Until the seven known medical papyruses were discovered during the last century, our knowledge of ancient Egyptian medicine came principally from the writings of Greek and Roman commentators such as Homer, Herodotus, Hippocrates, Pliny, Diodorus, and Clemens. The writings of Egyptians themselves, though abundant on historic ruins, were virtually indecipherable until the Rosetta Stone was discovered in 1799 during Napoleon’s conquest of Egypt. This basalt stela bore a tribute to Ptolemy V (196 B.C.) carved in hieroglyphics and repeated in demotic, or simplified, characters, and also in Greek, providing Jean-Francois Champollion necessary keys to decipher the language and open doors to a wider understanding of ancient Egypt.
The oldest of the medical papyruses is the fragmentary Kahun Papyrus, which deals with veterinary medicine and women’s diseases. The Edwin Smith Papyrus (of about the seventeenth century B.C.) is concerned with surgical matters, starting at the top of the head and working down—a type of medical organization often to be seen in subsequent texts in other countries—but the text stops abruptly at mid-chest. For the most part, this document is an empiric, secular, instructional system of practice, and evidently a copy of a much more ancient treatise. The Georg Ebers Papyrus, dating from the early sixteenth century, is the longest of the medical papyruses. An extensive medical therapeutic text covering many subjects, among them pharmacologic and mechanical means of treatment, it also contains many incantations and verbal charms.
The Hearst Papyrus (about the sixteenth century B.C.), the London (fourteenth century), the Berlin (early thirteenth century), and the Chester Beatty (late thirteenth century—dealing almost entirely with the treatment of diseases of the anus) may have been practical handbooks, whereas the Smith and Ebers papyruses may have been teaching materials. Part of the Ebers document is repeated in the Smith, and the Berlin Papyrus contains an entire treatise which also appears in the Ebers.
The oldest medical text extant anywhere is a cuneiform tablet from Mesopotamia. The most ancient known Egyptian medical writings date from a later period, but they refer back to texts far older. Most important among the more ancient treatises were: Book on the Vessels of the Heart, The Physician’s Secret: Knowledge of the Movement of the Heart and Knowledge of the Heart, and Collection on the Expelling of the Wehedu (a toxic principle in the body).
In the second century A.D., the Christian writer Clemens of Alexandria spoke of forty-two sacred books the Egyptian god Thoth gave to humankind, said to contain the fountainhead of all knowledge. Thoth had by that time become incorporated into the Greek god Hermes as Hermes Trismegistos (or, “thrice great”), and the legendary collection was therefore called the “Hermetic Collection.” Six of the Hermetic books were supposed to have been devoted to medicine, and Georg Ebers believed that his papyrus was the fourth medical book of the Collection.
Many mystical or fraudulent writings attributed to Hermetic origins kept appearing and reappearing in the centuries after Clemens. Secret processes and remedies became part of the medical folklore of the Mediterranean world, and the word “alchemy” may have come from the ancient name for Egypt: “Chem.”
It is now believed that about 3000 B.C. the two kingdoms of Upper and Lower Egypt were united under King Menes, a ruler of the Southern Kingdom (Upper Egypt). Early in history, the ruling kings of Egypt were regarded as gods, but they retained human qualities, as did the cosmic gods. As sons of Ra, the sun-god, the kings were both spiritual and temporal heads of state. Significant developments of this time were the Egyptian alphabet and the tools of writing: papyrus, reed pens, and ink.
The following period, about 2780-2200, is sometimes referred to as the Old Kingdom, and the great pyramids were probably constructed during this time. Over the next few centuries (Sixth to Eleventh dynasties), the strong central government weakened, but it was at least partially reestablished during the Eleventh and Twelfth dynasties, which marked the Middle Kingdom (2000-1750). This period has been called the “Classical Age” as an indication of its high intellectual emphasis, and medicine apparently held a prominent place in the pursuit of learning.
