Edwin Smith Papyrus: The

First Textbook in SurgeryAbderahman Kamaledeen

Salah Kamaledeen

Barts and The LondonChildren‘s Hospital

History ClubAberdeen - July 2010

Modern Day Thebes

in Egyptian Thebes . . ." the heaps of precious ingots

gleam.“the hundred-gated Thebes

Homer, The Iliad □Capital of Egypt in the New

Kingdom (1570 – 1070 BC)

□ Heart of rel igion, art and pol it ical supremacy in Egypt

Luxor

□Medicine in Ancient Egypt Similar to our practice today

□ Very advanced in al l branches ofmedicine

□ Surgical knowledge was wel ldeveloped

□ Medical texts and references were .wel l-written and wel l-preserved Some date back to 5000 years

” In medical knowledge, Egypt leaves the rest of the world behind.”Homer, TheOdyssey

First Depiction of Surgery

6th Dynasty Tomb of Ankh-ma-hor, SaqqaraNunn (1996)

First Depiction of Surgery

A celebrated group of instruments carved in relief at the temple of Kom Ombo

Wall painting of an oculist treating a workman . Tomb of master builder Ibwy , Thebe 1200 b.c.

Edwin Smith“The American Farmer of Luxor”

□ An American free wheeler and dealer of antiquities

,Reputed as advising upon and even practicing forgery

of antiquities.

□Bought a remarkable papyrus on 20 January 1862

from Mustafa Agha; an Egyptian

business man

□ Mr Smith realised that thepapyrus

is a unique ancient Egyptian .medical treatise

Edwin Smith

□ Edwin Smith kept the ancient treatise

□ In 1905, Mr Smith‘s daughter donated the artefact to

New York Historical Society

□ The medical treatise was written around 1700 B.C., but most of the information based on texts written around.3000B.C

Edwin Smith Surgical Papyrus

Stayed in print for at least 1500 years

Imhotep? □ ,PM for King Djoser

□ a priest and an architect□ a doctor

who was later deif ied by Egyptians as the

”God of Medicine“

The Author

Edwin Smith Surgical Papyrus 1 st Textbook in Surgery

Edwin Smith Surgical Papyrus 1 st Textbook in Surgery

□:Translated by

James Henry BreastedDirector of the Oriental Inst itute at University of Chicago

□ With medical notes prepared byArno Luckhardt

□ Published in 1930

Edwin Smith Surgical Papyrus 1 st Textbook in Surgery

The treatise gives us a remarkable insight into the medical practice of Ancient Egyptians

Amazing clar ity and diagnostic accuracy

The incomplete text describes 48 cases, All surgical, mainly trauma

69 explanatory notes (glosses) were added several hundred years after the original script

Starts with head injuries, then facial , cervical, thoracic, upper l imb and spinal injuries

Marks the birth of “Analytical Thinking” in medicine. It instructs doctors to examine the patient and look for revealing physical signs.

Presents medical data in the “case scenario format”

Edwin Smith Surgical Papyrus 1 st Textbook in Surgery

Edwin Smith Surgical Papyrus 1 st Textbook in Surgery

Each case starts with a cl inical examination, then comes diagnosis and prognosis: “Thou should say concerning him… “…an ailment I wil l treat”, “…an ailment I should contend with” or “ . .an ai lment not to be treated”

Case 2

Title: Instructions concerning a [gaping] wound [ in his head], penetrating to the bone.

Examination: If thou examinest a man having a [gaping] wound [ in] his [head], penetrating to the bone, thou shouldst pal[pate hi]s [wound]. If thou f indest his skul l [uninjured, not hav]ing a perforation in it . . .

Instructions concerning a [gaping] wound [ in his head], penetrating to the bone.

Case 2

Diagnosis: Thou shouldst say regarding [him]: "One hav[ing a gaping wou]nd in his head. An ai lment which I wi l l treat.“

Treatment: [Thou] shouldst bind [fresh meat upon it the f irst day; thou shouldst apply for him two str ips of l inen, and treat afterward with grease, honey, (and) l in]t every day unti l he recovers.Gloss: As for: "Two strips of linen," [it means] two bands [of linen which one applies upon the two lips of the gaping wound in order to cause that one join] to the other.

