The Doctors In Ancient Egypt
The doctor in Ancient Egypt
J.F. Nunn
It is widely believed that the modern concept of medicine commenced with the Hippocratic school in Cos (430-330 B.C.). Medical writings of the Graeco-Roman period were in languages which were never lost to scholars - although material in Greek had often to pass through Arabic before being recovered in the West - and much of their medical vocabulary remains in use today. Copious writings have survived intact. Furthermore, many items of surgical equipment from the Roman Empire have survived in excellent condition and there are many representations of medical treatment. In contrast, our understanding of Ancient Egyptian medicine is hampered by many factors. Knowledge of the Egyptian language in its older forms was totally lost from the early Christian period until the decipherment of the hieroglyphs was commenced by Champollion in 1822. To this day there is uncertainty as to the spoken form of the language, and the meaning of many words remains unresolved. Furthermore, the medical writings which have survived from Pharaonic times are sparse in comparison with those from Greece and Rome.
Doctors, priests and magicians were all involved in healing. The Ebers papyrus (854a: 99, 2-5) contains a misplaced gloss which makes this very clear:
There are vessels in him to all his limbs. As to these: If any doctor, any wab priest of Sakhmet or any magician places his two hands or his fingers on the head, on the back of the head, on the hands, on the place of the heart, on the two arms or on each of the two legs, he measures [or examines] the heart because of its vessels to all his limbs. It [the heart] speaks from the vessels of all the limbs.
This passage makes clear the parallel roles of doctors, priests and magicians in health care. Although this contrasts strongly with contemporary medical practice, our forefathers would not have found it in the least surprising. All three groups could be expected to make a positive contribution to healing, although there could well be differences in the harm they might do through errors of commission and omission. The Egyptian doctor had, by modem standards, a relatively weak pharmacopoea and a very limited repertoire of operative surgery. Nevertheless he had other powerful therapeutic tools at his command, which were probably shared to a large extent with the priests of Sakhmet and the magicians. These included tender loving care, the placebo effect, and attention to diet. In addition, there is good evidence that massage and other forms of physical medication were practised.
The Egyptian word for doctor
There is general agreement that the Egyptian word swnw (or simw) means physician or doctor. (The word is conventionally pronounced as 'sewnew'.) In a 1958 posthumous publication Jonckheere was able to list 101 known Egyptian doctors and dentists, and this number was expanded to 129 by Ghalionghui in 1983.1 The hieroglyphic writing for swnm is shown in Figure 1. The arrow is the trilateral phonetic for swn, while the pot or bowl is the very common bilateral nw. It is possible that the arrow may also have the role of a determinative, implying that the swnw was an arrow man, or one who was skilled at removing arrows from soldiers. The seated man is the male determinative. Egyptian
words were very commonly abbreviated, especially hieroglyphic inscriptions carved on stone, plaster or wood. The simplest designation of a doctor was in fact the arrow.
Figure 1. Full hieroglyphic writing for swnw (doctor).
On stelae, it is often abbreviated to the arrow.
The evidence for believing that swnw means doctor is very strong. Many Ancient Egyptian words survive in Coptic (a language spoken until comparatively recently and therefore well known), in which the word for physician is sain. Internal evidence from Egyptian papyri is also strong. In addition to the extract from the Ebers papyrus quoted above, there are a number of other passages from papyri which link the swnw to the care of the sick. The following are among the most convincing.
[Thoth] ... imparts useful knowledge to the learned and to the swnw his followers, in order to free those whom his god wishes him to keep alive. (Papyrus Ebers 1: 1, 1-11)
You should then prepare a secret herb remedy which the swnw makes ... (Papyrus Ebers 188: 36, 4-17)
Manual of a collection of remedies of the swnw. (Papyrus Chester Beatty VI)
And when you have fallen ill ... I will search for the chief swnw and he will prepare a remedy. (Papyrus Leyden I, 371)
Also relevant are an inscription to Amenhotep-son-of-Hapu, a graffito from the Hatnub quarry concerning Hery-shef-nakht, and a statue inscription of the swnw Wdja-hor-resnet, all mentioned below.
Ranks, titles and specific functions
Probably the majority of doctors were designated simply as swnw. However, special titles were not uncommon, particularly among the very distinguished doctors whose memorials have survived. We can identify six special grades of which the commonest is wer swnw, meaning 'chief (or master) physician', with 48 examples covering all periods. Not uncommon is the title of swnw per aa, which means 'doctor of the great house or palace' - probably the best English translation is 'Court physician'. By the time of the New Kingdom, the phrase per aa had come to refer to the king, and from per aa is derived the term 'pharaoh'. More specific is the rare title swnw neswt meaning 'royal doctor', which has only been found in the Middle and New Kingdoms. The title swnw nper hemet neswt
means 'doctor to the house of the royal wife or queen'. More than half of all known
doctors and dentists in the Old Kingdom had a royal connection, but this probably only indicates that a privileged position earned them either burial in a form which enabled information about them to be recovered by archaeologists, or a mention in the tombs of important officials. In the fifth century B.C. Herodotus remarked on the degree of specialisation he
found i
f Sakhmet,
while o
ome legendary doctors
araoh of the First Dynasty buried at Abydos around 3000 B.C.
