The Edwin Smith Papyrus, purchased in Luxor in 1862, represents the oldest known surgical treatise in human history. Written around 1600 BCE but copied from sources dating to approximately 3000-2500 BCE, this document details 48 cases of traumatic injuries arranged in systematic anatomical order. Now housed at the New York Academy of Medicine, the papyrus presents clinical examination protocols, diagnostic classifications, and treatment procedures that predate similar Greek medical texts by over a thousand years.
Material and Craftsmanship
The scroll measures 4.68 meters in length and between 32.5 and 33 centimeters in width. The document consists of approximately twelve individual sheets, each measuring roughly 40 centimeters wide, joined end to end with overlapping seams secured by adhesive paste. The papyrus remains largely intact except for a fragmentary outer column and the loss of both the beginning and conclusion of the original text.
The scribe used hieratic script, the cursive form of Egyptian hieroglyphs, reading from right to left. Black ink, composed of amorphous carbon particles such as lampblack or soot suspended in a water-soluble binder like gum arabic, was employed for the main text. Red ink, derived from iron oxide pigments such as ochre mixed with the same binder, marked case titles, section headings, explanatory glosses, and marginal corrections.
Analysis indicates that a single scribe copied the majority of the document, with only small sections transcribed by a second hand. The primary scribe made numerous copying errors, some corrected in the margins and others left uncorrected. The text breaks off abruptly mid-sentence at the bottom of the seventeenth column, leaving approximately 39 centimeters of blank space at the scroll's end. No author's name appears anywhere in the surviving manuscript.
Form and Features
The recto (front side) contains 377 lines organized in 17 columns, while the verso (back side) holds 92 lines in five columns. The recto presents 48 cases of traumatic injury arranged in descending anatomical order from the skull downward through the face, neck, shoulders, chest, and spine.
Each case follows an identical format consisting of four sections. The title describes the injury type and location using specific anatomical terminology. The examination section details the physical assessment procedure, including visual inspection, palpation to assess bone and soft tissue damage, checking for inflammation, pulse assessment, evaluation of facial appearance and color, examination of nasal discharge, testing motor function and sensation in affected limbs, and assessment of consciousness and cognitive function in head trauma cases.
The diagnosis and verdict classify each case into one of three categories. Cases labeled "an ailment which I will treat" were considered curable. Those designated "an ailment with which I will contend" presented uncertain prognoses. Fourteen cases received the verdict "an ailment not to be treated," indicating injuries deemed beyond treatment capacity.
For treatable injuries, the treatment section specifies procedures including wound closure techniques, immobilization methods, dressing materials, medication applications, and positioning requirements. The final component consists of 69 explanatory glosses written in red ink, defining unfamiliar anatomical terms and clarifying medical concepts. Scholars believe these notes were added several centuries after the original composition.
The papyrus contains the first written use of the word "brain" in any language. It provides the earliest descriptions of cranial sutures, the meninges, the external surface of the brain (compared to ripples formed in molten copper), cerebrospinal fluid, and intracranial pulsations. The text recognizes that vessels connect to the heart and distribute throughout the body. Case 31 describes cervical spine dislocation causing loss of awareness in arms and legs, with notation that middle cervical vertebra injury produces involuntary seminal emission. Other cases note that cranial injuries on one side of the head can cause paralysis on the opposite side of the body.
Function and Use
The document functioned as a surgical textbook, likely intended for training physicians who would treat battlefield casualties. The injury types described include penetrating head wounds, skull fractures from blunt force trauma, facial injuries, dislocations, and spinal trauma.
The examination protocols demonstrate systematic physical assessment procedures. Physicians were instructed to take the patient's pulse, palpate wounds to assess bone and tissue damage, observe wound characteristics, check for fever and inflammation, test motor function and sensation in limbs affected by spinal injuries, and evaluate consciousness and cognitive function in head trauma cases.
The three-category diagnostic system provided prognostic classifications. The "ailment not to be treated" category identified cases where intervention was deemed futile. For these cases, the text sometimes advises "Moor him at his mooring stakes," indicating maintenance of customary diet and comfort measures without aggressive treatment.
Treatment approaches included wound closure with linen sutures, particularly for injuries to the lips, throat, and shoulders. Fresh meat was applied to wounds on the first day. Honey was used extensively as an antimicrobial agent. Moldy bread was applied to wounds. Fractures received immobilization with wooden or reed splints padded with linen and secured with bandages. The text specifically recommends immobilization for head and spinal injuries. Case 14 instructs physicians to reduce broken nasal bones and "draw together for him the two lips of the wound with stitching." Cervical spine injury treatments involved positioning the patient upright on a brick support, applying ointments from the head to the neck, using alum powder and honey dressings, and maintaining specific postures during recovery.
