AS EGYPTIAN mummies go, Asru is a major celebrity. During her life in the 8th century BC, she was known for her singing at the temple of Amun in Karnak; now she is famous for her medical problems. Forensic studies have revealed that although Asru lived into her sixties, she was not a well woman. She had furred-up arteries, desert lung (pneumoconiosis) caused by breathing in sand, osteoarthritis, a slipped disc, periodontal disease and possibly diabetes, as well as parasitic worms in her intestine and bladder. Her last years must have been full of pain and suffering. After all, what could her doctor do to help? Say a few prayers and recite a spell or two?
If you read the history books, that’s about as much as Asru could expect. But not according to Jackie Campbell at the KNH Centre for Biomedical Egyptology at the University of Manchester in the UK. Her research suggests that Asru’s doctor probably consulted a handbook of remedies and prescribed something to soothe her cough, deaden the pain in her joints and perhaps even expel some of those worms (see “Cure of the mummy”). What’s more, Campbell’s findings indicate that Asru’s doctor had more than a thousand years of pharmaceutical expertise to draw on. If she is right, the history of medicine needs rewriting.
According to the textbooks, science-based medicine and effective pharmacy both began with the Greeks. In the 5th century BC, Hippocrates introduced rational medicine based on diagnosis and a reasoned approach to treatment. The first pharmacopoeia, De Materia Medica – a list of 600 drugs and how to acquire and prepare the ingredients – is attributed to Dioscorides in AD 50. And the “father of pharmacy” was another Greek, Claudius Galenus, who became surgeon to the gladiators in 2nd-century Rome. “The Egyptians clearly practised some medicine long before the Greeks, but much of it was thought of as fanciful and dominated by magic,” says Campbell. Could such a sophisticated people really lag so far behind in such vital skills? Campbell didn’t think so.
The key obstacle to establishing just what the Egyptians knew about pharmacy has been translation. While the Greeks left a vast legacy of medical texts in a familiar language, we know of only 12 from the time of the pharaohs – written on papyrus in a vanished language that scholars are still grappling with. From their descriptions of diseases and treatments, the texts have left little doubt that the ancient Egyptians had considerable medical skills, but weighing up their pharmaceutical knowledge has proved trickier: although the papyri include some 2000 prescriptions, doubts surround the identity of many of the ingredients listed.
Translators rely heavily on context to infer the meanings of ancient Egyptian words. “When words appear in writings on different subjects they can confirm whether the meaning they’ve assigned a word makes sense,” says Rosalie David, director of the KNH Centre. With the prescriptions, translators rarely have that option because medicinal plants or minerals seldom crop up elsewhere. “Worse, some of the words appear only in lists and never in sentences,” says David.
Stuck for the right word, translators have made educated guesses, narrowing down the options linguistically before consulting a pharmacopoeia to see which ingredient had the same medicinal use and best fit the description. “If the translator was working in the 1890s, they looked up the drugs available then,” Campbell says. “Later translators picked from the drugs available in their day.” As a result, some 30 per cent of ingredients in the papyri were disputed. Campbell realised she would need firmer identifications before she could say how fanciful – or helpful – ancient Egyptian remedies might have been.
“I’m not a linguistics expert so I used science to authenticate the prescriptions,” she says. With most drugs extracted from plants, her first check was whether a plant named in a prescription grew or was traded in Egypt at the time the papyri were written. If it wasn’t, she could rule it out. Fortunately, the flora of ancient Egypt is well known. Thousands of botanical specimens collected from archaeological sites are held in museums, many of them accurately dated, and some plants are illustrated in wall paintings and sculptures. Better still is the evidence from pollen grains incorporated in mud bricks or buried deep in the soil. Geological core samples have enabled archaeobotanists to reconstruct Egypt’s past flora in enough detail to say what was indigenous or traded.
Campbell’s second approach was pharmacological: could the named ingredient have worked the way a prescription indicated? Normally, this would be the province of a forensic chemist, who would take a sample, analyse its constituents and check for biological activity. Sadly, archaeologists have yet to find any pots of ointment or neatly moulded suppositories. “But we had something better,” she says. “Recipes.”
What the doctor ordered
Although often prefaced by a prayer or spell, each prescription provides all the information needed to reproduce the remedy, from its ingredients and method of preparation right down to the dose. They follow a standard format, listing the active ingredient first, followed by stabilisers, flavourings to mask unpleasant tastes, perhaps a soothing agent to help it down and sometimes secondary drugs to alleviate the side effects of the principal drug. Last of all comes the medium, or “vehicle”, in which everything is mixed.
