination of phimosis, but was a religious custom as it is still today among Jews and Muslims.

It made sense to supplement the evaluation of the few written and pictorial sources with paleopathological investigations on mummies. Archaeologists and pathologists started doing this towards the end of the 19th century. They had examined an estimated 30,000 mummies and mummy remains by the late 1920s without finding a surgical scar. This did not change in some later ventures of this type, as James T. Rowling stated in London in 1989. The archaeologists concluded that essentially only very superficial interventions were common in ancient Egypt.

New techniques, little sensations

In the search for pathological changes in mummy and skeletal remains from Thebes West, my colleagues and I have discovered traces of surgical art in the past seven years; We cooperated very closely with the Pathological Institute of the University of Munich, the Egyptological Institute of the University of Heidelberg, the German Archaeological Institute in Cairo and the Egyptian Supreme Council of Antiquities.

The first evidence was provided by the skull of an adult man who was brought to Germany around fifty years ago (unfortunately we do not know more about the find). The type of mummification suggests that he died in the first half of the Third Intermediate Period (1080-714 BC). An intact layer of skin and soft tissues, including thick hair, came to light under the linen bandages. After the external inspection and the removal of small resin seals that closed the nose and ears, we inserted an endoscope into the skull: first through the two middle ears, then over the nasal cavity and finally through an opening in the roof of the nasal cavity through which the embalmers remove the brain had (Spektrum der Wissenschaft 8/2001, p. 34).

We noticed immediately that the right chain of ossicles was complete and well preserved, while the left chain was missing. Was it removed while he was still alive or did it fall out during the mummification shortly after death? In the cranial cavity we saw a flat, brownish layer over the occiput. Such material was often poured to preserve the body cavities; it froze while the body lay flat on its back. In addition, a peculiar flat, dark brown layer covered an area of ​​the left side of the central fossa like wallpaper.

Computed tomography (CT) came as a surprise: We discovered a large, oval defect in the bone under completely intact skin and soft tissues above the left parietal bone just above the left ear, presumably as a result of a severe blow. A crack ran from the top of the fracture into the skullcap. A slight new bone formation could occasionally be seen on its edge. The histological analysis of a small sample underscored that the injury was not immediately fatal - there was pigment in places, such as is produced when the blood is broken down.

However, it seems far more interesting that bone fragments were missing in the defect zone. The deposits underneath inside - presumably remnants of the intact, albeit stuck together, hard meninges - and the also intact, i.e. healed, outer skin prove: a doctor had treated the wound, presumably cut the tissue open and folded it away, then removed the bone fragments that were certainly present. The ossicles on the left side had come out of their normal position during the blow and then fell out after death but before mummification.

Our second case was a mummified foot from a tomb complex in West Thebes; he came from the so-called Ramessiden period (1305-1080 BC), in which eleven pharaohs of the 19th and 20th dynasties were called Ramses. Characteristics of the person in question, such as age or gender, can no longer be determined on this part of the body. It is particularly noteworthy in that almost the entire forefoot was amputated. The operation succeeded because the wound healed: a completely intact layer of skin and soft tissue covered the interface, and even a scar or other defect can no longer be seen today. Our X-ray and CT examinations showed that only the fifth toe beam was partially preserved, but then atrophied. These recordings also show neither malformations nor consequences of injury.

Presumably, this patient had survived for several months, possibly even several years, although no significant remodeling reactions took place on the preserved bones, as would actually have been expected. There were no complications, for example a wound infection could have left scarring bulges or bony growths. One can only speculate about the reason for the amputation. Injury seems most likely to us. Although there is no evidence of this on the rest of the foot skeleton, there was no evidence of any other reasons for such a drastic intervention, such as circulatory disorders or non-healing inflammation.

A woman who died at the age of about fifty survived a comparable, although not quite as extensive, operation. Her mummy is badly damaged, probably the work of grave robbers, but both feet, the right lower leg and both thighs were still covered with resinous balm and also wrapped with linen bandages. We noticed the right forefoot because a foreign body was stuck between the strips of fabric. It was a carefully carved wooden substitute for the big toe that had apparently been severed a long time ago.

The stump of the former metatarsophalangeal joint was covered with intact skin and inconspicuous soft tissue, and there are no indications of wound healing disorders. X-rays also show a bulging remodeling on the remaining metatarsal bone of the first toe ray. This and the signs of wear on the underside of the prosthesis prove that the operation took place years before death. The ancient Egyptian surgeons had succeeded in amputating this case too, and they had also managed to heal the wound without complications.

