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The Mediterranean Journal of Otology

REVIEW

Otology in Medical Papyri in Ancient Egypt

Albert Mudry, MD

Correspondence Ancient Egyptian medicine evolved in a unique environment. Three main


Albert Mudry, MD historical sources are available for the study of ancient Egyptian medicine:
Avenue de la Gare 6
CH-1003 Lausanne, Switzerland
papyri, human remains, and visual art. The goal of this work was to com-
E-mail: amudry@[Link] pile a repertoire of ancient Egyptian medical treatises on the ear and its
diseases and to comment on them. Ear diseases and treatments are men-
tioned in 4 major papyri (the Ebers papyrus, the Edwin Smith papyrus, the
Paper presented at: Fifth Congress
of the European Federation of Oto-
Berlin papyrus, and the Kahun papyrus), in 2 minor papyri (the Leiden
Rhino-Laryngology Head and Neck papyrus and the Vienna papyrus), and on 1 ostracon (potsherd), which is
Surgery; September 11-16 2004; displayed in the Louvre. Those texts, which are the first written sources of
Rhodos/Kos, Greece otology in the history of medicine, are of great interest and include clear-
ly defined descriptions of the principal symptoms of ear diseases (hearing
loss, ear discharge, tinnitus, and ear pain). These ancient treatises show
Mediterr J Otol 2006; 3: 133-142 that the ear symptomatology of antiquity was not really different from that
of the present day.

Copyright 2005 © The Mediterranean


Society of Otology and Audiology

133
The Mediterranean Journal of Otology

Egyptian medicine evolved in a unique originals but are copies of copies that contain all the
environment. The geography of Egypt is like that of no mistakes and changes, additions, and omissions that a
other country in the world, and it formed the basis for tradition of revision over many centuries necessarily
the historical and cultural events that allowed a involves. Nevertheless, they provide descriptions of a
sophisticated system of medicine to develop and to be wide range of symptoms and illnesses that can be
recorded from the third millennium BC. Egypt is a child studied.
of the Nile. The term "ancient Egypt" refers to the Ear diseases are described in 4 major papyri (Ebers,
period between 3050 BC and 642 AD. The beginning of Edwin Smith, Berlin, and Kahun), in 2 minor papyri
recorded history is marked by the unification of Upper (Leiden, Vienna), and on 1 ostracon (potsherd) that is
and Lower Egypt under the first king of the First now housed in the Louvre. A description and
Dynasty. During the period predating 323 BC, the year commentary on each of those works is provided in this
of the invasion of Egypt by Alexander the Great, 30 report. Whether these texts were considered important
dynasties succeeded with varying levels of importance. at the time of their creation, whether they were
That era is referred to as "Pharaonic Egypt." The period characteristic of standard medical practices of their day,
from 323 BC until 642 AD is classified as the Greco- or whether they represented alternative medicine or the
Roman period(1). peculiarities of a certain school of treatment remains
The ancient Egyptians have been justly credited for unknown(3).
their medical knowledge. In the study of ancient
medicine, information from a variety of sources
Ebers Papyrus
contributes to a more complete picture of the diseases
The Ebers papyrus (550 BC) is said to have been
that afflicted specific populations. Egypt offers a range
found in a tomb with the Edwin Smith papyrus in 1862
of biological, written, and artistic ancient sources. By
by Edwin Smith. In 1873, Professor Georg Ebers
far the most important collection of knowledge of the
brought that eponymous papyrus to the University
ancient world is contained in medical papyri. Other
Library of Leipzig, Germany(4). The Ebers papyrus is a
sources are also important because they attest to the
complete compendium of medicine with a well-defined
variety and epidemiology of ancient diseases. The goal
and dignified introduction of 20.23 meters and 108
of this study was to compile a repertoire of ancient
columns of 20 to 22 lines each. In 1875, Ebers published
written sources that describe the ear and its diseases and
a facsimile edition of this papyrus. Later, individual
to comment on those texts.
parts of the papyrus were subjected to examination by a
The medical papyri of ancient Egypt are the oldest
variety of investigators, including Wreszinski, in 1913.
known written sources of medicine. The texts were
The papyrus was translated by Ebbell in 1937(5) and was
written in a hieratic language rather than in
partially reprinted after examination by Wreszinski.
hieroglyphics; this render their content more accessible
Ebbells’ translation is probably not perfect, but it is the
. Eight major and 5 minor medical papyri have been
version most used in English. In several places, the
catalogued date(2). Each is named for the site of its
Ebers papyrus describes its content as a "compilation"
current display or for the first owner or the editor of first
of recipes and remedies against various symptoms, and
publication. The oldest of those treatises is the Kahun
there is much evidence to show that it is a copy of
Papyrus, a gynecologic text. Establishing the exact date
various ancient works. However, this compilation was
of that work is difficult and remains a topic of debate
not undertaken casually but was written according to a
among experts (cut away). Establishing the exact date of
definitive and carefully considered plan, and care was
that work and each of those papyri is difficult, and
taken to include the greatest variety of diseases that a
remains a topic of debate. In addition, no author of any
physician would treat. The content of the Ebers papyrus
of the papyri is mentioned, and those texts are not
is used as the foundation for the knowledge of ancient

