The Edwin Smith Surgical Papyrus
The first use of "neuro" words in recorded history

I'm thinking of a word...
A simple word...
An important word...
A word for the most important organ in the body...

The word I am thinking of is...
Move mouse over this hieroglyphic

The brain was not always held in high regard. The Greek philosopher, Aristotle, thought the heart, not the brain, was the location of intelligence and thought. The ancient Egyptians also did not think much of the brain. In fact, when creating a mummy, the Egyptians scooped out the brain through the nostrils and threw it away. However, the heart and other internal organs were removed carefully and preserved. These organs were then placed back into the body or into jars that were set next to the body.
Nevertheless, the ancient Egyptians are responsible for the oldest written record using the word "brain" and have provided the first written accounts of the anatomy of the brain, the meninges (coverings of the brain) and cerebrospinal fluid. The word "brain" appears on an ancient paper-like document (a "papyrus") called the Edwin Smith Surgical Papyrus. This document was written around the year 1700 BC, but is based on texts that go back to about 3000 BC. This document is considered to be the first medical document in the history of mankind. It is possible that the papyrus was written by the great Egyptian physician named Imhotep.
Statue of Imhotep

A Papyrus

Hieroglyphic for "Brain"

The papyrus is a description of 48 cases that were written by an Egyptian surgeon thousands of years ago. The papyrus is about 4.68 meters (15 ft., 3.5 in.) long and 32.5 to 33 cm (13 in.) wide. Because some of the document is missing, the original papyrus was probably at least 5 meters long. Several cases are important to neuroscience because they discuss the brain, meninges (coverings of the brain), spinal cord, and cerebrospinal fluid for the first time in recorded history.

The surgical papyrus is named after Edwin Smith, an American Egyptologist who was born in 1822 and died in 1906. On January 20, 1862 in the city of Luxor, Smith bought the surgical papyrus from a dealer named Mustapha Aga. After Smith died, his daughter, Leonora Smith, gave the papyrus to The New York Historical Society. In 1920, James Henry Breasted, founder of the Oriental Institute of Chicago, was asked to translate the papyrus. Finally, in 1930, Dr. Breasted published the English translation for The New York Historical Society (University of Chicago Press.) According to Arlene Shaner, reference librarian of historical collections at The New York Academy of Medicine, the papyrus was sent to the Brooklyn Museum in 1938. Ten years later, the Museum purchased most of the Egyptian artifacts from the Society. At that time, however, the directors of the Society and of the Museum decided that the papyrus really belonged at The New York Academy of Medicine. The papyrus has been part of The New York Academy of Medicine collections since December 2, 1948.

(Note: I found a dusty copy of the 1930 publication in a back corner of the University of Washington Health Sciences Library.)

The 48 cases contained within the Edwin Smith Surgical Papyrus concern:

  • 27 head injuries (cases #1-27)
  • 6 throat and neck injuries (cases #28-33)
  • 2 injuries to the clavicle (collarbone) (cases #34-35)
  • 3 injuries to the arm (cases #36-38)
  • 8 injuries to the sternum (breastbone) and ribs (cases #39-46)
  • 1 injury to the shoulder(case #47)
  • 1 injury to the spine (case #48)

It is likely that the patients described in the 48 cases were injured by falls (maybe from working on monuments or buildings) or were victims of battle (many wounds appear to be caused by spears, clubs or daggers.) The brain is mentioned 7 times throughout the papyrus. However, there is no use of the word "nerve." Scholars of medical history have been impressed with the rational, scientific approach to diagnosing and treating the 48 patients. The methods used are based on rational observation and practical treatment and are for the most part, free of "magic" and superstition.

Each case is presented in a logical manner:

  1. Title: the type of injury and its location are described.

  2. Examination: the case and the manner in which the patient should be examined are described. The examination may include sensory testing, probing of the wound and movement of the affected body part. Some patients were examined more than once. The examination section of the papyrus always starts as:

    "If thou examinest a man having..."

  3. Diagnosis: the doctor has three choices and will say one of the following about the condition:
    1. "An ailment which I will treat" - this is used for injuries that most likely will be cured.
    2. "An ailment with which I will contend" - this is used for difficult, but not impossible cases. The doctor will try to treat the condition, but the outcome is uncertain.
    3. "An ailment not to be treated" - in these cases, the condition cannot be treated at all because the injury is thought to be incurable.

    The diagnosis section of the papyrus always starts as:

    "Thou shouldst say concerning him..."