In the Thirteenth dynasty (1750-1580), Egypt was invaded by the Hyksos, a Semitic people from Lower (Northern) Egypt, who held sway for about two hundred years and merged many of their gods and customs into Egyptian culture. Gradually the Hyksos overlordship was destroyed, but the struggle resulted in the establishment of a military state in the Eighteenth dynasty, under Ahmose and then Amenhotep I, which ushered in the period of the New Empire (1580-1350 B.C.). During this time, the extraordinary Queen Hatshepsut became the first woman ruler of all Egypt and extended the influence and power of her country. It was not uncommon later for queens to rule Egypt, but even as consorts of the pharaoh they wielded important political power. Whether there were actually women physicians, as has been deduced from philological evidence of a feminine form of the Egyptian word for physician, is not yet fully established.
It was also during this age that Pharaoh Amenhotep IV moved away from worship of the state god Amen and favored the developing cult of the sun-god Aten. He left Thebes to establish a new capital, Akhetaten (horizon of Aten), dedicated to the worship of this one god, and changed his name to Akhenaten (of service to Aten) in tribute. After Akhenaten’s death, his son-in-law and successor, Tutankhaten, returned the court to Thebes, restored the god Amen to supremacy, and changed his name to Tutankhamen. The discovery in November, 1922, of this ruler’s intact tomb, sealed for more than 2,000 years, was a major contribution to Egyptology.
After Tutankhamen, power shifted back to a dynasty of Hyksos derivation. The story of the enslavement of the Hebrews probably dates from this period in the thirteenth century B.C., and Ramses II, builder of the great temple of Abu Simbel, may have been pharaoh during the Exodus. Another pharaoh of Biblical times was Merenptah. The Royal College of Physicians in examining his mummy found that he had died in old age with bald head, obese abdomen, and an arteriosclerotic aorta (the main artery of the body).
Over subsequent centuries, as pharaonic power waned, the country successively fell under the hegemony of Libya, Ethiopia, Assyria, and finally Persia, when Egypt became a satrapy of that empire. In 323 B.C. Alexander the Great, the Macedonian Greek conqueror, defeated Persia and set his general Ptolemy on the throne as king of Egypt. (The famous Cleopatra VII of Roman times was the last of this Greek Ptolemaic dynasty.) Alexandria, the city in Egypt founded by Alexander, became the medical and intellectual capital of the Mediterranean world.
All deities were associated with some aspect of health or illness. Many began as local divinities, later to be taken up by the whole kingdom as cosmic gods. Others were melded into some other deity. Ra, the sun-god, held the highest place in the pantheon. Isis, a sort of primal earth-mother, was worshiped as a healing goddess. Her cult persisted for many centuries, and temples dedicated to her healing powers were still being established at the time temples to Asclepios began to appear in the Greek world. A brother of Isis was Osiris, a personification of the Nile, who was dismembered by another brother, Seth. Isis lay upon her brother Osiris, restored him, and also conceived her son Horus. The evil Seth, who together with his sister and consort Nephthys was a prime bringer of disease to humans, then destroyed the eye of Horus. Thoth, the source of all knowledge and physician to the gods, healed the eye. (Following divine example, Egyptian royal couples were often brother and sister. The custom of sibling marriage was also adopted at court, and eventually by the lower classes. By the second century A.D., it was estimated that two-thirds of the citizens of Arsinoe were offspring of sibling unions.)
Among other supernatural healers were Hathor, mistress of heaven and protector of women in childbirth; Bes and Thoeris, to whom pregnant women also prayed; Keket, who ensured fertility, and her ram-headed consort Khnum, who actually fashioned each child and created its ka, or spiritual projection. During Ptolemaic times, Serapis was a local deity who rivaled Asclepios among the populace of Egypt as god of healing.
The two most important healing divinities were Thoth, physician to the gods, and Imhotep, whom Sir William Osler called “the first figure of a physician to stand out clearly from the mists of antiquity.” Thoth became a patron god both of physicians (as the source of medical knowledge) and of scribes (as the inventor of writing).