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Otology in Medical Papyri in Ancient Egypt

Egyptian medicine(6). The ear is mentioned in many Eb. 767. What is done to treat effluence that is sent
sections of that work, some of which are presented in out from an ear: if it (the ear) exudes from its interior an
literal translations below. effluence like ks (dirt ?), (and) if it flows over with
humor like paster water, then thou shalt go round it with
a hpt-knife to the limits of all that decays in it; thou shalt
Treatments for Diseases of the Ear (Cut away)
prepare for it: oil, honey, seed-wool, (which are) placed
Ebers Papyrus
within it and applied to a fillet of linen and (the ear) is
Eb. 764 (Ebers papyrus, section 764). The beginning
bandaged therewith, until it is healed (Figure 1).
of remedies for an ear whose hearing is poor: red ochre,
juice of tamarix, are ground fine with fresh balanite oil
and applied to the ear.
Eb. 765. For an ear that emits a fetid humor:
frankincense with goose fat, cream of cow, issued (?) bdt,
are ground fine, mixed together and applied to the ear.
Eb. 766. To treat the ear; thou shalt treat it with cold
remedies, let it not be hot. If the (ear-) canal is painful
(?); thou shalt prepare for it: chip of malachite, which is
ground and applied thereto for 4 days; afterwards thou
shalt prepare for it: seed-wool oil 2/3, honey 1/3 is
applied to it many times. If its opening discharges, then
thou shalt prepare for it powder to dry a wound: juice of
acaria, juice of Ziziphus, fruit of willow, cumin, are
ground and given for it; if meanwhile it grows fatty
(xerotic), then thou shalt prepare for it remedies against
dryness of wounds: head of shrewmouse, mndr
(stomach) of a goat, shell of a tortoise, thyme (?), are
dusted on it very often.
Thou shalt do similarly as for a finger that is broken
and whose bone marrow flows to the ground; this is the
treatment of an ear that is split on stt sw (the vault?), Figure 1. Ebers Papyrus, sections 764-767 (from Ebers
(but) that does not fall to the ground: thou shalt prepare G. Papyrus Ebers)
for it a knotted net of flax and tie (it) up there with and
sap of sycamore, so that it (the ear) fastens to his (the
patient’s) blood; oil and honey not being applied to it. Eb. 768. Remedy for a bewitched ear w’f nf rjt:
Thou shalt cut one side of it (the ear) so that its blood balanite oil /, frankincense /, shpt /, is infused into the
may come down one side. Let it not suppurate at all. ear.
Now when thou hast perceived that it has grown Eb. 769. Another (remedy): shpt /, frankincense /,
together, then thou shalt prepare for it: oil and wax that northern salt, likewise.
are melted, and (the ear) is bandaged therewith, not
Eb. 770. Another (remedy) to dry an ear that emits
applying (too) much. Thou shalt apply to it the same as
humor: red ochre /, cumin /, ear of an ass /, finest oil /,
(to) every effluence from its splitting. If it passes on to
balanite oil /, likewise.
decay (necrosis), then thou shalt prepare for it a string of
Eb. 854 e. As to « that through which the ears
linen, tied on the back of his head.
become deaf »: there are 2 vessels that affect it, (namely)

