BJU International (1999), 84, 755–761
HI S T OR I C A L R E V IE W
The urology of Pharaonic Egypt
A.A. SHOKEIR and M.I. HUSSEI N*
Urology and Nephrology Center, Mansoura University, and *Department of Psychiatry, Cairo University, Egypt
Introduction
This review attempts to reconstruct the history of urology
in ancient Egypt. It is logical to assume that people who
had achieved suBcient knowledge and skill in engineer-
ing to erect such structures as the Pyramids, and whose
mathematical knowledge involved the use of complex
calculations and acquaintance with the principles of
cubic capacity, angles, decimals and square roots, must
have been advanced in other fields of intellectual endeav-
our, including medicine [1].
Sources of knowledge of Egyptian medicine
Most of the reliable knowledge of Egyptian medicine in
ancient times has been derived from three sources: (i)
the medical papyri; (ii) the statues, engravings and
paintings on the walls of temples; and (iii) palaeopatho-
logical studies.
The Papyri
Ancient Egyptian books were rolls of papyrus, made
from the plant Cyperus papyrus, a sedge, that grows wild
throughout Egypt. The stems were stripped of their outer
rind and pith, cut into slices and arranged vertically and
transversely in overlaying rows. This was pressed into
one sheet. The horizontal fibres were on the recto side
and the vertical on the verso. There are only 10 papyri
still extant which deal with medical matters: the Ebers,
the Edwin Smith, the Berlin, the London, the Hearst, the
Kahun, the Chester Beaty, the Carlsberg, the Zoega
medial papyrus and the Ramasseum papyri [2]. Only
five of these papyri contain information about urology.
Statues, engravings and paintings
Statues depicting cretinism, poliomyelitis and various
orthopaedic deformities are displayed in the Egyptian
museum in Cairo, and in other museums worldwide.
Engravings of Egyptian patients with abdominal swell-
ings, umbilical hernia and scrotal swellings are also
Accepted for publication 6 July 1999
© 1999 BJU International
displayed in temples and tombs, and on statues. The best
surviving illustration of a urological procedure is the
engraving depicting circumcision (discussed later); cir-
cumcision is apparent on the phalli of statues of the
pharaohs.
Palaeopathology
One of the principal sources of knowledge of ancient
Egyptian diseases is the study of mummified tissues, i.e.
palaeopathology. This study was first introduced by the
French scientist Fouquet and was continued by G. Elliot
Smith and F. Wood Jones [1]. Sir Marc Armond RuCer
treated the mummified tissues with a solution of an alkali
(sodium bicarbonate) combined with a hardening reagent
(alcohol or formaldehyde). The mummified tissues, when
immersed in this mixture, gradually swell to their former
shape and regain their flexibility. RuCer identified and
described the normal structures of the kidneys and the
testicles. He also discovered some pathological conditions,
e.g. urinary calculi, atrophic kidney, multiple renal
abscesses and schistosomal nephropathy [3].
G. Elliot Smith discovered the first vesical stone taken
from a mummy, among the pelvic bones of a young
person who lived during predynastic times (before 4800
BCE) [1]. RuCer also described three vesical stones weigh-
ing 30, 24 and 12 g and measuring 4.5, 3.4 and 2.5 cm,
respectively. One stone was pear-shaped, one globular
and one triangular; they consisted of mixed phosphatic
and uric acids, common enough in Egypt at that time
[1]. Three other stones were discovered in a mummy of
predynastic origin and found opposite the first lumbar
vertebra; because of their position Badr assumed that
these were renal calculi [1].
The ancient Egyptian medical system
The ancient Egyptian medical system, although associ-
ated with religion, mysticism and priestly magic, is to
some extent similar to the modern medical system, in
that both depend upon the study of anatomy and
pathology, and provide clinical descriptions of diseases
and specific measures for treatment [1]. A study of
Egyptian medicine shows that, even by the highest
755
756 A. A. SHOK EIR and M .I. HU SSE IN
orthodox modern standards, it was highly advanced.
However, it is clear that modern methods of investigation
reveal only one aspect of Egyptian medicine, i.e. scientific.
It is equally clear that Egyptian medicine was as much
an art as a science and the secrets of this art are
inaccessible to analysis. The testimony of ancient sources
refers to the Egyptians as the healthiest race of the
ancient world.
Herodotus, the ‘father of history’, noted the practice
of specialization among Egyptian physicians, stating that
‘the practice of medicine they split into separate parts,
