Ancient Egypt Disease Research Paper

Archaeology of Egypt
Ancient Egyptian Disease
An in depth Look at Archaeological Evidence of Ancient Egyptian Infectious Disease and Parasites

12/3/2010

Ancient Egyptian Disease
Throughout the passing of time great civilizations have come and gone. Of the six pristine ancient civilizations, none have drawn quite the sensationalism as ancient Egypt. For numerous centuries antiquities were dispersed throughout the world for monetary purposes; however, for the past few decades interest has been focused on understanding the people that inhabited and built this great civilization. A fascinating subject that has sparked much research is Egyptian medicine, and more specifically, disease. Archaeological investigation and
modern scientific technology have teamed up to unravel the strands of infectious diseases that were woven into the tapestry that made up the life of ancient Egyptians. Through analysis of medical papyri, mummies, ethnographic research, and tomb reliefs great insight into infectious diseases and parasitical infections that plagued Egyptian civilization has been found. Numerous parasites and infectious diseases have plagued mankind for centuries and the Ancient Egyptians were not immune. The presence of infectious disease and deadly parasitic infections throughout ancient Egypt is of special interest to archaeologists because it helps to explain community life. The utilization of an interdisciplinary approach aids archaeologists in the ultimate quest of understanding the culture of Ancient Egyptians. Through the analysis of mummies and the identification of diseases and parasites that infected them a more accurate interpretation of not only the people and their living conditions but the climate as well can be obtained.
Archaeologists have unearthed a plethora of artifacts and features in remarkably good condition due to the dry environmental conditions in Egypt. Their findings have given great insight into diseases that plagued Ancient Egyptians and how they treated the ailments. In 1973 the Manchester Egyptian Mummy Research Project was created. Its main purpose was to coordinate a scientific interdisciplinary approach to the study of human and animal remains. In 1995 a collaborative workgroup was formed with the Manchester Egyptian Mummy Project, the Egyptian Reference Diagnostic Centre of the Egyptian Organization for Biological and Vaccine Production and Medical Service Corporation International of Arlington, Virginia in order to create an epidemiological profile of schistosomiasis (bilharzias). Based on research done in 1996 through the worldwide Schistosomiasis Research Project, immunocytochemical methods can now be applied to Egyptian mummies in order to ascertain whether or not shistosomiasis was present in Ancient Egypt. After Egyptologist Armand Ruffer developed a technique to “rehydrate mummy tissue for histologic evaluation” (Harer, 1995: 67), he found an egg of the shistosomiasis parasite in the tissue of a mummy from the XX Dynasty that still had his kidneys. It appears that further evidence of bilharzia infection was found during the autopsy of Ramesses V, who “demonstrated gynaecomastia, enlarged scrotal sac, and an umbilical hernia; all complications of long-term Bilharzia infection” (Sullivan, 1995: 143). Another method of identification of infected mummies that has been utilized is a monoclonal antibody test. This particular test has given researchers the ability to determine if a mummy had been infected with the parasite even when the egg or worm cannot be identified by microscopy.
Analysis of human remains is not the only evidence of shistosomiasis in ancient Egypt. It is important to also examine the literary sources of Egypt that are found in ten medical papyri. Most of the documents date to ca. 1550; however, according to Harer there are a few that appear to be copies of earlier work. The medical papyri outline case studies and provide lists of symptoms, diagnosis, and treatments. The aaa-disease is a condition that is mentioned numerous times throughout the medical papyri. While in hieroglyphs a determinative was used at the end of a word to indicate its meaning; “in medical texts, the determinative which appears at the end of aaa represents a discharging phallus” (Harer, 1995: 225). This led one medical papyri translator to identify aaa as haematuria. This interpretation of the text has led some Egyptologists to claim that since schistosomiasis is a major cause of haematuria in Egypt, that these “references to the aaa-disease prove that the ancient Egyptians specifically diagnosed, identified and recorded this disease” (Harer, 1995: 225). This interpretation has been met with skepticism by others who argue that aaa is not schistosomiasis but rather a poison that was introduced into a person through magic that caused many diseases. Unfortunately, given the various interpretations of the medical papyri, there is no literal confirmation of schistosomiasis presence in ancient Egyptians. The only empirical evidence that has been offered is from analysis of mummified human remains from Egypt.
Analysis of medical papyri also offers illumination into diseases that afflicted ancient Egyptians. The Ebers 875 Papyrus was acquired by George Ebers in 1873. Its origins have been traced to Thebes and it dates to 1555 BC. It contains 876 remedies, uses 500 substances, and has brief remarks on surgical procedures. The Ebers papyrus makes reference to the word dqr, which has been argued by Gardiner to describe a gradual extraction of the guinea worm (Dracunculiasis) from the body by winding it on a stick as shown in figure 1.
Fig. 1