135
The Mediterranean Journal of Otology

the ones leading to the root of the eye; another lection: ancient Egyptians. Some authors consider Ebers
to the whole eye. When he is deaf, his mouth cannot paragraph 768 to be the first mention of tinnitus, but a
opened (ie, he cannot speak). Another lection: as to « recent publication called into doubt the validity of that
that through which the ears become deaf »: it is these interpretation(14). In the remainder of this report,
(vessels) that are on the temples of a man hr nssw; it is translations of remedies for ear diseases from the papyri
these (vessels) that give a cutter in a man, so that he (the and the ostracon previously cited are presented with
cutter) takes for him his air? comment (cut away).
Eb. 854 f. There are 4 vessels to his 2 ears together
with the (ear) canal; (namely), 2 on his right side and 2 Edwin Smith Papyrus
to his left side. The breath of life enters into the right
The Edwin Smith papyrus (1600 BC) was
ear, and the breath of death enters into the left ear;
discovered with the Ebers papyrus and other documents
another lection: it (the breath of life) enters into the right
by Edwin Smith in a tomb in 1862 and remained in his
side, and the breath of death enters into the left side.
possession until his death. His daughter presented it to
The Ebers papyrus has various interpretations. the New York Historical Society in New York, New
Stevenson noticed that the eustachian tube was York (cut away), in 1906. This papyrus is a large
recognized in the statement that the breath of life passes fragment (4.68 meters). It consists of 21.5 columns; 17
by the right ear (7). This concept is probably a spiritual (377 lines) columns are on the recto, and 4.5 (92 lines)
concept and not an anatomic one, as it is in another text, are on the verso. In 1930, Breasted published a
Eb. 855a, which states « As to the breath which enters translation of the Edwin Smith papyrus papyrus, which
into the nose: it enters into the heart and the lung; these is partially reprinted below(15). The Smith papyrus
give to the whole belly ». Pahor discusses the association pertains primarily to the treatment of wounds and
of the eustachian tube with 1 of the 4 vessels of the ear(8). fractures but also contains medicomagical incantations
Kamal associates the 2 vessels of the ear with the and prescriptions. The Edwin Smith papyrus is
external and internal auditory canals(9). Politzer’s considered to be the world’s first surgical treatise(16).
comment about these various interpretations of the Remedies for diseases of the ear that are listed in the
Ebers papyrus is interesting: “Since the language of Edwin Smith Papyrus are featured below.
these papyri is several thousand years old, identification
Sm 8, 18-22 (Edwin Smith papyrus, instructions
of anatomical detail is almost impossible”(10). The use of
18-22) (case 23). Instructions concerning a wound in his
a knife to treat ear discharge is also confusing. Pahor
ear. If thou examinest a man having a wound in his ear,
associated that treatment with a diagnosis of necrotizing
cutting through its flesh, the injury being in the lower
otitis externa(8) as the result of a translation by
part of his ear, (and) confined to the flesh, thou shouldst
Ghalioungui of decay by necrosis(11). This correlation is
draw (it) together for him with stitching behind the
may be incorrect, however, because the French
hollow of his ear. Thou shouldst say concerning him: «
translation by Bardinet(12) and the German translation by
One having a wound in his ear, cutting through its flesh.
Grapow(13) mention that according to the Ebers papyrus,
An ailment that I will treat ». If thou findest the stitching
the interior of the ear is tumefied. This could lead us to
of that wound loose (and) sticking in the 2 lips of his
suspect that the disorder requiring treatment with a knife
wound, thou shouldst make for him stiff rolls of linen
is probably a furuncle of the hearing canal.
(and) pad the back of his ear therewith. Thou shouldst
Unfortunately, in that example the exact site of incision
treat it afterwards (with) grease, honey, (and) lint every
is not mentioned. It is almost impossible to try to
day until he recovers (Figure 2).
correlate the descriptions given in the Ebers Papyrus
This is the only case in the Smith papyrus that
with current diagnoses of ear diseases. Diagnosis,
pertains exclusively to the ear, although a number of
however, is not a part of the medical concepts of the
injuries to the head (qv, cases 4, 5, 7, 8, 13, 17, 21, and

