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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
□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
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
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