Actually, that wasn't to be expected. During our further examination, we found calcifications on X-rays and CT images not only of the aorta, of which a segment about twelve centimeters long has been preserved above the thoracic spine, but also of the small arteries in the treated foot. Presumably arteriosclerosis had disturbed the blood flow to the big toe to such an extent that it became necrotic and had to be removed to save the patient's life. There was a high risk insofar as arteriosclerosis usually interferes with wound healing. The successful intervention and the skilful adaptation of the prosthesis show how carefully the attending physician planned and carried out the operation.

Incense for the pain

Oral surgeons are likely to have found work in ancient Egypt, just as they do today. The teeth of the ancient peoples suffered from mineral grains in the flour - abrasion of the stone flour mills. In addition, there was dust and fine sand in Egypt, which the west wind from the Libyan or the east wind from the Arabian desert blew into the narrow habitable strip of land on the Nile. The hard particles often abraded tooth enamel and dentin to such an extent that the root canal was eventually exposed, into which bacteria could then penetrate. Pharaohs and high dignitaries also suffered from painful root abscesses and other problems with the chewing apparatus, as the first dental x-ray examination of the mummies in the Egyptian Museum in Cairo in the late 1960s revealed. Dental care in the early high culture was discussed extensively without a clear opinion prevailing so far.

We ourselves have not found any evidence of an oral surgery, but it should be noted that two parallel, sharply delimited holes were found over a root abscess on a lower jaw from Saqqara from the time of the New Kingdom (1554 or 1551-1080 BC) look like they were deliberately drilled. Skeptics, however, believe that it is a spontaneously formed, merely unusual defect. The detailed analysis of now thousands of mummy skulls with countless root abscesses did not reveal any further findings of this kind.

The strongest - albeit controversial - indications for dental surgical measures to date are quite old. In 1914, the Austrian researcher Hermann Junker also discovered two molars attached to a mummy from Saqqara. A very similar find by Shafik Farid in 1952 finally corroborated the opinion that ancient Egyptian dentists had bridged gaps in the teeth with prostheses in this way. On the other hand, the objection was made that the foreign teeth show no signs of wear, so they were possibly only inserted after death in order to complete the corpse again.

The operation itself is only one side of the surgical art. In addition, there are procedures that alleviate the pain of the procedure itself and promote healing. Until around 150 years ago, major operations such as amputations or the removal of bladder stones were carried out without anesthesia and mostly without any significant pain treatment; Correspondingly, the good surgeons were primarily characterized by skill and speed. But many victims died of circulatory complications, which in turn resulted from unbearable pain.

Ancient Egyptian doctors discovered the pain-relieving effects of certain plants and herbal ingredients very early on. Frankincense, which - like hashish - contains considerable amounts of tetrahydrocannabinol, seems to have proven particularly successful; its euphoric effect also helps with pain processing. As early as the third millennium BC, merchant ships brought large quantities of the resin used in the temple cult from the land of Punt, a region mentioned in many inscriptions, probably located on the southern Red Sea behind the coast of today's Eritrea. Queen Hatshepsut (reigned 1490-1468 BC) and King Ramses III. (1193-1162 BC) even imported frankincense bushes, but the cultivation failed.

The use of the resin is known, on the one hand, from the description of incense scenes for numerous diseases, and on the other hand, it has recently been proven by biochemical studies of mummies, as we have done. We found tetrahydrocannabinol in the lungs of a mummy - it must have been inhaled during its lifetime. However, it is unclear whether other painkillers such as morphine were used, although poppy plants and their fruits were discovered as grave goods. In any case, it seems entirely plausible that the ancient doctors knew psychoactive substances that could relieve pain and thus have made surgical interventions easier.

The aforementioned Smith Papyrus reports on wound treatment. In addition to aligning fractures with the axis, various associations are given; the fracture fixation with wooden rails has already been mentioned. Raw meat served as the initial dressing for the wound. A common and important component of ointments was honey, whose adhesive, cleansing and slightly antibiotic effect should have been very beneficial. For example, under case 27 in this papyrus it says: "If you examine a man with a gash on his chin that reaches to the bone, then you should feel his wound. If you find his bone intact, then you should say: One with a gash on his chin that goes down to the bone has a disease I'm going to treat.Then you shall put two bandages on those gaps for him; you should bandage him with fresh meat on the first day, then treat them with fat, honey and fibers every day so that he feels better. "With such methods and means, surgical wounds can also be healed, like those of us in particular show discovered cases of amputations.

In our opinion, the ancient Egyptian doctors were very capable of successful surgical interventions. If there is so far little reliable evidence for this, it may be due to the fact that mummies and other human relics were not previously examined carefully enough paleopathologically. However, this is also difficult because of the inadequate preservation of soft body structures, because the substances used for embalming have significantly changed the skin and other tissues. In addition, wounds are often so well healed that only fine scars remained, which - as with the two amputation stumps described - are very difficult to see.

Bibliography


Egypt in the time of the pharaohs. Everyday life and social life. By Eugen Strouhal. Wasmuth Verlag, Tübingen, Berlin, 1994.

