Treatment Methods of Head and Facial Trauma

in the Edwin Smith Papyrus

And their Reflection of Egyptian Philosophy

Bachelor Thesis
Sonja Boschman
S0776564

Under the guidance of Dr. Jac. van Dijk

The skulls of the Egyptians are so tough that it is hardly possible to break them with a blow from a
stone. I was told, very credibly, that the reason was that the Egyptians shave their heads from
childhood, so that the bone of the skull is hardened by the sun this is also why they hardly ever
go bald, baldness being rarer in Egypt than anywhere else.
Herodotus, The Histories

To Michael
My rock from God

Acknowledgements
With extreme gratitude to Dr. Jacobus van Dijk for his
patience, kindness and expertise; and with many thanks
to my sister, who provided me with vital insights in the
nature of the anatomy of the head and the brain.

Table of contents
Introduction

Part I: The Edwin Smith Papyrus and modern medicine

I.I
Contents
I.II
Discovery and dating
I.III
Case summaries

6
6
7
8

Part II: The Egyptian medical worldview versus modern medicine

II.I
Palliative care, pharmaceutics and surgery
II.II
The heart and the brain
II.III
Religion, diseases and drugs

17
17
21
22

Conclusion

25

Bibliography

26

List of abbreviations

28

Introduction
The Egyptian medical corpus is an extensive one, and one that covers various disciplines ranging
from pharmaceutical to magical to surgical. We have papyri that detail female afflictions or head
injuries, and those that encompass an entire pharmaceutical library of recipes and remedies for all
afflictions one can possibly imagine.
This paper endeavours to find the relationship between Egyptian truth-seeking ideas and the
work of the contemporary physician through discussing the treatments of head and facial trauma in
the Edwin Smith Surgical papyrus, and comparing it with modern surgical practices where applicable.
In order to remain a clear and concise work, this paper shall highlight only cases one through 27
of the recto. The first part will focus on these cases and equivalent injuries and treatments in modern
medicine, whereas the second part will give attention to the Egyptian existential worldview, and how
the treatment methods as described in the Edwin Smith Papyrus reflect these ideas.

Part I: The Edwin Smith Papyrus and modern medicine

I.I

Contents

The Edwin Smith papyrus contains a surgical treatise the likes of which had heretofore not been
discovered in Egypt: it is a unique piece that provides us with valuable insight on the ancient Egyptian
approach to surgery and physical trauma treatment. The recto, encompassing 377 lines,1 contains 48
cases total, which all, barring one, focus on instructions for the physical and surgical treatment of
injuries of varying severity. This is in contrast to the gross of other known medical papyri, which are
not only focussed on pharmaceutical and/or magical cures, but are more accurately described as a
compilation of remedies.2
Both the configuration and the methodology of the cases in the Edwin Smith papyrus can be
described as top-down. These cases start with injuries to the head and travel steadily downward.
Though the papyrus is incomplete breaking off in the middle of case 48, a sprain of the spinal
vertebrae one can reasonably assume that this structure is maintained throughout the work, and
that the complete body of instructions would end with injuries to the feet. In addition, the
seriousness of injuries almost without fault moves from mild and easily treatable to severe and, in
some cases, even fatal.
Each case is equally ordered, starting with a descriptive title of the injury discussed, an
examination usually involving the physicians hands, eyes, and common sense , the diagnosis, and
the prescribed treatment if any for that injury. The diagnosis involves an indication of whether
the patient is expected to live or die, through the use of one of three formulaic statements. The first,
which shall be named diagnosis A for the purpose of this paper, an ailment which I will treat,
indicates that the patient is wholly expected to survive the trauma, and is the most frequently used
diagnosis throughout the papyrus. Diagnosis B, an ailment with which I will contend, is used to
describe a case the outcome of which is doubtful: the physician will do his utmost to effectuate a full
recovery, but the patient has equal chance to succumb to his injuries as he has to survive them. The
final verdict is the condemning an ailment not to be treated, i.e. an injury so severe that the
patient has no chance of survival. This diagnosis C, which is the second most common in the papyrus,
is only in a few cases followed by a treatment; this may be a form of palliative care to alleviate the
patients suffering.
Further added to the physicians instructions are 69 glosses with explanations of certain terms
that are used. These glosses seem to signify that this particular papyrus is a much younger copy of its
original, which contains terms that were no longer in frequent use.3
On the verso we find a text that, though jumbled in content, is definitively connected to medicinal
practice, since among its 92 lines are included eight magical incantations and five pharmaceutical
recipes focussed on the treatment of illness.4

Nunn, J. F., Ancient Egyptian Medicine, p. 26.

Idem, 27
3
Breasted, J. H., The Edwin Smith Surgical Papyrus, V1, p. 61.
4
Nunn, Ancient Egyptian Medicine, 30
2

I.II

Discovery & dating

The papyrus bears the name of Edwin Smith, an American who spent a considerable portion of his
life living in Luxor, Egypt.5 He was well-acquainted with Classical Egyptian and Hieratic, and
purchased the roll of papyrus from a merchant in 1862.6 Though he did attempt to translate the
papyrus, the first extensive translation of this work is by the hand of James Henry Breasted, who
completed this magnum opus in 1930.7
Scholars agree that the text, dating from the seventeenth century B.C.,8 is a likely copy of an
earlier work, though the exact dating is subject to discussion. Breasted puts forward the suggestion
that the original should be dated back to the Old Kingdom, as is suggested by the usage of certain
terms and grammatical peculiarities.9 This would mean that the medical and anatomical knowledge
of the Egyptian physician predates Hippocratic medicine (long since considered to be the ancestor of
Western medicine) by a good millennium or so. Others say that perhaps the original is not quite that
old, rather dating back to the Middle Kingdom.10
What we can be relatively certain of, however, is that the text is indeed a copy, since only this
would explain the glosses added to the work.

