Montag, 9. Juli 2018

Dissertation project by Jonny Russell: “Ethnomedical Theory in Ancient Egypt: Explanatory Models and their Historical Contextualisation”

Blog entry by Aleksandar Milenković.

Jonny Russell is a first-year PhD candidate doing his research at the department of Egyptology at the University of Leiden, while at the same time being an associate member of the GRK 1876. At the Plenary session on June 21st, he presented an outline of his dissertation project “Ethnomedical Theory in Ancient Egypt: Explanatory Models and their Historical Contextualisation”. In his paper, Russell focused specifically on the over-all aims of the project, the beginning phase of his research regarding the concept of ra-ib, and a case study on the concept of setet.
Figure 1: Jonny Russell presenting his paper (Photo by Shahrzad Irannejad)
What is medicine?

Russell begins by highlighting the discussion of making distinctions between “medicine”, “healing”, and “magic” in the context of ancient cultures. Medicine is distinguished as making use of scientifically acquired knowledge of the normal and abnormal states of the body, whereas healing “is the endeavour to prevent abnormal states of the body and to treat them if they occur… no theory is needed for this. It is pure empiricism” (Fn. 1).  Moreover, what Unschuld
in his monograph defines as medicine starts in the classical period (with Graeco-Roman and Chinese medical practices), while everything that happened before this period, including Egyptian medicine, is considered as a healing practice with no theory, and therefore not medicine. In order to avoid this western-centric and etic approach, Russell looks into Ethnomedicine — a sub field of Medical Anthropology — and its “explanatory models” as a method to examine ancient Egyptian medical texts and concepts found within.

Beginning with the work of Kleinman who — as Russell informs us — argued that, when speaking about medical theory, one must understand that there is a biophysical and a human (or cultural) science to any form of medicine. The former includes what is generally observed about the human body (e.g. water comes out of the eyes, we need to consume food, we defecate, etc.), while the latter includes what is “embedded in a given cultural context” (Fn. 2), which provides insight into how different cultures form different concepts regarding the body and its illnesses, and consequently how they apply treatments to such illnesses. Today, ethnomedicine studies “different societies’ notions of health and illness, including how people think and how people act about well-being and healing….” (Fn. 3).

Explanatory models (EM) show how people understand and make sense of their illness. They are a result of idiosyncratic and popular beliefs where culture plays a crucial role in influencing those beliefs. Russell explains that reasons for EM’s to develop are numerous. For the purposes of this presentation, he emphasises the relevance of the surrounding environment and phenomenological experiences as influencers of certain themes in ethnomedicines, such as — in certain cases — the theme of symmetry. This is arguably a product of symmetry in nature itself (flora and fauna) and even geography for certain societies (for example, the Nile—which dissects the landscape of ancient Egypt — played a huge role in cultural and cosmological conceptualisations, as well as how people conceptualized the body itself).

The aims of Russell’s project are quite clear. He primarily focuses on examining concepts of internal physiology represented in selected ancient Egyptian medical papyri, dating from the second millennium BCE up to the Roman period. He aims to examine how these concepts appear and, by means of historical contextualization, if they change over time. Additionally, looking into the surrounding cultures, Russell wants to see which of the concepts found in Egyptian source material can be seen as universal, culturally specific and interchanged. In order to approach these questions through an emic perspective, Russell naturally has to move away from the biomedical expectations on classifications of internal structures, physiology, and subsequent treatment strategies in the ancient Egyptian healing tradition. 
The beginning of the project: the concept of ra-ib

Russell’s work begins with the examination of the concept of ‘ra-ib’ mentioned in a part of the Ebers papyrus (Eb. 188-220). The Ebers papyrus — just over 18 meters long — dates to c. 1550 BCE, and is currently kept at the library of the University of Leipzig. The ra-ib is oftentimes translated as stomach, rarely as thorax/chest, but this translation — as previously remarked by Imhausen and Pommerening — “was established based on the symptoms of some diseases [and] does not adequately express the ancient Egyptian concept anatomically or physiologically…” (Fn. 4).  