http://www.proteinpower.com/drmike/wp-content/uploads/2007/03/dracunculus.jpg
Gardiner believes that dqr is a rather rare verb that literally means “to press” and “cites its use as a caption for the scenes of spinning at Beni Hasan” (Miller, 1989: 249). Apparently, Gardiner’s interpretation is related to a passage from P. Ebers 875 that he has translated as “thou wilt find it (scil. “the swelling” awt) going and coming, pressing(?) against the flesh that is under it” (Miller, 1989: 249). The Manchester Egyptian Project confirmed the presence of guinea worm disease with the discovery of a calcified male guinea worm in the mummy of a young female, Mummy 1770. The guinea worm disease is caused by ingesting a sand flea from contaminated water and complications of dracunnuliasis range from secondary infections leading to tetanus, septicemia, and gangrene, to chronic inflammation of the tendons or ankylosis of the joints. According to Miller guinea worm disease might be the cause of inflammations of tibias “noted by Wells in 15.2% of 92 ancient Egyptian examples dating from the fourth millennium BC to the first millennium AD. Medical papyri compare extracting the worm to spinning thread, which is depicted in the scene from the tomb of Bensi Hasan (fig.2).
Fig. 2

(Retrieved from Miller, 1989: 250) Furthering the argument that guinea worm disease was prevalent throughout the dynasties of Ancient Egypt is the archaeological evidence of open step wells found in New Kingdom communities at Deir el-Medina and Amarna and ones that date back to the early Middle Paleolithic. Open step wells were used to supply water to the people and they also provided prime conditions for the intermediate host of the guinea worm larvae. “Open wells of a design similar to those associated with low levels of guinea worm transmission in Sudan were widespread in the Egyptian desert by the early Neolithic ca. 10,000 years ago” (Miller, 1989: 253). Fortunately, the guinea worm is no longer a problem in modern Egypt due to accessibility to a safer water supply and better hygiene; however, the guinea worm would have had a dramatic influence on the ancient Egyptian population. There have been many articles written recently about King Tutankhamen from the New Kingdom being infected with malaria. This claim is evidenced by DNA of the parasite Plasmodium falciparum recovered from his body. The finding of “facliparum malaria requires the presence of the anopheles mosquito, which has not otherwise been identified in ancient Egyptian material” (Harer, 1995: 68). This discovery led to the conclusion that since mosquitoes require stagnant water to breed there must have been prime conditions for these insects in ancient Egypt. Studies to identify Plasmodium falciparum were conducted on mummies from the Predynastic to Early Dynastic site of Abydos dating from 3500-2800 BC, and mummies from tombs located in Thebes West, which were used between the Middle and New Kingdom and to the Late Period (ca. 2050-500). Out of 91 mummies tested for the P. falciparum chloroquine-resistance transporter gene using direct sequencing, only 2 samples from the New Kingdom tested positive for the malaria parasite. No other samples from this study of Predynastic, Early Dynastic, or Middle Kingdom Egyptian mummies tested positive for P. falciparum.
Nonetheless, a study of Egyptian mummies from the Anthropological and Ethnographic Museum in Turin, Italy, discovered by Professor Marro on the Italian Archaeological Mission from 1911-1923, uncovered evidence of sickle cells in a histological examination of one of the mummies. There were a total of 20 mummies from the Upper Egypt sites of Assiut and Gebelin examined by Nicoletta Cerutti, Emma Rabino Massa, and A. Marin D. Savoia. The finding of sickle cells has numerous implications to the understanding of the ancient Egyptian population. It is well documented in medical journals that the sickle cell trait is a genetic mutation that is found only in populations that originate in areas where malaria is prevalent. The sickle shape of the red blood cells offers protection from malarial death; however, individuals with sickle cell anemia usually live short lives that end in their 20s. This finding