The most common consequence of such extreme tooth wear and exposed dental pulp were abscesses. Studies by the Manchester Mummy Project showed that in twenty-nine male bodies there were seventy-two abscesses and in twelve females studied there were forty-five abscesses. This clearly was a widespread problem with many people having more than one. Treatment was limited to pain relief or draining, as the Ebers Papyrus informs us: ‘a disease that I treat with a knife treatment … If anything remains in pocket, it recurs.’82 ‘To expel growth of purulence in the gums; sycamore fruit, beans, honey, malachite and yellow ochre are ground and applied to the tooth.’ To drain an abscess, the physician cut it and let the pus drain out.83 Sometimes the doctors were too late and the abscess had started to destroy the jaw bone as it created a path to eject the pus. Mummy studies have shown teeth have fallen out of abscess cavities, as well as cavities caused by periodontal disease, indicating dentists did not perform extractions, even in extreme circumstances.84 This is based on the absence of forceps of the type found in the Roman Period, as well as conclusive results from examining the holes left in the jaw bones.85 It is possible, however, that teeth could have been removed by hand should they become loose, or even the old-fashioned method of tying string around a loose tooth and slamming a door.
The only real evidence of extraction can be seen on a mummified head in the Australian Institute of Archaeology dated to the Graeco-Roman Period.86 The head belongs to a young boy who died at approximately eight years old. The head was examined in order to try to age it, which showed that a number of teeth were missing that may have been removed in order to practice orthodontics. The missing teeth of particular interest were the upper molars, both the primary and the un-erupted pre-molars. The lack of bone where the tooth should be indicates there was once a tooth there and not that it was a congenital abnormality. Examination of the teeth show, had all the teeth been present, the canines would have protruded forward once grown, but the removal of the pre-molars would have enabled them to grow in a more natural position. If these teeth were removed for orthodontic reasons it indicates the Graeco-Roman dentists were familiar with dental growth patterns, and were confident enough to perform the surgery without adequate anaesthetic. It is, however, highly likely that the young boy died as a result of this surgery, probably as the result of infections. Until more examples of this process are identified, such surgery cannot be suggested as the norm at this time.
In cases of extreme tooth pain, the Ebers Papyrus suggests using bitter apple (colocynth), cumin, turpentine (terebinth), cow’s milk, earth almonds and evening dew as pain killers. It has even been suggested that in the New Kingdom opium was imported from Western Asia to be used as a pain killer in tall-necked jars.87 In some cases these cures may have made the infection worse, although cumin is known to have antiseptic and local anaesthetic properties.88
The Egyptians, while having extreme attrition, had very few caries (decay) as their diet was low in sugar. However, a change of diet during the Ptolemaic Period to one high in sugar and carbohydrates saw an increase in dental caries in mummies of this period.89 During the Pre-Dynastic Period, caries were present in about 3 per cent of the population, rising to 7 per cent by the end of the Ramesside Period and as high as 20 per cent in the Ptolemaic Period.90 As caries are diet related they affected the upper echelons of society rather than the lower levels.91
The Egyptians believed caries were formed by the tunnelling of the fnt-worm, or tooth worm, and Papyrus Anastasi IV identifies the problem of untreated caries; ‘All the muscles of the face dance, catarrh gets into his eyes, the worm gnaws as his teeth.’92 There is no evidence that dentists performed fillings and therefore caries continued to grow until they reached the inner pulp of the teeth, allowing bacteria to get into the tooth, resulting in further abscesses.
Another common ailment was periodontal disease (gum disease), which is caused by a severe build-up of plaque; this could result in loss of bone structure, and therefore the support for the teeth.93 With no real knowledge of the benefits of oral hygiene, other than dealing with bad breath, this affected many people.
