Health and hygiene in ancient Egypt

Health and hygiene in ancient Egypt

Limestone relief from the causeway of Unas ' pyramid, Saqqara, Fifth Dynasty, show¬ing the effects of famine. (Courtesy of the Musee du Louvre, Paris, E.17.376.)

During the 67-year reign of Ramesses II (Nineteenth Dynasty) an estimated 2112 million people lived in Egypt. Most were landless peasants, dependent for an existence upon the beneficence of the local landlord and the caprices or the Nile's annual inundation. When the Nile rose too high houses and fields were flooded but many times in Egypt's history the inundation proved inadequate. Lack of water brought famine, pestilence and disease (figure 1).

There arc no records of how many people died during the seven-year failure of the Nile's annual flood during the reign of the Pharaoh Djoscr (Third Dynasty) but it rangy have been many thousands. An inscription engraved on a granite block on the island or Schell during the Greek Period tells how, during this famine:

Children wept. Grown-ups swayed. As to the old, their heart was sad, their knees gave way, they sat on the ground, their arms swinging.

The most common ordinary dwelling in early Predynastic Egypt was the round hut built of poles, reeds and mud. This was later changed to a square shape and, later still, was built of mud bricks dried in the sun the traditional adobe house. These dwellings have survived less well than the stone-constructed tombs and temples from which much of our knowledge of ancient Egypt is derived.

During the Dynastic Period Egypt was divided into provinces, or names, and by the New Kingdom there were 42 nomes, each with its own administrative centre and urban development. The most densely populated areas were the Delta and the area in southern Egypt from Thebes to Aswan (estimated at over 200 people per square kilometer). Bubastis, the capital of the eighteenth Nome of Lower Egypt, which was inhabited throughout the Dynastic Period, covered an area of about 75 hectares. Heliopolis, near modern-day Cairo, was the largest city in the New Kingdom and had an urban area of about 23 square kilometers.

Apart from this natural urban development there were periods when large workforces were needed for the construction of state buildings, most particularly the Pharaoh's mortuary complex. The majority of the peasant workforces used for the building of public works were employed only during the period when the Nile flooded and work on the land ceased. Remains of housing built to accommodate at least 4000 workmen have been found near the pyramid of Khaefre at Giza (Fourth Dynasty) although the maximum seasonal workforce may have numbered 100,000.

Wall painting of a man vomiting at a banquet, Eighteenth Dynasty (Courtesy of the

Grown for oil, such as sesame; grapes for wine; pomegranate and palm wine were also made (the latter being used in embalming for rinsing out the abdominal cavity and washing the extracted organs); papyrus and flax for writing materials, clothing, sails and ropes. Honey, dates, raisins, 'tiger nuts' (Cyperus esculentus L.) and carob pods were available as sweeteners. Meat was a rare luxury for most people, herds being grazed on marginal land, especially in the marshes of the Delta. Cattle, sheep, goats and pigs were eaten. Meat, fish and fowl were dried and probably salted. Geese, ducks, quail and other game birds were fairly plentiful, and hunting these was a favorite pastime of the rich. Domestic fowl may have been a rare import during the New Kingdom but became popular in the Roman Period.

Eggs, cheese, milk and perhaps yoghurt were available. Whether milk was drunk in large quantities is uncertain. Nor is it known whether the Egyptians suffered the lactose intolerance seen in Middle Eastern and African populations today.

Most people ate three times a day even if the meal was simply bread and beer. The upper classes ate more richly if not more frequently (figure 3). Basic payment for workers and their families at Deir el¬Medina was in grain, fish, vegetables and water (there was no monetary system in Egypt until the Greek Period). They also received pottery and wood for fuel. Less regular deliveries were made of cakes, beer and dates but on festive occasions bonuses were paid in salt, natron, sesame oil and meat. Clothes were occasionally supplied to supplement those woven and made in the village.

Whilst the wages were regular the community lived well but a major strike occurred in the 29th year of the reign of Ramesses III when supplies were twenty days late. The workers' protests outline the problem: 'We have come because we are hungry and thirsty. We have no clothes, we have no ointments, we have no greens.' Several more strikes occurred in successive reigns and these are the first documented instances of collective protest by a workforce.

From the 'Instruction of Duauf (The Satire of the Trades, Papyrus Sallier II), written during the Middle Kingdom, we know the sort of life that the average Egyptian might expect in any trade except that of scribe, which was considered the easiest occupation of all.

I have seen the metal worker at his task at the mouth of his furnace. His fingers were like the hide of crocodiles; he stank worse than fish spawn.

The cobbler is very wretched; he is forever begging; he has nothing to bite but leather.

The fuller washeth upon the river bank, a near neighbor of the crocodiles.