The starting point of the project was aimed at re-accessing the ancient Egyptian concept of ra-ib, Russell looked into symptom clauses in order to understand what part of the body it refers to. The text provides a variety of examples, where most common body parts affected by the ra-ib are located in the torso (heart, belly, sides), but also mouth and rear, among others, as can be seen in Figure 2. In many explanations from the Ebers cases it has a gastrointestinal function, whereas in others it seemingly carries others such as respiratory attributes, distinguishing it from ‘stomach’. In all the Ebers cases, the health complaint is caused by an obstruction of the ra-ib, and the causes are varied to include food, faeces, obscure classifications such as setet (discussed below), or even ancestors or obscure demons or entities, as can be seen in Figure 3.

Figure 2: Data compiling anatomical designations listed in symptom clauses (Courtesy of Jonny Russell)

Figure 3: Data compiling aetiological matter in diagnoses (Courtesy of Jonny Russell)

Russell also notices how metaphors are often employed to describe such conditions, especially with the use of terminology drawn from the riverine landscape domain, as these concepts played a crucial role in the everyday life in ancient Egypt. Human body is described through the concept of river, where illness is conceptualized as obstruction of a flow due to various causes.

The literal meaning of the ra-ib is not easily interpreted either, as the first part ra means mouth, and the second part ib (often translated as heart) actually carries more semantic information, and shouldn’t, as Russell suggests, denote heart in the biomedical way. Using what Russell calls the ‘ra-X paradigm’ in Egyptian classifications, he demonstrates that the term ra-ib represents an ‘inner thoroughfare’ which shouldn’t be translated with biomedical terminology. It is an anatomical explanatory model – a concept which includes a region from the mouth to the anus. 
Case study: the concept of setet

In some cases, as seen in the Figure 2, the obstruction of the ra-ib was caused by setet, the translation of which is quite vague. It is mostly translated as some kind of secretion (Schleimstoff, Sekret), and the verb that it is derived from has the meaning of shooting or pouring. In medical texts its occurrence is negative for the well-being of the body.

In the examples provided by Russell, it is evident that the classification of setet has to descend downwards through the body, while in a case of an illness, such descending is obstructed. In cases where setet is obstructed further down the body, it then becomes something else; in an example shown, it transforms into a type of ‘worm’. One treatment from the ra-ib book (Ebers papyrus 192) includes the use of onions, beer and the fatty flesh of a cow, among other ingredients to treat fever-like symptoms: inflamed eyes and a running nose. The link between onions and the eyes is drawn upon as a potential explanation for why this ingredient was included. Furthermore, Russell highlights a striking similarity in the Akkadian Therapeutic Corpus (Fn. 5), where beer and fatty meat are often used as treatment for fever originating in the libbu (interestingly, the Akkadian for heart, stomach, or more generally the insides). Based on the exemplary evidence, it is very difficult to determine what physical substance setet can refer to – or indeed if it needs to be translated at all. In the light of the provided examples, Russell sees it as yet another culturally specific explanatory model of how disease occurs in the body, impossible to translate into the western medical tradition, but by all means worthy of being labelled as medicine.


[1] P. Unschuld, What is Medicine? Western and Eastern Approaches to Healing (Berkeley: 2009), 6.
[2] A. Kleinman, Medicine’s Symbolic Reality: On a central Problem in the Philosophy of Medicine, Inquiry 16 (1973), 206-13.
[3] M. Quinlan, ‘Ethnomedicine’ in M. Singer and P. Erickson (eds.), A Companion to Medical Anthropology (Chichester: 2016), 381.
[4] A. Imhausen and T. Pommerening (eds.), ‘Introduction’ in Writings of Early Scholars in the Ancient Near East, Egypt, Rome, and Greece (Berlin: 2010), 3-4. 
[5] See J. Johnson, Towards a Reconstruction of SUALU IV: Can we Localize K. 2386+ in the Therapeutic Corpus, Le Journal des Médicines Cunéiformes 24 (2014), 11-38. 

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