Focusing on four key papyri, which contain 1000 prescriptions and date from 1850 BC to around 1200 BC, Campbell analysed each prescription and compared it with contemporary standards and protocols. “I looked at the source of the drug and the formulation: was it a cream or an enema or a draught and so on. Then I looked at the preparation: would the active drug have been extracted appropriately? And then, could it have worked? Was the drug given the right way and in a suitable dose?” Several plants named in previous translations, such as cinnamon and aniseed, would not have worked in the ancient remedies and there is no evidence that they existed in Egypt at the time. Other plants existed but had been wrongly translated. “Some were obviously so right while others seemed improbable,” says Campbell.
After five years of painstaking analyses, she had compiled an ancient Egyptian pharmacopoeia listing all of the drugs in the papyri, their sources and how they were used. She had confirmed or come up with more plausible identifications for 284 ingredients – various parts of 134 species of plants, 24 animals and 28 minerals. Of the original 1000 prescriptions, she could now say exactly how 550 were made and whether they would work. For another 156, she knew all but a minor ingredient – enough to say if the remedy worked. That left 234 with unknown ingredients and 27 for which the prescription failed to identify what the drug was intended for. “We’ve got some of the mystery ingredients down to half a dozen possibilities. Others we’ll never identify,” says Campbell.
The Egyptians’ choice of ingredients has certainly stood the test of time. When Campbell consulted Martindale’s Extra Pharmacopoeia – the 1977 edition, when drugs were still prepared in a dispensary – she found that 62 per cent of ingredients named in the papyri were still in use in the 1970s. Many still are – or at least synthetic versions of them.
When preparing their remedies, the Egyptians used techniques familiar to modern pharmacists. They knew when to concentrate a drug by boiling, when to dilute it and when grinding released more of the active ingredient. They were expert in extracting drugs from plants, steeping them in either water or alcohol depending on the solubility of the active compound. “Colocynth (bitter apple), for instance, can only be extracted in mild alcohol and it always was – in either beer or wine,” says Campbell. Some preparations required a two-stage extraction – first in water or alcohol and then in acid – achieved by steeping in vinegary wine or soured milk, which produces butyric acid. Most remedies were made up as required, but if they had to last longer they were preserved in sugar or alcohol. “I didn’t find one drug that wasn’t prepared properly,” Campbell says. “I have no evidence that they were aware of the chemistry of their actions, but fortuitously or otherwise, they adopted the right techniques.”
The formulations stood comparison too. Checking against the 1973 British Pharmaceutical Codex, which lays down standards and protocols for making up medicines, Campbell found 67 per cent of the ancient Egyptian remedies complied, with one proviso – the Egyptians knew nothing of the need for sterility. Apart from drugs given by injection, they dispensed all the same types of medicines as we do. They had enemas, draughts and linctuses, lotions and liniments, creams, ointments and mouthwashes. They had eye drops (to be dripped through a bird’s quill), pills, powders and poultices and, for gynaecological conditions, pessaries. For nasal congestion, doctors prescribed remedies to be inhaled (pour onto hot stones and breathe through a hollow reed). They were particularly adept at preparing suppositories, mixing the drug into a heavy grease and then rolling this into a pellet firm enough for insertion but which would melt at body temperature.
Effective remedies
So the ancient Egyptians had expert knowledge of drugs and knew the most effective ways to prepare and deliver them, but was that enough to call them pharmacists? For that, their remedies had to be effective.
Ignorant of the causes of most diseases, ancient Egyptian doctors inevitably focused on symptoms. Then, as now, a soothing linctus quietened a cough whatever the cause, and a warming poultice that stimulated blood flow would relieve joint pain, whether from rheumatism or osteoarthritis. In some instances, where the cause was obvious, as with a wound or intestinal worms, the chosen drug tackled both symptoms and cause.
Knowing the drug, the dose, how it was to be administered and what it was prescribed for meant it was possible to compare its effectiveness with modern remedies. Campbell was impressed. “Sixty-four per cent of the prescriptions had therapeutic value on a par with drugs used in the past 50 years. In many cases even the dosing was right.”