  4. Treatment: these include bandages, plasters, stitching, cauterization (heating of a wound), and splints. Surgical dressings included honey, grease and lint.
    The treatment section of the papyrus always starts as:

    "Thou shouldst ..."

  5. Glosses: these are short dictionaries of terms. Not all of the cases have a gloss.

Let's look at some of the cases that concern the nervous system.

Case 6

Case 6: A gaping wound in the head, fracture of the skull and opening of the meninges. This case describes the:

  1. Convolutions of the brain - the author of the papyrus describes these "like those corrugations which form molten copper." This most likely refers to the wrinkled appearance of the brain created by the gyri and sulci of the brain.


    "Corrugations" of the Brain

  2. Meninges (coverings of the brain) - described as the membrane enveloping the brain.


    "Membrane" enveloping the Brain

  3. Cerebrospinal fluid - described as the fluid in the interior of the head.


"Fluid" in the Interior of the Head

Case 6 was "An ailment not to be treated."

Case 8

Case 8: Fracture of the skull with no visible external injury. Apparently this patient injured his head, but the skin remained somewhat undamaged. This case is important because it describes which side of the body is affected by a head injury. In this patient, there was abnormal eye movement and paralysis of the arm and leg on the side of the body that was the same as the head injury. Because the right side of the brain controls the left side of the body and the left side of the brain controls the right side of the body, it is thought that the damage to the brain was caused by a contracoup injury. A contracoup occurs when impact to one side of the head pushes the brain within the skull such that the brain hits the opposite side of the skull. This results in brain damage on the side opposite to the side receiving the impact. The description of this case indicates that the Egyptian surgeon may have known that the brain controlled movement.

Case 8 was "An ailment not to be treated."

Case 22

Case 22: Fracture of the temporal bone (of the skull). This patient could not speak and this case is thought to be the first to document aphasia. If this is a description of aphasia, it would pre-date the famous work on aphasia by Paul Broca (1861) by thousands of years!

Case 22 was "An ailment not to be treated."

Cases 31 and 33

Case 31: Dislocation of cervical vertebra; Case 33: Crushed cervical vertebra. Both cases describe paralysis and sensory problems caused by injuries to the backbone.

Cases 31 and 33 were both classified as "An ailment not to be treated."

Case 48

Case 48 is the last case and describes a sprain in the spinal vertebra. When the patient was asked to move his legs, the surgeon noted that this caused pain. The text of case 48 comes to an unexpected stop in the middle of a sentence. This suggests that there may have been more cases in the original papyrus.

Case 48 was "An ailment which I will treat."

Our understanding of the brain has come a long way since 3000 BC. Now, through brain imaging techniques such as positron emission tomography (PET) and magnetic resonance imaging scientists can "look" at how the brain works. Neuroscientists also know what many parts of the brain do, what brain cells look like and how drugs affect the nervous system. However, many mysteries of the mind still remain:

How are memories formed and lost?
What are the causes and cures for Alzheimer's disease and Parkinson's disease?
Why do we sleep?
What is consciousness?

These are just a few of the many unanswered questions, but like case 48 in the papyrus, this page is coming to a sudden...

For more information on the Edwin Smith Surgical Papyrus and ancient Egyptian medicine, see:
  1. Edwin Smith Papyrus - from the Cyber Museum of Neurosurgery
  2. Photograph of Dr. Breasted
  3. The Oriental Institute

References:

  1. The Edwin Smith Surgical Papyrus: Neuroscience in Ancient Egypt
  2. Brandt-Rauf, P.W. and Brandt-Rauf, S.I., History of occupational medicine: relevance of Imhotep and the Edwin Smith papyrus, Brit. J. Industrial Med., 44:68-70, 1987.
  3. Breasted, J.H., The Edwin Smith Surgical Papyrus, Chicago: University of Chicago Press, 1930.
  4. Cadwallader, T.C., Semrau, L.A. and Cadwallader, J.V., Early physiological psychology: circa 3000 BC, Proc. Ann. Conv. American Psychol. Assn. 6:719-720, 1971.
  5. Estes, J.W., The Medical Skills of Ancient Egypt, Canton: Science History Publications, 1989.
  6. Gross, C.G., Brain, Vision, Memory. Tales in the History of Neuroscience, Cambridge: MIT Press, 1998.
  7. Hughes, J.T., The Edwin Smith Surgical Papyrus: an analysis of the first case reports of spinal cord injuries. Paraplegia, 26:71-82, 1988.
  8. Reeves, C., Egyptian Medicine, Buckinghamshire: Shire Publications, 1992.

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