Amen d there
n Egypt. Most of the known specialist medical titles were carried by a certain Ir-en-akhty discussed below. Dentists carried the separate title ibeh. Three of the five known dentists of the Old Kingdom also carried the title swnw. Although the tradition of separation of medicine and surgery is generally thought to go back a long way, it is unlikely that in Ancient Egypt the role of the surgeon was distinguished from that of the swnw. The only known depiction of a surgical operation (in the tomb of Ankh-ma-Hor) is of a circumcision and this is being undertaken by a hem-ka or funerary priest. Many swnw had priestly titles. Four of the known swnw were priests o
thers carried titles indicating their status as professional magicians. The word saw appeared in the first quotation from the Ebers papyrus above (page 3) and is translated simply as 'magician'. This title was borne by two physicians of the Middle Kingdom. Priesthoods of the god Heka and the goddess Serket also implied status as professional magicians. The title kherep Serket was borne by at least four swnw. One swnw was a lector-priest (khery-hebet), a title closely associated with magic and, in particular, the recitation of spells and incantations.
S
Djer (or Athosis) was a Ph
Information on his alleged role in medicine stems solely from the lost 'History of Egypt' written for the Greeks by the Egyptian priest Manetho in the third century B.C. Later writers (Africanus and Eusebius) quoted Manetho as claiming that '[Athosis's] anatomical works are extant, for he was a physician'. But it is hard to believe that, at such an early date, a Pharaoh would either have been a swnw or engaged in anatomical studies. A second instance concerns Imhotep, the royal chamberlain to King Netjerkhet (Djoser) of the 3rd Dynasty, and the architect of the step pyramid at Saqqara, the oldest surviving major stone building in the world. Very much later, during the 30th Dynasty, in the inscription on a private statue Imhotep was addressed as 'one who comes to the one who calls to him to cast off sickness and heal the body'. Some further centuries later, in Ptolemaic times, the Greeks identified Imhotep with Asclepios, their god of medicine. However, Imhotep's tomb has never been and it is therefore not confirmed that he held the title of swnw. Finally, the base of a statue, placed by an otherwise unknown daughter of Psamtek I of the 26th (Saite) dynasty, bears the following remarkable inscription. Oh, prince Amenhotep son of Hapu, justified [i.e. dead]. Come, Oh good doctor. Behold, I
suffer in my eyes. Cause me to be well immediately, because I made this [statue] for you ... hotep-son-of-Hapu was a royal scribe under Amenhotep (18th Dynasty) an
is no contemporary evidence that he held the title of swnw. Apparently he had been deified by the time of the 26th dynasty.
Eight selected pharaonic doctors
Hesy-ra (Old Kingdom, 3rd Dynasty) is unique in being the first authenticated doctor in history. A man of great distinction, he held many exalted titles under King Netjerkhet (Djoser) and would have been a contemporary of Imhotep. His tomb, now in the Cairo Museum, contains six magnificent wooden niche-stelae in a wonderful state of preservation. The top right-hand corner of one of these shows the swallow, tusk and arrow, meaning 'chief dentist and doctor'.
Peseshet (Old Kingdom 5th Dynasty) had her own stela in the tomb of Akhet-hotep, probably her son, in Giza. In three places on the stela are hieroglyphs which would appear to translate as '(male) overseer of female physician(s)'. The Egyptians were none too meticulous in the use of the feminine termination, this termination being omitted in Peseshet's other title 'overseer of the funerary priests'. But the Egyptians almost never used, in error, a feminine termination in a masculine word, and swnwt must surely mean female physician(s). I therefore believe the title to be 'overseer of the female physicians', and I would therefore like to believe that Peseshet was a swnwt herself.
Mereruka (Old Kingdom 6th Dynasty) was vizier and son-in-law to King Teti. As might be expected, he was granted a splendid tomb immediately adjacent to the pyramid of Teti in Saqqara. The mastaba of Mereruka contains far more titles than any other tomb and among these is a unique title translated literally as 'overseer of the two sides of the boat of the doctors of the great house'. This would appear to be an adaptation of a nautical tradition which divided the crew of a ship into two teams of oarsmen, one for each side.
Ir-en-akhty (First Intermediate Period) is known by his false door (Figure 2), which was found in Giza by Junker. The particular interest lies in the wide range of medical specialities which it appears that the deceased practiced. Readings on the false door include the following: swnw per aa (appears five times), court physician; sehedj swnw per aa, inspector of court physicians; swnw irty per aa, doctor of the eyes or court oculist; swnw khet per aa, doctor of the belly or court gastroenterologist; nerw pehwt, herdsman of the anus or proctologist; aaa mew m-khenw netetet, interpreter of liquids in the netetet.
Figure 2. False door of the multi-specialist Ir-en-akhy (10th Dynasty)
Gwa and Seni (Middle Kingdom 11/12th Dynasty) were each wer swnw and their beautiful wooden inner coffins, typical of the Middle Kingdom, lie beside one another in the British Museum (nos. 30.840 and 30.842). In each case, the arrow of swnw is represented by a quiver containing two arrows.