Awakening of the healing arts. Medicine in ancient Egypt. By W. Westendorf. Artemis and Winkler, Zurich 1992.

Ancient Egyptian prosthesis of the big toe. From A. G. Nerlich et al. In: Lancet, Volume 356, p. 2176, 2000.

Ancient Egyptian medicine. By J. F. Nunn. In: British Museum Press, p. 163, London 1996.


Medical papyri


From around three millennia BC from the unification of Egypt and the development of hieroglyphics to the reign of Octavian, the later Roman emperor Augustus, only about a dozen documents of medical content are known. In addition, numerous smaller magic texts make more or less clear reference to diseases. The medical works were written in everyday language and written in the cursive script referred to in the hieratic. Important passages such as headings, drug quanta and the structure of the diagnoses have been highlighted in red ink.

The most important textbook, mainly devoted to wound treatment, is the Smith Papyrus. It is named after the American adventurer and antique dealer Edwin Smith, who bought it from Mustafa Agha, the British consul in Luxor, in 1862. It comprises 377 lines on the front and 92 lines on the back; it was created around 1700 BC, but is largely based on texts that are around 900 years older. James Henry Breasted, director of the Oriental Institute at the University of Chicago, published a facsimile in 1930 with inscription, introduction, English translation and commentary, as well as medical notes by Arno B. Luckhardt. The papyrus is kept by the New York Academy of Sciences.

The most extensive medical composite manuscript with a length of more than 20 meters is the Ebers papyrus (below), which also came into the possession of Smith in 1862. The Egyptologist Georg Ebers acquired the document in 1872 for the Leipzig University Library and three years later published a facsimile with an introduction as well as an English and a Latin vocabulary. It lists diseases and injuries in various parts of the body, diagnoses, prognoses and remedies - including those related to gods - in a rather arbitrary arrangement. According to a note on the back, the papyrus was written in the reign of Pharaoh Amenophis I, i.e. in the late 16th century BC; in this case, too, at least parts of the content seem to have originated much earlier.

The Kahun Papyrus contains 34 paragraphs on conception, contraception, pregnancy, childbirth and gynecological problems. The work from around 1810 BC was found in 1889 by the English archaeologist Flinders Petrie in the oasis area of ​​Fayum; it is now in University College London.

Other medical textbooks are the Papyrus Ramesseum V with recipes against stiffening and warping and the Papyrus Beatty VI, which describes enemas against diseases of the body. Other documents deal with snake bites, pregnancy tests and birth prognoses, but also contain many cosmetic recipes, for example for anti-graying, wrinkle and bad breath remedies or for hair removal. Even a veterinary text has been preserved.


Medicine in the time of the pharaohs


Medicine was a highly developed branch of Egyptian high culture. Many facets of the treatment of the sick and injured have so far remained in the dark despite intensive research. Our understanding is made more difficult by the strange way of thinking of the ancient Egyptian doctors. On the one hand, they used an abundance of medicinal plants; In written sources, more than 700 medicines are listed, the active ingredients of which have only been identified to a small extent. On the other hand, they had little knowledge of the anatomy and functions of the human body, although thousands of corpses were systematically opened for mummification and the internal organs removed. The heart was seen as the seat of thinking and feeling and the center of a vascular system that supplies all parts of the body with blood, water and air and also transports tears, urine and sperm; it was seldom removed during mummification. Characteristic was the amalgamation of empirically proven, partly scientifically appropriate, with mythical-religious behavior such as dream interpretations as well as the use of magic spells, amulets and many substances such as contraception pills made from crocodile excrement. At that time, "malevolent men and women", "living or even dead", as it is called in the Smith Papyrus, were considered to be the causes of suffering, which we know as infection with pathogenic germs. "Run out, you cold ... you break the bones, tear the skull and chop in the brain and make the seven openings of the head sick," is an incantation in the Ebers papyrus. However, the magical practices only seem to have gained the upper hand in the New Kingdom, i.e. from around 1550 BC.

However, a number of papyri also list many diagnostic and therapeutic methods that correspond to the latest state of knowledge, such as castor oil as a laxative, smoking with frankincense for pain relief or the roots of the pomegranate tree against parasitic worms. Such herbal ingredients are still used. For night blindness, which may be due to a lack of vitamin A, animal liver was prescribed, for headache a moist compress, for coughing milk and honey, for constipation an enema, for a dislocation a bandage and daily massage. Herodotus was amazed at the general need for cleanliness; According to him, at least the priests bathed twice a day and twice at night, and every third day they shaved not only their heads but also their bodies, "so that neither a louse nor any other vermin could attach themselves to them".

From: Spectrum of Science 2/2002, page 76
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This article is included in Spectrum of Science 2/2002