Breasted, The Edwin Smith Surgical Papyrus, 21

Nunn, Ancient Egyptian Medicine, 25
7
See: The Edwin Smith Surgical Papyrus Volume I: Hieroglyphic Transliteration, Translation and Commentary.
8
Breasted, The Edwin Smith Surgical Papyrus, xiii
9
Idem, 3
10
Nunn, Ancient Egyptian Medicine, 27
6

I.III

Case summaries
Resume of Cases I VIII: Injuries pertaining to the top of the head

As is conventional throughout the Edwin Smith papyrus, the cases are subdivided (though without
markings such as subheadings, references, et al.) in sections of the limb currently under discussion
in our case, the head , with the injuries ranging from mild to severe.
Cases one through eight, therefore, all deal with injuries to the top of the head, where a cut or
wound in the scalp has exposed the cranium and, in some cases, damaged the skull cap. In all cases,
the physician is instructed to examine the wound to determine the severity of the injury. There is no
mention of any instruments he might have used for this; it seems the physicians hands are his most
important equipment. After the diagnosis is made, a treatment if applicable is prescribed. The
treatment is fairly consistent throughout the papyrus, often involving a dressing or poultice of
grease, honey and lint. The injuries are usually initially bound with fresh meat,11 e.g. in cases I-III.
Case IV, a deep cut that exposes a split cranium, deviates from this treatment by instructing the
physician to simply make the patient sit and moor him at his mooring stakes,12 a phrase that refers
to keeping him on his usual diet, without any oral medications.13 There is some physical therapy in
way of applying grease to the patients neck and shoulders to soften them; possibly a form of
therapeutic massage to loosen the muscles. After this, the physician must wait until it is clear
whether the patient will make it through.
Where case IV receives diagnosis B, our hypothetical patient is not so lucky in the next cases. V
and VI deal with a compound fractured (i.e. smashed) cranium, and a compound fractured cranium
where the meninges has ruptured, respectively. These are both given the dreaded third diagnosis: an
ailment the physician cannot treat. The results for cases VII and VIII are similar. Case VII, an injury to
the cranium, carries a distinct risk of an infection developing and might result in the patients death.
In case VIII, a compound fracture of the cranium without visible external injury, the situation is
severe enough to receive diagnosis C as well. These last two cases will be discussed in greater detail
below.
Cases VII & VIII: Two cases of particular interest in respect to the Egyptian physicians anatomical
knowledge.
Case VII A Gaping Wound in the Head Penetrating to the Bone and Perforating the tpA.w
The first difficulty that arises in the interpretation of this case is the translation of the anatomical
term tpA.w. Breasted translated this as sutures, meaning the suturae coronalis and lambdoidea, the
lateral connective tissue joints at respectively the top and base of the skull, but that interpretation
has since been contended with by various Egyptologists and medical professionals alike. According to
Paul Chapman (1992), the suturae are difficult to identify [in adults], being represented only by
faint, serpiginous lines on the surface of the skull14, thus rendering it improbable that the Egyptian
physician would have had intimate knowledge of them. Further rejecting Bendix Ebbells translation
11

Breasted, The Edwin Smith Surgical Papyrus, 96

Idem, 150
13
Idem, 139
14
Chapman, P. H., Case seven of the Smith surgical papyrus: the meaning of tpA.w, JARCE 29, p. 38.
12

of this term as the tentorium cerebelli15, and Hildegard von Deines and Wolfhart Westendorfs
suggestion that the structure in question is the falx cerebri16, Chapman postulates that the tpA.w
should be taken as the frontal sinus, the two cranial cavities situated just above the nose and
between the brows.17 This would be in concordance with the box of his head mentioned a little
further down in the second examination.
For the purpose of this discussion, the tpA.w will be considered to be the frontal sinus, as per
Chapmans interpretation.
The case starts with an initial examination of the patient that yields a set of symptoms including,
but not limited to, difficulties in opening the mouth, stiffness in the neck and blood flowing from
both nostrils and both ears. These symptoms are still associated with cranial trauma in modern
medicine;18 the pain in opening the mouth may be a spasmodic masseter muscle,19 and the stiffness
of the neck could be due to meningeal irritation.20 Despite the gravity of a smashed skull exposing
the frontal sinus, the physician is generally favourable about the outcome of this injury after this first
examination: he appends diagnosis B, an ailment with which he will contend.
The prescribed treatment consists of applying something hot to the contracted jaw muscles to
ease the spasms, and bandaging the wound until the patient has reached a decisive moment.
It is unclear if the second examination describes one possible change in the clinical course after
this decisive moment. Risse has suggested that a couple of days have passed since the first
examination,21 but it may very well be that the second examination illustrates an alternative
prognosis of the injury described at the beginning of the case. The observable symptoms in this
examination include a fever, a red and sweaty face, a bound mouth (possibly an aggravation of the
spasmodic masseter muscle), and a particularly egregious smell emanating from the box of his
head (i.e. the frontal sinus that was exposed by the injury), all of which, but the bound mouth,
indicate a possible local and systemic infection.22
An interesting term is tya: (...) while that man has developed tya from that wound. The exact
interpretation is uncertain, but one may reasonably conclude that this is some type of infection, a
diagnosis that is supported by the fact that the patient also has a fever, a common side effect of
infections. Ebbell has suggested that tya be interpreted as tetanus,23 a diagnosis backed by Risse,
Sanchez & Burridge, et al., but which seems to hinge on the interpretation that some time has passed
since the first examination, the same patient still being under treatment. Tetanus has an incubation
period of several days and therefore, without a clear indication of the relationship the second
examination has in regards to the first, we cannot say for certain whether it is, in fact, tetanus. It
must be mentioned that the bound mouth and distorted facial features may point to risus
15

Ebbell, B., Die gyptische Chirurgie, p. 24-28.

Deines, H. von & Westendorf, W., Grundriss der Medizin der alten gypter vol. 7 (II): Wrterbuch der
Medizinischen Teksten, p. 948.
17
Chapman, The Meaning of tpA.w, JARCE 29, 42
18
Risse, G.B., Rational Egyptian Surgery: A Cranial Injury Discussed in the Edwin Smith Papyrus, Bull. N. Y.
Acad. Med. 48 (7), p. 914.
19
Idem, 914
20
Idem, 914
21
Idem, 915
22
Sanchez, G. M. & Burridge, A. L., Decision Making in Head Injury Management in the Edwin Smith Papyrus,
Neurosurg. Focus 23 (1), p. 6.
23
Ebbell, B., Die gyptische Chirurgie, 24-28
16