each doctor being responsible for the treatment of only
one disease. There are, in consequence, innumerable
doctors, some specialized in diseases of the eye, others of
the head, others of the stomach, and so on; while others,
again, deal with the sort of troubles which cannot be
exactly localized [2]’. In the tomb of an eminent man
who lived at Saqqara during the time of the pyramids,
we find his title, i.e. ‘priest of Selkis, goddess of magic,
royal physician, and interpreter of a diBcult science’ [4].
The court was served by a specialist who designated
himself as ‘palace eye physician, palace physician of the
belly, one understanding the internal fluids, and a guard-
ian of the anus’. Egyptian physicians had ranks, e.g.
generalist, specialist, chief of physicians, inspector of
physicians, superintendent and ‘greatest physician’ of
Upper and Lower Egypt [5].
Case presentations, particularly in the Edwin Smith
Papyrus, are systematic and meticulous. Every case starts
by the words ‘information regarding . . .’ suggesting the
history of the disease, then an examination follows and
starts with ‘if you examine a patient with . . .’, then the
physician expects the prognosis of the disease by writing
one of the following expressions: ‘I will treat’, ‘I will
fight’, or ‘I will not treat’, and finally the treatment is
described [6].
Philologists have translated a few of the Egyptian
papyri that discuss medical subjects. These translations
confirm the existence of medical literature and a fairly
extensive pharmacopoeia in ancient Egypt. Treatment
was oCered on a rational basis and it was in co-operation
with nature, i.e. a diet was prescribed for the patient,
strict hygienic regulations were enforced and medic-
aments were administered. When ordering a drug, the
Egyptian not only gave the name of the drug, but
stipulated the quantity needed and advised a method of
preparation.
Egyptian knowledge of schistosomiasis
Schistosomiasis was first recorded in the oldest papyrus
of Kahun (1900 BCE). It was named ã-a-ã disease, the
hieroglyphic script of which is presented in Fig. 1. The
phallus symbol was used to represent any fluid emitted
a a a
Fig. 1. Hieroglyphic script of haematuria referring to schistoso-
miasis (ã-a-ã disease) as it appears in Kahun papyrus.
from the penis and in this case it is possible to represent
haematuria [7]. To the ancient Egyptian physicians, the
symptom was always regarded as the disease. As haema-
turia is the chief symptom of urinary schistosomiasis,
Kamal assumed that it refers to this disease [8]. The
disease was mentioned 50 times in the medical papyri, i.e.
28 times in the Ebers, 12 in the Berlin, nine in the Hearst
and once in the London papyri. Kamal presumed that
these frequent mentions indicated an endemic disease [9].
A causal relationship to a verminous parasite named
‘hr wt’ is reported in prescription 62 of the Ebers papyrus
(1550 BCE) [10]. The hieroglyphic script of that prescrip-
tion and its English translation is given in Fig. 2. Several
clinical symptoms were mentioned for the disease in the
Ebers and Berlin papyri, including haematuria, frequency
of micturition, painful micturition, eCects on the anus,
abdominal pain, diarrhoea and blood in the stool, cardiac
disturbances and mental weakness. These symptoms
represent both urinary and intestinal bilharziasis. The
cardiac disturbances and mental weakness referred to in
the papyrus possibly represent a picture of chronic
anaemia [11]. Engravings of Egyptian patients with
abdominal swellings, umbilical hernia and scrotal swell-
ings are displayed at the tombs of Ptah-Hetep and
Ankha-ma-Hor in Saqqara (Fig. 3). These probably rep-
resent the late manifestations of bilharzial hepatic fibrosis
with ascites [6].
Several drugs for the treatment of schistosomiasis were
described in the Ebers, Berlin and Hearst papyri. These
included palliative drugs, i.e. sedatives (Hyoscyamus),
antispasmodics (ammi-visnaga), diuretics (juniper and
beer) and colon evacuation (caster oil). In the Hearst
papyrus, prescription 83, antimony (inset) was men-
tioned for the first time as a treatment for schistosomiasis
[11] (Fig. 4). Ancient Egyptians also pioneered the pre-
vention of this disease by discouraging people from
polluting and contacting polluted water. One of the
confessions noted in the Book of the Dead reads: ‘I have
not waded water’ [12].
Egyptian knowledge of bladder tumour
Ancient Egyptians were one of the first people to recog-
nise urinary bladder tumours as disease entities called
‘bn wt’, the hieroglyphic script of which is shown in
Fig. 5, as it appears in the Edwin Smith papyrus [13].
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 U ROLOGY OF P HAR AONIC EG YP T 757

