The Gynaecological Papyrus Kahun

The Papyrus Kahun is oldest known Egyptian medical document addressing issues of midwifery, dating back to the second Millennium BC. Here it follows a study of the papyrus, featuring hieroglyphic text and its transliteration and translation versions. This work also features commentaries regarding the papyrus’medical substances and some linguistic evidences on the intimacy between spiritual and physical spheres in the Egyptian therapeutics. After the papyrus text, there is an Egyptian-English glossary.

The work comprises three pages, is divided into 34 horizontal columns, oriented from the right to the left, that have a common format: begin with a brief report of the symptoms; then, the doctor is advised on how to approach the patient to present his diagnosis and, finally, treatment is suggested. However, no mention is made of the likely prognosis. This process of symptoms, diagnosis, report and treatment described makes up the various sections. Naturally, as in other medical works, Papyrus Kahun refers to an enchantment 5 .
The suggested treatments are diverse and include fumigations, massages, and medications introduced into the body as pessaries or as a liquid to be drunk or rubbed on the skin. Donkey milk and perfumed oils are part of the medical material to be used in these procedures.
The text does not refer to any proposed surgery. The final paragraphs of the text are dedicated to pregnancy, presenting teachings related to conception which include the use of incense, fresh oil, dates, and beer, to contraception, suggesting the use of crocodile manure and also honey and natron and, again, gynaecological treatments.
After the publication of the Papyrus Kahun by Griffith [2] at the end of the XIX century, only in the second half of the XX century, the text is again the subject of study and publication within the scope of the most important investigation of medical papyri coordinated by H. Grapow [4], between 1954 and 1973. A hieroglyphic transcription of the papyrus Kahun is done in volume V and the translation and commentary of the text is presented in Volume IV.
In 1975, J. Stevens [5], presented an English translation of the text, and in 1995, Th. Bardinet, also presented his translation of the papyrus [6] and some comments on the text.
In 2002 Stephen Quirke published his transliteration and translation of the text online [7] and shared that translation again in the work he produces with M. Collier [8] in 2004.
Finally, in 2017, Didier Fournier introduced us to [9], where he performs the hieroglyphic transcription, transliteration, and translation of the papyrus as well as medical comments and lexical, syntactic and semantic considerations to the text. The work also reproduces the text in hieratic from facsimiles proposed by Griffith in 1898.
In addition to the publication and translation of the papyrus, the studies dedicated to the gynecological treatise presented in Papyrus Kahun are also very small. In 1952, C. D. Leake makes the first references in [10]. In 1992, C. Reeves in a small essay [11] also dedicates two pages to it. Four years later, J. F. Nunn in [1] introduces the papyrus and makes some comments on the text. Finally, in 2011, Lesley Smith published the latest article on the gynaecological papyrus Kahun [12]. Other references, in general works, although very reduced, happen in Strouhal, E., Vachala; B., Vymazalová [13], dated from 2014.
There are multiple semantic definitions and explanations for cure. Some of them are also based on mythical systems. In fact, this work assumes that cure is a doublefolded concept. On one hand, the semantic meaning of cure manages to assert a cultural identity and a gender delimitation: Healthy vs. Diseased; Favoured by the gods vs. Abandoned by the gods, etc.
This approach of the Papyrus focuses on the so-called supernatural elements that, by any means are being mentioned in the therapeutics. We understand the separation between magic and medicine was unknown in Ancient Egypt, as they are the product of modern Egyptology problematization. The Egyptian medicine coordinates natural and supernatural elements in their therapeutics. Thus, we shall investigate the ontological specificities of the ancient Egyptian cure process. From the diagnosis to the therapeutics. 3 The Gynaecological Papyrus Kahun DOI: http://dx.doi.org/10.5772/intechopen.98039

On the papyrus
The papyrus was composed in Hieratic, using a simple and direct language. It was probably compiled from some personal notes or a vade mecum.
There are 34 cases, along 3 columns of horizontal text, written from right to the left. Its first column (Figure 1) has 33.5 cm of height and starts the gynaecological tractate. This section has 29 short lines of text in good conditions. The second column (Figures 1 and 2) has 38.5 cm of height and presents heavy damage on the central area of the page, between lines 26 and 59. So, only 7 lines out of its original 30 are complete. The second column also presents longer lines of text than the first one.
The third column (Figure 2) measures 33 cm of height and is also heavily damaged. Its 28 lines of text are the longest of the tractate. However, only one line is complete, from the beginning to the end. This column is divided into fragments A and B. Fragment B is just a small scrap with 4 incomplete illegible lines. Therefore, this work will deal with column 3 -fragment B only.
Another point of interest concerning column 3 is the transition to a totally different style of heading and organization of the treatments. That suggests column 1 and 2 have the same origin, while column 3 was copied from a different source.
For didactical matters, we decided to revert the text direction when we established the hieroglyphic matrix of this version. We also decided to present the source in a format case-by-case for reasons of practicality. The present version of the text was originally built in Portuguese [14], and then, translated into English.