sardonicus,24 however, which does, among other symptoms, support a diagnosis of tetanus, as does
the following physicians verdict: an ailment not to be treated.
The third and final examination is either another alternative prognosis for the original injury, or, if
a few days have indeed passed between the first, and second and third examinations, a further
possible step in the injurys clinical course. In this examination, the patient is white rather than red in
the face, a symptom that may point to the absence of wound infection.25 The physician is required to
make for his patient a brace of wood that is to be placed in the mouth, and position him between
two brick supports while he is being fed liquid nutrients, possibly to give his body time to recover
from the injury. The associated diagnosis is diagnosis B; an ailment the physician may contend with,
and the patient is to be treated in this manner until he has once again reached a decisive point.
Case VIII A Smash in the Skull Under the Skin of the Head
Case VIIIs main attraction lies in the following section:
Should you find that there is a swelling protruding on the outside of that
smash which is in his skull, while his eye is askew because of it, on the side
of him having that injury which is in his skull; (and) he walks shuffling with
his sole, on the side of him having that injury which is in his skull (...).
(Breasted, 1930)
In this paragraph, the author of the papyrus gives a set of symptoms that occur specifically on the
same side of the body as that of the skull which received the injury the earliest known mention of
what seem to be coup26 and contrecoup27 injuries. Like case VIIs mention of the frontal sinus, this
gives us an intriguing look into the ancient Egyptian physicians knowledge of anatomy.
The symptoms refer to an off centre eye and a partially paralyzed leg on the side of the injury,
which would point to contrecoup trauma to the brain: generally, paralysation occurs on the other
side of the brain that has been damaged. This, in turn, suggests that the injury has been obtained
through a fall or other accident in which the head, in movement, struck a static object, rather than
due to a moving object striking the head. This is in accordance with the mention that the patient
does not have any visible external injuries to his scalp: while this is possible in case of a fall, it is
unlikely to happen when the injury was obtained through a blow with a fast-moving object.
The surgeon gives his diagnosis in three parts. Both one who does not release the head of his
shoulder-fork and one who does not fall with his nails in the middle of his palm are unclear in
their meaning, but the third, the blood discharging from both ears and the nose, are a unambiguous
indication of the severity of the injury.
It is quite clear that the patient is suffering from a basilar skull fracture.28 Therefore the surgeon
appends diagnosis C, a diagnosis that in this case does not seem to unequivocally mean that the
patient will die the treatment as prescribed is the patient resting until he has gained some colour
24

Risse, Rational Egyptian Surgery, Bull. N. Y. Acad. Med. 48 (7), 916

Idem, 917
26
(injury) under the site of impact with an object
27
(injury) on the opposite site of impact with an object
28
Stiefel, M., Shaner, A. & Schaefer, S. D., The Edwin Smith Papyrus: The Birth of Analytical Thinking in
Medicine and Otolaryngology, Laryngoscope 116, p. 185.
25

10

and reached the decisive point. This may suggest that the surgeon simply had no other treatment for
this specific trauma available in his repertoire. However, the patient would still have had a very slight
chance of surviving the injury.
During the second examination, the surgeon finds that the skull has been severely damaged by
palpating the wound and determining that the throbbing and fluttering of the brain is visible when
it should not be in adults whose fontanels have closed.29 In this case, too, the verdict is diagnosis C
without prescribed treatment, this time. It is evidently expected that the patient is to die.

Resume of Cases XI-XIV: Injuries pertaining to the nose

The papyrus now leads us down towards the area of the nose (for a resume of cases IX and X, see
below). In particular, fractures of the nasal bones as well as injuries to the surrounding tissue, are
discussed.
Cases XI and XII both make mention of a type of splinting. The former deals with a broken nose
without displacement of the bones, and after the nose has been cleaned of old blood, two greased
plugs of linen are inserted in each nostril, and the nose is splinted with stiff linen. On the other hand,
the latter expressly references the nasal bones as those suffering the fracture, and the bones are set
before the cleaning and splinting, indicating that this is a more severe fracture where the nasal bones
have shifted upon fracturing. Both these cases are injuries the patient is expected to survive.
This, unfortunately, is not the state of affairs in the following case, which deals with an injury to
the Sr.t nostril, as Breasted reads it.30 According to Hermann Grapow, it is a female synonym for
fnD, used to denote the nose as an organ of breathing and smelling,31 specifically.
Even taking the uncertainty of the translation into account, one can reasonably assume that the
injury is more than a simple flesh wound: the papyrus makes a mention of affected bones in the
examination. The patient is expected to die of this injury.
Case XIV treats a different type of injury to the nose, namely a cut in the flesh of the nose. The
physician is instructed to draw the edges of the wounds together using two strips of adhesive linen,
and the regular treatment for wounds, existing of poultices of fresh meat, and grease, honey and lint,
follows until the cut has healed.
Case XII will be discussed in greater detail below.

29

Breasted, The Edwin Smith Surgical Papyrus, 170

Breasted, The Edwin Smith Papyrus, 252
31
Grapow, H., Grundriss der Medizin der Alten gypter vol. 1: Anatomie und Physiologie, p. 36.
30

11

Case XII: A case of particular interest in respect to the Egyptian physicians ability to splint and set
bone fractures
Case XII A Break in the Chamber of the Nose
The chamber of his nose is explained by the first gloss appended to this case as being the
middle of his nose as far as the back, extending to the region between his two eyebrows (Breasted,
1930), i.e. the nasal bone. The patients face is disfigured, with the nose clearly at an angle and
swollen. This injury, then, is a closed nasal fracture32, an ailment the physician is perfectly able to
treat.
The physician is instructed to force (the bone) to fall in (...) its place (Breasted, 1930), which
cant but refer to the physician setting the broken nose by applying manual pressure. He is then to
clean out the nose with linen swabs, place two greased linen plugs into the nostrils, and splint the
nose with two stiff linen rolls. Afterwards, the area of the injury ought to be treated with grease,
honey and lint until the patient has recovered.
It is a pretty straightforward case, yet one that gives us a little more insight into the workings of
the Egyptian physician. Moreover, the treatment is very similar to modern day therapy.33
The subsequent treatment of grease, honey and lint, which recurs time and again throughout the
papyrus, is an effective balsam due to the hygroscopic34 and bacterial growth-inhibiting properties of
honey.35

Resume of Cases XV-XVII: Injuries pertaining to the maxilla or zygoma

The next cases in the papyrus describe damage to the maxilla or zygomatic bones (i.e.
cheekbones). The severity of the injuries is progressively worse, as is habitual in this work: XV is a
perforation of the maxilla or zygoma, XVI a split of the same, and finally, in XVII, these bones are
smashed.
Though case XV includes an infection, and infections were a grave risks in pre-antibiotic times, its
result seems to be far more in the patients favour than case XVII indeed, a smashed maxilla or
zygoma is, according to the papyrus, untreatable. However, since the treatment suggested has an
until he recovers appended to it, one must wonder if the diagnosis is not, in this case, due to a
scribal error;36 or, conversely, whether the until he recovers is erroneous.
All three of the cases include the grease, honey and lint treatment.
Case XV will be discussed in greater detail below.