The other important god of healing, Imhotep, began as a historic personage in the Pyramid Age (about 2600 B.C.) as a many talented genius: vizier to the pharaoh, architect (he is said to have built the step pyramid at Saqqara), poet, scribe, and apparently also physician although no writings or teachings have been ascribed to him. By the sixth century B.C. he had displaced Thoth as the chief healing god of Egypt and been given a divine father, the god Ptah. In time the Greek Asclepios and the Egyptian Imhotep were combined as Asclepios-Imhoutes.
Death and Afterwards
The attitude toward death is a key to much of ancient Egypt’s civilization and contains many paradoxes. Life was a preparation for afterlife; yet life was lived to the fullest—at least among royalty and the rich. Burial practices were a paean to life after death—which was to be a new existence, a joyful experience. Nevertheless, the dead were mourned openly and elaborately, even at times with self-flagellation. Embalmers often removed the internal organs of the dead body and left only a shell, yet this preserved remnant was important to spiritual reawakening in the hereafter. The living body was the abode of a divine spark which left after death to become a ghost or demon, but the soul (ka), a sort of spiritual double of the person, remained forever in the embalmed body. An important ritual called “the opening of the mouth” was often depicted in the Book of the Dead, a guidebook to the afterlife and regulator of all funerary practices. Presumably it readied the body for receiving the life force necessary for future resurrection.
The extent of embalming was determined by the status of the deceased and the money to be spent. The most elaborate procedure called for, among other things, four stone canopic jars in which to preserve the extracted liver, lungs, stomach, and intestines. To ensure that these organs would function for eternity, the covers of the jars were carved to represent the four sons of Horus: Dutamutef the jackal-headed, Kebehsenuef the falcon-headed, Imsety the human-headed, and Hapi the ape-headed. The cranial contents were removed through the nostrils with hooks, and the skull and abdominal cavity were then washed out with spices. The body was soaked for seventy days in natron (a mixture of clay and salts of carbonate, sulfate, and chloride) and then thoroughly washed. Finally, the corpse was coated with gums and wrapped in long strips of fine linen. Less costly embalming included only some of the preparations, and the poor were simply buried in the sand.
Anatomy and Physiology
Despite the continual exposure of internal organs by embalmers, information on anatomy and physiology was sketchy and closely linked with theology. The listing of organs of the body was a religious recital of those belonging to the great god Ra, and each body part also had a special deity as protector. This projection of the human body into the cosmic scheme continued to be a universal medical and philosophical concept, especially emphasized in Europe during the Middle Ages.
A similar linkage of internal human functioning to the functioning of the outside world may have prompted the Egyptians to view the anatomical and physiological makeup of the body as a system of channels (metu) similar to the network of canals which spread throughout their land. The heart was at the center of the system, the station where the metu delivered and received. The pulsation of the heart was known, and the propagation of its beats throughout the body was perceived, for as the Smith Papyrus states: “Its pulsation is in every vessel of every member.” Air came in through the nose (but also the ears), entered the channels, was delivered to the heart, and from there was sent to all parts of the body. However, the metu also carried blood, urine, tears, sperm, and feces. Around the anus, the channels coalesced into a sort of collecting system where the contents of the rectum could enter the network; however, they became the main cause of disease if allowed to build up. Hence, the intestinal contents were cleaned out regularly by emetics, purges, and enemas, and the anus became a prime target of medical treatment. Most medical therapies were directed toward the metu: to calm if irritated; to soften when too firm; to stimulate if sluggish; to cool when hot; to deflate if swollen; to relieve when painful.
The importance of the brain was well appreciated, and the Smith Papyrus spoke of a sensation of throbbing and fluttering beneath fingers palpating the surface of an injury-exposed living brain. The Papyrus also spoke of the effects on motor functions of brain injury; the results were seen to be different depending on which side was injured. Other organs were also mentioned and even described in the various medical papyruses, but the Egyptians misunderstood or misinterpreted much of what they saw.