Hery-shef-nakht (Middle Kingdom 12th Dynasty) bore an even more illustrious title than that of the previous example. Hery-shef-nakht was wer swnw n nswt, chief of the king's physicians. However, he is known to posterity only as a result of a hieratic graffito in the Hatnub alabaster quarries, near Tell el-Amama.2 Hery-shef-nakht is unique is bearing the triple qualification, as specified in the excerpt from the Ebers papyrus above: he was wer swnw, wab priest of Sakhmet and also an overseer of magicians (imy-r hekaw). Also unique is a tantalisingly brief and corrupted glimpse of his professional work:
Reading the papyrus rolls daily ... when he is sick, who places his hand on a man when he knows it [the illness], who is skilled when examining strongly.
Wdja-hor-resnet (Late Period, 27th Dynasty) is depicted in a green basalt naophore statue in the Vatican (inv. no. 196). An extensive inscription gives an important biographical account of the establishment of the 27th (Persian) Dynasty by Cambyses (Cambyses II of Persia), who assigned to Wdja-hor-resnet the office of wer swnw.
Training, practice and reputation
Countless stelae bear testimony to sons following the profession or craft of their fathers. It is likely that this also applied to the medical profession, although there are only two known examples of a son following his father as a doctor in Ancient Egypt. There can be
little doubt that the medical papyri fulfilled a role no less important than that of medical texts today. Reference to papyri would have required the swnw to be literate and some swnw have recorded that they were also scribes. Papyri were copied and stored in the per ankh (house of life) but it is uncertain whether the per ankh was also a medical centre where doctors were taught. Part of the inscription on the stela of Wdja-hor-resnet states:
His Majesty King Darius commanded me to return to Egypt ... in order to restore the department[s] of the House[s] of Life [dealing with medicine] after [they had fallen] into decay. ... This his majesty did because he knew the virtue of this art to revive all that are sick ...
This suggests that, as elsewhere, medical institutions had their ups and downs.
Unfortunately we have virtually no contemporary evidence of how the swnw undertook his work, or how his efforts were viewed by his patients. However, the Edwin Smith papyrus and some sections of the Ebers papyrus evidence a structured approach to clinical problems, especially trauma. Clinical examination is described, and this is followed by a formal declaration of the essential clinical signs. The diagnosis is then pronounced and is followed by the prognosis. Only then is the treatment described and this is usually logical, having regard to the resources available at the time.3 There is no difficulty in recognising the ancient Egyptian swnw as our professional ancestor.
It is clear that Egyptian doctors were held in high repute in neighbouring countries. In response to a request, Ramses II despatched a doctor, Pariamakhu, to the Hittite court 'to prepare herbs for Karunta, King of the land of Tarhuntas'. Other requests for medical help were less charitably received.4 The New Kingdom physician Neb-Amon is portrayed receiving gifts for services rendered to a Syrian prince.5 Comments recorded outside Egypt are even more convincing. In the Odyssey (4, 229-32), Helen of Troy uses a drug which banishes pain and sorrow. This has been given to her by Polydamna, daughter of Thon, an Egyptian:
For in that land the fruitful earth bears drugs in plenty, some good and some dangerous; and there every man is a physician and acquainted with such lore beyond all mankind.
Another instance of Eyyptian prestige was recorded by Herodotus (3, 1). One of the reasons why Cambyses - son of Cyrus II, the Persian king who captured Babylon in 539 B.C. - attacked and conquered Egypt, to become the first king of the 27th (Persian) Dynasty in 525 B.C., was that he was incited to do so by a disgruntled Egyptian. Against his will, this man had been despatched to Persia when Cyrus sent to the Pharaoh Ahmose 'for the services of the best oculist in Egypt'.
The Ptolemaic period, beginning c. 300 B.C., which may be considered as marking the end of 'Ancient Egypt', saw the flowering of an essentially Greek medical school in Alexandria, including the researches of Erasistratus and Herophilus who undertook human dissection and even vivisection of condemned criminals. Their works are lost but are extensively quoted and their achievements are not in doubt. The Alexandrian school continued to prosper, with Galen as its most illustrious former student. Although Egypt remained a centre for medical studies, Greek medicine had by now entirely eclipsed traditional Egyptian medicine and academic experimentation was carried out in almost complete isolation from the native Egyptians.
NOTES
1. F. Jonckheere, Les médecins de l'Égypte Pharaonique, Fondation Égyptologique Reine Élizabeth, Brussels. 1958; P. Ghaliounghui, The physicians of Pharaonic Egypt, Al-Ahram Center for Scientific Translations, Cairo, 1983.
2. R. Anthes, Die Felseninschriften von Hatnub, Leipzig, 1928.
3. J.F. Nunn, Surgery in the Egyptian Old Kingdom, Vicary Lecture of the Royal College of Surgeons, 1983
4. K.A. Kitchen, Pharaoh triumphant, Warminster, 1982, 91.
5 G. Lefebvre, Essai sur la médecine Égyptienne de l'époque pharaonique, Paris, 1956, 1 and plate 1.