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Journal of Investigative Surgery, 23, 327334, 2010

C 2010 Informa Healthcare USA, Inc.


Copyright 
ISSN: 0894-1939 print / 1521-0553 online
DOI: 10.3109/08941939.2010.515289

Ancient Egyptian Surgical Heritage


Aly Saber
Port-Fouad General Hospital, Port-Fouad, Port-Said, Egypt

ABSTRACT
Egyptian medicine influenced the medicine of neighboring cultures, including the culture of ancient
Greece. From Greece, its influence spread onward, thereby affecting Western civilization significantly. The oldest extant Egyptian medical texts are six papyri: The Edwin Smith Surgical Papyrus
and the Ebers Medical Papyrus are famous.
Keywords: ancient Egypt, Imhotep, Ebers Papyrus, Edwin Smith Papyrus, protosurgery, medical texts

INTRODUCTION

EARLY SPECIALIZATION

Driven by their deep-seated desire for eternal life in a


healthy body, ancient Egyptians were one of the first
civilizations to begin collecting and recording medical
lore and medicinals that were effective for a healthy
body [1]. Homer put in the Odyssey that of all the
branches of science pursued in ancient Egypt, none
achieved such popularity as medicine [2].

It may be significant that the oldest swnw we know,


Hesy Re, who lived at the time of the legendary
Imhotep (c. 2800 BC), was associated with the treatment of teeth, for specialization in single segments or
functions of the human body seems a particular feature
of the ancient kingdom [6].

That a well-developed and hierarchical medical profession existed in Pharaonic Egypt is without doubt
as well as a recognizable surgical profession. Medical
papyri and the treatises of the historians of antiquity
provide a far more reliable source of information on
surgical practice. They have indicated possible titles
for surgeons and the types of instruments used [3].
The ancient Egyptian word for doctor is swnw. There
is a long history of swnw in ancient Egypt. The earliest
recorded physician in the world is also credited to ancient Egypt: Hesyre, Chief of Dentists and Physicians
for King Djoser in the 27th century BC [3, 4]. The lady
Peseshet (2400 BC) may be the first recorded female
doctor and on a stela dedicated to her in his tomb she
is referred to as imy-r swnwt, which has been translated
as Lady Overseer of the Lady Physicians (swnwt is
the feminine of swnw) [5].

Herodotus wrote, Medicine is practiced among them


(ancient Egyptians) on a plan of separation; each physician treats a single disorder and no more: thus the
country swarms with medical practitioners some undertaking to cure diseases of the eye, others of the head,
others again of the teeth, others of the intestines, and
some those which are not local [2, 7].
Specialists were a minority, and the majority did
not record any specialization [6]. We know from
records that the ancient Egyptians adopted a hierarchy system reminiscent of todays health service [8]
(Table 1).
The Egyptians can claim credit for the first populations
to have practicing physicians. Doctors in Egypt usually
went through years of hard training at temple schools
in the various arts of interrogating the patient, inspection or examination, palpation, and treatment [9].

SURGERY AS A SEPARATE PROFESSION


Received January 01, 2010; accepted August 05, 2010.
Address correspondence to Aly Saber, Consultant Surgeon, PortFouad General Hospital, 19 al-guish Street, Port-Fouad, Port-Said,
Egypt. E-mail: Alysaber54@gmail.com

It was suggested and perhaps finally supported that


surgeons were a separate group in ancient Egypt [6]
(Figure 1).
327

A. Saber
Table 1 Shows the adopted hierarchy system put by the
ancient Egyptians reminiscent of todays health service

Junior doctors (swnw).


Doctors (imy-r-swnw).
Senior doctors (wr-swnw).
Registrars (smsw-swnw).
Consultants (shd-swnw).
Specialists in a given field, such as Sekhet-n-Ankh, a nose
doctor.

INSTRUMENTS
Many examples of proposed surgical instruments have
been discovered. Some were undoubtedly used in the
mummification process. The medical papyri contain
many references to instruments and surgical tools that
included knives, drills, saws, hooks, forceps and pinchers, scales, spoons, and a vase with burning incense [10]
(Figures 2a and b).
Some of the antique instruments used in traumatology,
the general surgery and in cosmetic-plastic operations,
are in a scarcely modified manner employed for the
same purposes in modern surgical interventions nowadays (Figures 3 and 4). The surgical diagnostics and
therapy of that time is demonstrated by the surgical
instruments stock being in the possession of the Agyptisches Museum of the Staatlichen Museen zu Berlin
[1114].

2. removal of a tumor of fat (3t nt d) (Ebers Papyrus,


pp. 863877).
In Ebbells translation of the Ebers Papyrus, then thou
shalt go round it with a Ipt-knife to the limits of all. . .,
George Ebers further discussed the case of this instrument, referring to a different word, xpr. It appears that
the function of Ipt, or xpr, was to debride a wound, and
the most logical instrument would have been a curved
scalpel [17] (Figure 3c).
Blades made of iron and bronze came relatively late to
Egypt. In some procedures, the blade would be heated
until it glowed red and then used to make incisions. It
would cut as well as seal up the wound to limit bleeding
[18].