Herodotus called the Egyptians the “healthiest of all men.” Whether this remark was based on a general impression or on secondhand information similar to his erroneous conclusions regarding the absence of doctors among the Babylonians is not known. However, a sweeping statement with the opposite conclusion was made by Pliny five hundred years later, when he referred to Egypt as “the motherland of diseases.”
The ancient Egyptians paid much attention to cleanliness of body and home, probably to a great extent for religious reasons. Among all economic and social classes washing was practiced every morning, evening, and before each meal, but since soap had not yet been invented a type of alkali was used. The purgings, vomitings, and enematizing which ancient Egyptians engaged in each month were also a sort of symbolic internal cleansing as well as a method of ridding the channels (metu) of dangerous intestinal contents.
The water of the Nile was thought to be of great purity and salutary effect, and its supply was usually abundant. An elaborate system of dams, basins, and canals fulfilled all agricultural needs. For the most part this network was effective, but Egypt was still dependent on the periodic rise and fall of its great river for the fertility of its land and the orderly flow of water through its sluices and reservoirs. It is doubtful that in ancient Egypt refuse was dumped into the river as it was in Greek, Roman, and Muslim times—when the Nile became a veritable cesspool. However, many canals, pools, and puddles always were suited to breeding insects. Herodotus spoke of the need to find high ground or towers for sleeping places to avoid clouds of gnats.
A number of diseases can be reasonably well identified from descriptive reports in papyruses, pictorial representations, inscriptions, mummies, and contemporary accounts. Diseases resulting from water and food contamination, notably intestinal ailments, were evidently common and disabling, and parasitic infestations, especially by the schistosome and other worms, also have been discovered in mummies. Although malaria appears not to have been quite as common nor as severe as in Mesopotamia, India, and Greece, fevers of all kinds were a problem.
Diseases of the eye were frequent and included infections such as trachoma (which is still common in Egypt), night blindness, cataract, and distortions of the eyelids. Arteriosclerosis was surely a disease of the ancient Egyptian judging by pathologic findings in mummies, and epidemic diseases such as smallpox and plague were probably as much a scourge then as they were later. The vertebrae of mummies often suggest the late effects of Pott’s disease (a tubercular infection).
Some ailments described in the writings resemble gonorrhea, but at present no obvious instances of syphilitic infections of the bones or soft parts have been proved. Leprosy may well have been present, but as in virtually all ancient civilizations it was probably often confused with other skin conditions. Acute illnesses were certainly well known even though their precise nature is difficult for us to reconstruct, but penumonia and appendicitis clearly may be inferred from some of the information available. Certainly the muscle wasting of poliomyelitis can be recognized in a few temple reliefs.
Arthritis, gout, and kidney and bladder stones were probably frequent, and tumors of the ovaries and of bone have been identified. The occurrence of cirrhosis of the liver is also generally accepted. The reported large consumption of beer and wine may have been a causative factor.
Egyptian methods of diagnosis used information from the patient, but the actual taking of a detailed history had not yet developed. Nevertheless, examination was complex and included probing of wounds with the fingers and study of the sputum, urine, feces, and other bodily emanations. Inasmuch as the pulse was recognized as transmitted by the heart, it was carefully checked in different parts of the body.
The papyruses contain many astute observations from which a reconstruction of some disease entities can be surmised. For example, hernias were clearly noted: “When you judge a swelling on the surface of a belly… what comes out… caused by coughing.” References to bloody urine may call to mind cystitis (bladder inflammation), stones, or parasites. Indeed, infestations with worms of different types must have been as common then as they are now—to judge from the findings in mummies with organs intact.