32

Stiefel et al., The Birth of Analytical Thinking, Laryngoscope 116, 187

Idem, 187
34
readily taking up and retaining moisture
35
Sipos, P., Gyry, H., Hagymsi, K., Ondrejka, P. & Blzovics, A., Special Wound Healing Methods Used in
Ancient Egypt and the Mythological Background, World. J. Surg. 28, p. 213.
36
Breasted, The Edwin Smith Surgical Papyrus, 98
33

12

Case XV: A case of particular interest in respect to the treatment of infections

Case XV A Perforation of the Cheek (Damaging the Maxilla or Zygomatic Bone)
This interesting case mentions infected, possibly gangrenous,37 flesh around the wound. It is
unclear whether this is because of outside influences, or because the patient has waited too long
before he saw his physician a theory that, considering human nature, might not even be too far off
the mark. The physician is nevertheless fully convinced that he is able to treat the wound and
effectuate a cure, which might speak against a cautious diagnosis of (gas) gangrene.
The case is slightly difficult to interpret, not only because it is very short, but also because it
makes mention of the use of the substance imrw, a substance that is not yet found in any source
outside of the Edwin Smith papyrus, and is therefore not yet known. Westendorf et al. have
interpreted it as a mineral substance. It may, considering its usage, have certain qualities that inhibit
microbial growth (such as that other often-used mineral in pharmaceutical recipes, ochre), or it may
purely be a substance that has a mythological background and no discernible medical effect at all. At
the present, we simply do not know enough to make an educated guess.

Cases XVIII-XXII: Injuries pertaining to the temple

Injuries to the temple are amongst the most serious types of head trauma, and the author of the
papyrus pays due attention to the temporal region in the following five cases, starting out with a
relatively minor wound that did not damage the skull, in case XVIII. The suggested treatment is, as
per usual for flesh wounds and non-fatal bone fractures, the binding of fresh meat on the first day,
followed by bandaging the site of the injury with grease, honey and lint until the patient recovers.
Both case XIX and XX treat a perforation of the temporal bone, denoted by gma,38 yet where the
former is easily treatable with rest and a poultice, the latter is clearly fatal and the only treatment
suggested is a form of palliative care by softening the head with grease and pouring milk in both ears.
The final two cases deal with a split temple and a compound fracture of the temporal bone
respectively. Case XXI is an injury the patient may live through; the instructed course of action is for
the physician, after having made the diagnosis, to have the patient rest and wait until he has reached
a decisive point.
Of particular interest is case XXII, which contains the first known mention of the chin in the
medical corpus of ancient Egypt.39 During the examination, the physician is instructed to put one of
his fingers on the patients chin and another on the ramus mandibulae. This is supposed to cause a
flow of blood that can be subsequently cleaned up, but unfortunately for our hypothetical patient,
this changes nothing about the fatal outcome of this injury.
Cases XX and XXI will be discussed in greater detail below.

37

Breasted, The Edwin Smith Surgical Papyrus, 264

Breasted, The Edwin Smith Surgical Papyrus, 275
39
Idem, 289
38

13

Cases XX & XXI: Two cases of particular interest in respect to anatomical knowledge and diagnosis
Case XX A Wound in the Temple, Penetrating to the Bone and Perforating the Temple
This severe injury is a perforation of the temporal bone. The physician finds symptoms such as
bloodshot eyes, bleeding from the nose, terrible pain upon palpation of the wound, and crying. In
addition, the patients neck is stiff and he is unable to talk.
This severe injury receives the diagnosis an ailment not to be treated an unsurprising fact,
considering temporal or sphenoid fractures are treatable in modern medicine only via immediate and
complicated surgery.
Case XXI A Split in the Temple
Subsequent case no. XXI deals with a fully fractured temple, an injury that seems to be far more
grave than the one discussed in case XX, yet is appended a slightly more optimistic diagnose in the
form of diagnosis B, an ailment to be contended with.
In the examination, the physician observes a set of symptoms that include a swelling of the area
around the wound, blood flowing from the ear and nostril on the side of the injury, and hearing any
sound on that side as being extremely painful. There is no mention of any partial of full paralysation.
Based on this, we may assume that the injury in this case is a coup injury instead of contrecoup.
The prescribed treatment is to keep the patient on his usual diet until he has reached a decisive
point. Though this is a somewhat less hopeless verdict, it is still unlikely many patients would have
had good prospects of surviving this type of head trauma, for the same reasons as described above in
case XX.

Cases XXIV-XXV: Injuries pertaining to the mandibula

Nearing the end of the treatises discussing injuries to the head, we arrive at the mandibula, or
lower jaw. There are two cases, the first of which deals with a fractured jaw. This case, the 24 th
discussed, is so serious that the patient is expected to die. According to Breasted,40 this is a
compound fracture that severely damaged the circumjacent tissue. Infection is inevitable, and
therefore the patient is doomed. Even today a broken jaw can lead to death, most commonly due to
laceration of the maxillary artery by fragments of the fractured bone, filling the patients mouth and
throat with blood. Access is difficult and usually accomplished by intricate surgery, and we may
reasonably assume that the Egyptian physician would not have had the skill nor the means to
successfully treat the resulting haemorrhage.
Case XXV, however, is a wholly treatable injury: a dislocation of the jaw. The specific appeal in this
case lies in its treatment method of manually manipulating the jaw to fall back in its place. A
treatment of combining the mineral imrw with honey to form a poultice seems to be mostly there to
soothe the sore muscles. This case will be discussed in greater detail below.
Case XXV: A case of particular interest in respect to bone manipulation
40

Breasted, The Edwin Smith Surgical Papyrus, 303

14

Case XXV A Dislocation of the Mandible

This cases proceedings are slightly atypical for the rest of the papyrus: the examination gives a
brief description of a dislocated mandible: should you find his mouth open (and) his mouth cannot
close for him, and then immediately gives the required treatment. This treatment is very similar to
the way modern day doctors remedy a dislocation of the jaw: by placing the thumbs on the patients
rami mandibulae, and the fingers of each hand underneath the chin, the physician is able to force the
mandible to fall back in its place. This method has also been used in Hippocratic times41, and it is
testimony to the medical proficiency of the ancient Egyptian physician.
The subsequent pharmaceutical treatment, which is preceded by diagnosis A for completeness
sake, is one focussed on alleviating the patients pain after his unfortunate injury. This consists of a
compress made from imrw and honey, topically applied until the patient has made a full recovery.