irrt/ m/for iht/useful

^ phrt/remedy
^ kt/other
prepare

sms/chams isw/rosseuisou ht/belly

^ n/for

ns/man wnm/eaten hrbyt/cooked

^ nw/ground
in honey

htf/his belly m/in hrwt/worm nwt/who

(has)

stn/ kma/produce â a â/haematuria n/it

they not (is)

nbt./all phrt/remedy
^ n/not mt/killed

Fig. 2. Prescription 62 of the Ebers papyrus showing the aetiology and intractability of schistosomiasis. As it reads (from right to left), it
characterises the disease (haematuria), causative parasite (worm in belly), some herb therapy (chams and rosseuisou) and a comment on
its intractability; (they are not killed by any remedy). From [11] with permission.

Badr assumed that the inclusion of an erect phallus in genitourinary tract [14]. However, Faulkner’s dictionary
Fig. 5 indicates the characteristic hardness of tumour of middle Egyptian (the recognized reference) translates
tissues in general, as well as its possible reference to the ‘bn wt’ as ‘hard sandstone’. Bladder tumours were also

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758 A. A. SHOK EIR and M .I. HU SSE IN

mentioned twice in the Chester Beaty papyrus [15]. The a

ancient Egyptian words ‘dyjt’, meaning lower urinary
tract disturbances, ‘hdbw’, signifying severe burning
during micturition, and ‘nnw’, denoting marked dysuria
in the male, may be understood as indicating vesical
irritation caused by tumour [11,14,16]. RuCer, in his
palaeopathological studies, described a tumour of the
bony pelvis of a 20th dynasty mummy, and reported the
possibility of it being metastatic from a primary tumour
in the bladder [3].

Egyptian knowledge of nonsurgical treatment of

some urological disorders
Among the urological conditions described in the papyri
are retention of urine, enuresis, incontinence and cystitis
syndrome.
b
Retention of urine
Of the 24 paragraphs in the Ebers papyrus dealing with
urological diseases, 10 are devoted to retention of urine,
which was called ‘accumulation of urine’. The principal
symptom noted was pain in the lower abdomen caused
by the inability to pass urine. Various treatments were
advised to regulate the act of micturition (Ebers papyrus
261, 262, 263, 270, 271 and 283) [10], and these
prescriptions were described as preparations ‘to regulate
or put in order the act of micturition’. Incomplete
retention was also discussed and this condition was
known to culminate in absolute retention. Prescription
262 of the Ebers papyrus details the treatment of reten-
tion of urine in an infant [1,10].