Case 4Instructions concerning a gaping wound in his head penetrating to the bone and splitt ing his skul l

Examination: If thou examinest a man having a gaping wound in his head, penetrating to the bone, thou shouldst palpate his wound. . . , he discharges blood from both his nostri ls (and) from both his ears, he suffers with st iffness in his neck, so that he is unable to look at his two shoulders and his breast. . .

Diagnosis: Thou shouldst say regarding him: “One having a gaping wound in his head, penetrating to the bone, (and) spl itt ing his skul l ; whi le he discharges blood from both his nostri ls (and) from both his ears, (and) he suffers with stiffness in his neck.

An ai lment with which I wi l l contend.”

Case 4

Treatment: Now when thou findest that the skul l of that man is spl it , thou shouldst not bind him, (but) moor (him) unti l the period of his injury passes by. His treatment is sitt ing. Make for him two supports of brick, unti l thou knowest he has reached a decisive point. Thou shouldst do l ikewise for every man whom thou findest having a spl it skul l . . .

Gloss: As for "(Until) thou knowest he has reached a decisive point," it means (until thou knowest whether he will die or he will live; for he is (a case of) "an ailment with which I will contend.”

Case 4

Case 33 Instructions concerning a crushed vertebra in his neck

Examination: If thou examinest a man having a crushed vertebra in his neck (and) thou f indest that one vertebra has fal len into the next one, whi le he is voiceless and cannot speak; his fal l ing head downward has caused that one verte bra crush into the next one; (and) shouldst thou f ind that he is unconscious of his two arms and his two legs because of it . . .

Case 33

Diagnosis: Thou shouldst say concerning him: "One having a crushed vertebra in his neck; he is unconscious of his two arms (and) his two legs, (and) he is speechless.

An ai lment not to be treated.“…

Case 35 Instructions concerning a break in his col lar-bone

Examination: If thou examinest a man having a break in his col lar-bone (and) thou shouldst f ind his col lar-bone short and separated from its fel low.

Diagnosis: Thou shouldst say concerning him: "One having a break in his col lar-bone. An ai lment which I wi l l treat."

Treatment: Thou shouldst place him prostrate on back, with something folded between his two shoulder-blades; thou shouldst spread out with his two shoulders in order to stretch apart his col lar-bone unti l that break fal ls into its place. Thou shouldst make for him two spl ints of l inen, (and) thou shouldst apply one of them both on the inside of his upper arm. Thou shouldst bind it with ymrw, (and) treat it afterward with honey every day, unti l he recovers.

Case 35

Surgical Treatments

□ Manipulation (fractures + dislocations)

□ Cauterisation

□ Splinting

□ Cleansing, drainage, debridement of wounds

□ Anti bacterial wound dressings Honey, Moldy bread…

Nunn (1996)

Surprising Observations Colourful yet

accurate

“a puncture in a pottery jar” (on a depressed fracture of the skul l)

Colourful yet accurate

“ in his skul l l ike those corrugations which form in molten copper” (on the brain‘s surface in a gaping wound in the head)

□ 1 st written evidence ofscientif ic

reasoning (observation to(conclusion

□ 1 st description of brain, meninges and CSF

□ 1 st evidence of systematic tr iage (ai lment to treat /not to treat)

□ 1 st use of spl ints and bandages

□ 1 st to note effects on lower l imb from

head trauma

First Prize In a number of things!

Edwin Smith Surgical Papyrus

1 st Textbook in Surgery

Oldest trauma reference

5000-year old

Stayed in print for >1500 years

Case scenario format “Problem-Based Medicine”

The birth of “Analytical Tinking” in medicine

A remarkable insight into the medical practice in Ancient Egypt

Thankyou

Salah Kamaledeen