Important dentistry evidence can be found in the form of two bridges found near Cairo. One was discovered at El-Quatta in the remains of a crushed skull. The bridge was between a central and lateral incisor and a right canine. The central incisor also had a groove on the labial side to accommodate the wire comfortably within the mouth. Calculus on the canine and associated teeth suggests to some that the bridge had been worn for some time. However, due to the alignment of the roots in the bridge, food would have got trapped under them, causing irritation, indicating the bridge had not been worn. Additionally, the gold wire holding the teeth together may not have been strong enough for day-to-day wear caused by chewing. It is suggested that these teeth were dislodged during the mummification process and the bridge made to hold the teeth in place for the wrapping.
The other bridge was discovered in Giza, and comprised a second and third molar connected with a gold wire. Examination of the teeth have identified that they are not from the same mouth as the wear on the third molar is greater than that on the second, which would have erupted first. As with the El-Quatta example, the gold thread was not strong enough to hold teeth in a working mouth.94
The ancient Egyptians cleaned their teeth using toothbrushes made of the frayed end of a twig, as the highly polished appearance of the teeth of mummies suggest. They also used cinnamon breath fresheners and chewed on natron to cleanse the mouth. Cloves were used for pain relief, as were beans ground up with willow. Willow forms the basis of modern aspirin and may therefore have been affective in deadening the pain a little.
What is rather surprising is that although most people suffered with extremely painful dental problems the Deir el-Medina absentee records show the workmen did not take days off due to toothache,95 although nearly 100 days were taken off for illness.96 Recent studies have uncovered a mummy from Deir el-Medina who suffered from osteomyelitis, a bone inflammation caused by a blood-borne infection. It was clear that he continued to work regardless of the pain and discomfort. Perhaps their pain threshold was higher than modern individuals’, the pain was considered normal and something to be ignored or, it has been suggested, there was a great deal of state pressure to remain at work regardless of health.97 One record states, ‘the boss does not order the sick to lift the stone,’ indicating sickness was, however, a legitimate reason for absenteeism.98
Through the examination of mummies it is possible to identify how unhealthy an average Egyptian was and how many of the ailments mentioned were suffered by one person. The mummy of Asru, a chantress of Amun in the temple of Amun at Karnak (900 BCE), is a wonderful example. Her mother also held the same title and it is assumed she was of noble birth. She was buried in two highly decorated coffins and her body was extremely thin upon discovery, although she had been mummified to a high standard. Her mummy was examined by the Manchester Mummy Project, who discovered she suffered from four parasitic worms: ecchinoccus (dog tapeworm), which had caused a twenty-centimetre cyst on her lung, strongyloides, schistosomiasis and chrysomyia in the brain. These four parasites would have caused Asru numerous symptoms.
The ecchinoccus worm, probably contracted through contact with a domestic dog, perhaps a pet, was discovered in the lungs and would have caused breathlessness, pleurisy and possibly live worms in her stools. This breathlessness was exacerbated by Asru’s sand pneumoconiosis, a common disease associated with the inhalation of the wind-blown sand of a desert environment. This may have added a nasty cough to her symptoms.
Strongyloides, caught through walking barefoot through infected water, caused bowel problems, with blood in stools, chronic diarrhoea, and anaemia. About a quarter of the remedies in the medical papyri are for stomach problems, although they did not address the causes, just the symptoms; ‘Another for the purging of the belly and to drive out suffering from the belly of a man. Fruits/seeds of ricinus (castor-oil plant) chewed and swallo
wed with beer so that everything which is in the belly comes forth.’99 It has been suggested that this was a cure for either constipation or diarrhoea, which are both plausible.
The schistosomiasis discovered in her bladder was contracted through a water snail in stagnant water and can lead to blood in the urine. Eventually her bladder would start to calcify, causing water retention, swelling, pain, exhaustion and sickness. Blood in the urine was a common problem for Egyptians and the Ebers Papyrus has a remedy ‘to make normal again the urine of a man who has excessive blood’, which includes a drink of beer with tiger nut, peret-cheny fruit and beheh plant.100
The fourth parasite, chrysomyia, was discovered in Asru’s brain, where it had caused a cyst that no doubt caused headaches at the very least.