TREPHINATION
The Egyptians invented the circular trephine, made by
a tube with serrated borders, which cuts much easier by
means of rotation and which was then extensively used
in Greece and Rome, and gave origin to the crown
trephine, used in Europe from the 1st to the 19th century [19].
The Ebers Papyrus (pp. 109, 876) discusses the use of
the swt to treat oozing in any limb, probably a description of a hematoma. It would seem that the swrreed was akin to the modern surgical lancet for the
relief of subcutaneous pressure points [20, 21].
Perhaps swt was composed of metal or ivory, and the
reference to the reed simply implied its shape. Alternatively, the word may be the ancient Egyptian equivalent
of the lancet [2023].

SUTURES
The first description in written history of suturing
is found in the Edwin Smith Papyrus (pp. 225233).
Breasted thought that the word ydr stood for sutures
[15]. Catgut and silk are known since antiquity as earliest written records date back to ancient India and
Egypt, between 1600 and 1000 BC, when flax and hemp
were used to close wounds. Since then many materials
have been tried including the heads of giant black ants,
catgut (sheep intestine), and tree bark [15, 16].

INCISIONS
There are many references in the Ebers Papyrus to the
undertaking of the knife-treatment (dw), particularly
for
1. opening of abscesses (3t nt ryt and 3t nt whdw)
and
328

CAUTERIZATION
Cauterization is first described in the Ebers Papyrus
where instructions concerning a swelling of vessels,
probably an aneurysm are given (pp. 108, 872 CVIII).
Further, it is described in Edwin Smith Papyrus
(Chapter 39 XIII312), describing tumours or ulcers
in the breast, perhaps resulting from injury

PROPER MANAGEMENT OF SURGICAL


PATIENT
History and Examination of the Patient
The Edwin Smith Papyrus (17th century BC) and the
Ebers Papyrus (16th century BC) are an instructional
system of the diagnosis and practice of medicine, which
referred to audible signs of disease within the body and

Ancient Egyptian Surgical Heritage

FIGURE 1. Shows that surgeons were a separate group in ancient Egypt.

stated that the Egyptians were the first to systematically


document the practice medicine [24].
The text instructs the physician to examine the patient
and look for revealing physical signs that may indicate the outcome of the injury. Although in modern
medicine we take for granted that the use of physical
examination and rational thinking lead to an accurate
conclusion, 5,000 years ago, the ancient Egyptians did
this extraordinary act [24].
Probably the doctor would make a home visit if you
could afford it. The first thing that he might do is examine your pulse, although it was never really clear
what information the ancient Egyptians learned from
this procedure.
Then your physician would interrogate you, according to the Smith Papyrus, to find out about your general condition and symptoms, just as doctors do today.

The doctor might ask you if you had any enemies or


did anything recently to incur anyones wrath. If you
thought so, he might chant a spell to help rid the entity
that was causing your cystitis. Alternatively, give you
an amulet or healing charm to wear [25].
Then the doctor would examine you with a lot of
hands-on observation, probing here, palpating there.
He might ask for a urine sample to look at or test when
he left your bedside. Finally, he would pronounce what
he thought was wrong with you and what your treatment should be [25].
According to the Edwin Smith Surgical Papyrus, a doctor had three options when dealing with a sick patient:
(a) to treat the illness (when he anticipated that a cure
was likely or that the patient would recover regardless),
329

A. Saber

FIGURE 2. (a) Shows the first known image of a doctor. Wooden relief of Hesyra, dating to the third dynasty, and found at
Saqqara. The panel is now in the Egyptian Museum, Cairo. (b) Shows the image of the incised relief of the Wall of Temple of
Kom Ombo. Many instruments are labeled according to medical use, but some do not have a clear purpose. Could the tube in
the lower left corner of the relief between the cupping vessels and shears have been a hearing device used as a stethoscope?

(b) to contend with the illness (if a cure seemed unlikely but palliation was possible), or
(c) to avoid treatment altogether (if the case seemed
hopeless).
(d) It was the physicians call [26].

Ancient Egyptians were fully aware that accurate diagnosis of diseases and their symptoms was fundamental
for effective treatment. These are the earliest surviving examples of observation and conclusion, the oldest
known evidences of an inductive process in the history
of the human mind. These read: [27].

Accurate Diagnosis

(a) Until he recovers.

The diagnosis is always introduced by the words:


Thou should say concerning him [the patient] . . . and
ends with one of three statements:

330

(b) Until the period of his injury passes by.


(c) Until thou knowest that he has reached decisive
point.

(a) An ailment that I will treat.

Treatment

(b) An ailment with which I will contend.


(c) An ailment not to be treated [25].