Resume of Cases IX-X, XXIII, XVI-XXVII: Miscellaneous

Follows below a resume of solitary cases in the Edwin Smith papyrus, usually dealing with cuts
and splits of the flesh.
Case IX is the odd one out: it is the only case in the papyrus that does not give a surgical
treatment method for its corresponding injury a wound to the forehead with a smashed cranium ,
but instead a pharmaceutical recipe and an incantation to effectuate a cure. The recipe requires an
ostrich egg triturated with grease to be applied to the wound, and once the healing process has
begun, an incantation invoking Horus and Isis follows.
Case X treats a simple gaping wound down to the bone, just above the eyebrow. There is no
mention of any cranial matter being cracked, split or smashed, and the treatment prescribed is
closing the edges of the wound together with two strips of linen,42 after which a bandage is applied
to keep the cut closed.
Case XXIII deals with a slit auricle the outer portion of the ear. The diagnosis is fairly simple, and
the subsequent treatment talks about stitching43 44 the wound. According to Breasted, this should
be taken to mean sutures like those in modern medicine.45 One can reasonably assume that the
scribe here is talking about closing the edges of the wound in some manner, followed by bandaging
it, but there is no conclusive evidence that the physician was in this case required to stitch the
wound. The scribe might equally plausibly refer here to the linen strips that function like adhesive
plaster, as mentioned above. The rest of the treatment includes a splint of linen in case the stitches
come loose, and the usual bandaging with grease, honey and lint.
41

Stiefel et al., The Birth of Analytical Thinking, Laryngoscope 116, 187

Breasted, The Edwin Smith Surgical Papyrus, 229
43
Idem, 226
44
Idem, 299
45
Idem, 227
42

15

Case XXVI is a split upper lip. The physician is instructed to close the wound either by sutures or
adhesive linen plaster, that much is not mentioned , and bind it with fresh meat. The customary
grease and honey (no lint, in this case) are applied until the cut has healed.
Case XXVII, a gaping wound of the chin, closes the first part of the papyrus that deals with head
and facial injuries. In this case, it is specifically mentioned that the cut should be closed by use of
linen strips. Fresh meat is applied afterwards, and grease, honey and lint are used to consolidate a
complete recovery.

16

Part II: Egyptian medical worldview versus modern medicine

II.I

Palliative care, pharmaceutics and surgery

Active ingredients in pharmaceutical treatments

Even though the Edwin Smith papyrus is a predominantly surgical work, it does cover some
aspects of pharmaceutical knowledge. Not, in any way, as much as other medical papyri, such as the
Papyrus Ebers, but it is at least of an amount and a kind that is of definite interest to this paper, for it
shows that a physicians work did not stop after the surgical aspect but rather, continued on until
such time the patient had either made a full recovery, or died.
In 20 of the first 27 cases, the treatment involves some type of medicinal dressing, usually
employed when dealing with a cut or flesh wound. In ten of these 20 cases, the initial treatment is a
poultice of fresh meat on the first day. 14 cases call for a treatment with grease, honey and lint,
supposedly combined and then applied topically; eight of these are follow-up treatments after the
fresh meat has been applied; in five instances this mix is a standalone treatment; and in one case the
wound is to be treated with the mineral substance imrw before the mix is applied. The substance
imrw occurs in one other treatment, mixed in with honey before application. Two cases mention only
grease and honey as treatment, and both of these are preceded by the fresh meat poultice. Grease
as a standalone treatment appears in one case, and seems to be aimed not at restoration, but at
palliation. Another palliative measure seems to be the pouring of milk into both patients ears, which
occurs in one case. Finally, there is a single mention of using ostrich eggs and grease in the healing of
a wound, followed by a compress of figs, grease and honey, which must be cooked and cooled before
application.
The question is whether these treatments actually contributed to the healing process. By far one
of the most used ingredients in the medical and pharmaceutical papyri is honey. It has been long
since known that raw honey has antibacterial properties,46 and would be a highly effective ingredient
in wound dressings. The application of fresh meat to a wound on the first day would have stopped
the bleeding: the hemostatic effects of meat are well-documented.47 Grease may have reduced
swelling and redness of cuts and abrasions. The addition of lint, though unknown to have any
medicinal properties, may be to either absorb any blood or discharge from the wound, or to act as a
matrix to make application of the dressing easier.
It is not unreasonable to assume, in light of the almost scientific nature of the Edwin Smith
papyrus, that a good many of the pharmaceutical treatments handed down in the medical papyri had
been, at least in part, effective where it came to the inhibition of bacterial and microbial growth, and
that the continued use of these treatments was supported by empirical evidence of their efficacy.

46
47

Sipos et al., Wound Healing in Egypt, World J. Surg. 28, 213

Idem, 213

17

Equipment and instruments

As mentioned above, the most important instrument of the physician seemed to be his hands at
any rate, there is as of yet no known mention of instruments that were solely meant for surgical
work on living patients. Undoubtedly, many of the instruments that have been uncovered would
have found use in the mummification process. One may assume that the physician, by very virtue of
the nature of the operations he was performing, would have made some use of these, but it is at the
time difficult to give an unambiguous answer to this question.
Should we assume that the physician did use the tools that were also available to the embalmers,
we may look at, for example, the relief on Kom Ombos temple wall, detailing a veritable treasure
trove of instruments, including callipers, mirrors, scalpels, and cauterization tools among others, to
determine what the physician would have had available to him.
One particularly contended case in ancient Egyptian surgical work, is the question whether or not
they made use of stitching to draw a flesh wound together. Within the Edwin Smith papyrus, there
seem to be two different ways of treating a gaping cut of the flesh. One, the drawing together with
linen strips;48 and two, the drawing together with idr.49
Breasted has first suggested the second be read as drawing the wound together with stitches,
referring to the practice of closing a wound with needle and thread. Among others, Richard Sullivan
is also of this opinion, citing case X: If you find the idr of this wound loose, you should draw it
together for him with two strips (of plaster),50 51 proposing that idr thus refers to a different method
of wound closure than the adhesive strips mentioned earlier in the papyrus.
The phrasing in the various cases which employ the term idr e.g. now after you have idr it52,
you should draw it together for him with idr53 does seem to support this theory, and we can
append the tentative conclusion that the idea of the Egyptian physician practicing stitching in some
way akin to modern procedure is not unlikely. The known skill of embalmers in this increases the
likelihood of the hypothesis.
The physician would also have had skill in wielding the knife or scalpel. Many treatments in the
Ebers papyrus, for example, make mention of dwa, or knife-treatment. This may refer to the lancing
of boils or removal of tumours.
Both cauterization and the splinting of broken bones have ample evidence in the literature to
suggest that the physicians were capable of performing these treatments. Cauterization is often
mentioned in the Ebers papyrus and its ilk, as well as in the Edwin Smith papyrus, with reference to
the DA, or fire-drill. Splinting, as mentioned above, has been seen in case XII: the broken nose.