So what did Egyptian doctors prescribe? They were especially keen on laxatives, and dispensed irritants such as castor oil or colocynth, lubricants including balanites (extracted from the kernel of the desert date), or simply recommended bulk fibre, such as figs or bran. For indigestion, they prescribed an antacid of powdered limestone (calcium carbonate) where we take magnesium carbonate. For diarrhoea, doctors dispensed something to absorb water and toxins from the gut, such as kaolin or powdered carob, or a plant containing hyoscine, an alkaloid that relaxes smooth muscle and reduces gut movement. For flatulence and intestinal cramps, patients could rely on cumin and coriander – both effective antispasmodics. The discomfort of piles was eased with a suppository laced with hemp.
The ancient Egyptians had effective remedies for waterborne parasites too. The most common was extract of pomegranate, which contains pelletierine, a powerful antihelminthic used until 50 years ago to get rid of tapeworms. Antimony was effective against flukes, and balanites oil, although given to soothe burning in the bladder symptomatic of schistosomiasis, would also have killed the worms that caused it.
Like Asru the chantress, many people suffered from musculoskeletal disorders. The treatments were also many and varied. A patient might be instructed to rub liniment into aching joints, or bandage a warming poultice over the painful area. Extracts of mustard, juniper and frankincense or turpentine stimulated blood flow, providing warmth and enhancing the immune response.
Treatments for wounds were clearly effective. Mummy studies have revealed evidence of potentially fatal injuries that had healed. Egyptian physicians treated wounds with resins and metals, both of which have antimicrobial properties, and with honey – which does not comply with modern pharmaceutical standards but nevertheless works and is increasingly used to treat ulcers and burns when antibiotics fail. By extracting water from the wound by osmosis, it makes conditions too dry for the growth of bacteria.
If two-thirds of remedies were sound, what of the remainder? Some were obviously symbolic: hedgehog quills will not cure baldness, and a tap on the head with a dead fish won’t do much for a migraine. Others were more a case of hope triumphing over experience: when it came to impotence, for instance, the Egyptians prescribed a remedy with 39 active ingredients – none of which would have had the slightest effect.
“Hedgehog quills will not cure baldness, and a tap on the head with a dead fish won’t do much for a migraine”
Yet some of the odder prescriptions may turn out to be more sensible than anyone imagined. Crocodile dung as a contraceptive? There is some suggestion that, applied as a pessary, its acidity would be spermicidal. For pain relief, the papyri recommend celery seed, chewed and swallowed in alcohol. “When I began this study I thought that was one of the fanciful remedies but today celery is being investigated for its anti-rheumatic properties,” says Campbell. Ancient Egyptian physicians also recommended saffron for back pain and both Crocus sativa, the source of saffron, and safflower (false saffron) are used this way in traditional medicine.
Although Campbell’s findings show that the ancient Egyptians were practising a genuine form of pharmacy long before the Greeks, many questions remain about how advanced it was. Campbell hopes to answer some of these in collaboration with Mohamed El-Demerdash and his team, which is working on Egypt’s Conservation of Medicinal Plants Project. The project aims to re-establish and protect wild medicinal plants and to preserve the age-old knowledge of Bedouin healers.
One puzzle is why both ancient prescriptions and Bedouin healers specify doses for some drugs that appear to fall below the threshold for activity. Campbell and El-Demerdash suspect that Egypt’s wild-grown plants are more potent than those cultivated for conventional medicine. “Plants that grow in harsh environments synthesise more of certain active compounds to enable them to withstand the stress of drought or extreme temperature,” says El-Demerdash. Analyses of plants grown by the team should resolve this.
The project could also help Campbell identify some of the ingredients that still defy translation. Bedouin healers harvest the same species and make remarkably similar remedies as in pharaonic times. If Campbell is lucky, she may find they still make remedies containing some of the mystery ingredients – and for once there will be samples to analyse.
On a visit to Sinai in October, Campbell ran through her pharmacopoeia with Ahmed Mansoor, a prominent local healer. “For days all I could find was similarity – nothing that I didn’t know of already,” she says. Before she returned to Manchester, however, Mansoor surprised her with a gift – a bag containing dung from feral donkeys that roam the mountainsides where many medicinal plants grow. “This is nature’s pharmacy,” he said, explaining that the Bedouin boil the dung to make a tea, which they drink as a tonic or for upset stomachs, or apply to wounds.
The Egyptian papyri include half a dozen apparently irrational prescriptions based on animal dung – so did Campbell try it? “No. But I brought a sample back for analysis.”
From issue 2634 of New Scientist magazine, 15 December 2007, page 40-43