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Saturday, January 3, 2015

1500 B.C.: Asthma in Ancien Egypt: the Ebers Papyri

Facsimiles from the Ebers Papyrus in Egyptian Hieratic characters,
the upper containing three, the lower eleven dental prescriptions.
From Walter Libby's 1922 book on the history of medicine (12, page 6)
In the early 19th century two very old scrolls were discovered between the legs of a mummy in Assasif, which is in the necropolis of Thebes on the west bank of the Nile River in Egypt. These documents contain our first description of asthma-like symptoms, and the first inhaler.  (1, page 1517)

The two scrolls ended up in the hands of a native dealer named Mustafa Agha, who may have had no idea of their historical value. He sold them both in 1862 in Luxor to American dealer and collector of antiquities Edwin Smith (1822-1902). (3, page 30)(10)

The two documents were initially thought to be the work of Imhotep, and perhaps the Hermetic documents.  Later, however, the documents were carbon dated to about 1500 B.C.  They did, however, contain knowledge that went as far back as 4500 B.C.  Experts speculated they were probably copies of older documents.  (5, page 305)

Once the value of these scrolls was learned, the person who found them had passed away, and so the exact details as to how or where they were found remains a mystery, although the idea they were discovered together between the legs of a mummy in an Egyptian tomb sounds impressive. (2, page 17) (3, page 30)(10)

Where they truly found together? Were they actually found in a tomb? Did this tomb belong to a priest/physician? These are questions that may never be answered.

Regardless, what is known is the smaller of the two documents was kept by Edwin Smith, and is now referred to as the Edwin Smith Papyri.  It's about 4.68 meters long with 21.5 columns of hieroglyphics.  It consists of 17 pages (377 lines) on the front, and 5 pages (92 lines) on the back.  The entire document was written by the same hand.   (5, page 304)(15)

It was published in 1930 by James H. Breasted, director of the Oriental Institute at the University of Chicago.  It's believed to be a fragment of an even larger surgical text (or a variety of ancient texts).  (5, page 304)(15)

A majority of this papyri is a  "description of 48 cases, injuries, wounds, fractures, dislocations, tumors, in other words the kind of troubles that fall into the realm of the surgeon," said Henry E. Sigerist in his 1951 history of medicine.(5, page 304)

It is written by one hand, and it ends abruptly in the middle of a description of the spine.  (5, page 305)

After Smith's death in 1906, his daughter donated the scroll to the New York Historical Society, and it now resides in the New York Academy of Sciences. (15)

The other, the large of the two documents, was soon discovered to be one of the longest medical papyri known to history, and it was very well preserved, and even includes the notes of the owner in the margins. (1, page 1517)

The scroll was advertised as a historical document of great historical value in 1869, and purchased by Egyptologist George Ebers in 1873. When he came into possession of it, "it consisted of a single, tightly rolled piece of the finest yellow-brown papyrus. The width of the document was 30 centimeters, and the length of the written part 20.23 meters. No other papyrus known to Egyptologists is better preserved." (10)

He had it translated and published, and from here on out it has been referred to as the Georg Ebers Papyrus. (3, page 30)

Ebers gave the original scroll to the University of Leipsic "for safe keeping," and where it can be observed by anyone who visits the museum. (10)

The 20.32 meter long scroll, the one referred to as the Georg Eber Papyri, consists of 108 neatly organized columns of 20-22 lines (about 110 pages) written in hieratic*. This text is printed in black ink. Each column is numbered (the rubrics) and printed in red ink (that contained red lead). (4, page 49)(5, page 311)(10)

Fielding Hudson Garrison, in his 1922 book, "An introduction to the history of medicine," explains that the papyrus appears to be written "edition de luxe, as it is prepared for some great temple." (4, page 49)

Translating the text proved to be complicated, as many of the Egyptian descriptions of ailments and remedies proved hard to translate into modern languages. Dr. Joachim translated it into German in 1890, and this was translated into English in 1930 by Dr. Cyril Bryan.  (3, page 30)

Later, in 1937, Dr. Ebbell attempted another English translation and he appeared to be bolder in his translation, and it is from here that we come to our belief that this great document describes symptoms of modern diseases such as diabetes, angina, jaundice and asthma. Other experts have criticized Ebbell for overly using his imagination in his interpretations. (3, page 30)