Of 1188 teeth examined from the Giza collection of eighteen skulls _ the remains of the kinsfolk and courtiers of Pharaoh Khufu (Fourth 1 iynasty) _ there were only 38 carious cavities. In only one instance had the cavity progressed beyond the enamel to invade the pulp cham¬\ll:r and cause an apical (root) abscess. The Manchester Museum collection consists of material dating from the late Dynastic, Greek and Roman Periods, where the carcinogenic factor was much higher and where .almost all the cavities had resulted in abscesses.

Whilst caries results in progressive loss of tooth substance and is associated with increased use of dietary sugars, periodontal disease is characterized by inflammation of the gum surrounding the tooth. Chronic inflammation eventually leads to loss of both the alveolar supporting bone and the tooth. In Egypt periodontal disease was very prevalent and was provoked by the stresses and strains applied to the teeth during chewing and by serious dental attrition (wearing down of the teeth, figure 4). 'A remedy to treat a tooth which is eaten away where the gums begin' may be found in the Ebers Papyrus. It consists of a mixture of cumin, frankincense and carob-pod pulp ground to a powder and applied to the tooth (Eb 742).

Dental attrition is common to all early populations but that seen on

the teeth of almost every ancient Egyptian, throughout all periods of history, is much more extensive. Vegetables containing a high silica content, easily abraded querns for grinding corn and ill-cleansed foods are explanations common to all cultures but the Egyptians had the additional hazard of the contamination of their cereals, flour and consequently their bread by fragments of sand and by grit which may have been introduced during the milling process to act as a cutting agent. Attrition wore down the teeth to such an extent that the dental pulp became exposed and infected. This resulted in abscesses and the formation of cysts in the jaw. It also altered the shape of the cutting surfaces (cusps) of the teeth am} this, in turn, caused the movements of the temporomandibular joint to become abnormal and overloaded. This eventually led to marked osteo-arthritic changes, which are very commonly seen in Egyptian skulls.

Many jaw bones show evidence of small holes, which have been interpreted as 'bore holes' made by dental surgeons to drain pus from abscesses. However, scholars such as Eke Leek have offered the alternative explanation that these holes were caused by the dissolution of the bone by pus. So numerous foci of dental infection must have undermined the health of many people and resulted in widespread halitosis. A recipe for a breath sweetener (frankincense, myrrh, cinnamon bark and other fragrant plants boiled with honey and shaped into pellets) was also used as a house fumigator.

Personal cleanliness and the appearance were considered to he extremely important. Soap was unknown in Egypt but a refreshing body scrub could be made from a mixture of powdered calcite, red natron, salt and honey (Eb 715). Rich and poor washed frequently and before every meal. Much use was made of ointments to keep the skin soft, and unguents and aromatic oils were considered extremely important. At anqucts and on the occasions men and women wore lumps of animal fa~ on top of their wigs or hair (figure 56). These were impregnated with perfume and, as the fat melted, it ran down the body, drenching it with scent. . Deodorants were made from ground carob-pod pulp (Eb 709) or a mixture of incense and porridge rolled into pellets (Eb 71 I).

Women shaved their bodies with bronze razors and used tweezers to pluck out stray hairs. A prescription for a depilatory included the boiled and crushed bones of a bird mixed with fly dung, oil, sycamore JUice, gum and cucumber (Hearst Papyrus 155). Men were generally clean-sha~en; often the head was also shaved. Herdsmen who guarded th~ cattle In the pastures were the exception and were often depicted wrath bear's. In a climate where parasites, fleas and lice were plentiful, hair p\ovlded ~ natural and attractive habitat and lice eggs have been found lI1 the hair of mummies.

Although translations of various texts have suggested the symptoms of venereal disease, there is no clear evidence for its existence. However, prostitution was an established aspect of sexual behavior and, although adultery was officially condemned, there is textual evidence fro~-r: Deir el-Medina of both adultery and abortions. A man might legitimately have~ a mistress while he remained unmarried but polygamy and .the POss~sslOn ?f concubines appear to be rare outside the royal family and high society, The evidence from Deir el-Medina suggests that ~ w0J.!1an's legal status regarding marriage, ownership of property and inheritance was equal to that of her husband. Consanguineous manage was ~ar~ except amongst the royal family, where a Pharaoh might marry his Sister or daughter in order to establish an inheritance through the female line.

Sexual deviation Such as bestiality, necrophilia and homosexuality are not well attested. The Dream Books contain references to the coupling of men and women with certain animals but these dreams ~ere usually considered to be bad omens. Herodotus, writing in the fifth century BC, observed that the beautiful wives of notable men were not delivered to the embalmers until several days after death in order to lessen the chances .of violation of their bodies. Lastly, there is the apocryphal tale, written on a Twenty-fifth Dynasty papyrus (Louver E25~51), the Pharos Pepi II (Sixth Dynasty), who enjoyed an illicit relationship With his general, Sisene

Although age at marriage varied,. Egyptian girls usually married at twelve or thirteen and the boys a year or so older, immediately upon reaching sexual maturity. A study of 709 Dynastic skulls from sites at Asyut and Gebelein (housed in the Institute of Anthropology, Turin) revealed the average age at death to be 36 years.