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Surgical secrets of the ancients

We in the 21st century have a deplorable tendency at times to look down on those who lived in centuries preceding ours as primitive, ignorant people.

No, I’m not talking about those poor benighted souls of the late, unlamented 20th century (especially since I was one of them). I’m thinking of a bit further back—say, ancient Egypt.

Fortunately, every now and then, something crops up that shows us that our typical condescension toward the people of the past is misplaced. One such artifact is the Edwin Smith Surgical Papyrus, the oldest known historical text on surgery—and, in fact, the oldest known medical document of any length—in the world.

I confess I had never heard of the Edwin Smith papyrus until I ran across a mention of it in one of the science blogs I peruse daily: in this case, Medgadget. It’s not that it’s a new discovery: it was purchased by Connecticut-born Egyptologist Edwin Smith in Luxor, Egypt, in 1862. He attempted to translate it, but never published anything about it. When he died in 1906, he left the papyrus to his daughter, who donated it to the New York Historical Society, who finally got around to asking James H. Breasted of the University of Chicago to translate it in 1920. He completed and published his translation in 1930.

Since 1948 the papyrus has been held in the rare books vault at the New York Academy of Medicine—but this past Tuesday, September 13, it went on public display for the first time since 1948. You can see it through January 15 at the Metropolitan Museum of Art, as the centrepiece of a new exhibition called “The Art of Medicine in Ancient Egypt.”

The papyrus, which consists of 377 lines of text on the front and 92 lines on the back, has been dated to around 1700 B.C., but it’s believed to be a copy of a text originally written a few hundred years earlier. It tells physicians how to recognize, examine, diagnose and treat forty-eight distinct injuries. Much like a modern anatomy textbook might, it begins at the top of the head and works its way down to the shoulder blades and chest. (It presumably at one point continued to the feet, but that part of the text didn’t make it into the surviving copy.)

Its similarity to a modern medical text is, ultimately, what is so fascinating about the Edwin Smith papyrus. It deals entirely in practicalities, with magic mentioned in only one of the 48 case studies. By contrast, more general medical documents from ancient Egypt, dealing with the myriad diseases that plagued the Nile valley, are full of incantations. (That’s not surprising, since in ancient Egypt, the local physician, priest and magician might very well be the same person.)

Most of the injuries described are the sort of thing you might suffer in a Bronze Age battle. That’s consistent with the theory that all surgery began with the treatment of military injuries.

One surprising bit of modernity in the manuscript is the equivalent of the famous medical injunction to “First, do no harm.” Surgeons are loathe to perform unnecessary surgery, because surgery itself damages the body. In the Edwin Smith papyrus, cases are classified as favorable, uncertain, or “an ailment not to be treated.” The latter concept is not found in any other Egyptian medical document. The author of the papyrus includes 14 types of injury which he cannot cure; the fact he nevertheless includes detailed descriptions of them indicates what today we would certainly call a scientific interest in the workings of the body.

The Edwin Smith papyrus also contains the first descriptions of the cranial sutures (those squiggly cracks in a skull where the various plates of bone join together), the meninges (the lining of the brain), the surface of the brain, cerebrospinal fluid, surgical stitching, and various types of dressings. It indicates that surgeons were already beginning to recognize that the heart pumped blood all around the body—something not firmly established until the 17th century. It talks about using honey (which kills bacteria) on open wounds, and giving patients a potion based on willow bark to ease pain (willow bark contains a compound chemically related to aspirin).

James H. Breasted called the document “the oldest nucleus of really scientific knowledge in the world.”

Perhaps putting it on display will teach us 21st-centurians to appreciate our many-times-great-grandparents’ achievements a little bit more.

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