Some passages in the text refer to past Egyptian Pharaohs going all the way back to the First Dynasty of around 3400 B.C., wrote Dr. Elliot Smith in his introduction to Bryan's translation. (9, page xii, xv)

Although, he says, the mentioning of such names is unreliable in dating because tying script with known names was common among ancient societies in order to garnish credibility. (9, page xii, xv)

The document was ultimately dated thanks to experts who were adept at dating the methods of Egyptian writings; it was dated to about 1550 B.C.  (5, page 49)(9, page xii, xv)

Considering there is a description on the back side of the scroll of Amenhotep I, who lived around 1500 to 1526 B.C., these dates are also frequently noted. (1, page 1517)

Although, based on references sited in the text, such as that of Amenhotep I, the document is thought to contain knowledge that goes all the way back to the 1st Dynasty, or about 3000 B.C., and sometimes further back than that.  

It was this observation, perhaps, that inspired the imagination of Georg Eber to speculate that the document might have been a copy of the last six of the Hermetic texts, perhaps recorded by Imhotep, which are thought to contain medical wisdom from the god Thoth (referred to as Hermes by the ancient Greeks).

Thoth was the moon god, and he had a significant role in medicine (similar to Apollo in ancient Greece). It is believed he talked to an Egyptian priest (or priests) during the early ages of Egypt, and this priest (Imhotep perhaps?) wrote down the wisdom he learned from the god. There are various references to these documents by various physicians, although the original texts have long disappeared. (2, page 19)(4, page 49)

However, this theory, while garnishing some excitement, was ultimately believed to be untrue, as experts now figure the document to be an encyclopedia of all sorts of medical wisdom from various ancient documents. (9, page xv)

Smith Quotes Warren R. Dawson from his 1929 book "Magician and Leech" as saying the Ebers Papyrus is basically a compilation of recipes for the various ailments of that time taken from various other books that are "many centuries older."  (9, page xv)

Dawson, referencing Smith, says the Ebers Papyrus... (9, page xv)
" not a book in the proper sense of the word: it is a miscellaneous collection of extracts and jottings collected from at least forty different sources. It consists mainly of a large collection of prescriptions for a number of named ailments, specifying the names of the drugs, the quantities of each, and the method of administration." (9, page xv)
As noted above, a few sections deal with diagnosis, symptoms and anatomy. (9, page xv)

This theory may be supported by the fact the papyrus has scribbles in the margins, such as "this is a genuine remedy," or "Excellent. I have often made it, and also proved it," said medical historian Edward Withington. (2, page 17) 

Perhaps notes similar to these were scribbled next to the description of our first inhaler:
Thou shalt fetch 7 stones and heat them by the fire, thou shalt take one therof and place (a little) of these remedies on it and cover it with a new vessel whose bottom is perforated and place a stalk of a reed in this hole; thou shalt put thy mouth to this stalk, so that thou inhalest the smoke of it. Likewise wit all stones. Thereafter thou shalt eat something fat, of fat meat or oil." (6, page 9
It is unclear exactly what herbal preparations were used, although it's probable that they used stramonium, belladona, henbane, and bitumen to "alleviate catarrh and coughs, and ease breathing," said Mark Jackson in his article, "'Divine Stramonium': The Rise and Fall of Smoking for Asthma." (14, page 174)

One major difficulty with interpreting these old documents, or so the experts say, was that it may sometimes be difficult to translate Egyptian writing into our modern language. This in mind, I think, therefore, I can honestly say there is scanty evidence this Egyptian "inhaler" was used for anything more than a priest-physicians's trick to fool a patient into thinking something was being done, perhaps by the magic of the gods.

Henry Sigerist, in his 1951 book "A History of Medicine: Primitive and Archaic Medicine," notes that "Fumigations were not infrequently used in the treatment of anus and vagina and a recipe of the Berlin Papyrus (and Ebers Papyrus) tells us what the technique was. Seven bricks were heated, and the cold drug was poured over one after another while the patient was held over the developing fumes."