On the therapeutics
The 34 cases described in the papyrus are normally divided into mini-sections with the support of red ink. First, the disease is described. After making the diagnosis directly to the patient, a treatment is given.
The treatment presents the ingredients and, occasionally, the precise dosage of each element. Interestingly, this papyrus gives preference to generic measures, such as "spoon" or "jar". Then, the method of preparing the ingredients is concluded by the way the medicine must be applied to the patient.
Medicines are always taken orally, inserted into the vagina, or applied on the skin using massages or bandages. Fumigation seems to be the most common therapy, always incorporating various ointments with incense. There is great concern about therapy with the patient's uterus. Virtually all the diseases described are somehow linked to an origin in the uterus, and it is through the uterus that they seek to treat them [15].
The translation of this document took care to compare hieroglyphic versions established by British authors with Griffith's (1898) slides of hieratic text. It is interesting to note that all the translations previously cited reproduce the text in hieratic from facsimiles proposed by Griffith.

5
The Gynaecological Papyrus Kahun DOI: http://dx.doi.org /10.5772/intechopen.98039 Hence, we found that the present version promoted "corrections" in the vocabulary proposed by previous works. The reader will find two diagnoses of incurable diseases (cases V and XIII), that are normally left aside by English translations. There is a short discussion on the spiritual dimension on Egyptian medicine (2.4). Further contributions are the identification of ingredients in the materia prima section (2.5), and of the procedure of verifying the patient's arterial pulse mnjⳍ (cases XXIX and XXXII).

P.Kahun as an educational text
From its 34 cases, there are 18 occurrences (1-17 & 25) where the papyrus actually can be used as a didactic textbook. In those texts, there is an approach aiming to guide the reader across each step of the therapeutic process. Such texts adopt the sequential sḏm.ḫr=f("then, he should listen") providing the reader with the "what follow next" for each section. It is possible to summarize this pattern as the following: • A heading to identify each new case (e.g. "A treatment for a woman who suffers A, B, C, etc."). A diagnostic is proposed to the reader. Then, the text concludes the first section with the recommendation: "then you should say to her" and announce the treatment.
• The diagnosis is described via a nominal identification sentence: "Disease-D" pw (this is a disease-D); • Finally, the papyrus proceeds with the next step with the sayings: "then you must prepare for her" (here translated as "(then,) you should treat her), followed by the prescription of ingredients for each case and the right way of its application.
The didactic structure of this papyrus fits with the features of typology 4a, as proposed by [15], from which the table below is based on (

Regarding incurable diseases and spiritual influences
The Egyptian believed that both physical and the spiritual spheres of being were closely linked. The whole physical existence was understood as part of an eternal struggle between the cosmic forces of chaos and order. Simply put, a disease was nothing more than the physical manifestation of spiritual causes.
That said, a disease that was known to be intractable had its existence ascribed to some harmful spiritual force. These forces had several names, which traditionally Egyptologists translate as "demon", although that word does not have a direct equivalent in the Egyptian language.
In this papyrus we find only two therapies mentioning irreversible conditions. The term used to describe them is "bṯw" , that is, a malefactor, according to lemma 10241 in [16]. The determinative (I 14) suggests a spiritual origin for that evildoer, meaning "demon".
That hieroglyph also is used as determinative of several minor spiritual powers [17], likefor instanceⳍkryw (chthonic gods or demons) in the Coffin Texts (II, 112e -Spell 105, S1C). However, it must be remarked the word bṯw is also synonymous with "incurable disease".
Due to a strong tendency to hide or diminish the importance of the spiritual in Egyptian medicine, the anglophone authors consulted translate btw as "worm" [7,8] and "colic" [2], which is simply impossible, given the importance of the term at the conclusion of those cases.
Another connection between the physical and spiritual spheres in the Egyptian therapeutics is the usage of the verb dr. The word means equally "to expel" (case VIII: residuals from the body), "to drive away" (cases XXVIII and XXXIII: "pain") and is synonym with "to exorcize" (demons and disease demons) in the dictionary, lemna 39117 [16]. Generally speaking [3,17,18], a disease whose origin is ascribed to a spiritual origin sometimes can also/only be treated through magic formulas and prayers. Those incantations, or "heka" are normally dedicated to gods or minor spiritual entities, which would also be translated as "demons", but which are not necessarily evil forces. In this document, there is only a single case of enchantment, in the form of a prayer to Horus (case XXX), but the text is too damaged to let one understand exactly the possible usage of that magic formula.