Combinations of symptoms were occasionally grouped together, but for the most part the symptom was the disease: cough, fever, swelling, skin rash—each was an ailment itself. Inflammation as “disease” was recognizably described as follows in the medical texts: “It means that the wound which is in his breast is sluggish, without closing up; high fever comes forth from it, its two lips are red, and its mouth is open.” Medical classifications, therefore, tended to be of symptoms rather than diseases.
Although the Egyptian healers did not state a prognosis specifically, they did make decisions on whether to “contend with,” or to avoid treating—which implied estimation of the future course of a sickness. A very serious illness which had even a chance of responding favorably the physician agreed to contend with, but conditions thought hopeless were denied treatment. This attitude of withholding medical ministrations to the incurable was a recurring theme throughout history, frequent especially in Greek times. The basis may well have been pragmatism or insensitivity, but honesty may also have underlain the decision.
In treatment itself, religio-magical gestures played a vital role. Accompanying the administration of drugs and mechanical procedures were incantations to drive out demons and supplications to the gods for protection from evil spirits. Amulets could ward off illnesses of most kinds, but serious mental disease required the exorcism of demons, often calling for the use of excrement. For snakebite, rituals were virtually the only therapy—in marked contrast to the management of snakebite in India, where sound, rational medical principles were combined with the supernatural. Nevertheless, in most other healing activities the Egyptians combined their religious rituals with an exceptional and varied array of vegetable, mineral, and animal drugs.
Their pharmacopoeia was vast. A great many of the medications and plants that later found their way into the herbals of Dioscorides, Galen, and Pliny, and also into the Hebraic, Syriac, Arabic, and Persian armamentarium came from Egyptian sources. But the Egyptians also imported substances from abroad: saffron and sage from Crete; cinnamon from China; perfumes and spices from Arabia and Abyssinia; sandalwood, gums, and antimony.
They administered medications in many forms—as pills, cakes, suppositories, ointments, drops, gargles, fumigations, and baths. Even enemas were a popular route for the introduction of drugs as well as a means of evacuating the bowels. (Incidentally, the ibis, symbol of the god Thoth, was supposed to have originated the enema by inserting its long beak into its own anus.) The liquid vehicles were water, milk, beer, and wine, each sweetened with honey, and the ingredients were expected to remedy a variety of problems, not just illness: recolor gray hair; restore thinning hair; beautify; clean house; create pleasant odors; and control flies and other insects.
Egyptian physicians made use of a wide variety of medicinal plants, but the most numerous remedies were purgatives and emetics. The cathartic oil of the castor plant was used both as an internal drug and as a medication for wounds and irritated areas. Products from the opium poppy may have come into use in Egypt relatively late, but some scholars believe the plant was a therapeutic drug in the second millennium B.C. Substances such as hyoscyamus and scopolamine (an ingredient of “twilight sleep” in recent obstetrical practice), which are both related to mandragora from the mandrake plant, probably also were employed, but the time of their introduction is not established. Some of the vegetable decoctions may. well have had antiseptic action. The “rotten bread” prescribed in several formulas might have been effective on wounds because of the presence of antibacterial molds (just as penicillium mold is used today).
Minerals and metals in the Egyptian pharmacopoeia included antimony, copper, salt, alum, carbon from charred wood, and possibly also iron from meteorites. The paints used for beautifying a woman’s eyes were probably high in antimony, which became an important pharmacologic substance in the Renaissance and after. Black eyelid linings apparently were produced by a composition of antimony or lead. (Many centuries later in Arabic times finely powdered antimony came to be called al-kohl. In the sixteenth century Paracelsus applied this term to the subtle spirit in wine, alcohol.) The green color in eye makeup probably came from copper salts. These natural substances are inherently antiseptic, but whether they were effective inadvertently in preventing or treating the eye infections common in Egypt cannot be ascertained. Yet it is of more than passing interest that copper preparations are the main agents of the present century against trachoma, a blinding infection very common in Egypt.
