Surgery in ancient Egypt was practiced by physicians implementing a well-understood and codified surgical art according to the possibilities of the time, as indicated in medical papyri. This surgery was performed daily by religious, civilian, or military physicians who were already well-versed in the anatomical, physiological, and clinical knowledge of that era. The practice of this art was also conditioned by the technical means available in this field, especially regarding pharmacopoeia and surgical instruments.
Anatomical and Physiological Knowledge
The anatomical and physiological knowledge of the ancient Egyptians was already significant. These notions resulted from observations made in various situations, such as careful examination of living patients, findings on corpses, and, as today, observations on animals.
Indeed, a certain number of elements are known to have been accessible from war injuries, after serious “work accidents” or domestic incidents. Other anatomical elements may have been identified during the invention of mummification of the deceased. This mortuary procedure was probably inspired by the natural desiccation of bodies found practically intact in the desert but necessarily reproduced artificially and quite sophisticatedly. We also know that several organs were removed to be preserved in special vases or canopic jars. As for the heart, it was removed, treated separately, and then normally placed back into the chest of the deceased.
Thus, “human anatomical lists” have been well documented since the Old Kingdom; for example, they are found in pyramid texts and other later religious writings. Interesting concepts are, of course, found in the pharaonic medical and surgical texts that have come down to us. Then, human dissections are documented in Alexandria. It should be noted that these studies remained prohibited for a long time afterward.
Clinical Approach
Medicine at that time was surely intertwined with magic; however, the subjective care of the patient did not exclude the search for objective signs of illness or injury. Upon reading Egyptian medical texts, it is surprising to note a certain modernity in the clinical sense of this pharaonic science, considering the means of that time. Grouped in papyri dedicated to them, the observations constitute genuine literary units describing pathological cases and their treatments. These scrolls were often laden with comments written by experimenting practitioners. The surgical writings that have not disappeared are mainly contained for us in the Edwin Smith papyrus and the Ebers papyrus.
The authors outline concepts such as:
- Physical examination;
- Diagnosis;
- Differential diagnosis;
- Favorable, reserved, or frankly poor prognosis;
- Follow-up of the evolution;
- all with the perspective of “curing.”
Then, the proposed therapies are graduated according to the severity of the surgical pathology and adapted according to evolution. Like today, after the initial “look,” the first symptomatic elements are gathered from the patient’s history. The selected subjective and objective signs are isolated during the general examination, followed by local inspection and exploration. For injuries, the location, appearance of the skin, and retractions were noted quite precisely; depth was explored using a probe and a retractor; and splinters and foreign bodies were identified. According to the descriptions, the successive states of the wounds were observed quite finely.
Surgical Practice
After study, it appears that the pragmatic gesture of the Egyptian surgeon stems from thoughtful and codified indications.
Thus,
- instruments are chosen and adapted for a given intervention;
- they are used consecutively during the different stages of the operation.
For example, in the context of surgical treatment of an abscess,
- it is necessary to mention acts such as “incising” and “debriding”;
- it may be useful to “cauterize” with a “cautery blade”;
- then, it may be necessary to establish drainage, for example, using a segment of reed, and to mention the use of wicks made of “cloth lint”;
- the device was supplemented with “dry fibrous pads.”
Other Examples
- Dressings:
- Dressings were carefully made. They could be occlusive.
- Simple or complex bandages were well applied.
- In the most common practice, the use of cold compresses or hot compresses should also be mentioned.
- Warm clays and grease enriched with plant extracts were also applied, of which effective compositions remain.
- Extraction of thorns,
- Care for bites (dog, monkey, crocodile, lion, hippopotamus, horse, etc.)
- Sutures:
- Sutures of non-contused skin wounds were made with a “sewing needle” and “linen” thread.
- The application of skin sutures in small strips of adhesive fabric is also known.
- Trimming war wounds,
- Amputations:
- post-traumatic,
- punitive: nose, tongue, ears, hand, etc.
- Hemostatic cauterization was done with a blade heated in the fire.
- Toe prostheses have been made.
- Reductions:
- Reductions of dislocations such as those of the shoulder joint, or the reduction of mandibular subluxation,
- Reductions and splints for limb fractures (splinting).
- Nasal fractures were maintained by rolls of greased cloth in the nostrils. Two small external splints could complement the device.
- Cervical sprain; severe cervical dislocation and compression fracture of the vertebral body with quadriplegia are fairly well described in the texts.
- The texts also speak of burns. They received special treatments.
- Circumcision is depicted on at least two bas-reliefs (including that of the tomb of the physician Ânkh-ma-hor of the VI dynasty). Several techniques have been used over time. A fairly detailed analysis has been published.
- Ophthalmology:
- Removal of foreign bodies from the eyes.
