The medical advice it contains is fairly straightforward. To fix a fractured collarbone, the medical practitioner is advised to "spread apart his two shoulders . . . until the break falls into its own place. Thou should make for him two splints of linen, and thou should bind him every day until he recovers . . ."
This procedure forms a figure-eight bandage, says Dr. James Salander, an associate professor of surgery at the Uniformed Services University of the Health Sciences in Bethesda. " It's not much different than what is done today."
But the instruction comes from the Edwin Smith Surgical Papyrus, the oldest known medical text. The scroll, now held by the New York Academy of Medicine, was hand-written in 1600 B.C. and apparently is a copy of a work that may be almost 3,000 years older.
Salander gave a lecture last week on the Smith papyrus for the Washington Society for the History of Medicine in the Lister Hill Center at National Library of Medicine. He explained how some of the medical practices described in the papyrus -- the physical exam, trauma as a disease, the concept of triage -- are as important today as they were 35 centuries ago.
The papyrus was named for Connecticut-born adventurer and Egyptologist Edwin Smith, who purchased it in 1858 in Luxor, Egypt, shortly after it was discovered. During the 1920s, James Henry Breasted from the University of Chicago began translating it into English.
The papyrus was a textbook, says Salander. The writer was "guiding the student and telling him what to do rather than just observing and explaining. He's taking the student through the steps of a physical examination, taking him through the steps of the reduction of a fracture. This speaks to a relationship not unlike what we have in medical schools in this country."
Like many of Salander's own patients, nearly all of the cases -- 45 of the 48 -- described in the papyrus are trauma victims. "Most of these injuries are violent in nature, clearly injuries that could have been sustained in battle, whether by sword or by club.
"As such, it could have been some sort of military surgery text."
The papyrus begins with a description of "a gaping wound to the head with . . . fracture of the skull," and works down the body to injuries of the face, neck and shoulders.
In the middle of a description about a sprain of the spine, the unknown scribe put down his pen and quit work on the papyrus. "You can see that he's got plenty of papyrus left," Salander says, "but he just stopped work in the middle of a sentence in the middle of a case." MM any of the surgical interventions described in the papyrus are surM prisingly sophisticated. Sutures are mentioned a number of times. Following the treatments described in the papyrus, there is a prognosis called a "verdict." This process seems similar to the modern practice of triage, in which doctors decide which emergency patients to treat first based on their chances of survival. Time is not spent on patients sure to die.
In almost a third of the cases in the papyrus, the surgeon is told not to treat the injury. "Some of cases are big-time injuries, like open fracture of the skull with neurologic deficit and infection ," Salander says.
But not all the untreated patients suffer injuries that would be considered "obviously devastating" by modern standards. An open fracture of the humerus (upper arm), a broken nose and an open fracture of the rib were considered untreatable.
The papyrus shows that the Egyptian physicians also had a reasonable grasp of basic anatomy and physiology.
The ancient surgeon who wrote the papyrus was apparently aware of such concepts as the the relationship between spinal cord damage and paralysis and the existence of membranes that cover the brain and spinal cord. There are even descriptions of the circulatory system, which William Harvey is credited with discovering in 1652.
On circulation, the papyrus says, "there is in it a canal leading to every member of the body. Concerning these, if the physician places the fingers on the . . . pulse of the legs, he discovers the heart, which speaks in the canals of every member . . ."
"You have to be careful about making conclusions about their state of the art," Salander says. "You can't give the author too much credit based on our frame of reference, but I think they understood a lot more than what we give them credit for."