It is interesting to investigate the evidence we have


for the existence of protosurgery in ancient Egypt

Ancient Egyptian Surgical Heritage

FIGURE 3. (a) Shows few examples of needles dated back to the early dynastic period, 3150 BC2181 BC. (b) Shows a copper
needle, a silver needle (missing the eye), and a copper pin with loop head. All are dated to the predynastic period. (c) Various
instruments that were unearthed in Egypt. Dated to 3000 BC.

during the dynastic period (c. 3200323 BC). Climate


and chance have preserved medical literature as well as
paleoarcheological specimens, and these artifacts along
with extant Greek and Roman treatises appear to support the conclusion that protosurgery was practiced in
ancient Egypt (the prefix proto designates an original
or early form). Elements of protosurgical development
included analgesia and sedation, the incision, trephination, protosurgery of trauma, and antisepsis, drawing
on primary sources [28].
Although there is no evidence of surgical scars in any
of the mummies so far found, the papyrus refer to
the stitching of incisions and closing wounds by binding them with adhesive tape made of linen. The Smith
Papyrus also indicates that the ancient Egyptians dissected human cadavers [29].
The following therapeutic accessories are mentioned in
the Edwin Smith and Ebers papyruses:
1. Dressings for wounds
(a) Lint (ftt) is of vegetable origin: it can be used
dry to absorb secretions (on throat, Edwin
Smith, case 28) or impregnated with medicaments for local application (in ear, Ebers 91,
767).
(b) Linen: made of flax, is used in different forms
(v.i.).

2. Sutures (Edwin Smith, case 10).


3. plints: three types (possibly 4) are described:
(a) Brace of wood padded with linen (Edwin
Smith, case 7) inserted into the mouth to help
feeding the patient (vi).
(b) Splint made of linen (Edwin Smith, case 35,
fractured clavicle).
(c) Stiff post-like roll of linen (Edwin Smith, cases
11 and 12).
(d) it is possible that cartonnage was used, similar to our plaster of paris to splint fractures,
also made of linen.
4. Cautery: either by means of the fire drill or with
a heated scalpel [1525, 30].
In many cases the treatment was beyond the capability
of the time and the surgeon simply states that this is
. . . an ailment not to be treated, i.e., with a very poor
prognosis. Nevertheless, he meticulously described the
physical findings [27].

Wound Care
The treatment of acute and chronic wounds is an ancient area of specialization in medical practice, with a
long and eventful clinical history that traces its origins
to ancient Egypt and Greece. The Papyrus of Ebers,
331

A. Saber

FIGURE 4. (a) This object is recognized to be an Egyptian toilet tool, but its function has not been uncovered. Dated to the 18th
dynasty, 1570 BC1293 BC. (b) These instruments were used to pull out the brain during the process of mummification.
(c) Collection of ancient Egyptian medical knives, cupping cups, spatula, and forceps. Dated to about 4000 BC.

FIGURE 5. The Eye of Horus as an ancient Egyptian symbol of protection and royal power from the Gods.

332

Ancient Egyptian Surgical Heritage

c. 1500 BC, details the use of lint, animal grease, and


honey as topical treatments for wounds. The lint provided a fibrous base that promoted wound site closure,
the animal grease provided a barrier to environmental
pathogens, and the honey served as an antibiotic agent.

DECLARATION OF INTEREST

The Egyptians believed that closing a wound preserved


the soul and prevented the exposure of the spirit to
infernal beings, as was noted in the Berlin Papyrus
[31].

REFERENCES

The ancient Egyptians were masters in applying and


arranging bandages, and they recognized the cardinal
signs of infection and inflammation. Egyptian drug
therapy can be regarded as having evolved from a
system rooted in magic and empirical observation
[32].

The Eye of Horus


The Eye of Horus or Eye of Ra was called the Udjat.
It represents the right eye of the Sun God Horus (Figure 5). According to legend, the left eye was torn from
Horus by his brother Seth. It was magically restored
by Thoth, the God of Magic. The Eye of Horus was believed to have healing and protective power, using the
mathematical proportions of the eye to determine the
proportions of ingredients in medical preparations and
to prepare medications. The eye of Horus has a very
specific meaning. The eye is represented as a figure
with six parts corresponding to the six senses: touch,
taste, hearing, thought, sight, and smell [3335].
The Egyptians did write prescriptions. Those prescriptions were first magical verses and then the real prescription. The Eye of Horus was an important part of
the magical part of the prescription. With time the magical part became smaller and the real prescription more
important. Eventually, all that was left of the magical
verse was the Eye of Horus. It remained in prescriptions
to this day as the R at the beginning of each prescription. Recently, it has been suggested that the symbol
originates in the eye of Horus [36].

ACKNOWLEDGMENT
To Mrs. Mervat Kamel for her help in writing and editing this report and my daughters Dr. Asmaa and Dr.
Aya for their cooperation and preparation of the software of figures that made this work possible; really I
feel indebted.

The authors report no conflict of interest. The authors


alone are responsible for the content and writing of this
paper.

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