Handout from Paula Veiga - Oncology in ancient Egypt – London, November 16th, 2018

Our knowledge of oncology in ancient Egypt is derived from three main sources:

• Study of human remains: these can be both mummified and skeletonized bodies and fragments. Most of our
information comes from the later source (bones).
• Visual art or iconography: Ancient Egypt has left us with a wealth of visual art, some of which depict
diseases.
• Literature: medical and magical papyri (complete and fragmented) and ostraca.
The Ebers Papyrus’ Treaty of Tumours is a series of prescriptions that are thought to be reminiscent of a 'Book of
Tumours’ of ancient Egypt, but which also deals with benign masses, polyps, cysts, varicose veins and aneurysms.
Some references are made to evidence found in Egyptian human material in various locations in Egypt that reveal the
presence of tumours. The knowledge about medical practices in ancient Egypt was not acquired through
autopsies or the study of human bodies as it is today; the embalmers learned about the human body and the doctors,
swnw, learned their craft in the Houses of Life, studying from the knowledge compiled in ancient texts.
Many names of internal organs are made from the butcher's and cook's crafts (Strouhal 1992: 243-245). Some
hieroglyphic determinants used to describe human body parts and pathologies use the characteristics of animal
body parts and this explains why they were more familiar with animal bodies (mammals) and knew that they
would not be very different from human bodies.
Since the legacy of the bodies of ancient Egypt consists of mummified and skeletonized whole bodies and fragments,
analysis of soft tissues is practically out of the question for diagnosis of these diseases, since it is very difficult to
remove this information, given the state of preservation of bodies.
All the diagnoses to the present are controversial; what has been published since 1825 until today makes us conclude
that, being the average age at death of 36 years, that the tumours mainly affected young people. Nasopharynx and
uterus carcinomas were the most common.
Some medical articles and professional literature attest that EP referrals known as 'The Tumour Treatise' are
considering the cases described as cancers (Lunghi 2002: 11).
Strouhal finds a correlation between knowledge of the common occurrence of the tumour, including the malignant,
and these ancient Egyptian medical papyri: Ebers (EP), Hearst, and Kahun (Strouhal, 1981). Just as a curiosity, none
of the Egyptian mummies (170 complete bodies and several pieces as heads and limbs) belonging to the
Czechoslovakian collections studied by Strouhal and the radiologist Vyhnanek showed some signs of malignant
pathologies; most of the pathological discoveries in these were extreme tooth wear and other dental conditions (very
common in ancient Egypt), also osteoporosis, osteophytosis, and degenerative arthritis. (Strouhal, 1992) 248,
(Strouhal 1980b: 25-129).
Different types of tumour appear to have been identified or are indicated as such by medical papyri.
The ancient Egyptians thought that the body contained mtw, channels, and that these were both the carriers of bodily
fluids and were subject to obstructions that resulted in disease. The mtw, can be interpreted as muscles and tendons,
the vessels and ducts of the body together with the substances that flow through them such as blood, snf and urine wsS
(Nunn 1996). Comparisons were drawn between these and the Nile, its tributaries, and its flow. As Ghalioungui states,
quoting Marti-Ibañez, ‘the physiology of ancient Egypt stated the existence of conduits in the human body to carry the
blood and humours, where obstructions caused floods in some parts of the body and droughts in others (...). But the
mtw, that conveyed health, could also carry disease’ (Ghalioungui 1973, 57).
Meningiomas
Rogers (1949) described two skulls, one from First Dynasty and another from Twentieth Dynasty, showing
hyperostosis probably produced by meningiomas.

