Hektoen International

A Journal of Medical Humanities

Medicine in the afterlife – The Egyptian Book of the Dead

Maureen Hirthler
Bradenton, Florida, United States

Fig. 2.  Nebseni spearing a crocodile. From https://www.metmuseum.org/blogs/now-at-the-met/2016/book-of-the-dead
Fig. 1. Nakht with a knife. BM EA 10471, 16 (© Trustees of the British Museum)

“And therefore shall I neither be borne away, nor carried by force to the East to take part in the festivals of the fiends; nor shall there be given unto me cruel gashes with knives, nor shall I be shut in on every side, nor gored by the horns of the god Khepera.” Spell 93

In ancient Egypt, life after death was not significantly different from life itself; existence was simply transferred to another, more remote realm.1 Once deceased, a person existed in several forms: the sah, or corpse, the ba, or mobile soul, the ka, which restored the social form of the self (status, honor, dignity), and the akh, or glorified figure.2 The deceased then began a series of perilous travels on his way to the Field of Reeds, where he would be reunified with his ba and ka, enter the Field of Reeds as an akhu.

Fig. 3. The Great cat of Ra and Apophis. From Papyrus of Hunefer, 1300 BCE. https://www.metmuseum.org/art/collection/search/548564

The Egyptian Book of the Dead, also known as The Book of Coming Forth by Day, contained detailed instructions for this passage. The earliest examples of these spells were found at Saqqara in the tombs of the Old Kingdom pharaohs of the Fifth and Sixth Dynasties (2400-2300 BCE), and are called the Pyramid Texts. In the First Intermediate Period (2181-2055 BCE) and Middle Kingdom (2050-1710 BCE), some texts were deleted and new ones added. These appeared inside square wooden coffins, and are referred to as Coffin Texts. The first evidence of attempts to collect and revise all the various Coffin Texts appears during the Thirteenth Dynasty (1795-1650 BCE). By the New Kingdom (1550-1070 BCE), these spells were grouped into a collection called The Book of Coming Forth by Day. The coffins were anthropoid, and so text was written on papyrus scrolls and placed next to the deceased. Sections of it were also inscribed on the walls of tombs and on various funerary items such as shrouds and masks. Vignettes, powerful in their own right, now preceded the text. Texts continued to be deleted, added, or modified over the centuries. The often-used copy of the Book of the Dead, the Papyrus of Ani (c. 1250 BCE), was translated by Wallace Budge in 1895.3

Egyptians at this time made little distinction between medicine and magic. Both magic and medicine used exotic and complicated techniques to counter illnesses and afflictions, and their procedures and remedies overlapped to a great extent.4 This fluidity between medicine and magic continued into the afterlife. The protective spells in the Book of the Dead were as valid to the Egyptians in death as they were in life.

Fig. 4. Nakht spearing a snake. BM EA 10471, 16 (© Trustees of the British Museum)

Because the corpse or its image was essential to the reunification of the parts of the deceased, preservation of the body in some form was needed. The process of mummification was meant to transform the corpse into a perfect eternal image, but the Egyptians were still haunted by the fear that their bodies would rot away.5

“Hail to you, my father Osiris! You shall possess your body; you shall not become corrupt, you shall not have worms, you shall not be distended, you shall not stink, you shall not become putrid, you shall not become worms.” Spell 154

The Papyrus of Nu, Sheet 18, is even more specific: “I shall not decay, I shall not rot, I shall not putrefy, I shall not turn into worms . . . My eye shall not decay. The form of my face shall not disappear. My ear shall not become deaf. My head shall not be separated from my neck. My tongue shall not be removed. My hair shall not be cut off. My eyebrows shall not be shaved away.”

As the deceased moved along the path of the underworld, he encountered all the trials of Egyptian life. Protective spells, therefore, against trauma and illness populate the Book of the Dead.

The Nile contained many dangers, chief among them the crocodile. In the Papyrus of Nakht (c.1350-1290 BCE), the deceased is shown wielding a spear against three large crocodiles. This image also appears later in the Book of the Dead of the Priest of Horus, Imhotep (c.332–200 BCE).

“Get back, you crocodile of the West, who lives on the Unwearying Stars! Detestation of you is in my belly, for I have absorbed the power of Osiris, and I am Seth. Get back, you crocodile of the West!” Spell 32

From the Papyrus of Nebseni, Sheet 3, and also in the Book of the Dead of the Priest of Horus, Imhotep (c.332–200 BCE):

Fig. 5. Nakht killing the apshai-insect. BM EA 10471, 16 (© Trustees of the British Museum)

“Deliver me ye from the crocodile which is in the place of the lords of right and truth.”

Snakes were also a danger, both in and out of the water. There are five spells directed against snakes (33-35, 37, 39, 40).

“O rerek-snake, take yourself off, for Geb protects me; get up, for you have eaten a mouse, which Ra detests, and you have chewed the bones of a putrid cat.” Spell 33

Spell 40 asks for protection “from him who swallowed an ass,” and the vignette shows a snake who is biting the neck of an ass.

In addition, there is Spell 34, protection against snakebite, and Spell 35, protection against being eaten by snakes.

Another hazard was the apshai-insect, a corpse-eating beetle.