48

Breasted, The Edwin Smith Surgical Papyrus, 122, 124

Idem, 225-226
50
Sullivan, R., The Identity and Work of the Ancient Egyptian Surgeon, J. R. Soc. Med. 89, p. 470.
51
Breasted, The Edwin Smith Surgical Papyrus, 228
52
Idem, 228
53
Idem, 228
49

18

Evidence of surgical treatments

It is one thing to have a papyrus detailing surgical treatments, yet another to interpret this text to
mean that the ancient Egyptian physician would definitely have had a surgical repertoire that
coincides with a modern surgeons on treatments such as splinting, lancing and stitching. The next
logical step in this is to find archaeological evidence to support these claims a task that is,
admittedly, complicated by the unmistakable skill of the Egyptian embalmer, proof of which is found
in many, if not all, of the mummies that have been examined to date.
One way to determine whether a treatment has been performed ante- or post-mortem, is to look
at the rate of tissue repair, if present. If the treatment has occurred after death, it may be clear that
such healing would not have taken place. Nerlich, Panzer and Lsch have detailed a couple
examinations of mummified remains in their 2010 article.54
In the skull of an adult male (ca. 1070-300 B.C.), they found evidence of blunt force trauma to the
side of the head. Because of the presence of some new bone tissue, and the skin over the side of the
injury being mostly intact, it may be concluded that the patient has survived the injury by at least a
couple of weeks.55 There is evidence that the Egyptian physician has removed the bone fragments
from the site of the injury this, again, is another treatment method that is still in use in modern
medicine , which may have prevented a lethal case of epidural haematoma.56
Another example is found in the mummy of a 55 year-old female (ca.1070-700 B.C.), whose right
big toe had been amputated and replaced with a wooden prosthesis.57 Both the healing pattern of
the right foot, as well as the markings left on the prosthesis, indicate that the surgery was performed
during life, and the artificial toe used extensively.
Though these are but a few examples, and it is, as mentioned, tricky to determine whether or not
a procedure has been performed intravitally, one can reasonably assume that these are not simply
exceptions that confirm a rule of little surgical intervention, especially in view of the treatments
discussed in the Edwin Smith papyrus.

Palliative care
Overall, the Edwin Smith papyrus contains 14 instances of diagnosis C; an ailment not to be
treated. Nine of these are found within the first 27 cases treated above (ten, if we include the
possibly erroneous statement in case XVII).
Five of these diagnoses are still followed by the phrase his treatment is, which then detail a set
of measures taken that cannot be meant to save the patient. It is therefore assumed that what we
see here are palliative measures means to make the patients life, what little there be left of it,
more bearable.
The most frequent soothing treatment is the application of grease, usually combined with a
waiting period until the patient has reached a decisive point though what this decisive point
54

Nerlich, A. G., Panzer, S., Lsch, S., Surgery in ancient Egypt palaeopathological evidence for successful
medical treatment by surgery, Pharmacy and Medicine in Ancient Egypt, pp. 117-121.
55
Idem, 118
56
Idem, 118
57
Idem, 119

19

should entail in this case is unclear, if the patient was assumed to die of his injury. In case XX, the
grease application is combined with milk to be poured in both ears.
This shows that the work of the Egyptian physician went beyond simply trying to effectuate a
cure: even if the verdict was hopeless, the physician, beholding a certain compassion, would stand by
the patient to make his last few hours on this mortal coil just slightly more tolerable.

20

II.II

The heart and the brain

The speaking of the heart

The seemingly ambiguous phrase the heart speaks (feebly) is used in various instances
throughout the medical corpus of ancient Egypt. Translations vary; some authors prefer to interpret
the phrase as he (the patient) is too weary to speak, either attributing ib=f to a scribal error, or
interpreting it as an alternative way of referring to the patient.
However, in the first gloss of case I, the scribe has appended an explanation of the term that
might shed light on its meaning (emphasis the authors):
As for: you examine a man, [it means] counting any one - - [like cou]nting
things with a bushel. (For) measuring is [like] ones [counting] a certain
quantity with a bushel (or) counting something with the fingers, in order to
[know] - - -. It is measuring things with a bushel which - - - one in whom an
ailment is [cou]nted, like measuring the ailment of a man; [in order to
know the action] of the heart. There are canals in it to [every] member.
Now if the priests of Sekhmet or any physician put his hands (or) his fingers
[upon the head, upon the back of the] head, upon the two hands, upon the
pulse, upon the two feet, [he] measures [to] the heart, because its vessels
are in the back of the head and in the pulse; and because its [pulsation is
in] every vessel of every member. He says measure regarding his [wound]
because of the vessels to his head and to the back of his head and to his two
feet - - - - his heart in order to recognize the indications which have arisen
therein; meaning [to meas]ure it in order to know what is befalling therein.
(Breasted, 1930)
Even with the lacunae impeding a clear reading of the gloss, it seems that our scribe is here
referring to checking the pulse in order to ascertain the patients health status. Grapow, also,
mentioned that the heart speaks in the vessels through the pulse.58 It appears to be a standard
practice of examination, and in some cases it is part of the diagnosis, as per example in case VII,
where it is stated that the heart is weary to speak. This may be interpreted as the patient having a
weak pulse.
The papyrus Ebers gives us a detailed discourse on the anatomy of the vessels that run throughout
the body, starting with the telling phrase the beginning of the physicians secret: knowledge of the
hearts movement and knowledge of the heart. (Ebbell, 1937). The heart is considered to be the
well from which vessels run to all the limbs,59 an idea that demonstrates the importance of diagnoses
based on the speaking of the heart.
This significance may be both attributed to empirical observation and philosophical meaning: to
the Egyptians the heart was the seat of all thought and the single most essential organ in the human
body. If the heart is weak, then so is its owner. That this notion coincided with empirical observation
within medicinal practices, may have only strengthened this idea, further cementing the importance
of the heart in Egyptian ideology.
58
59

Grapow, H., Anatomie und Physiologie, 65

Bryan, C. P., Ancient Egyptian Medicine: The Papyrus Ebers, p. 124.