My point here is we must be careful in thinking any inhalers or fumigations used by the ancient Egyptians were anything more than just something that was not understood being used for an ailment that was not understood. 

Jackson said:
While Ebell's specific interpretation has been challenged by other translators, the papyrus certainly appears to list remedies to remove phlegm, alleviate catarrh, coryza, and coughs, and to ease breathing. Significantly, Egyptian treatments for respiratory conditions included not only the oral consumption of a variety of concocted vegetable, mineral, and animal products but also the delivery of active substances directly to the lungs by inhalation. (13, page 38)
So, as you can see, we could easily use our imaginations here as it comes to the treatment of asthma in ancient Egypt. You are short of breath, you call for a priest/physician, and a specialist comes to your house. You hope he's an Internist who specializes in diseases of the chest, and you hope he has knowledge to this primitive inhaler, and that he also has a medicine called Belladonna that he tosses on those heated bricks. Belladonna would take the edge off by easing both your breathing and your mind.

Sigerist said the teeth, where food enters, and the anus, where food exits, were highly regarded by the ancient Egyptians. Sigerist even notes various references to "the holy anus," and "shepherd of the Anus." (Sigerist, page 317, 335)

These shepherds were probably physicians who specialized in ailments of the anus, such as "hemorrhoids, prolapsus recti, inflammation and pruritus of the anus." (Sigerist, page 317, 335)

The pharaoh had his very own anal physician to take care of it, and perhaps this physician recommended this inhaler for hemorrhoids, a remedy we might think of as purely irrational, although to the Egyptians, it was most surely rational. (Sigerist, page 317, 335)

We must realize that Egyptian physicians had scanty knowledge of anatomy, and this is true despite the fact they prepared animals for food and sacrifice, and humans for mummification. They knew about the inner organs, and they knew about vessels and blood, but they didn't know about the relationship with these and ailments of the body. They did not make that connection.

So they would have no idea about diseases like asthma, nor other diseases that would make a person short of breath. Basically, all physicians could do was note the symptoms -- chest pain, short of breath, wheezing -- and what remedies seemed to work.

Likewise, it must be understood here that Egyptian medicine was based on mythology, and ailments were caused by the wrath of gods, particularly the god Isis. So remedies, in a sense, were believed to be gifts from the gods of health and healing, such as Isis, Thoth, Sekhmet, Heka, Serket, and Ta-Bitjet. They worked by magical means. So while these remedies may seem irrational to the modern reader, they were quite rational given the medical wisdom of the time.

Once translated, the Ebers Papyrus scroll was learned to contain over 700 magical formulas as remedies for the most common ailments of that time, with various incantations randomly assorted through the text. Some of the remedies included pills in the form of dough, herbs and minerals that were put into beer and wine, salves and oils to rub onto the skin and wounds, a salve made from honey was put over wounds, and gargles and inhalations.

If you had complained of an ailment, a physicians would be summoned. Egyptian physicians specialized in particular symptoms, so you would see a physician who specialized in treating your symptoms. If your specialist was an internist, perhaps you would be provided with the remedy above, which may actually contain breathing relief, considering Belladonna was later proven to contain a mild bronchodilator component.

Yet, more than likely, your treatment would be a general treatment. Since the Egyptians were among the first society to attribute sickness to good health, he might suggest something simple to cleanse your body, which may involve any of the following:
  • Enemas (the stomach was believed to be a cause of most diseases, including breathing problems)
  • Emetics (to vomit out the poisons)
  • Animal excreta (including crocodile and camel)
  • Herbs such as squill and henbane
  • Fumes of burned sundried and crushed Belladonna leaves and roots (as noted above)
  • Eating foods such as figs , grapes, frankincense, cumin and juniper fruit
  • Drinking wine and sweet beer 
Along with the above treatments, the following were considered routine in order to keep your body clean: (11, page 18, 23)
  • Daily baths
  • Abstinence from certain foods (like cow flesh, pigs, flatulent beans, etc.)**
  • Gymnastics
  • Linen clothing worn for cleanliness
  • Purgatives and emetics every three months to cleans body***
  • Friction and inunction of the body (basically involves rubbing certain parts of the body)
  • Fumigations (usually during epidemics to "purify the air."  
  • Inhaling steam from inhalations 
  • Careful system of nurturing from childhood
  • Incantations (magic words)
  • Amulets (to wear or keep close to you and or your home to ward off spirits and for healing)
Or, if your asthma-like symptoms were diagnosed as being caused by witchcraft, the following remedy may be used:
"Against all kinds of witchcraft -- a large beetle; cut off his head and wings, boil him, put him in oil, and apply to the part. Then cook his head and wings, put them in serpent's fat, warm it, let the patient drink it." (2, page 18)
If your physician didn't heal you, you might consult a priest or magician who would provide you with an amulet or incantation to say each morning. Or he might place his gentle palm over your throat or chest and chant an incantation to induce healing and scare away the evil demons that were causing you to breathe heavy. Perhaps the good feeling of hope by this method was more healing to you than what your physician might recommend.