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Otology in Medical Papyri in Ancient Egypt

Figure 2. Edwin Smith Papyrus, cases 21-28 (New York Historical Society, New York, NY, USA)

22) have ear involvement. The use of stitches to treat a The text is extremely faulty, sometimes to the level of
open wound is clearly explained in the description of unintelligibility. Some sections of the Berlin papyrus
placing the 2 lips of the wound together to ensure pertain to the ear.
healing. Bln 70 (Berlin Papyrus, section 70). Fumigation
(to chase) the deafness provoked by that which comes
Berlin Papyrus 3038 ( or Brugsch papyrus) from outside: cat dung, crocodile dung, swallow
droppings, doe’s horn. Fumigate the person with all of
The Berlin Papyrus (1200 BBC) is a well preserved
this.
manuscript found at (cut away) in a jar 10 ten feet under
the ground at Saqqara, Egypt. This papyrus was brought Bln 71. Other (fumigation), to chase away a dead
with the Passalacqua Collection to Europe in the early that find itself in an ear: khet-des tree, scorpion dart,
19th century and was deposited in Berlin. It has 25 dorsal fin (literally « which is on the back ») of a
pages (3 of which are on the verso and were written by cynodont. Use as before.
a second hand) with a total of 279 lines and 204 recipes.
A lithographic facsimile of the Berlin Papyrus was ashe
published in 1863 by Brugsch, who also gave his name
Bln 163g. There are 2 mt on the back of his head,
to that treatise(17). Wreszinski published the first correct
there are 2 mt on his front, there are 2 mt in his eyes,
translation in (cut away) of this papyrus in German in
there are 2 mt in his eyebrows, there are 2 mt in his nose,
1909(18). The content of the Berlin Papyrus is very
there are 2 mt in his left ear, through which the breath of
similar to that of the Ebers and Hearst papyri, and it
life enters; there are 2 mt in his right ear through which
includes several passages duplicated from those works.
the breath of death enters.

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The Mediterranean Journal of Otology

Bln 200. Remedy to expel dullness in ear: ink Bln 204. (…): Seeds of pyrethrum, 1/64; cumin,
(plant), 1 (part) ; resin of terebinth, 1; celery, 1; bread of 1/64; peret-cheny fruit, 1/64; seed from ârou tree, 1/8;
offering (?), 1; ox bile, 1; make into a pellet and put into ânkh-imy plant, 1/4; melilot, 1/32; acacia leaves, 1/3 ;
the ear. (…) of djai, 1/64; honey, 1/8; light beer, 15 ro. Reduce
Bln 201. Another remedy for lancinating pain in the to ashes. (This) will be drunk by the person.
ears: melilotus; make into ointment with laudanum. Put Some information in the Berlin Papyrus has been
in ear. plagiarized from the Ebers Papyrus. According to the
Bln 202. Another (remedy): fresh ben-oil, 1 (part); Ebers papyrus, the breath of life enters the right ear; in
Nubian mud, 1; seeds of melon, 1; to be put into the ear. the Berlin Papyrus, it enters the left ear. That difference
has not been explained but may be either an error
Bln 203. Another remedy for a lancinating pain in
introduced during the transmission of knowledge over
the ear: Galena (collyre noire) 1 (part); cream (?) to be
centuries (the Berlin Papyrus predates the Ebers
put into the ear (Figure 3).
Papyrus by almost 350 years) or a deliberate difference
of opinion. The interpretation of the Berlin Papyrus also
led to speculations by Pahor, who equated the described
"dullness" of the ear with Menière’s disease(8). Once
again, it is impossible to correlate the given descriptions
with actual diseases.