In addition to these four parasites, Asru had osteoarthritis in her fingers and there were numerous telltale changes to her joints. She had calcification in the aorta, the bronchi and the lower legs and feet, and a few years before her death she fractured her lumbar vertebrae and the bone had regrown over this area. Increased calcification of the spine in the lower region connected with this old injury would have sent sciatica-like pain down her left leg due to pressure on the nerve endings of the spine.
Her dental health was no better, as many of her back teeth were missing and she had suffered from painful toothache for most of her later life. There was a serious infection in her jaw, with damage to the bone around the roots of her teeth caused by abscesses rotting through the bone itself. Her remaining teeth were extremely worn with the associated sensitivities.
While it is hard to imagine living with the pain of one of these ailments, it is impossible to imagine the pain and discomfort of all of them at one time. It is impossible to identify what Asru died of, although she was in her fifties or sixties, which at the time was considered elderly. Such a variable array of ailments was not unique to Asru, and really does raise the question of the ancient Egyptian tolerance for pain and perhaps lack of concern at blood in urine and stools. While the Egyptian doctors were well known around the world, a large number of their ingredients would have hindered rather than helped the healing process of many ailments and there were no doubt many deaths caused by infection rather than the initial disease. However, once a terminally ill patient had endured the tinkering of a physician he was at least ensured a long, peaceful and prosperous time in the afterlife.
9.
DEATH AND BURIAL
‘Old age is the time of death, enwrapping, and burial.’1
As discussed in the previous chapter, by the age of thirty-five an ancient Egyptian was considered elderly. Women, on the other hand, were considered old when they were no longer able to bear children. Rameses II wrote a letter to Hattusili III, the king of the Hittites, discussing this very subject;
Concerning what my brother has written to me regarding his sister Matanazi; ‘May my brother send to me a man to prepare a medicine so that she may bear children.’ So has my brother written. And so I say to my brother; See Matanazi, the sister of my brother, the king, your brother knows her. A fifty year old. Never. She’s sixty. Look a woman of fifty is old, to say nothing of a sixty year old. One can’t produce medicine to enable her to bear children.2
There were three words in the Egyptian language for old: iau and teni, which appear to be similar and may bear the same distinction as between old and elderly in modern English, and the third word, kehkeh, refers to the physicality of old age and may mean something like ‘hacking cough’.3 The afflictions of old age are reflected in the discovery of a number of walking sticks at Deir el-Medina, one of which was inscribed, ‘Come my stick, so that I might lean on you and follow the beautiful West, that my heart may wander in the Place of Truth.’4
Although the concept of old age occurred earlier than in the modern age, the ideas and stereotypes surrounding the elderly is remarkably similar. The opening paragraph of the ‘Instruction of Ptahhotep’ (fifth dynasty) describes old age;
Old age is here, high age has arrived,
Feebleness came, weakness grows,
Childlike one sleeps all day.
Eyes are dim, ears are deaf,
Strength is waning, one is weary,
The mouth silenced, speaks not
The heart, void, recalls not the past
The bones ache throughout.5
While Ptahhotep emphasises only the physicality, the wisdom of old age was also greatly revered. In the Westcar Papyrus the magician Djedi is greeted by the Prince Hardedef in reference to his advanced years: ‘Your condition is like that of one who lives above age – for old age is the time of death, enwrapping, and burial – one who sleeps till daytime, free of illness without a hacking cough.’6
In a community with no state-run care system it was essential for people to have many children in order for someone to provide for and care for them in old age. In a situation where a couple were childless it was not unusual to adopt an orphan or an older individual who then had the responsibility of taking care of their adoptive parents. It is difficult to identify whether there was an official adoption system, as the same terminology was used for adoption of a child or an apprentice. However, the implications were the same. It was the filial duty to be a ‘staff of old age’, and without children an elderly man or woman could be rendered helpless within the village. In the ‘Instruction of Ptahhotep’, a fifth-dynasty vizier asks the king, ‘May this servant be ordered to make a staff of old age and let his son step in his place.’7
The eldest son or ‘staff of old age’ supported their father throughout his life, and enabled him to essentially retire; as Amenemhat, a high priest of Amun from the reign of Amenhotep II, explains, ‘I was a priest and a “staff of old age” with my father while he was living on earth.’8 Some children played the role well, and one son, Weskhetnemtet, after taking over his father’s role, gave him over half his salary for ten months, and on festival days he offered the use of a maidservant, clothes, honey, meat and oil.9 Another son, the workman Usekhnemte, sent numerous items to his father, including cakes, meat, fat, honey and clothes. The total given to his father was more than half of his own monthly rations. However, not all children were as accommodating. Papyrus Insinger has a passage which indicates should the parent act foolishly then the children are allowed to abandon them. However, this was not the norm, although some children did not carry out their filial duties to the required standard.
