Egyptian Medicine - II - Medical Texts

Medical Texts

Edwin Smith's Medical-Surgical Papyrus.

"After a pause, the cause of which we cannot guess, but during which his well-filled reed pen dried up, he resumed his work on the papyrus. He made two more barely perceptible strokes with the almost exhausted brush, which he then dipped deep into his inkwell. After drawing the two pale strokes again, hard but so carelessly that the original faded lines are still visible, he laid down his brush and pushed the surgical treatise he had copied away from his hand, leaving 39 bare centimeters unwritten at the end of the scroll...''

"...It was as if he had seen a hand lift a curtain covering a window, and then suddenly that hand had refused to lift it any further. That provincial scribe, sitting on that scroll three thousand five hundred years ago, could hardly have imagined that every word he added would one day be hungrily cherished as the only surviving copy of the ancient treatise he was transcribing."

I cannot resist copying the words James Henry Breasted wrote as he reached the end of the papyrus translation. Archaeology has an extraordinary charm, it is an interrogation of the past, with an alert spirit, with the living sensation of communicating with men and women of the past, apparently dumb, until the hand of the archaeologist makes them speak.

One fine day, Mustafa Agha, a man of good standing in the Egyptian community, appeared at the door of Edwin Smith, an American farmer who had lived in Luxor for years. After a first uninteresting visit in which nothing of importance was shown to him, Mr. Smith made it clear that he would be willing to buy something more interesting.

After a while the Egyptian returned, but this time with a kind of fake papyrus, prefabricated from pieces of three others, carefully glued together with glue. Mr. Smith could not help but notice the prefabricated nature of it, but at the same time his knowledge of Egyptology allowed him to realize that it was an important medical document. He accepted the deal and took the papyrus.

Edwin Smith, Egyptologist

Edwin Smith was born in Connecticut in 1822, coincidentally the same year that Champollion first deciphered Egyptian hieroglyphs. He was one of the first students of Egyptology in the world. He went to London and Paris to study hieroglyphs when the science was in its infancy. He was probably the first American to study scientifically what was then little known about the Egyptian language. He decided to live in Egypt in 1858. He settled in Luxor, where he remained for about twenty years. He acquired the papyrus that bears his name in 1862.

Although he recognized the importance of the papyrus as a medical treatise and devoted much time to its study, he never made any effort to publish it. However, he did not hesitate to show it to all the experts of the time who visited him in Luxor. The brief notes that were published or commented on the case did not arouse much interest. Perhaps because of Smith's peculiar personality, far from the university circuits and more interested in developing his own independent lifestyle, he refrained from any attempt at publication. On the other hand, the serious, conscientious translation of the papyrus and its publication required a considerable amount of time and money. For a time, the papyrus was forgotten, until fate pointed its finger at the eminent Egyptologist Dr. James Henry Breasted, who was commissioned by the New York History Society to undertake the task. 

Dr. James Breasted

The Society had owned the papyrus since 1906, when it was given to them by Mr. Smith's daughter. J.H. Breasted devoted nearly ten years of painstaking effort to its publication.

Where did Mustafa Agha get the papyrus, where did it remain hidden for thousands of years? It is not known for sure, it seems to have been in the hands of someone else who had died years before. This papyrus, along with another medical papyrus that we will talk about later, were both in the possession of Mr. Smith for some time. Some references say that it was found in a tomb at El-Asasif, between the legs of a mummy. 

El-Asasif, a necropolis on the west bank of the Nile, in front of Thebes, near Deir el Bahari.

Other suspicions suggest that the two papyri belong to the group found by the then Consul of England in Egypt, Mr. Harris, in 1857, in a grotto among the rocks, about 20 feet deep, in Deir el Medina, near exactly where the tomb of the mysterious vizier Amenhotep, son of Hapu, second version of Imhotep himself, who was worshipped for hundreds of years as a protector against disease, and of whom we will speak later.

Amenhotep, son of Hapu

What kind of papyrus was it? Was it a textbook, or a textbook, a teacher's notebook? The fact that there were independent annotations on the back, without any connection to the front, suggests that it was rather used as a personal notebook, either by a teacher or a student.

In fact, it has the character of a memorandum, where the brief notes and words suggest that the reader already understands them, without the need for further clarification. The form it takes is that of a teacher instructing a student, with frequent expressions such as "if you see such and such... you must do such and such a thing".

THE CONTENT

Forty-eight cases are discussed, classified in order, from the top down, from the outside in, in a very regular and systematic way, typical of teaching systems.