Kahun Papyrus
The Kahun Papyrus (1900 BC) was discovered in
1889 at Kahun in the Fayyum district of Lower Egypt.
Although fragmentary, it contains portions of 34
sections (all of which are gynecologic disorders that are
sometimes associated with symptoms from other
organs) and a section on veterinary medicine(12).
Kah 8 (Kahun papyrus, section 8). Description
(medical) concerning a woman affected in the neck,
pelvic region, and the ears (in such a way that) she is
unable to hear that which is said. (That) what you
should say about this subject: "It is the uterine
substances (called) neryou. (That) what you should
prepare for this: the same remedy as for chasing away
the uterine substances (called) sehaou.
In the excerpt above, the writer states that an ear
disorder can be a manifestation of another disease. No
actual disease can be inferred from that description, but
Figure 3. Berlin Papyrus, sections 200-203 (from
the concept of associating all the symptoms together in
Wreszinski W. Der grosse medizinische Papyrus der the same entity is new.
Berliner Museum, Berlin, Germany)

138
Otology in Medical Papyri in Ancient Egypt

Leiden Papyrus 348 Vienna. Probably dating from the second part of the
The demotic Leiden Papyrus 348 (1291-1185 BC), second century AD, this papyrus consists of 16 partly
which dates from the 19th dynasty(19) and includes preserved columns of text of which there is an almost
references to both magic and medicine, was discovered complete column concerning ear treatments (Book D,
at Memphis with other papyri pertaining to different Col. x + IX and x + X)(20). Ten prescriptions (9 pertaining
subjects. It was bought by the Dutch government in to ear symptoms and 1 devoted to swelling of the parotid
1828 and was first studied by Brugsch. The papyrus has gland) are recognizable (lines 28-34).
13 columns on what is now its recto and 12 columns on
its verso. One column on the verso mentions ear Dem Wien (Demotic Vienna Papyrus) IX, 17-19
treatment. The following text is excerpted from the
Treatment for humming in the ear. Apply a red stalk
translation by Griffith and Thompson(20).
to his hearing organ; sap of black reed; take measure of
Verso col IV. Medicament for an ear that is watery. herbs of any kind 1/10: salt, hulwort in chip(s), oles-
Salt, heat with good wine; you apply it after cleansing resin, oily ointment, sap of lotus 1/4; to be triturated
(?) (the ear) first. You scrape salt, heat with wine; you finely; to be applied to it. Another (prescription): fresh
apply it for 4 days (Figure 4). medicinal oil of rose; to be strained; to be applied to it.

Demotic Vienna Papyrus 12287 Dem Wien IX, 19-24.


The Vienna demotic Papyrus was purchased by Treatment of acute pain in the ear. Another
Theodor Graf in the latter part of the 19th century. Also (prescription) for recovering from acute (pain in the
described as a medical book from the Fayyum ear). ( )… ( ); to be triturated finely; to be applied to
(Crocodilopolis), this papyrus is a part of many other it. Another (prescription): radish, reed ( ); to put it into
papyri displayed in the Austrian National Library in one; to place 1 bowl at its mouth, there being 1 (dose of)

Figure 4. Leiden Papyrus, verso column IV (Leiden Museum)

139
The Mediterranean Journal of Otology

oil ( ) his mouth. How art to place ( ) to fumigate his Dem Wien IX, 35-37.
(ear) 1 bo(wl (…), while it steams away; to heat Treatment of hardening of the ear. The physician’s
underneath it till (reed) to his ear. To the pipe to enter feat (even) his (method of) awakening (the) hearing: the
the stream into it. Another (prescription): wild water Persea tree, natron ( ), medicinal oil according to the
cucumber, thorn acacia, cannabis undivided; to be prescribed measure. « Eating every heart » which is to
triturated finely; ( ) (to’ one) ear of them. Here are 2 befall. The physician’s feat (even) his (method of)
pipes ( ) bowl to his ear, to one of them. Thou art to awakening (the hearing), water 1/2 of liquid measure; to
sprinkle into the other? Another (prescription): hulwort, be triturated finely; to be strained; to be drunk for 5
black reed ( )…, iris, mecon; to be applied to it. days. It is usually made for the man who removes ( ) (
Another (prescription): hot wine milk
n ; to make it hot; to be applied to it.
Dem Wien IX, 38.
Treatment of the worm in the ear. The physician’s
Dem Wien IX, 24. feat that makes the pnty (hof worm) to settle down
Treatment of disturbance in the ear. Another (Figure 5).
(prescription): for recovering from a disturbance in the
ear ( ). Juice of mulberry; to be applied to it.