is intriguing; nonetheless, with only one mummy showing the trait, conclusions about the overall population cannot be accurately reached. Further research was also conducted on 80 predynastic mummies from the site at Gebelin located in the Luxor area dating to 3200BC. The most common technique used to identify the presence of Plasmodium falciparum is the ELISA immune-enzymatic assay which tests for a water-soluble protein that a parasitized erythrocyte releases; however in order to use this technique on the mummies being studied, some modifications were required. Out of the 80 mummies only 88% were able to be tested. Of those tested 42% were positive for Plasmodium falcilparum based upon the results from the immunological test. Further evidence of malarial infection in ancient Egypt is evidenced by analysis of the skeletal remains that show signs of severe anemia which malaria can cause.
While a great amount of the research on parasites has been done by the Manchester Egyptian Project on mummies with shistosomiasis and dracunnuliasis, other specific parasitic infections have been discovered.
Since the implementation of the monoclonal antibody test numerous other parasites have been identified including “the liver fluke Fasciola Hepatica, Strongyloides, Dracuncula, Trichinella, Taenea solium, Trichurism, and Echinococcus” (Harer, 1995: 68). Another technique of study that has been implemented is a genetic test that looks at the polymerase chain reaction (PCR) which has allowed “medico-Egyptologists to determine the types of infection that afflicted [ancient Egyptians] and to build a picture of disease migration and prevalence during almost the entire Dynastic period” (Sullivan, 1995: 143). A cranial lesion that is believed to be a tapeworm cyst was found in mummy 22940 from the collection of mummies at the Manchester Museum. Teania and Trichenella spirali infestations were also found in the mummy of the weaver Nakht who lived during the reign of Smenkhkare in the XX
Dynasty.
An interesting anomaly of Egyptian archaeology is an “emphasis on monumental architecture [with] few town sites [that] have [actually] been fully documented” (Zimmerman, 1977: 33). Even though archaeological evidence of towns is limited, what has been documented reveals closely arranged houses and “the makeup of individual households appears to have been fairly consistent throughout Egyptian dynastic history” (Zimmerman, 1977: 33). The lack of documentation regarding sewage systems leads to the interpretation that crowded living conditions with limited waste disposal methods creates a prime environment for the transmission of infectious disease. This conclusion is evidenced by the pathological studies of human remains that have been examined at Dra Abu el-Naga. In this study 25 adults and 5 children were examined using Ruffers technique of rehydration. Unfortunately, this study is problematic because it was not done on a true population from an anthropological perspective, but “rather a somewhat random collection deposited in the tomb over a number of centuries” (Zimmerman, 1977: 34). Microscopic analysis of the vertebral bone of the relatively complete mummy of a child approximately five years old revealed tubercle bacilli (fig.3). Unfortunately, the tomb was not preserved well and the mummies were not a good sample of one population from a specific time period, so drawing conclusions regarding infectious diseases of any dynastic period is virtually impossible.
Nonetheless, the diagnosis of tuberculosis does have implications for Egyptian archaeology.
The close living quarters that have been identified in the sites that have been excavated supports the finding of tuberculosis in the child mummy because that is the precise conditions that allow the disease to be transmitted and thrive. This finding is “indirect evidence of multigenerational rather than bigenerational households in ancient Egypt” (Zimmerman, 1977: 35) and this pattern still persists today. Notably tuberculosis has been identified in the mummy of Nesperhen from the XXI Dynasty and according to Richard Sullivan tuberculosis “was prevalent as early as 3300 BC during the initial herding period of Fayium A” (Sullivan, 1995:
143).
Fig. 3