Although there is no special indication, the cases are arranged in homogeneous groups related to a part of the body (head, neck, ribs, etc.) Each of these cases is arranged according to a criterion: Expression, Diagnosis and Treatment. The examination always begins with the statement: "If you examine a man who has...". The diagnosis, often a repetition of the statement, is usually introduced by the expression: "You must say about him (the patient)... that he has such and such a disease" and ends with a statement about the decision to be made: 

• "This is a case I will deal with."
• "This is a case I will struggle with."
• "This is a case I will not treat."

Sometimes pre-treatment conditions are added:

• "Until he recovers"
• "Until the period of damage is over"
• "Until you know he has reached a turning point (in his development)". 

The language used is striking, for some it represents the first babbling of the Egyptian language to create a technical and scientific vocabulary. However, it rather represents the natural way of explaining things, as can be seen in other classical medicines. Hippocrates himself advises to use a language that everyone can understand, closer to nature. Wisdom not only does not contradict simplicity, it is one of its distinguishing characteristics. Among the expressions used, we find descriptions such as the following: 

• The puncture in the skull bone is likened to a hole in an earthenware jar.
• The mandibular process is described as the double fingers of a bird.
• A piece of the skull is described as the shell of a turtle.
• The brain resembles the striations produced on the surface when copper is melted.
• The sinuses are called secret chambers. 

The means used in the cures are variable:

• Tape, made with bandages smeared with resins.
• Scabs of various kinds, slings.
• Sutures for wounds.
• Bandages of various kinds.
• Sophisticated systems of bandages. 

What does it teach us?

 The treatment is basically rational and surgical, with only one case of resorting to magic. The common opinion that the Egyptians always used magic and religious formulas in medicine is wrong in view of this papyrus. Remembering at the same time that even today there is no separation between science and religion, it is enough to observe the saints, scapulars, candles and prayers next to the sick, not to mention the chapels attached to all hospitals. If we call this the need for spiritual consolation, we will say that we agree. But if we want to accuse the ancient Egyptians of being superstitious, we will have to do the same with our contemporaries. Today, however, not even this exists, because our unbelieving and atheistic, hedonistic and individualistic society no longer relates to anything other than itself, not even doctors can maintain a certain friendship with the patient, they want to make them functionaries, mechanics, administrators of what the pharmaceutical industry points out.

A complete system of approach to the patient is described in the text:

• Examination of the character of the wound.
• Examination of the affected tissues.
• Interrogation and instructions to the patient: movements, postures.
• Data obtained by the doctor through direct inspection.
• Palpation.

The concept of prognosis was developed, a relatively recent conquest in the medical tradition, since it must be taken into account that until recently such a concept was not used. According to D. Gregorio Marañón, prognosis is "the art of the angels". It requires the use of all our knowledge and experience to determine whether someone will survive or not. Today it is no longer practiced, because what is offered today as a prognosis is merely a statistical statement: "Look, my friend, your wife has a ninety percent chance of surviving this surgery," which does not alleviate the poor husband's doubt, because where does his wife stand: in the ten percent that dies or the ninety percent that is saved?

The papyrus shows a knowledge that could only have been acquired through scientific judgment and direct observation of the anatomy of the living being, and is not the result of the accumulated experience of embalmers, who were not related to doctors. 

It also shows an interest in pure science. The Egyptian surgeon appears here as a man with the ability to observe, to draw conclusions from his own observations, and to maintain a scientific attitude toward phenomena. A profound knowledge of the pulse and the cardiac system, of the tendinous-muscular system, though not clearly of the circulation, is also shown.

Finally, we must mention the existence of one of the most extraordinary glosses, the extracts referring to the so-called Secret Book of the Physicians, of which we have no copy except for these annotations and some others in other papyri. In these extracts, the measurement and examination of the heart by means of the pulse is mentioned, and a general theory of the channels leading to the different parts of the body is introduced: these are the so-called met/metu, channels that have been identified with the blood vessels, with the muscles, and even with the peripheral nerves. As we shall see, they should really be translated as channels, in the same way that Chinese medicine uses the concept of meridians.

There are surgical practices described in the Smith Papyrus that were later passed on to the Greeks and Romans, such as in case number 26 of this papyrus, which discusses the maneuver to be performed to set a dislocated jaw:

``If you examine a man whose jaw is dislocated, you will find that his mouth is open and he cannot close it. You should place your thumbs over the ends of the two clusters (apophyses) of the jaw in his mouth, and the rest of your fingers under his chin, so that they move backward and fall into place.''

In a Byzantine manuscript from 1100 A.D., exactly the same maneuver of reduction of mandibular dislocation described in the papyrus can be observed. 

To be continued