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Ancient Egyptian Surgical Practice and the Smith Papyrus

07 Jun

Our understanding of ancient Egyptian medical practices comes from the handful of documents that have survived the millennia. The one of the oldest is the Edwin Smith Surgical Papyrus, which dates to the 17th century B.C. This document is not a textbook nor is it a didactic discussion of medical treatment but rather it consists of case presentations. There are 48 cases presented and over half of them deal with trauma to the head and neck.

The treatments offered were rudimentary but in some cases effective. The author describes how best to approach open head wounds, some with and others without fractures of the skull and exposure of the brain. Most of the victims described had serious head injuries as indicated by the fact that the skull was often breached, brain material often exposed, and with bleeding from the nose and the ears. Some of the injured were comatose, some were awake. Some had stiff necks, others paralyzed. Some could walk and talk, others could only mumble and stagger.

Each of these signs and symptoms would put the modern neurosurgeon into a fit of activity. If you want to raise a neurosurgeon’s blood pressure, have someone present to the emergency room with a head blow and exposed brain material or bleeding from the nose or ears or listing to one side when he attempts to walk. These will get his attention.

In ancient Egypt, there were few surgical techniques for any condition and essentially none for these types of injuries, so the treatment of these head injuries was much more conservative and of course the mortality rate high. The victim would often be bound to a chair and his head stabilized in the upright position. This probably offered some benefit in that the effect of gravity would lower the blood pressure in the head, which might lessen bleeding and reduce brain swelling, both beneficial in this type of injury.

Sometimes grease or honey or cotton lint would be applied to the wound. I would suggest that each of these helped the blood clot. And honey, interestingly, has antibacterial properties. They would’ve used these materials on a completely empirical basis since they had no understanding of what was really going on. Knowledge of how blood clotting worked or that bacteria caused infections was still several millennia away. They had simply seen this work in the past and this knowledge had been passed down from practitioner to practitioner.

Another interesting form of treatment in some of these injuries was the recommendation for placing raw meat over the wound. This also could have some beneficial effect since the coagulating proteins in the blood of the fresh meat could also help with blood clotting and lessen blood loss.

In one case, an ostrich egg was use to make a poultice that was then placed on the wound. Again, the protein membrane that lines the inside of the shell might have had some coagulant effect.

But since religion and magic were never divorced from ancient medicine, certain incantations often followed any of these treatments. The healer might cast out “the enemy that is in the wound” or “the evil that is in the blood.” He would often call on Isis or another god for help.

It is interesting that these ancient medical practitioners had some understanding of prognosis. They would state that the victim’s future was favorable, uncertain, or unfavorable. In the first two categories they would attempt treatments and state that it is “an ailment which I will treat,” but in the latter they would simply state “an ailment not to be treated.” They were very formal in their language but the bottom line is that the physician would treat things that he thought he could help and shy away from those were the prognosis was dismal.

This papyrus is fascinating and offers a glimpse into a long lost world.

 

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