Edwin Smith Papyrus: Ancient Egypt's Surgical Textbook

The Edwin Smith Papyrus is an ancient Egyptian medical text copied around 1600 BC and the oldest known treatise on surgery. It sets out 48 cases of injuries, from head wounds to broken collarbones, each with an examination, a diagnosis and a treatment. Named after the American collector who bought it in 1862, it shows Egyptian healers observing the body with a method that looks remarkably systematic to modern eyes.

Background: medicine in ancient Egypt

Egyptian doctors were famous across the ancient world. Medical practitioners, called swnw, worked alongside priests of the goddess Sekhmet and specialists in magical protection. Treatment combined practical remedies, such as bandages, splints and drugs made from plants and minerals, with prayers and spells.

About a dozen major medical papyri survive. They include the Ebers Papyrus, a long collection of remedies from about 1550 BC, and the Kahun Gynaecological Papyrus of the Middle Kingdom. The Edwin Smith Papyrus stands out because it is organised as a textbook of cases rather than a list of recipes.

Many of its cases describe the kind of injuries suffered by labourers on building sites, soldiers in battle or people in accidents: crushed skulls, split noses, broken ribs and dislocated shoulders. For this reason some historians have suggested that the treatise grew out of the experience of healers attached to armies or to large work projects, although this cannot be proved.

The document

The scroll is about 4.7 metres long. It is written in hieratic, the cursive form of hieroglyphs, with headings and key words in red ink and the rest in black. The front (recto) has 17 columns containing the surgical cases; the back (verso) has 5 columns of other material.

The surviving copy dates to about 1600 BC, in the Second Intermediate Period, probably the time of the Sixteenth or Seventeenth Dynasty. Its language includes old words and phrases that the copyist explained in 69 short notes, or glosses. Breasted argued that the original was composed in the Old Kingdom, around 3000–2500 BC; other scholars place its composition later, but agree that the copy draws on an earlier work. The scribe made mistakes, and the text breaks off in mid-sentence, so the original was longer.

Contents of the papyrus

The 48 cases

The cases run in order from the top of the body downwards. Around 27 deal with the head and skull, followed by the nose, ears, throat and neck, the collarbone, the upper arm, the chest and ribs, and finally the spine, where the text stops.

Each case follows the same pattern:

1. A title, such as instructions for a gaping wound in the head.
2. An examination, describing what the practitioner should look at and feel, and how to test the patient’s movements.
3. A diagnosis, ending with one of three verdicts: an ailment “I will treat”, an ailment “I will contend with”, or an ailment “not to be treated”.
4. A treatment, where one is offered.

The three verdicts show an awareness of prognosis. Cases judged hopeless, such as some severe skull fractures, were still described and observed rather than ignored. In several of them the text advises the practitioner to keep the patient comfortable and to watch how the condition develops, a cautious approach that modern readers have often compared with later Greek medical writing.

Treatments

The remedies are mostly practical. They include bringing the edges of wounds together with strips of adhesive linen or stitches, laying fresh meat on a wound on the first day, and later dressing it with honey, grease and lint. Fractures were set and held with splints of linen-wrapped wood or stiffened bandages. The papyrus describes how to reduce a dislocated jaw by pressing down with the thumbs, a method still recognisable today.

Only one of the surgical cases, a wound in the forehead, relies on an incantation.

The brain and the spine

The papyrus contains the earliest known written references to the brain. It describes the folds on its surface, the membranes around it and the fluid beneath, in cases where the skull has been broken open.

It also records that injuries to one side of the head could affect the body, and that a dislocated vertebra in the neck could leave a patient unable to move the arms and legs or control the bladder. These are among the first recorded observations linking the brain and spinal cord to movement and sensation. The text also relates the heart to the pulse felt in different parts of the body.

The back of the scroll

The verso is quite different. It contains incantations against a seasonal pestilence, called the “pest of the year”, and recipes for problems such as women’s ailments and skin care. One recipe claims to transform an old man into a youth. This mixture shows that the owner saw practical and magical medicine as parts of the same profession.

Discovery and translation

Edwin Smith, an American who lived in Luxor and dealt in antiquities, bought the papyrus there in 1862. He could not fully read it. After his death in 1906 his daughter gave it to the New-York Historical Society.

The Egyptologist James Henry Breasted of the University of Chicago, working with the physician Arno Luckhardt, prepared a full translation and commentary, published in 1930 in two volumes. In 1948 the papyrus was transferred to the New York Academy of Medicine. It was displayed at the Metropolitan Museum of Art in 2005, when a new translation by James P. Allen was published.

Key people

• Edwin Smith (1822–1906): an American born in Connecticut who lived in Luxor for many years, studied Egyptian writing and traded in antiquities. He bought this papyrus and, according to most accounts, also handled the Ebers Papyrus before it was sold to the German scholar Georg Ebers.
• James Henry Breasted (1865–1935): a leading American Egyptologist and founder of the Oriental Institute in Chicago, who spent about a decade on his edition of the papyrus.
• Arno Luckhardt: a physiologist at the University of Chicago who advised Breasted on the medical meaning of the cases.
• James P. Allen: an Egyptologist at the Metropolitan Museum whose 2005 translation updated Breasted’s work in the light of later research on the Egyptian language.

Myths and facts

The papyrus is sometimes said to have been written by Imhotep, the architect of the Step Pyramid who was later worshipped as a god of healing. Breasted suggested this possibility, but nothing in the text names its author. Another common claim is that Egyptian medicine was entirely magical; this papyrus shows careful, practical observation, although magic remained part of medical practice. It does not, however, describe dissection or internal surgery on the organs.

Timeline

• c. 3000–2000 BC: The original text is composed (date debated).
• c. 1600 BC: The surviving copy is made.
• 1862: Edwin Smith buys the papyrus in Luxor.
• 1906: Smith dies; the papyrus goes to the New-York Historical Society.
• 1930: Breasted publishes the first full translation.
• 1948: The papyrus moves to the New York Academy of Medicine.
• 2005: It is exhibited at the Metropolitan Museum of Art.

Why it matters

The Edwin Smith Papyrus shows that more than a thousand years before Hippocrates, Egyptian practitioners organised medical knowledge by examining patients, judging outcomes and recording treatments. It is a key source for the history of surgery, neurology and medical writing.