Deciphering the Cairo toe

Scientists are trying to determine if a millennia-old artificial big toe from ancient Egypt could really walk the walk.

If so, that would make the so-called Cairo toe, a cunning contraption of wood and leather, the oldest "functional" prosthesis ever identified, according to researchers at England's University of Manchester and archaeological experts. Moreover, a functional toe would point to the possibility that surgical skills in Egypt were more advanced than believed, and that "healer-priests" of the time might have had the ability to perform simple amputations, perhaps using cauterization to stop infection and bloodflow.

The false toe in the Cairo Museum is still attached to the mummified right foot of a woman thought to have been in her 50s when she died somewhere between 1069 and 664 BC.

Now researcher Jacky Finch of the University of Manchester's KNH Center for Biomedical Egyptology is recruiting volunteers missing their right big toe to wear duplicates of the artifact, to see whether it really helps with balance and stride. If it does, that would suggest the appendage served a medical purpose and was not simply another funeral adornment in a culture famous for sending the dead off in style.

Finch and her collaborators are also studying a second ancient artificial toe at the British Museum that they suspect might also have served as a prosthesis.

"If we can prove that one or both were functional, we will have pushed back the dawn of prosthetic medicine by at least 700 years," Finch said in an interview. "The Cairo toe seems the more likely of the two, since it is articulated" -- made of three pieces, allowing for more natural movement -- "and shows sign of wear."

The British research, which Finch hopes to complete this year, marks the first practical effort to prove the theory that the Egyptians possessed the medical wherewithal to design and fit artificial limbs.

"Egyptian embalmers regularly replaced missing body parts to try to 'perfect' the body for the next life," said Lesley Dean-Jones, professor of classics at the University of Texas and former president of the Society for Ancient Medicine. She is not involved in the Manchester research. "It would take a great deal more sophistication to make functional prosthetics."

Of even greater interest, she said, is "whether they possessed the medical knowledge required to do amputations and stanch the bleeding. No one knows if the Egyptians were up to it."

Since the female mummy was unearthed in 2000 from a tomb of ancient Thebes, near the present-day city of Luxor, there has been often-hot debate about the toe's purpose. Many mummies possess false appendages -- toes, feet, hands, even male sexual organs.

"The ancient Egyptians were intent that bodies be complete when they were sent into the afterlife," Finch said.

But the Cairo toe is a more complex apparatus. It is jointed, allowing flexibility, and bears scuff marks suggesting it bore the weight of a living person. But function didn't entirely dominate form -- the wooden digit boasts an elegantly carved toenail.

"We feel this may indeed have been worn in life," Finch said. "But there could be other explanations for the abrasions. Perhaps it was roughly handled by the embalmers or was scraped as it was placed in the tomb."

Researchers believe that if volunteers can wear duplicates of the Cairo toe in comfort and gain some mobility or balance, that will represent strong evidence that the appendage was truly a medical device, Finch said.

Andreas Nerlich, a German pathologist who helped uncover the Theban tomb and has extensively studied the remains, believes the wooden toe is a functional replacement, and that it shows ancient Egyptian surgical skills.

"We have evidence that the amputation had taken place a significant time before death," said Nerlich, head of the Institute of Pathology at the Bogenhausen Academic Hospital in Munich. Scientific scrutiny showed the wound to be healed and that the wooden toe appears to be a precise fit for the scarred remnant, designed for use.

"This prosthesis is very different from any other type of limb replacement for dead bodies" associated with Egyptian mummies, Nerlich said. "The big toe normally bears 40 percent of the weight when standing. In present days, loss can be compensated by adequate shoes. Egyptians had no shoes; they wore sandals. These were not able to compensate for the loss of a big toe."

Ritual items found in the burial chamber indicate the woman was the wife of a high priest. Medical examination by Nerlich and other researchers suggests she suffered from diabetes. Researchers speculate the toe might have been removed because of bad circulation, a symptom of diabetes. There are faint signs the wound was cauterized, indicative of early surgery.

Until discovery of the Cairo toe, the oldest functional prosthesis was thought to be the "Roman Capua Leg," a limb fashioned of bronze and dating to about 300 BC. The metal appurtenance was kept at London's Royal College of Surgeons, but destroyed by German bombs during World War II.

Ancient texts from India, Greece, and other sites allude to artificial limbs, but the toes and the destroyed Roman leg are the only prosthetic devices that researchers are fairly confident in identifying. But replacement body parts date even further back -- last year, archeologists working at the so-called Burnt City site in Iran uncovered a 4,800-year-old skull bearing a false eyeball.

The era of modern prosthetics dates to the 1500s, when French surgeon Ambroise Pare' introduced artificial limbs to complement his amputation techniques.

Nerlich believes the high priest's wife probably did not use her wooden toe on a daily basis. The wear suggests occasional use.

"More likely it was worn at special events," he said. "Religious ceremonies, perhaps."