- Cataract surgery is attested under the Ptolemies.
- Various local and general infections are well described.
- In all cases, postoperative follow-up was monitored.
- Treatments could be stopped during a critical phase, and then resumed.
The texts indicate that Egyptian physicians knew their limitations. For example, contrary to what many books may suggest, many interventions were not practiced in ancient times. This is the case, for example, of trepanation (only “perhaps” one or two instances – over more than three thousand years – in a country where anthropological research is abundant).
Pharmacopoeia
The medications used in surgery by practitioners of the time might surprise us. Many of them have been described as “repulsive.” They are indeed derived from “natural products.” Among the components listed in medical texts, various minerals, plants, and animal extracts are found, all taken from the environmental milieu.
However, historical and pharmacological studies show us that these prescriptions could sometimes be useful.
This is notably the case in surgery for certain calming procedures using minerals and plants. The same applies to reducing infection risks and promoting healing.
Surgical Therapy
Egyptian practitioners could adjust medical-surgical and/or purely operative therapies according to the different pathologies encountered. Here are some examples.
Medical-Surgical Treatment
For a chronic suppurative lymphadenopathy:
“Description concerning a swelling formed by pus in the neck of a patient. If you examine a swelling formed by pus on the neck of a patient; if the tumor has burst after increasing in size, if it has formed its superficial flesh for several months, or for several years, and what comes out of it is comparable to synodonts’ barbels in the shape of thick hair, you will say about it: This is a patient suffering from a swelling formed by pus. A condition I will treat. You will have to prepare treatments to remove the prominences that are in his neck…”
— Ebers Papyrus
Followed by the prescription of a mainly cooked dressing composed of: wax, beef fat, willow, red ochre, cumin, copper salts, chrysocolla, white clay, sea salt, goose fat, turpentine, and galena.
Surgical Treatment
For a cold abscess:
“Description concerning a swelling formed by pus. If you examine a swelling formed by pus in any part of a patient’s body and find its head being elevated, circumscribed, and fluctuating, you will say about it: it is a swelling formed by pus localized in his flesh; a condition I will treat with the scalpel. There is something in it like mucilage, and something may come out after that like wax, it forms filaments; it will recur.”
— Ebers Papyrus
For a cold tumor:
“Description concerning a superficial flesh tumor on a patient’s limb. If you examine a flesh tumor on a limb and find it similar in color to his flesh with a to-and-fro movement under your fingers but limited by its base, you will say about it: it is a flesh tumor, a condition I will treat, by touching it with the specialist’s cauterizing iron.”
— Ebers Papyrus
For an armpit wound:
“… You must connect the edges (of the wound) with (linen) thread… A condition I can treat. Bandage it with fresh meat for the first day.
— Edwin Smith Papyrus
- But if you find (upon examination) that his wound gapes, the threads all slack, you will reconnect (again) the edges with two (adhesive linen) strips… then treat it with fat, honey, and (apply) vegetable tampons daily until healing…
- But if you find that the skin of the wound is warm because of this armpit wound, while the wound itself is burning, gaping, its threads slack, you will approach your hand and feel heat coming from the wound’s orifice against your hand, while collections of pus escape, cold like grape juice… a condition with which I will fight…
- But if you find that this wounded person is feverish, while his wound is burning, you should not bandage it. Leave it at rest until the painful phase passes.
- And (then) as soon as the fever stops, if the heat at the wound’s orifice completely subsides, treat it with fat, honey, and (apply again) vegetable tampons daily until healing.”
Surgical Instruments
To perform these procedures, the physician needed to have a few instruments. Initially made of coppery metal, various sizes of objects existed to be used at different stages of surgery.
For example, forceps and tweezers are quickly recognizable. Various probes, elaborate styli, and, for example, almost identical curettes are still used today. We have different types of knives. In ancient times, a particular scalpel was well differentiated; its blade aspect clearly resembled our fixed-blade scalpel. We also have several types of retractors. They could be multifunctional. Additionally, “single-use” utensils could also be used.
We find in museums a number of these small metal objects whose use is compatible with the practice of this art. Many of them can be compared with modern instruments. The effect is striking. The shapes encountered foreshadow the increasingly sophisticated equipment that surgeons themselves will be led to create. They will be refined from these moments and their uses consecrated. However, the history of surgery shows that several of these elements will disappear only to return much later. Thus, the physician’s kit seriously begins to take shape… since the pharaonic period!
A late but famous relief from the temple of Kom Ombo depicts a table on which instruments are arranged, some of which are recognizable, along with other items such as a balance, medication sachets, a sponge, and bandages. A purification basin is placed nearby.
We truly witnessed in Egypt the birth of surgery.