Enuresis and incontinence
The word ‘dja det’, used in connection with urinary
disease in an infant, implies continuing or ongoing, and
Badr assumed that it means enuresis [1]. Prescriptions
273, 274 and 275 in the Ebers papyrus describe a
treatment for ‘stopping the urine when it is very frequent’
[1,10]. Possibly this is the earliest mention of inconti-
nence in the history of medicine. The treatment varied,
but generally consisted of a combination of a vegetable
substance and a mineral salt in a fluid vehicle such as
water, beer or honey. In the Edwin Smith papyrus a
case is described (passage 31) in which subluxation of a
cervical vertebra caused paralysis of the upper and lower
limbs, incontinence and priapism [1].
Fig. 3. a, Abdominal swelling and umbilical hernia in a boatman
(temple of Ptah-Hetep in Saqqara). b, Scrotal swelling in a farmer
(temple of Ankha-ma-Hor in Saqqara). From [11] with permission.
with painful micturition. This phenomenon is referred
to by the word ‘hdbw’. In such cases the urine was
described as contaminated by mucus, pus and blood. A
similar condition is described in the Hearst papyrus. The
treatments are referred to as ‘prescription for treatment
of ‘hab’ (burning) in the bladder’. In the Berlin papyrus,
prescriptions 143–147 apply to the ‘elimination of acute
pain during micturition’; such pain was described as
violent and severe. Dawson suggested that the condition
referred to is prostatitis [17].

Cystitis syndrome Egyptian knowledge of urological anatomy

Three prescriptions in the Ebers papyrus are suggested The practice of embalming the dead aCorded the
to relieve burning pain in the bladder, which is associated Egyptians at least a superficial knowledge of the structure