Most mechanical methods of treatment involved application of cold, heat, and dressings. Bloodletting by scarifying and puncturing the skin and by attaching leeches apparently also was a regular practice. Surgery was directed principally to the management of wounds and fractures, for which molded splints of bark and cloth steeped in resins may have provided comfortable fixation. Hemorrhage was controlled by pressure, sometimes with the addition of slabs of fresh meat, the muscle juices of which may have acted as styptics.
The surgical use of the knife, except for circumcision (common among all classes of Egyptians), is barely discussed in the few surviving medical papyruses, but there were several kinds of blades: stone, metal, and papyrus reed. The openings cut by embalmers in their work were stitched closed in at least some instances, and it is possible that stitching was used similarly by doctors. Trepanation, though widespread among early cultures, appears not to have been a prominent part of ancient Egyptian surgical practice. Cauterization, however, was clearly indicated for the removal of surface tumors and cysts. The fire-drill—a heated sharp utensil—is mentioned as a surgical tool, and in a textual reference to upgrading a medical school there is evidence that other instruments were available. We have learned that, among lesser surgical aids, the Egyptians made a type of adhesive tape by impregnating gums into linen strips used to pull gaping wounds together. Although some botanical and mineral concoctions used in treating wounds were in all likelihood antiseptic, many plant and animal substances were probably harmful in that they produced contamination and sealed off open drainage.
Tooth ailments must have been frequent and distressing. The earliest human remains show cases of severe wearing down of the teeth, even to the point of exposing the pulp—but with virtually no cavities. The evidence of cavities and abscesses in less ancient mummies has been interpreted to be a result of the eating of more refined, softer foods. But it is also possible that climatic, geological, and cultural changes altered the presence of cavity-preventing minerals in the diet.
Some mummies show evidences of severe infections, cavities, and loose teeth, but also teeth that were wired together and artificial prostheses. (Nefer-it-etes, who lived about 2600 B.C., was mentioned as a maker of teeth). Possibly the fire-drill was inserted to drain abscesses, but the treatment of most infections of the teeth consisted of applying medications aimed at drawing out the “worms.” This idea of worms as a cause of tooth disease was also prominent in Mesopotamia, and continued in Western medicine throughout the Middle Ages and even into recent centuries.
Women’s diseases occupy a fair proportion of the medical writings. Healing substances were introduced into the vagina by tampons and also by fumigation, a technique whereby a woman straddled hot stones on which a medicated solution was poured to produce vapors that could enter her vagina.
An exceptional method was offered for diagnosing pregnancy. A woman would urinate over a mixture of wheat and barley seeds combined with dates and sand. If any grains later sprouted, the woman was sure to give birth. If only wheat grew, the child would be a boy; if only the barley, a girl. This fanciful-sounding ritual may have had some success because of the hormonal content of urine, a factor in contemporary urine examination for pregnancy. Of course, fantastic and magical means of diagnosing pregnancy were also followed by the Egyptians.
Although contraceptive methods were described in the medical papyruses, fertility was most desirable. In addition to prayers and offerings to fertility deities, an infertile woman might have symbolic intercourse with a bull to open the pathway to conception. The necessary contribution of semen to fecundation was appreciated, but the understanding of sexual physiology was minimal. The people, and probably physicians as well, believed that impregnation could occur through the mouth as well as the vagina. Dung, honey, and a carbonate salt made up one contraceptive combination. Vaginal insertion of acacia leaf-tips was another method, and that plant has been found to produce lactic acid—a common ingredient of modern vaginal douches.
The reputation of medical practitioners was consistently high throughout Egypt and the rest of the Mediterranean world. Egyptian physicians were often called to treat members of the ruling classes in other countries and were mentioned frequently in court records of Persia and Palestine. However, they did not always emerge as superior practitioners. The Greek Democedes, who lived about 500 B.C., for instance, cured the ankle of the Persian monarch Darius and the breast of his daughter while Egyptian physicians stood by unable to help.