“Begone from me, O Crooked Lips! I am Khnum, Lord of Shen, who dispatches the words of the gods of Ra, and I report affairs to their masters.” Spell 36

The afterlife was still not safe for the deceased. Many tomb illustrations depict decapitation of enemies, which are then hung upside down and trampled by beasts or the pharaoh himself.  Those who fail the weighing of the heart are also treated in this manner. For the ancient Egyptians decapitation meant irreversible second death, or total extinction.6

Spell 43 protects against this decapitation in the afterlife: “I am a flame, the son of a flame, to whom was given his head after it was cut off, the head of Osiris shall not be taken from him, and my head shall not be taken from me.”

Fig.7. Ani having passed through the slaughterhouse. From Scalf, Foy. Book of the Dead: Becoming God in Ancient Egypt. OIM39 (Bridgeman Images)
Fig.6. Enemies of the deceased carried upside-down over his coffin. From Scalf, Foy. Book of the Dead: Becoming God in Ancient Egypt. OIM39 (Bridgeman Images)

Spell 53 and its vignette stops the dead from the fate of walking upside-down in the afterlife.

The deceased must also escape from the slaughter-place (Spell 50 – the Papyrus of Nu, Sheet 18).

“Give thou me not over to the Slaughterer in this execution chamber, who killeth the members and makest them rot, being himself invisible, and who destroyeth the bodies of the dead, and liveth by carnage.”

He is also to be protected from dying a second time in the realm of the dead:

“I am crowned like unto the king of the gods, and I shall not die a second time in the underworld.”  The rubric provided for this spell states: “If this chapter be known by Osiris Ani (the deceased), he shall not corrupt in the underworld.” Spell 44

The concurrent existence of the living and the dead is seen in Spells 163-165, where the text states that these spells could be used on earth as well to preserve the person from injury and death.7

The ancient Egyptians viewed death, therefore, as simply another place for trauma or illness, and requiring protection from danger. The Book of the Dead provided magical medical care into the afterlife, guaranteeing that the deceased would be reunited with all his components and become a transfigured akh.


  1. Emily Teeter, Religion and ritual in ancient Egypt (Cambridge: Cambridge University Press, 2011).
  2. Jan Assmann, Death and salvation in ancient Egypt (Ithaca, N.Y. ; London: Cornell University Press ;, 2005). Table of contents http://www.loc.gov/catdir/toc/ecip057/2005002783.html.
  3. E. A. Wallis Sir Budge, The Book of the Dead : an english translation of the chapters, hymns etc. of the Theban Recension ([S.l.]: K. Paul, 1901).
  4. Byron E. Shafer et al., Religion in ancient Egypt : gods, myths, and personal practice : Symposium on “Ancient Egyptian religion” : Papers (Ithaca: Cornell University Press, 1991).
  5. John H. Taylor, Journey through the afterlife : ancient Egyptian Book of the dead (Cambridge, Mass.: Harvard University Press ; London : British Museum Press, 2010).
  6. Foy Scalf, Kevin Bryce Lowry, and University of Chicago. Oriental Institute. Museum, Book of the dead : becoming god in ancient Egypt, Oriental Institute Museum publications, (Chicago: Oriental Institute of the University of Chicago, 2017), still image.
  7. Taylor, Journey through the afterlife : ancient Egyptian Book of the dead.


  • Assmann, Jan. Death and Salvation in Ancient Egypt. Ithaca, N.Y. ; London: Cornell University Press ;, 2005. Table of contents http://www.loc.gov/catdir/toc/ecip057/2005002783.html.
  • Budge, E. A. Wallis Sir. The Book of the Dead : An English Translation of the Chapters, Hymns Etc. Of the Theban Recension. [S.l.]: K. Paul, 1901.
  • Scalf, Foy, Kevin Bryce Lowry, and University of Chicago. Oriental Institute. Museum. Book of the Dead : Becoming God in Ancient Egypt. Oriental Institute Museum Publications. Chicago: Oriental Institute of the University of Chicago, 2017. still image.
  • Shafer, Byron E., John Baines, Leonard H. Lesko, and David P. Silverman. Religion in Ancient Egypt : Gods, Myths, and Personal Practice : Symposium On “Ancient Egyptian Religion” : Papers. Ithaca: Cornell University Press, 1991.
  • Taylor, John H. Journey through the Afterlife : Ancient Egyptian Book of the Dead. Cambridge, Mass.: Harvard University Press ; London : British Museum Press, 2010.
  • Teeter, Emily. Religion and Ritual in Ancient Egypt. Cambridge: Cambridge University Press, 2011.

The author wishes to acknowledge the assistance of Foy Scalf, Ph.D, with primary sources.  https://oi.uchicago.edu/

MAUREEN HIRTHLER, MD, MFA, is a physician and writer who is currently an Assistant Professor at the Lake Erie College of Osteopathic Medicine, Bradenton, Florida. A graduate of the University of Pennsylvania School of Medicine, she practiced Emergency Medicine for 20 years. In 2015, she received her MFA in Creative Writing from the University of Missouri-Kansas City. Her most recent essay “Yellow” appeared in the Winter 2019 Intoxication issue of Creative Nonfiction.

Spring 2019



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