On the medical materia prima 6
The prescriptions of this papyrus normally combine ingredients of vegetal, animal and mineral origin in their different estates (solid, liquid, etc). Ingredients of mineral origin occur in less variety and those of animal origin are even rarer. There are multiple ways of preparation: fumigation, ingestion, etc.
It is possible to divide the medical materia prima in two greater groups, by distinguishing ingredients of anthropic nature (it needs to be manipulated and transformed by man) versus ingredients that can be found in its natural milieu [18]. Thus, the Egyptian pharmacopeia is composed by hundreds of products collected and/or transformed from local flora and fauna.
In fact, Egyptian vegetal ingredients are mostly related to endemic specimens, However, out lack of knowledge about the Egyptian vegetal world posits a great obstacle to connect Egyptian names to actual plants. Therefore, traditional works by Egyptologists keep the Egyptian names untranslated [1,18,19].
A small lexicon follows, which complements the glossary at the end of this work. Vegetal • Vitex (vitex agnus castus). Case XIII -Its leaves, flowers, seeds and roots can be consumed with food or as an elixir. There is clinical evidence that it works to treat premenstrual tension [20].
• White Mullbery (Morus alba). Cases X, XII e XVI -Its extract has several medicinal properties. Here we highlight its effect with antibacterial, and in the treatment of hyperuricemia [21].
• Onion. Case XXVIII • Beer. Case VI (to avoid it) • Sweet beer. Cases XX e XXIV • Fermented/ardent beer. Case X -Normally that term is translated as "djadjatbeer". It is a beer, fermented in some specific way. As the term djadjat is synonymous with "ardent", it can be a particularly strong beer.

• Fruit (any). Cases III e XVII
• Fruit of the Onenu-tree. Case XX -Thus far an unidentified tree.
• Fruit of Egyptian balm (Balanites aegyptiaca). Case XVI -It was necessary to resort to the Hieratic text to propose the replacement of the unknown term for . The sacred "ished" is a mythical tree referred to in the Book of the Dead spell 335. That passage mentions that it grows in the domain of the gods. A possible translation of "ished" is pistachio (Pistacia vera). However, the Egyptian balm is still used in Africa as a medicinal plant. It is employed to fight parasitic infection, headaches and liver disorders. Plus, its fruit is also indicated for stimulating lactation, while the bark of the tree is a natural abortive [22,23].  [18]. The mineral was used as a pigment for the green colour. In Egyptian, the same word can be used for naming "vigor", "vitality" and "freshness". Thus, by consuming the green pigment, one also acquired the properties that the magic pun (rebus) [24] provided in via "sympatheia".
• Unidentified origin • Emetic. Case XI (Its ingredients are not described) • Fresh fat rancid oil. Case XII (It is not clear whether the fat is animal or vegetal).  Treatment of a woman whose eyes are aching till she cannot see, on top of aches in her neck: 2 you should say to her: " it is discharges of the womb in your eyes!". You should treat her: 3 fumigate her with incense and fresh oil, fumigating 4 her vulva with it, and fumigating her eyes with goose leg fat. 5 Then, you should give her to eat a fresh donkey liver.