Although the Egyptian healer was a person of standing, he was not beyond reach of malpractice suits. He was warned to use only the methods promulgated in authoritarian ancient treatises, for then, even if the results were poor, he would be above reproach. This rigidity was a deterrent to following one’s own observations, and woe to the doctor who deviated!
Altogether, the names of several hundred physicians can be gleaned from the writings, references, and inscriptions extant. Among them was Iry, called “Keeper of the King’s Rectum,” a court physician who, about 2500 B.C., attended to diseases of the eye and belly as well as the anus. Hawi was an Old Kingdom healer of the teeth and anus. This seemingly bizarre combination actually makes embryological sense, for the mouth (stomadeum) and the anus (proctodeum) are derived from the same types of tissue systems. The high position of Hesi-Re, a tooth specialist, as Chief of the Court College of Physicians suggests the repute and respect given to doctors concerned with teeth.
Herodotus, in the fifth century B.C., wrote this of the Egyptians: “Medicine with them is distributed in the following way: every physician is for one disease and not for several, and the whole country is full of physicians of the eyes; others of the head; others of the teeth; others of the belly, and others of obscure diseases.” Yet specialization is not necessarily evidence of an advanced system of medicine. The Hermetic Collection of writings was apparently so large that to learn all would have been a gigantic task; thus there may well have been considerable incentive for concentrating on a limited area of knowledge.
The standards of training and of practice seem to have been set by the pharaoh’s physician, who stood at the apex of the hierarchy. Beneath him were the palace physicians, among whom one may have been the supervisor of physicians. The others were inspectors of physicians, a group of lesser chief physicians, and a lower order of physicians comprising the great bulk of practitioners. There were also physicians who took care of workmen and a special cadre of doctors for miners; these healers may have been salaried. (Herishef-nekhet, about 2000 B.C., was a chief physician who served at a quarry. Metm was termed a “physician of serfs.”) Temple physicians, possibly of lower social standing, were available to all and visited patients’ homes as well. Army doctors accompanied military expeditions and gave service to soldiers in the barracks.
Special schools for training physicians were attached to temples. User-horresinet, the chief physician at the time of the Persian hegemony, was sent to improve a medical school and boasted that he had selected no students from the poor, which suggests that medical students were not always from the upper classes. Whether they were educated as scribes as well as healers is not clear. However, Iwty in the New Kingdom was described as a royal scribe and chief of physicians.
An apprenticeship of some kind must have been a part of the schooling for surgery, but it is not clear whether surgery was a highly reputed specialty, a province of all physicians, or a separate but lower form of practice; perhaps its status varied with the period in history. However, since the Ebers Papyrus and the Smith Papyrus both deal with surgical matters, one may infer that physicians were expected to have knowledge of all types of medicine.
In the absence of a monetary system (gold as a medium of exchange was introduced only in the New Kingdom), physicians were usually paid with goods or services. Generally they were well rewarded. In the temple, however, physicians probably were salaried, ministering to the populace without fee. Whether paid with fees or salaries, physicians charged for dispensing medications. Although they may have obtained basic plants and drugs from various sources, they seem to have prepared their own medicines. Even the above-mentioned Iwty was said to have mixed his own salves.
Since the texts on which all medical lore depended were thought to have been given by the gods, particularly by Thoth, the writings were both divinely based and secret—a sacred trust of the healers. For instance, the book referred to in the Ebers Papyrus which described the functions of the heart was pointedly called The Physician’s Secret. The Egyptian physician therefore, whether a priest or a specially chosen layman, was considered to possess divine knowledge and have special access to the deities and demons. Some of this tendency to ascribe possession of unimpartable information to professionals of the healing art has continued to permeate medical practice in all countries throughout the many intervening millennia. This divine self-image has had effects both beneficial and detrimental. The devotion, ethics, and skill which characterize elitism at its best are a benefit to the sick, so that even mediocre personalities can be exceptional physicians in the special context of treating. On the other hand the self-image of godliness can also breed arrogance, excessive secrecy, and unwillingness to recognize limitations.