CRANIAL INJURY: a brief overview of the ancient Egyptian and Nubian sources
by Joyce Filer (formerly Curator of Human & Animal Remains, Department of Ancient Egypt and
Sudan, british Museum, London)
Throughout history cranial injury has been a universal event - people have inflicted injury upon one
another sometimes in civilian or domestic disputes and more often during the course of
warfare. The people of ancient Egypt and Nubia were no exception to this fact and we have
evidence of such injuries, from predynastic times right through to the Christian Medieval period
(1). Thus, the first aim of this article is to outline the range of sources informing us about the ancient
Egyptian and Nubian experiences of head injuries (2).
Overall, injuries to the head are more likely to be intentionally inflicted than those to other parts of
the body, although accidental falls, although perhaps rarer, cannot be disregarded. Interestingly,
regardless of the ancient culture concerned or the period in history under study, research has shown
that universal patterns can be observed in head injuries with regard to gender involvement, position
of injury and types of weapons used. Thus, the second aim of this article is to demonstrate how
ancient Egypt and Nubia fits into this universal model of cranial injury. For both aims of this article
notes and further references are included, where relevant.
Sources: artistic and textual
We are very fortunate that ancient Egypt offers researchers a large selection of artistic and textual
sources concerning aspects of their society and from these we can glean quite a lot about trauma to
the skull. Artistic sources clearly demonstrate the power of an actual cranial injury or the implied
threat of inflicting one. A familiar ancient Egyptian artistic motif is that of the king (later Pharaoh)
standing legs astride, grasping enemies by the hair and holding a weapon threateningly over
them. Perhaps, the most familiar example of these 'smiting' images is that of the predynastic
Narmer Palette - here, the king (Nar-Mer) grasps the locks of a bearded (ie. non-Egyptian) enemy
with his left hand whilst holding a mace in his right hand; this iconographic stance is repeated
throughout Egyptian history, probably as a symbol of power. Whether or not the kings of ancient
Egyptian actually engaged in physical combat is not the point here - clearly the possible after effects
of an injury to the skull ( brain injury, disability or death) was understood by all parties involved and
thus, the power of merely the threat of such an injury would have been enough to subdue most
enemies of Egypt. Further artistic evidence for head injuries is clearly demonstrated in the large
number of battle scenes available for us to study (fig. 1); they also indicate the types of weapons
available at particular periods of history. Thus, hand-to-hand battle scenes may show crushing,
cutting or slicing injuries inflicted by maces, swords and knives whilst longer range combat scenes
show bodies being pierced by arrows.
Ancient Egypt is a vast source of textual information and the medically related documents are most
informative. Perhaps the most useful text pertaining to cranial injury is that known as the Edwin
Smith Papyrus (3). It is often termed the 'Surgical' papyrus as it seems to pertain to the diagnoses
and management of a variety of bodily injuries, many of which involve trauma to the head. The
papyrus was purchased by a wealthy American, Edwin Smith, after whom it is named and was
translated by James Breasted in 1930 and a remarkably fine piece of work it is! The work is
seemingly topographic in its design - in that it describes injuries to parts of the head and works its
way down to the upper body. The cases of injury described were possibly those witnessed, recorded
and reported upon by a surgeon; each case describes an injury, suggests a prognosis and
recommends treatment (or not, as the situation demands). However, it breaks off (ie, the rest of the
text is missing) in the middle of a medical case and we are left without knowing more! The Edwin
Smith Papyrus describes a range of injuries from broken noses and cuts, which are deemed
treatable, to the more serious incidents involving severe gashes and exposure of the brain - which,
unsurprisingly, the author deems as fatal, using the ominous phrase "An injury with which I will not
contend".
Sources: biological
The archaeological excavation of human remains in Egypt and Nubia have brought to light quite a
large number of head injuries and it is interesting to see how these compare with the universal
pattern of head injuries and with those depicted in artistic and textual sources, as alluded to above.
Researchers have noted that in most ancient cultures males sustained more head injuries than
females, possibly because traditionally men were more involved in situations leading to trauma heavy labouring jobs and, of course, war. This gender ratio is seen in Egyptian and Nubian biological
remains. We see men engaged in manual work in many Egyptian tomb scenes; other scenes show
men engaged in combat, often with unprotected heads. In the universal sense, the majority of head
injuries were inflicted to the left side of the head indicating a right-handed face-to-face assailant and
possibly reflecting the Egyptian preference for right-handedness; some injuries affected the top part
of the head suggesting an assault from above. My personal research has found injuries to the back
and right side of skulls but they seem to be in the minority.
Clearly, types of head injuries will reflect the type of weapon used. For example, the scene in figure 1
shows men engaged in hand-to-hand combat - thus any ensuing injuries will reflect this. Here we
would expect slicing injuries, the severity of which would depend upon the strength of the metal
from which the weapons were made. As this scene is from the Old Kingdom period the weapons
were likely to be made of copper or bronze - which, although capable of inflicting serious injury, are
softer metals than the iron used in later periods.
In a large group of Nubian skulls I studied, the injuries were mostly depressions - some round, some
ovoid, others longitudinal. The injuries on these skulls, which were from Kerma and dated to the
Middle Kingdom period, clearly reflected the types of weapons and tools available to that society at
that particular period: mallets, throwsticks and maces. By contrast, a large group of Egyptian skulls
(from Giza) which I studied were from a much later period (600 - 300 BC) and so showed far more
serious injuries: gashes, blows and deep penetrating wounds; by this period of their history the
ancient Egyptians had developed iron technology resulting in some heavy duty weapons - axes,
swords and knives - capable of causing quite massive injuries (fig. 2). The head injury seen in figure 2
is a deep, penetrating gash probably made by an axe, however, despite its severity, the wound has
healed well.
Ancient Egypt and Nubia offers a large range of sources for the head injuries experienced during
their history - textual, artistic and biological but clearly only a small sample can be included
here. Few ancient societies can offer such a comprehensive range of materials for us to study in
order to try and comprehend human behaviour in the ancient world and compare it with that of the
modern world!
Further reading:
(1) Readers may be interested in looking at G. Elliot Smith and F. Wood Jones (1910), The
Archaeological Survey of Nubia. Report for 1907-08, Volume II: Report on the
Human Remains. Cairo: 1910 - although this is an 'elderly' work it is an excellent example of the
study of burials from these periods of Egyptian history; often
quite 'dramatic' head injuries are noted for some bodies examined during this survey.
(2) See further: Joyce M. Filer, 'Ancient Egypt and Nubia as a source of information for violent cranial
injuries' in J. Carman (ed) Material Harm: Archaeological
Studies of War and Violence, Cruithne Press: 1997, p.
(3) Edwin Smith (Surgical) Papyrus (2 vols). Published in facsimile and hieroglyphic transliteration
(with translation and commentary). Chicago, Illinois: University
of Chicago Press: 1930