Schistosomiasis in Ancient Egypt: The ‘AAA’ Debate

In 1910, Sir Marc Armand Ruffer (1859-1917), considered to be one of the founders of paleopathology, discovered the calcified eggs of Schistosoma haematobium in the kidneys of two mummies from Egypt’s 20 dynasty (1250-1000 BC). Since Ruffer’s discovery, debate has ensued over whether the medical papyri offer conclusive evidence that schistosomiasis, or bilharziasis, was known to the ancient Egyptians. In the medical papyri, the word transliterated as ‘aaa’ was recorded almost fifty times, along with numerous remedies, including preparations made from antimony and honey. Today, antimony compounds are known to be effective, albeit debilitating, antischistososomal drugs. In addition, associated with the word ‘aaa’ in the medical papyri is the determinative of a discharging phallus. This association, plus art created by the ancient Egyptians depicting men with physical characteristics known today to be sequelae of schistososomal infection, has been used by several researchers to support the theory that the ‘aaa’ condition mentioned in the ancient Egyptian medical papyri was the disease known today as schistosomiasis. Immunocytochemical analysis of preserved tissues from mummies discovered in ancient Egypt and nearby Nubia indicates that schistosomiasis was indeed a widespread disease in ancient times. Thus, it is likely that the symptoms attributed to schistosomiasis today were experienced by the ancient Egyptians. Recently, however, several researchers have argued that the evidence linking the affliction ‘aaa,’ as mentioned in the medical papyri, to schistosomiasis is tenuous, and these researchers support a more spiritual interpretation. Specifically, these researchers consider it more likely that the word ‘aaa’ referred to an evil spirit in the form of an incubus, which was a common theme in ancient Egyptian mythology, or to a negative influence generated by magic, which was a common theme in the medical papyri.