Index of cases
No. II 5 šsⳍw s.t mr n(j) 6 jd.t=s m ḫp(j) ḏd.ḫr=k r=s ptr ssn.t(=ṯ) jr ḏd=s n=k jw=j 7 ḥr ssn.t ⳍšr ḏd.ḫr=k r=s nmsw pw n jd.t jr(j).ḫr=k r=s 8 kⳍpsjḥr ssn.t=s nb.t m ⳍšr Translation 5 Treatment of a woman in pain. Her 6 womb does not deliver (its period). You should say to her: "What do you smell?". If she says to you: "I 7 smell some roasting." Then you should say to her: "This is some effusion of the womb!". You should treat her: 8  Then, you should treat her: 1 qd of chufa (cyperus esculentus), 1 qd of fruit, 1 hin of 11 cow milk. Boil, let it cool down, 12 17 : after fumigating her with incense in a djadjaw-pot, pour on her 18 [ … ] the urine of a donkey that has "created its second" the day after it was feed. 19 If her pain is situated from the bellybutton to her buttocks, it is a demon (untreatable).
No. VI

Some final remarks
The ancient Egyptian medical papyri are an important source to understand the Egyptian approach to health treatment. Ancient Egyptian therapeutics were as equally familiar with pharmacy as they were with medicine and incantations. Thanks to the medical papyri, we know details about many of their treatments and prescriptions for diseases. They call for the treatment of many disorders and the use of a variety of substances, plant, animal and mineral.
However, the essential nature of Egyptian healing is deep-seated on religious notions. Hence, magical practices are wholly integrated with empiric-rational approaches to form an integrated but multi-faceted medical therapy.
Traditionally, Egyptology reproduces ideological prejudices regarding the ancient Egyptian medicine empiricism. All supernatural elements are normally treated as mere superstition or, in the best cases, a tool for some placebo effect. On the other hand, though a neurolinguistic approach it becomes clear how intimate was the relation between physical health and spiritual order (in opposition to the cosmic forces of chaos).
One of the main problems on dealing with medical papyri is that they usually do not check or advance with the study of the provided vocabulary. An interesting point for the benefit of Egyptology would be the review of all medical papyri in search of better information about their technical vocabulary, pharmacopoeia, medical substances, and the like.
Such study also considers the proposition of an ontology and semantic analysis. Per definition, ontology, describes the concepts of medical terminologies, practices, and the relation between them, thus, enabling the sharing of medical knowledge. Ontology-based analyses are associated with a tool to represent medical knowledge, thus relying more on the computer science-based understanding of medical terms. This approach is useful for a data entry system, in which the users merely need to browse the hierarchy and select relevant terms.
The language (logos) is the key for a culture's mentality (nous). Thus, it is impossible to deal with language without analysing the thought it's portraying. A Semantic approach aims for the real-world scenario of dealing with grammatically complex terms, which are documented in the ancient Egyptian native language.
The essential nature of Egyptian healing links religious notions and so-called magical practices wholly integrated with empiric-rational approaches to form an integrated but multi-faceted therapeutic.
There are three points to be debated by our source' analysis. Firstly, the usage of a noun, usually translated as "demon", as a synonym for incurable diseases. In case the word is taken literally, then the treatment would be incomplete. Since a "demon" could have been identified and/or exorcized, the therapeutics rather closed the case and move on. Thus, it is most likely the term is here employed as a "harmless" technical term for an untreatable condition.
Secondly, there is a verb, which is synonym with "exorcizing" (evil spirits), although it is here employed in the technical sense of dismissing pain and the expelling of any material residuals from the patient's uterus. By the second time, the term assumes a non-magical usage as a technical jargon. Then, the materia prima identifies a magical ingredient: malachite powder. This ingredient would act via the principle of sympatheia, as it would restore one's health, thanks to a magical pun (rebus) relating malachite, the green colour, and the Egyptian word for "vigor" and "freshness".
Finally, another case shows a fragment of a prayer to Horus in its therapeutics; listed as part of the recommended treatment.
During the preparation of this conclusion, our first impulse was to reduce the words "demon" and "to exorcize" as metaphors, embedded by something as an Ancient Egyptian medical terminology. Then, oppose them to the hymn to Horus and the malachite powder as "magical" elements. However, that would just replicate our prejudice against Egyptian medicine, as we would reproduce the labels of "natural" and "supernatural" as necessary and antagonist categories.
The lack of exorcisms, indexes of demons and magical ingredients (such as amulets) does not "purge" the papyrus from its divine, mythical and magical aspects. The concept of cure is different from the semantic field of the word cure. The cure also performs a transcendent effect, for it changes the patient's destiny. Such effect presupposes some previous formal divine consent.
Therefore, the therapeutics consists of attempts to change the individual destiny. Thus, the transcendent world was unequivocally behind the success or failure of any medical treatment.