Another neat thing to note here is that by dating the Ebers Papyrus to around 1500 or 1550 B.C., this would place it as being written about the time of the Exodus. That means it was probably written around the time Moses walked the earth, and the wisdom it contained was available to him. So the Bible may provide us with another good source for learning what life was like for Asthmatics in Ancient Egypt.

Further reading:
*Hieratic is a form of Egyptian cursive, and was used "chiefly on sacred and medical papyri and on wooden coffins... the characters are written from right to left... about 300 A.D. all knowledge of the meaning of the characters had died out, and it was not until the discovery in 1799 of the Rosetta stone (by Boussard, a French artillery officer) that any real progress was made in the decipherment." (10)

** Note that the upper classes of Egypt did not eat pig, and despite this, historians note a high incidence of hardened arteries.  One study of Egyptian mummies found hardened arteries in three fourth of the mummies studied.  While this was a recent study, some historians noted this as far back as the 1930s. You can read more about this here

***While many historians have noted the Egyptians to drink to excess, others speculate, that while beer and wine was consumed during meals (and mostly wine), it was watered down and not very potent.   

  1. Selin, H., "Encyclopedia of the History of Science, Technology and Medicine in Western Cultures," 2nd edition, 2008, Springer
  2. Withington, Edward Theodor, "Medical History from its earliest times," 1894, London, Aberdeen University Press
  3. Nunn, John F, "Ancient Egyptian Medicine," 1996, University of Oklahoma Press
  4. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia and London, W.B. Saunders Company
  5. Sigerist, Henry E, "A History of Medicine," vol II, "Primitive and Archaic Medicine," 1951, New York, Oxford University Press
  6. Ebell, B.,  translator, "The Papyrus Ebers: The Grea)test Egyptian Medical Document," 1937, Copenhagan, page 67.  I found references to this passage by Mark Jackson (Asthma: A biography," 2009, New York, Oxford University Press, page 39), and Henry E. Sigerist (see reference immediadely above, page 339).  Sigerist says that a similar passage can also be found in the Berlin Papyrus.  
  7. Reference Pending
  8. Osler, William Henry, "The evolution of modern medicine," 1921, New Haven, Yale University Press
  9. Smith, G. Elliot, introduction to Cyril, Bryan,s book, "The Papyrus Ebers," 1930, London, The Garden City Press, Bryan's book was an English translation of the German translation of the papyrus. 
  10. Von Klein, Carl H., "The Medical Features of the Papyrus Ebers," The Journal of the American Medical Association, December 23, 1905, Volume 45, page 1928, George H. Simmons, editor, volume XLV, July - December, 1905, Chicago, American Medical Association Press.  This article provides a fuller story of how the document ended up in the hands of Georg Ebers, how it came to existence, etc.  
  11. Baas, Johann Herman, author, Henry Ebenezer Sanderson, translator, "Outlines of the history of medicine and the medical profession," 1889, New York
  12. Libby, Walter, "The history of medicine in its salient features," 1922, Boston and New York, Houghton Mifflin Commpany
  13. Jackson, Mark, Asthma: A biography," 2009, New York, Oxford University Press
  14. Jackson, Mark, "'Divine Stramonium': The Rise and Fall of Smoking for Asthma," Medical History, 2010, 54: 171-194
  15. "Medicine in Ancient Egypt,",, accessed on 6/5/14
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