The seventeen columns on the recto comprise part of a surgical treatise, the first thus far discovered in the ancient Orient, whether in Egypt or Asia. It is therefore the oldest known surgical treatise.
This surgical treatise consists exclusively of cases, not recipes.
The treatise is systematically organized in an arrangement of cases, which begin with injuries of the head and proceed downward through the body, like a modern treatise on anatomy.
The treatment of these injuries is rational and chiefly surgical; there is resort to magic in only one case out of the forty-eight cases preserved.
Each case is classified by one of three different verdicts: (1) favorable, (2) uncertain, or (3) unfavorable. The third verdict, expressed in the words, ‘an ailment not to be treated,' is found in no other Egyptian medical treatise.
This unfavorable verdict occurring fourteen times in the Edwin Smith Papyrus marks a group of cases (besides one more case) which the surgeon cannot cure and which he is led to discuss by his scientific interest in the phenomena disclosed by his examination.”1
It is of special interest to the neurosurgeon because it contains the first descriptions of the cranial sutures, the meninges, the external surface of the brain, the cerebrospinal fluid, and the intracranial pulsations. It also contains the first accounts of surgical stitching and of various types of dressings. Brain injuries are noticed to be associated with changes in the function of other parts of the body, especially the lower limbs, and hemiplegic contractures are described in Case 8. Changes in bodily functions are also described in association with injuries of the cervical spine. Case 31 contains the first description of quadriplegia, urinary incontinence, priapism, and seminal emission following cervical vertebral dislocation.
The Egyptologist who brought this manuscript to light, Edwin Smith, was born in Connecticut in 1822, the year that Egyptian hieroglyphic was first deciphered. In Luxor, Egypt, in 1862, Smith bought an ancient manuscript roll which lacked some of its outer portions. Two months later the same vandals sold him the remaining fragments glued onto a dummy roll. Although Smith recognized the fraud, pieced the two together, and made an attempt at translation, it was not until 1930 that James H. Breasted translated the treatise and established its importance. Breasted was then Director of the University of Chicago Oriental Institute, and had been requested by the New York Historical Society to translate the papyrus, which the Society had received in 1906 from Edwin Smith's daughter.
According to Breasted, the Edwin Smith Papyrus is a copy of an ancient composite manuscript which contained, in addition to the original author's text (3000–2500 B.C.), a commentary added a few hundred years later in the form of 69 explanatory notes (glosses). It contains 48 systematically arranged case histories, beginning with injuries of the head and proceeding downward to the thorax and spine, where the document unfortunately breaks off. These cases are typical rather than individual, and each presentation of a case is divided into title, examination, diagnosis, and treatment. There is a definite differentiation between rational surgical treatments and the much less employed medico-magical measures. Significantly, trepanation is not mentioned.
“The scribe of over 3,500 years ago, to whom we owe our present manuscript, could have had little consciousness of the momentous decision he, or possibly some one for him, was making when he pushed aside the ancient Surgical Treatise, then already a thousand years old, while his own copy was still incomplete. He had copied at least eighteen columns of the venerable treatise and had reached the bottom of a column when, pausing in the middle of a line, in the middle of a sentence, in the middle of a word, he … laid down his pen and pushed aside forever the great Surgical Treatise he had been copying, leaving 15½ inches (39 cm.) bare and unwritten at the end of his roll.”1
“The latter, according to our present day terminology would be classified as follows: two compound linear fractures; four compound depressed fractures; four compound comminuted fractures; and one comminuted fracture without external wound. The symptoms and signs of head injury are given in considerable detail. Feeble pulse and fever are associated with hopeless injuries and deafness as well as aphasia are recognized in fractures of the temporal region.”5
BreastedJ. H. The Edwin Smith surgical papyrus. Chicago: Univ. Chicago Press19302 vols. (see 1: pp. xvi 6 430–435 437–439 446–448 451–454 466; 2: pl. XVII XVIIA).Breasted J. H. The Edwin Smith surgical papyrus. Chicago: Univ. Chicago Press 1930 2 vols. (see 1: pp. xvi 6 430–435 437–439 446–448 451–454 466; 2: pl. XVII XVIIA).
ElsbergC. A. The Edwin Smith surgical papyrus and the diagnosis and treatment of injuries to the skull and spine 5000 years ago. Ann. med. Hist.1931 n.s. 3: 271–279.Elsberg C. A. The Edwin Smith surgical papyrus and the diagnosis and treatment of injuries to the skull and spine 5000 years ago. Ann. med. Hist. 1931 n.s. 3: 271–279.
MettlerC. C. F. A. Mettler Ed. History of medicine. A correlative text arranged according to subjects. Philadelphia: Blakiston Co.1947xxix1215 pp. (see pp. 795–797).Mettler C. C. History of medicine. A correlative text arranged according to subjects. F. A. Mettler Ed. Philadelphia: Blakiston Co. 1947 xxix 1215 pp. (see pp. 795–797).
O'ConnorD. C. and WalkerA. E. A. E. Walker Ed. Prologue. In: A history of neurological surgery. Baltimore: Williams & Wilkins Co.1951xii583 pp. (see pp. 1–22).O'Connor D. C. and Walker A. E. Prologue. In: A history of neurological surgery. A. E. Walker Ed. Baltimore: Williams & Wilkins Co. 1951 xii 583 pp. (see pp. 1–22).
Reprinted in part from The Edwin Smith Surgical Papyrus. By James H. Breasted. Chicago: Univ. Chicago Press, 1930, 2 vols. With the kind permission of the University of Chicago Press.