A child 's vertebra showing signs of tubercular infection Source: V.Easy (http://www.reshafim.org.il/ad/egypt/timelines/topics/medicine.htm) It is very difficult to draw conclusions about cultures in the past; yet, the discovery of DNA analysis and the utilization of new techniques to analyze Egyptian mummies have allowed archaeologists the opportunity to obtain empirical evidence of infectious diseases and parasitic infections in Ancient Egypt. That fact does not undermine the contribution that analysis of archaeological artifacts, medical papyri, and tomb reliefs offer. In order to understand a past culture it is important to look at all the archaeological findings in their context. Unfortunately, for centuries Ancient Egyptian communities were plundered by grave robbers and it has been difficult to find artifacts that have not had their surroundings altered by man’s hands for the only purpose of profit. But, what has been preserved has opened a window into understanding a culture that has been vastly speculated about for centuries. As science evolves and new methodology is revealed, archaeologists expand their knowledge of Egypt. This growth of knowledge and understanding of how diseases and parasites impact societies has relevance not only in past but in the presence. If there is one conclusion that can be drawn from the analysis of infectious diseases and parasites in Ancient Egypt, it is that they were dealing with something that every nation in the world has dealt with in the past and in the present.

Bibliography
Cerutti, Nicoletta, Massa Emma Rabino, Savio, A. Marin D. (2000) Malaria in Ancient Egypt: Paleoimmunological Investigation on Predynastic Mummified Remains. Chungará (Arica). Vol. 32. No. 1.(7-9)

David, A. Rosalie, Lambert-Zazulak, Patricia .L, Rutherford, Patricia. (Oct., 2003) The International Ancient Egyptian Mummy Tissue Bank at the Manchester Museum as a Resource for the Palaeoepidemiological Study of Schistosomiasis. World Archaeology. vol. 35, no. 2. 223-240.

Dittrich, Sabine, Jelinek, Thomas, Nerlich, Andreas G., Schraut, Bettina, Zink, Albert R. (Aug. 2008) Plasmodium Falciparum in Ancient Egypt. Journal of Emerging Infectious Disease. Vol.14. no. 8. 1317-1319.

Gray, P. H. K. (Dec., 1966) Embalmer’ ‘Restorations’. The Journal of Egyptian Archaeology. vol. 52. 138-140.

Harer, Benson W. (1995) Implications of Molecular Biology for Egyptology. Journal of the American Research Center in Egypt. vol. 32. 67-70.

Leek, Filce F. (1985) Review: [untitled]. The Journal of Egyptian Archaeology. vol. 71. 11-12.

Miller, R. L. (1989) Dqr, Spinning and Treatment of Guinea Worm in P. Ebers 875. The Journal of Egyptian Archaeology. vol. 75. 249-254.

Nunn, John. (1996) Ancient Egyptian Medicine. Norman University of Oklahoma Press.

Myers, Micheal, Watson, Elizabeth J. (1993) The Mummy of Baket-en-her-nakht in the Hancock Museum: A Radiological Update. The Journal of Egyptian Archaeology. vol. 79, 179-187.

Sullivan, Richard. (March, 1995) A Brief Journey into Medical Care and Disease in Ancient Egypt. Journal of the Royal Society of Medicine. vol. 88. 141-145.

Todd, T. Wingate. (Oct.-Dec. 1921) Egyptian Medicine: A Critical Study of Recent Claims. American Anthropologist. vol. 23. 460-470.

Williams, G.D. (Oct.-Dec., 1932) Review; [untitled]. American Anthropologist. vol. 34. No. 4. 710-711.

Zimmerman, Michael R., (1977) The Mummies of the Tomb of Nebwenef: Paleopathology and Archaeology. Journal of the American Research Center in Egypt. vol. 14. 33-36.