21

Characteristics of the brain

Should you find that smash which is in his skull [like] those corrugations
which form in molten copper, (and) something therein throbbing (and)
fluttering under your fingers, like the weak place of an infants crown
before it becomes whole (...). (Breasted, 1930)
This excerpt from case VI illustrates another part of the Egyptian physicians knowledge of
anatomy. The author likens the appearance of the brain to the rippling of molten copper when it
starts cooling and solidifying again, and describes the pulsing of blood through it by tying it to the
fontanels of a newborn, thus showing us that not only were the Egyptians familiar with the
appearance of the brain, they were also well aware that a childs skull does not completely close until
a couple of years into its life.
The word used to describe the brain, Ais, is used in the phrase Ais of the skull, meaning marrow
of the skull60 the organ that can be exposed and injured after damage to the calvaria, and would
so evidently indicate the brain.
The Egyptian materia medica has already revealed observations of the brains connection to the
central nervous system. These are observations that would not have been easy to make without
contemporary knowledge, yet this, as mentioned before, does not mean the physician fully
understood the function of the brain as we do now that is, the control centre of the human body,
and the origin of our consciousness and thought. Indeed, the brain used to be considered a part of
the reproductive system, from whence the seed of a man originated.
The Egyptians, then, paid very little attention to the brain after death: it was removed from the
body and discarded prior to mummification. In comparison to the treatment other organs received,
this is telling. Though the physician was certainly able to recognize the vitality of the brain remaining
undamaged in life, the Egyptians seemed to think the brain did not have any other function
important enough to warrant preserving it. Or are there perhaps other practical considerations we
may look at to propose a different theory?
To wit, the brain is the one organ that is most promptly affected by the onset of decomposition.
Especially in warm weather, this process can set in within a day of death, and it will compromise the
structure of brain tissue so heavily that it will fall apart at a touch. One might assume the removal of
brain tissue to simply be a practical solution, but it is a conclusion with which one must be careful:
there is no actual evidence of this notion, and we cannot put words in the Egyptian physicians
mouth.

60

Breasted, The Edwin Smith Surgical Papyrus, 167

22

II.III

Religion, diseases and drugs

Medicine and magic were closely related to each other in ancient Egypt. However, not all medical
papyri had equal amounts of incantations versus pharmaceutical/surgical treatments: the papyrus
Ebers, for instance, has distinctly fewer magical spells than does the London papyrus.61
Above we have already briefly touched upon the question whether the pharmaceutical
ingredients used in the Edwin Smith papyrus had any demonstrable efficacy, and for the purpose of
this paper, we will further focus on the religious ideas behind disease and treatments.
Religion and disease
Ancient Egyptian medicine made a distinction between disease caused by malign influences and
injuries due to trauma. A disease without a clear external origin was more often than not thought to
be brought about by malevolent deities or demons, and therefore combated by invoking other, more
benign, deities and spirits62 through incantations and treatments with substances that were thought
to have magical powers.
Conversely, traumatic injuries such as the head injuries discussed above, had an observable
source whether a blow from a mace or a cut of a knife and were thus considered to be without
any external influences. Trauma, therefore, was treated far more practically with bandages, stitches
or splints.
Interestingly, some subsequent infections and consequences were considered to be the work of
an outside influence, especially where injuries to the brain are concerned. We see an example of this
in case VIII of the Edwin Smith papyrus, gloss D: As for: Something entering from the outside, it
means the breath of an outside god or death; not the intrusion of something which his flesh
engenders. (Breasted, 1930). Though the Egyptian physician undoubtedly saw the results of a
traumatic injury to the head reflected in the resulting symptoms, an indication of the physicians
observational skills, he did not always understand the relationship fully. The physician was not
infallible in his scientific endeavours, but we may forgive him for that in view of his other
unmistakable accomplishments.
This is not to say, of course, that the relatives of the patient would not pray to their gods to
effectuate a speedy recovery for their kin. Religion was a innate part of the Egyptian world, and
inseparable from earthly matters and do we, ourselves, not, in our modern world, sometimes
invoke God or Allah to help us through difficult times, even as we place ourselves in the skilful hands
of our doctors and surgeons? Egyptians, in the same way, invoked their religion to effectuate a cure:
Jacobus van Dijk has suggested specifically that particular types of incantations, such as those
accompanying the untying of a bandage, were also meant to achieve a form of psychological comfort
for the patient.63

61

Leitz, C., Die Rolle von Religion und Naturbeobachtung bei der Auswahl der Drogen im Papyrus Ebers,
Papyrus Ebers und die antike Heilkunde: Marburger altertumskundliche Abhandlungen 7, p. 42.
62
Nunn, Ancient Egyptian Medicine, 96
63
Dijk, J. van, The Birth of Horus according to the Ebers Papyrus, Jaarbericht Ex Oriente Lux 26, p. 24.

23

Religion and drugs

The remedies prescribed by the physician, whether magical or purely medicinal in nature, came in
various forms. They could be applied topically or ingested, inserted vaginally or rectally, through
inhaling, or used as a rinse, to name but a few methods.
Often, in the case of diseases that were thought to be due to outside influences, these treatments
were accompanied by an incantation, particular amulet, or the painting of, for example, the wDAt eye
on the patients skin.64
One of the most extensively used magical-medical ingredients in prescriptions were faeces an
ingredient that was off-putting even for malign deities and demons, as shown by various sources
such as the Book of the Dead and the Ebers papyrus. In chapters 51 and 52 (Lepsius numbers) of the
Book of the Dead, the deceased specifically mentions not eating excrement65 a consequence of the
world turning upside down in the afterlife. The Ebers Papyrus mentions that a loss of consciousness
is due to faeces in the vessels of the heart.66
The religious connotation might be the main reason for the use of this ingredient, but as modern
research has shown, excrement does have antibiotic effects.67
Other well-known ingredients are mineral-based, such as ochre, malachite or antimony. These
were used cosmetically as well as pharmaceutically. Malachite, specifically, protected the eyes from
various afflictions, such as trachoma.68
We may assume that the use of quite a few ingredients stems from a religious belief particular to
the ancient Egyptian worldview, and continued to be in use because observations showed these
treatments to be effective.