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Fig. 4. Prescription 83 of the Hearst papyrus, in which antimony (inset) is mentioned to treat schistosomiasis. From [11] with permission.
of the human body. The embalmer took care not to
injure the internal organs, particularly the heart, which
was regarded as the abode of the soul and the seat of
the intellect. The belief was that ‘no mutilated person
could enjoy the blissful life of the future world’. Egyptian
knowledge of anatomy provided the basis for the proper
study by the Greeks.
A king-physician named Athotis, son of king Menes,
the founder of the first dynasty, and the author of a
manual on anatomy, but nothing is known of its contents
[6]. Professor J.H. Breasted, who first described the Edwin
Smith papyrus, maintains that this papyrus aCorded
evidence that anatomy was studied for its own sake and
that this document is, in the true sense, a scientific
medical book [13].
Only a little was known about urological anatomy.
The whole urinary tract was not specifically referred to
as a system, but the individual parts of the tract were
mentioned in some way. There is no hieroglyphic word
in the medical papyri for kidney. The words ‘depet’,
‘geget’, ‘geret’ and ‘gelet’ all signify loin. Some authors
support the opinion that the Egyptian physicians con-
sidered the kidneys to be very important organs, because
Fig. 5. Hieroglyphic script of tumour (bn’wt) as it appears in the
Edwin Smith papyrus.
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U ROLOGY OF P HAR AONIC EG YP T 759
the embalmer left the kidneys in the body, as for the
heart, indicating that special significance was attached
to these two organs. If the kidneys were undesirable,
they would have been removed with other viscera. Other
authors believe that the kidneys were left behind in
ignorance, because their retroperitoneal location made
them inaccessible in the normal evisceration that was
part of mummification. The ureters (mt) were referred to
as vessels. The description 854n in the Ebers papyrus
reads: ‘there are two vessels which conduct urine to the
bladder’. There is no mention of a specific term for
ureter. Every tube that carried a fluid or secretion was
called a vessel [17]. As the Egyptian physicians knew
that the ureters conveyed urine to the bladder, Kamal
assumed that they also knew that the kidneys were the
source of that urine [9]. However, in most references it
is stated that the role of the kidneys was completely
ignored.
In paragraph 864 of Ebers papyrus, the bladder was
definitely mentioned (chyptyt) and described as a separate
organ located in the frontal portion of the abdomen
[18]. The urine itself was noted separately, named ‘moyt’,
and considered a clean fluid. One of the magical treat-
ments reads: ‘thou art a servant who cometh in vomitus;
thou art a noble who cometh in urine’ [1].
Egyptian knowledge of urological surgery
Mummies and statues occasionally show scars in the
lumbar region, possibly indicative of previous surgery.
Operations to correct hernia and hydrocele were
760 A. A. SHOK EIR and M .I. HU SSE IN
Fig. 6. Illustration of a bas-relief from temple of Ankha-ma-Hor in Saqqara showing the technique of circumcision (read from right to left).
described in the Ebers papyrus [9]. The best examples of
ancient surgical prowess can be seen in extant represen-
tations of circumcision, an operation that was performed
at least 2000 years before the reign of Rameses II. The
advantages of the procedure were first limited to mem-
bers of the priesthood but were later adopted by royalty
and the nobility. Still later, circumcision became a
universal practice, although the operation was not per-
formed until the youth had reached puberty. The tech-
nique of the operation is best illustrated in a bas-relief
on the wall of the temple of Ankha-ma-Hor at Saqqara
(fifth dynasty, 2400 BCE) (Fig. 6). The scene on the right
depicts the preparation for the operation. The surgeon
is possibly anaesthetising the body of the penis of the
adolescent boy standing before him. The patient supports
himself by holding the surgeon’s head, saying, ‘rub
properly what is there’. The surgeon answers, ‘I shall do
what will be comfortable for you’, meaning that it will
not hurt. In the scene on the left, the hieroglyphics read
‘circumcision by lector-priest’. The surgeon tells his
assistant, who is standing behind the young man and
holding him by the wrist, ‘hold him tightly, don’t let
him faint.’ The assistant replies, ‘I shall do as you wish’.
It would be interesting to discover more about the
anaesthetics used and how they were administered. The
famous ‘Memphis stone’ could be the key to this secret.
The stone is composed of carbonates of lime and an acid,
such as vinegar. Upon contact between the stone and
the moist skin, carbonic acid would be released and act
as a local anaesthetic [9].
Ancient surgical instruments discovered in Egypt
include delicate scalpels, probes, forceps and knives. A
knowledge of urological surgery is indicated in the
records stating that the Egyptians used bronze and tin
for making catheters and this could have been as early
as the third millennium BCE [19].
Ancient Egyptian concepts of sex
Erotic life flourished at all levels of society and, contrary
to what is generally thought, it was recorded in words
and pictures [20]. The belief in an afterlife was all
important to the Egyptians; they believed that as the
union of male and female was a necessity for the creation
of a new being, the erotic force also enables a person
who had departed from this life to continue existing in
the afterlife [2]. Therefore, the sexual power of the
mummy had to be maintained and stimulated. This is
always visualized as pertaining to the mummy of a man,
never that of a woman. In Egyptian art the idea is
expressed in a symbolic way which is straightforward
once the coded language is understood.
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Sexual disorders
In prescription 663 of the Ebers Papyrus impotence was
mentioned as ‘grapo’ or ‘weakness of the penis’, and
honey was among 37 drugs that were recommended for
its treatment. Priapism was also described and prescrip-
tions 658, 660 and 661 of the Ebers Papyrus described
drugs for its treatment. Moreover, prescriptions 705,
706, and 707 of the Ebers papyrus described gonorrhoea
(chyn) and that it may cause narrowing of the tissue of
the penis [9]. In addition to the organic sexual disorders,
ancient Egyptians recorded some of the psychosexual
disorders, e.g. homosexuality, necrophilia, bestiality,
incest and gender identity disorders [2].
Conclusions
The written and pictorial evidence of the Egyptian knowl-
edge of urology and other fields of medicine confirm that
Egypt and not Greece was probably the original source
of many of the medical ‘arts’. Ebbell [10] stated that
‘. . . Greek medicine is by no means original as people
were formerly inclined to believe, but . . . a very great
deal of it has been taken over from ancient Egyptians.’
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Authors
A.A. Shokeir, MD, PhD, Associate Professor of Urology.
M.I. Hussein, Research Fellow.
Correspondence: Professor A.A. Shokeir, Associate Professor of
Urology, New Jeddah Clinic Hospital, PO Box 7692, Jeddah,
Saudi Arabia.