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Carcinoma of the breast (Edwin Smith papyrus):
This is the main surgical papyrus of ancient Egyptian Medicine, mainly dealing with trauma. However, case 45 is
probably carcinoma of the breast, it reads:
“If thou examinest a man having a bulging tumours on his breast, (and) thou findest that swellings have spread over
his breast; if thou puttest thy hand upon his breast upon those tumours, (and) thou findest them very cool, there being
no fever at all therein when thy hand touches him; they have no granulations, they form no fluid, they do not generate
secretions of fluid, and they are bulging to thy hand…Swellings on his breast are large, spreading and hard; touching
them is like touching a ball of wrappings; the comparison is to a green hemat-fruit, which is hard and cool under thy
hand, like touching those swellings which are on his breast.” (Sweha, 1986).
Gynaecological neoplasm:
This is considered the gynaecological medical papyrus of ancient Egypt. Case 2 deals with foetid vaginal discharge:
“..What is the smell that thou emittest. If she says to thee, “I am emitting the smell of roast meat,” then thou shalt say
as to it, it is nemsu uteri. Thou shalt do for it thus: Fumigate her with every sort of roast meat the smell of which she
emits.”
This is possibly a case of neoplasm (Sweha, 1986). Neoplastic pathologies theoretically only appear in advanced ages.
Since in ancient Egypt the average life expectancy was between 30 and 40 years, these types of pathologies should not
be present in the populations. (Nunn, 1996); (Estes, 1989: 46-47); (Rowling, 1961)
According to a study carried out in 1972, the average life expectancy of the ancient Egyptians was approximately
36 years in the dynastic age and 30 years in the Pre-Dynastic era. Mortality in young adults was extremely high in
both periods (Masali and Chiarelli, 1972). Infant mortality was also very high but, of those who survived and became
20 years old, two-thirds would live on average until the age of 45 and less than half of them would reach 65. This
indicates an aging population, a group that shows a high incidence of tumours.
Although computerized tomography (CT) may reveal different layers of tissue, and objects such as amulets, revealing
bones depending on their location, relative to their position in the carton, when dealing with a still bandaged mummy,
little or no evidence of soft tissue is found. There are, however, more examples of bone tumours detected in the
mummies of ancient Egypt, but nonetheless they are a minimal number compared to the present statistics. (Harris
2007: 201).
The concept of a tumour in ancient Egypt, according to other authors, searching for mummies of ancient Egypt in
1956-59 (Marcsik, 2000), distinguishing between simple ulcers and tumours, makes no distinction between benign
and malignant tumours. Descriptions of the EP and Hearst mention tumour, sfw. But the notion of tumour designates
both tumour and swelling (Gyula, 1974), (Nunn 1996: 168). The lower incidence of cancer in ancient Egypt appears to
have been due to several factors: shorter life expectancy, and absence of carcinogenic factors in the environment
(Nunn 1996: 64). Both the environment and diet are factors to be considered in the analysis of cancer in ancient Egypt
(Ebeid 1999: 114). Other authors say that cancers in ancient Egypt would be detected in individuals of high social
strata because their diet and sedentary lifestyle made them more amenable to this type of pathology, and that these
cancers must have been incurable. (Halperin, 2004). Some cases appear to be malignant tumours. Zimmerman also
says that, 'there are only a handful of tumour records in ancient human remains' (Zimmerman, 1977). We can now add
a few more discoveries thanks to the development of techniques and studies done on excavated material that would
not have been available before.
So how can we explain that the EP has so many prescriptions for the treatment of 'bumps' that are interpreted as
tumours?
There are reasons to think that, from studies done in the EP, the existence of oncology would be a fact in ancient
Egypt. Doctors in ancient Egypt would already have information that would enable them to diagnose and treat cancers,
although literary sources do not clearly describe how they distinguished an abscess from a pustule or a neoplasm
(Temkin, 1938); (Meyerhof, 1926).
And although the material remains of tumours found at various sites in Egyptian mummies are not extensive, they are
nevertheless considerable, and include many examples (Brothwell, 1981) (Strouhal, 1999) (Ruffer, 1921) 1980),
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(Spigelman, 1997), (Van Hasselt, 1999), (Estes, 1989), (Capasso, 2005), (Leslie and Levell, 2006), (Halperin, 2004),
and (Mark, 2006).
In 2006, 28 cases of malignant neoplasms of ancient Egypt and Nubia were reviewed by an Italian team that stated an
important fact; the occurrence of malignant tumours represents the quantification of the excavation activity in the
region (Gamba, 2006). This does not mean, of course, that the greater the digging activity in Egypt, the more cases of
tumours are revealed, but it is an indicator that, although this population may have been less exposed to these
pathologies, there is also a shortage of material for study. Not only because this disease is difficult to detect in ancient
tissues (including bone) but also because not everything has yet been excavated.
The analysis of 44 cases of malignant tumours provides more information about the age, professional position,
geographic location and gender of individuals, as well as the specificity of the tumour (Giuffra, 2006). Nerlich et al
also identified 39 malignant tumours in human remains of ancient Egypt (Nerlich, 2006).
If carcinomas were common in ancient Egypt, we could detect them in the mummies of older individuals (Halperin,
2004). The examinations already carried out, and a few more that will continue to be done in Egyptian mummies soon,
will provide more material on which we can base ourselves for the interpretation of these pathologies. Many
excavations continue in Egypt and present-day Sudan and these may reveal human remains, and this will be a source
of valuable information for Egyptologists and physicians to find more information on hitherto incurable pathologies.