Here we turn to the case of Naunakhte, a woman living in Deir el-Medina in the twentieth dynasty. She was first married to the scribe Kenherkhopshef, who was perhaps forty years her senior when he died and left her a widow. They married when she was perhaps only twelve years old and he was in his fifties. It is also thought that he adopted her as a daughter,10 in order to enable him to leave all his possessions to her when he died rather than the legal third she would receive as a widow. He died when he was eighty-six years old and Naunakhte was in her late twenties.
Her second marriage was to the workman Kha’emnun,11 and they had eight children together:12 four sons who were all workmen, called Maaynakhtef, Kenherkhopshef, Amennakhte and Neferhotep; and four girls, Wosnakhte, Man’enakhte, Henshene and Kha’nub.13 There is little surviving evidence of the life of Naunakhte, other than her will, which is of particular interest to us here. This document disinherits four of her children, Neferhotep, Man’enakhte, Hen-shene and Kha’nub,14 for neglecting her in old age, meaning they would only receive their share of two-thirds of their father’s wealth and nothing of her third. ‘As for any property of the scribe Kenherkhopshef, my husband, and also his landed property and this storeroom of my father and also this oipe of emmer which I collected in company with my husband, they shall not share them.’15 The other four children had obviously provided for her, perhaps giving monthly rations to her. To ensure this document was legally recognised Naunakhte took it to the knbt (see chapter seven), in year 3 of Ramses V (1142 BCE). In front of fourteen members of the workforce at Deir el-Medina sitting
as judges, she announced her reason for the will was neglect.
As for me I am a free woman of the land of Pharaoh. I brought up these eight servants of yours, and gave them an outfit of everything as is usually made for those in their station. But see I am grown old, and see they are not looking after me in my turn. Whoever of them has aided me, to him I will give of my property but he who has not given to me, to him I will not give any of my property.16
The document was recorded by the scribe Amennakhte, the same scribe who recorded the Turin Strike Papyrus (discussed in chapter six). Naunakhte gave one of her sons, Kenherkhopshef, ‘a special reward, a washing bowl of bronze over and above his fellows, 10 sacks of emmer’. It seems that he was a good son and in his own document he promises to take care of his father in old age: ‘If I take away the ration of my father my reward shall be taken away.’17 Her husband Kha’emnun stated at the knbt, ‘As for the writings that Naunakhte has made, concerning her property, they shall be carried out exactly as prescribed.’18 This indicates he thoroughly agreed with her reasons for disinheriting her children and was to respect her final wishes. However, situations like this can result in the children contesting the will, and a year later her husband Kha’emnun was back at the knbt with his children;
As far as the writings are concerned which the citizen Naunakhte has made about her things, they are thus exactly, exactly. The workman Neferhotep will not share in them. He will take an oath with the Lord (life prosperity health) saying: ‘If I turn back on my word again, he shall receive a hundred blows and be deprived of his things’.19
Another example of a contested will was the case of Tgemy, who was married to the workman Huynefer. In her will she names her son Huy as the recipient of all of her goods, as he was the only child who was able to take care of her burial. When Huy died he left part of this inheritance to his son Hay, but Tgemy’s other children came forward to claim their share, hoping the first will was forgotten. Their challenge was even brought to the knbt, only to be overthrown by the court officials.
Lost Voices of the Nile: Everyday Life in Ancient Egypt Page 22