64

Silva Veiga, P. A. da, Health and Medicine in Ancient Egypt, BAR Int. Series 1967, p. 40.
Quirke, S., Going out in Daylight - prt m hrw - The Ancient Egyptian Book of the Dead: translations, sources
and meaning, pp.131-132.
66
Ebbell, B., The Ebers Papyrus, p. 117.
67
Sipos et al., Wound Healing in Egypt, World J. Surg. 28, 211
68
Idem, 212
65

24

Conclusion
The Edwin Smith papyrus gives the modern reader an unprecedented look into the mind of the
Egyptian physician. It seems as though he is not so far off from a modern surgeon, with his rational
observations and methodical approach to examination and diagnosis. Yet, even in an almost scientific
work such as this papyrus, there are hints that the Egyptian physician had not completely abandoned
religion and magic in favour of scientific knowledge when it came to the treatment of traumas.
The clearest example of this is case IX, where a smashed cranium is treated with a curious blend
of ostrich eggs and incantations. The ostrich egg seems to be a replacement for the part of the
cranium that had been damaged, and the invocation that follows is to make sure all evil influences
leave the wound. Another hint is found in case VIII, where something from the outside has entered
the patient and caused the paralysation in the leg, rather than that being the direct consequence of
the injury. This may indicate the idea that any injury makes the patient more susceptible to malign
influences from the outside: and what better way to repel these than by invoking the deities of
protection? From an Egyptian point of view, this is thus a logical part of the healing process.
Philosophical beliefs that modern researchers may find laughably superstitious notwithstanding,
the Egyptian physician was a curious creature; one who did not back down in the face of sometimes
insurmountable odds. He had a responsibility towards the patient that is reminiscent of the
Hippocratic Oath still taken by physicians today, and he took it seriously.
The glosses appended to the cases are not only a useful tool in dating both the current copy and
the original, they also bespeak of the importance the physician attached to correctly diagnosing his
patient, and show us how the Egyptian surgeon thought. By attaching comparisons of every-day
objects to the descriptions of various anatomical features, he ascertained that his successors would
make as few mistakes as possible in their medical endeavours.
They also provide us with valuable insights, covering terms we may otherwise have not been able
to interpret. The papyrus makes clear that the Egyptian physician knew how to determine a patients
health at least in part by checking the pulse. This should not be surprising, considering the
importance the heart has in Egyptian philosophical thought. Grapow even suggests that the very
observation of the relationship between pulse and overall health is the reason the heart begot its
importance,69 though of that we can obviously never be certain.
There are certain aspects of Egyptian surgical work that will remain problematic to interpret
anatomical terms such as tpA.w, the ingredient imrw, and the practice of drawing a wound together
with idr, to name but a few. This can complicate the inference, but if there is one thing we may be
certain of, it is that medicine as practiced by the ancient Egyptians was a diverse blend of religion,
science and magic. There is no separating these, even if they were not always used in concordance
with each other.
We may thus conclude that the empirical observations and rational scientific approach to trauma
injuries in the Edwin Smith papyrus is at least in part fuelled by a desire to understand the world
from a more spiritual point of view. Personal piety and religion were intrinsic parts of society, and
therefore of medicine.

69

Grapow, Anatomie und physiologie, 65

25

Bibliography
Breasted, J. H., The Edwin Smith Surgical Papyrus I (OIP 1-4), (Chicago, 1930).
Bryan, C. P., Ancient Egyptian Medicine: The Papyrus Ebers (London, 1930).
Chapman, P. H., Case seven of the Smith surgical papyrus: the meaning of tpA.w, JARCE 29 (1992).
Deines, H. von & Grapow, H., Grundriss der Medizin der Alten gypter vol. 6: Wrterbuch der
gyptischen Drogennamen, (Berlin, 1959).
Deines, H. von, Grapow, H. & Westendorf, H., Grundriss der Medizin der Alten gypter vol. 7:
Wrterbuch der Medizinische Texte, band I&II (Berlin, 1961-62).
Dijk, J. van, The Birth of Horus according to the Ebers Papyrus, Jaarbericht Ex Oriente Lux 26
(Groningen, 1979-1980).
Ebbell, B., The Papyrus Ebers (Copenhagen, 1937).
Ebbell, B., Die gyptische Chirurgie (Oslo, 1939).
Grapow, H., Grundriss der Medizin der Alten gypter vol. 1: Anatomie und Physiologie (Berlin, 1954).
Leitz, C., Die Rolle von Religion und Naturbeobachtung bei der Auswahl der Drogen im Papyrus
Ebers, in Papyrus Ebers und die antike Heilkunde: Marburger altertumskundliche Abhandlungen 7
(Wiesbaden, 2005).
Nerlich, A. G., Panzer, S., Lsch, S., Surgery in ancient Egypt palaeopathological evidence for
successful medical treatment by surgery, in Cockitt, J. & David, R., eds., Pharmacy and Medicine in
Ancient Egypt (2010).
Nunn, J. F., Ancient Egyptian Medicine (London, 1996).
Quirke, S., Going out in Daylight - prt m hrw - The Ancient Egyptian Book of the Dead: translations,
sources and meaning (London, 2013).
Risse, G.B., Rational Egyptian Surgery: A Cranial Injury Discussed in the Edwin Smith Papyrus, Bull.
N. Y. Acad. Med. 48 (7) (1972).
Sanchez, G. M. & Burridge, A. L., Decision Making in Head Injury Management in the Edwin Smith
Papyrus, Neurosurg. Focus 23 (1) (2007).
Silva Veiga, P. A. da, Health and Medicine in Ancient Egypt, BAR International Series 1967 (2009).

26

Sipos, P., Gyry, H., Hagymsi, K., Ondrejka, P. & Blzovics, A., Special Wound Healing Methods
Used in Ancient Egypt and the Mythological Background, World. J. Surg. 28 (2004).
Stiefel, M., Shaner, A. & Schaefer, S. D., The Edwin Smith Papyrus: The Birth of Analytical Thinking in
Medicine and Otolaryngology, Laryngoscope 116 (2006).
Sullivan, R., The Identity and Work of the Ancient Egyptian Surgeon, J. R. Soc. Med. 86 (1996).
Westendorf, W., Handbuch der altgyptischen Medizin, vol. I & II (Leiden-Boston-Kln, 1999).

27

List of abbreviations
JARCE
Bull. N. Y. Acad. Med.
Neurosurg. Focus
World J. Surg.
J. R. Soc. Med.

Journal of the American Research Centre in Egypt

Bulletin of the New York Academy of Medicine
Neurosurgical Focus
World Journal of Surgery
Journal of the Royal Society of Medicine

28