Dem Wien IX, 24-25.


Treatment of the sny – disease of the ear. Another
(prescription) for recovering from the sny – disease (of
the ear) the ear: real cereal, shoot of raspberry; to make
it hot; to be applied to it.

Dem Wien IX, 25-26.


Treatment of putrefaction. Another (prescription) for
drying up the putrefaction in the ear: poro-oil, heated Figure 5. Vienna Demotic Papyrus, column IX (Austrian
National Library, Vienna, Austria)
cadmia to be triturated finely to be applied to it. Water-
parsnip according to the previous (methods). Another
(prescription): mouse’s dung, hot wine; to be applied to
it. Another (prescription): myrrh, ebony, cc-drug. It is Different points are relevant in this papyrus. As in
beneficial. the Ebers Papyrus, ear pain is expressed by various
descriptions of the symptoms, and putrefaction in the
Dem Wien IX, 26-27. ear is attributed to chronic inflammation of the ear, such
as that caused by worms. This notion of chronic disease
Treatment of disturbance in the ear. Another
is also found in the Ebers Papyrus (Eb. 765) when
(prescription) for recovering from the disturbance in the
treatment for fetid humor is described. The bandage
ear (when) the putrefaction is in it: oleo-resin, cc-drug,
applied to the ear was probably used to retain the
crushed golden thistle; to be triturated finely; to be
formulation in the ear. Almost all the different ancient
applied to it. A bandage is made in hot water for any
methods of treating ear diseases are mentioned here:
kind of ailment in the ear.
local application of a dry or hot preparation, local
fumigation, and a drinkable solution. Also of interest is

140
Otology in Medical Papyri in Ancient Egypt

the order of description used in this papyrus, which is may he see as ye see; may he stand as ye stand; may he
similar to that used by Galen (book XIV, 330). This fact sit as ye sit » (23).
leads one to suspect that a common source of medical
information was used by the Egyptians and was
CONCLUSION
disseminated throughout the ancient world through the
channel of Alexandria(21). The medicine of ancient Egypt undoubtedly
occupies an important place in the history of
medicine(24). The texts described in this report are the
Ostracon 3255 (Musée du Louvre, Paris, France)
first written sources of otology in the history of
Isolated prescriptions are rare, but a few have been medicine. The interpretation of these texts is sometimes
found on ostraca. One such ostracon (1550-1185 BC), difficult because it is necessary to try to interpret each
which dates the 18th and 19th dynasties and is now disease in the context of the era in which it is described.
displayed in the Louvre Museum, contains 2 Only symptoms were known in ancient Egypt, and the
prescriptions for the ear (22). symptom was the disease!
O Lv (Ostracon Louvre). A doe’s horn, finely When we try to correlate symptoms with an actual
ground. Another fumigation similar to this: crocodile diagnosis in ancient medicine, the risk of error is great.
droppings, frogs’ spawn; fumigate the ears (with this). A In addition, some of the remedies used then are
tortoise shell; fumigate the ear (with this) (Figure 6). unknown to the modern world. Treatments changed as
more clinical information about ear diseases and
disorders became available. Nevertheless, the medical
papyri of ancient Egypt are of great interest because the
principal symptoms of ear diseases (hearing loss, ear
discharge, tinnitus, ear pain) are clearly defined. These
treatises show that ear symptomatology in ancient Egypt
was not really different from that of the present day. In
these papyri, anatomic knowledge is nearly absent.
Embalming and mummification usually did not involve
the careful preservation of an organ as intricate as the
ear (7). The different otologic texts found in these papyri
Figure 6. Ostracon 3255 (Musée du Louvre, Paris, show that otology (and medicine in general) was not a
France) component of a scientific system but rather of an
empiric one. In an approach different from that of
current medical treatments, ancient remedies were based
Unfortunately, the beginning of that text is missing; only on clinical descriptions and were not correlated
thus, it is not possible to know the indication for the use with known defined diseases.
of those preparations. It is clear, however, is (cut away)
that the remedies mentioned are to be used to treat an ear
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