Ancient surgery
Egypt
Surgeons in ancient Egypt were both priests and doctors, blending ritual with medicine
In November 2001, in the shadow of the first royal pyramid at Saqqara (built c. 2630 BC), about 19 miles south of Cairo, archaeologists made an extraordinary discovery. Buried under 5 metres (16.4 feet) of sand was a tomb that had been hidden since 2000 BC. In the writing on its walls was a hint that surgery had actually been practised in ancient Egypt – the first hard evidence of it being performed as early as this.
Chief physician
This was the tomb of Skar, the chief physician of one of Egypt’s rulers of the 5th dynasty. It contained about 30 bronze medical implements, the oldest ever found, including scalpels, needles and a spoon.
Archaeologists also found an alabaster altar and 22 statues of different gods and goddesses inside the tomb. As was usual in ancient times, when science and religion were inseparable, Skar would also have been a priest, mixing ritual and magic with his medicine. But what kind of medicine and what kind of surgery?
Free-wheeling
It was in the Egyptian city of Luxor in 1862 that the first proof was found that surgery was being carried out in ancient times.
The free-wheeling American trader Edwin Smith spent much of his time trawling the Luxor markets hoping to discover ancient artefacts he could sell for an easy profit. Smith even described himself as ‘an American farmer of Luxor’. According to Dr Richard Sullivan of University College London, ‘most Egyptologists regard him as a bit of a bounder and a cad.’
Ancient medical treatise
Usually, Smith was quite happy to buy a well-made fake, which he had few scruples about selling on as the genuine article. But he knew his business, and he treated one papyrus, which looked genuine, very differently. Able to read hieroglyphs, he could see that this was an ancient medical treatise and therefore highly unusual.
Although he could have got a good price for the papyrus, for unknown reasons Smith decided to keep it, and it remained in his family for more than 70 years. It was only when it was fully translated in the 1930s that its full significance was recognised.
Acacia thorns and flax
The Edwin Smith Surgical Papyrus – as it is now known – is a detailed (if incomplete) compendium of surgical treatments for wounds, starting with head injuries and working down the body. Surprisingly, of the 48 case studies in it, only one mentions magic, and a modern surgeon would be familiar with the way each case is set out.
The papyrus goes into great detail describing each individual trauma: how you would look at it, how you would diagnose it, how you would examine it and then how you would treat it. It describes how to stitch a gaping wound with acacia thorns as needles and pieces of flax as suturing material. For pus-filled tumours, it recommends cauterisation, in which a very hot copper instrument would be used not only to cut away the damaged tissue but also to seal all the blood vessels. Today, a similar technique called diathermy is used, with an electric current taking the place of heat.
Unfinished
Even more important are the neurological insights that the Edwin Smith papyrus gives. It contains the first descriptions of the meninges (the membranes covering the brain), the external surface of the brain and the cerebrospinal fluid. It also notes that brain injuries are associated with changes in the function of other parts of the body, especially the lower limbs.
The papyrus was actually copied in about 1700 BC from an ancient composite manuscript that contained – in addition to the original author's text, written in 3000-2500 BC – a commentary added a few hundred years later in the form of 69 explanatory notes. The scribe who copied it made many errors, some of which he corrected in the margins. He had copied at least 18 columns of it, when, having reached the bottom of a column, he paused in the middle of a word and laid down his pen, leaving the papyrus unfinished for all time.
Nose jobs for the dead
Other clues that tell us that the Egyptians had discovered the principles of surgery can be found in the way they prepared their dead. For instance, the mummy of the great pharaoh Rameses II, now in Cairo Museum, was surgically altered by having a small bone and a quantity of seeds inserted into his nose. In life, this had been his most prominent feature. The Egyptian surgeons ensured that, in death, it remained just as prominent.
The mummy of Queen Nunjmet was also enhanced. Her cheeks and belly were stuffed with bandages, resin and a cheesy substance. Today, plastic surgeons would use materials such as silicon.
So the Egyptians used surgery on the dead. And, as the Edwin Smith papyrus shows, they had the skills to perform such operations on the living. But did they? The mummies don’t reveal any evidence that proves this one way or the other.