Magic appears in only one case among the 48 trauma descriptions (Case 9) and in eight additional spells on the verso side along with five prescriptions for minor ailments.
Cultural Context
The surviving papyrus dates to the Second Intermediate Period, Dynasties 16 to 17, around 1600 BCE, when the Hyksos ruled Lower Egypt while Theban kings controlled Upper Egypt. The archaic grammar, obsolete terminology, and ancient hieroglyphic forms indicate it was copied from sources dating to the Old Kingdom, approximately 3000 to 2500 BCE.
James Henry Breasted, who completed the first comprehensive translation in 1930, speculated that the original author might have been Imhotep, the architect, high priest, and physician who served Pharaoh Djoser around 2650 BCE. Imhotep was later deified as a god of medicine and wisdom. However, no definitive evidence links him to this text.
The papyrus indicates that Egyptian medicine had developed specialized practitioners and systematic training. Medical education occurred in institutions called "Houses of Life" attached to major temples, where physicians underwent instruction in anatomy, diagnosis, pharmacology, and treatment techniques.
The approach differs from other Egyptian medical texts such as the Ebers Papyrus, dating to approximately 1550 BCE, which contains over 700 remedies heavily emphasizing magical incantations. The Edwin Smith Papyrus demonstrates a distinction between external trauma, which received treatment based on anatomical knowledge and physical examination, and internal diseases, which might invoke magical remedies.
The three-tiered prognostic system allowed physicians to provide honest assessments while maintaining professional integrity. The "ailment not to be treated" designation ensured truthful communication about outcomes.
Discovery and Preservation
On January 20, 1862, Edwin Smith purchased the papyrus in Luxor from an Egyptian merchant named Mustapha Aga. The document likely originated from a tomb in the Theban necropolis, though exact provenance was not recorded. Smith, born in Connecticut in 1822, had established himself in Egypt as both a moneylender and antiquities dealer.
Smith acquired the document in two separate transactions. He first purchased a roll missing portions of its outer sections, then bought additional fragments two months later that had been glued onto a dummy roll. Smith recognized these belonged to the same manuscript and reunited them. At some point in the 19th century, the scroll was cut into 17 separate columns.
Smith attempted translation but did not possess sufficient hieratic knowledge to complete the work. After his death in 1906, his daughter Leonora donated the papyrus to the New York Historical Society. The manuscript remained relatively unstudied until 1920, when the Society entrusted it to James Henry Breasted, director of the Oriental Institute at the University of Chicago.
Breasted collaborated with physician Arno Luckhardt to provide medical commentary. In 1930, the University of Chicago Press published their work in two volumes. Volume One contained 596 pages of hieroglyphic transliteration, English translation, and commentary. Volume Two presented collotype facsimiles of each column with facing hieroglyphic transcriptions printed in red and black ink.
In 1938, the papyrus was transferred to the Brooklyn Museum. In 1948, the New York Historical Society and Brooklyn Museum jointly presented the manuscript to the New York Academy of Medicine, where it remains on permanent loan. From 2005 to 2006, the Metropolitan Museum of Art exhibited the papyrus. James P. Allen, the museum's curator of Egyptian Art, published a new translation coinciding with the exhibition, offering the first complete English translation since Breasted's 1930 work.
The National Library of Medicine has created a digital presentation allowing virtual examination of the papyrus.
Why It Matters
The Edwin Smith Papyrus established that systematic clinical observation, logical diagnosis, and evidence-based treatment existed in the third millennium BCE, predating similar Greek medical texts by over a thousand years. The document contains the first descriptions of cranial anatomy including sutures, meninges, cerebrospinal fluid, and brain pulsations. It demonstrates understanding of the relationship between cranial injury location and paralysis on the opposite side of the body.
The anatomical knowledge and treatment protocols influenced the development of medical practice. Spinal immobilization for cervical injuries, recommended in the papyrus, remains standard emergency medicine protocol. Honey's antimicrobial properties, described in multiple cases, have been validated by modern research. The case format, with examination findings, diagnosis, treatment recommendations, and prognosis, established a clinical documentation structure that continues in medical practice.
The papyrus provides evidence of specialized medical training institutions in ancient Egypt and systematic knowledge transmission across generations. The text demonstrates that ancient Egyptian physicians distinguished between natural and supernatural causation in disease, applying rational methods to external trauma while reserving magical interventions for unexplained internal conditions.