Medicine on the Nile

AModern accounts of Egyptian healing almost always begin by sorting the surviving instructions into two columns, one holding drugs, dressings and the setting of broken bones, the other holding formulae addressed to gods, after which the first column is quietly promoted to the rank of an ancestor. The division is convenient, and it is also modern. Nothing in the hieratic manuals marks a boundary between the two, since a single prescription may call for a poultice of ground willow, a dressing renewed at dawn and words to be spoken while the linen is tied, all in one uninterrupted sentence. No change of tone warns a reader that one element was expected to act chemically and another socially. Once the two columns exist, however, the historian is obliged to ask what proportion of the practice deserves to be called rational, and that proportion can be established only by counting documents. Documents record what was prescribed, not what became of the patient. For a century the question of whether any of it worked was therefore left where it could not be answered, and the reputation of Egyptian physicians rested on the eloquence of their manuals rather than on any measured outcome.

BThat silence has been broken not by a new papyrus but by a cemetery. Marit Sundqvist, an osteologist at the Ostberg Institute for Bioarchaeology, has spent much of her career on the burial ground of a quarrying settlement south of Thebes, first opened in 1907 and re-excavated between 2009 and 2015 under conditions its Edwardian discoverers would not have recognised. Of the 264 adults whose remains could be measured, 71 carried a long-bone fracture that had healed before death, and in 49 of those cases the bone had knitted at an angle close enough to the original alignment for the limb to have remained usable. Sundqvist argues that alignment of that quality does not occur unaided. A limb left to itself heals crooked far more often than not, whereas a limb splinted, padded and kept still for several weeks heals straight, and the difference between the two outcomes is legible on a radiograph three thousand years later. She maintains, accordingly, that the manuals were being followed by people who had performed the procedure before, and followed with a competence that the texts alone could never demonstrate. The bones, in her phrase, are the only surviving patients.

CThe same evidence leads her to a second and more contentious claim. If the manuals worked, she insists, then they worked as wholes, and the modern habit of crediting the bandage while discounting the recitation misdescribes a procedure in which the two were inseparable. A formula of fixed length, spoken over a wound, tells an attendant how long to keep pressing; recited four times, it measures the interval between one dressing and the next; the words carry no pharmacology, yet the ritual that contains them enforces a schedule, and a schedule is a large part of what wound care consists of. The proposal has boundaries that Sundqvist herself sets out. It applies only to injuries whose handling is described step by step, chiefly fractures and open wounds, and it says nothing about the far larger body of remedies aimed at fevers and internal complaints, where no bone records the result. Among adults over forty in the same cemetery, moreover, healed fractures fall to 19 per cent, which she attributes to the quarry sending older men home rather than to any decline in the standard of care. The evidence is strong where it exists and silent almost everywhere else.

DYoussef Barakat, a chemist at the Pharos Centre for Ancient Pharmacology, is sceptical of the whole enterprise. Bone, he objects, cannot distinguish a splint from a period of enforced idleness, and a quarry worker too badly hurt to walk will lie still whether or not anyone has told him to, so the straight femurs of Thebes may record nothing more than the stillness that follows serious pain. He prefers to test the drugs themselves. Between 2016 and 2019 his laboratory examined residues scraped from 42 storage vessels recovered from three temple dispensaries, and identified in 19 of them the chemical signature of honey, a substance whose antibacterial action is now well documented. Barakat concedes, however, that his own material is fragile in ways his criticism of Sundqvist is not. Honey holds bacteria in check only at concentrations above roughly thirty per cent, a proportion no residue can establish, because evaporation across three millennia alters the ratio beyond recovery; the vessels were, in addition, lifted from a store rather than from a sickroom, and a jar in a store proves the purchase of a substance rather than its use on any patient. Contamination from later handling could not be ruled out for 6 of the 42.

ENeither position has displaced the other, and the disagreement has settled into a division of ground. Most specialists now accept that Egyptian practitioners handled visible injuries competently and that their internal pharmacology remains unproven, which is close to what Sundqvist claims and not far from what Barakat will allow. Two difficulties block any firmer verdict. The first is that the two bodies of evidence answer different questions, since bone reports an outcome without naming a treatment while a papyrus names a treatment without reporting an outcome, so neither can be used to check the other. The second is the shape of the surviving sample; a survey of museum holdings published in 2018 found that 49 per cent of the vessels catalogued as medical had no recorded findspot at all, which puts them beyond the reach of the very chemistry Barakat depends on. The writer's own view is that Sundqvist has the better of the argument for injuries that can be seen, provided her claim is kept inside that boundary. Beyond it, the reputation of Egyptian medicine still rests where it has always rested, on the confidence of its own prose.