The Origin: Surgery in Ancient Africa

Learning Objectives

By the end of this lesson, students will be able to:

• Describe the physical evidence of surgery in Kemet — including ancient splints and the tomb reliefs at Saqqara.
• Explain what the Edwin Smith Papyrus is — and how its forty-eight cases were organized.
• Describe how physicians in Kemet treated wounds, broken bones, and a dislocated jaw.
• Explain what the Ebers Papyrus says about the heart and the vessels of the body.
• Describe the cesarean birth performed by healers in the kingdom of Bunyoro in 1879.
• Evaluate the claim that these practices were the origin of techniques still used in medicine today.

Key Vocabulary

• Kemet — The name the ancient people of the great river valley gave their own land. It means the Black Land. Today it is known as Egypt. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.
• Surgery — Treating an injury or illness by working directly on the body with the hands or with instruments. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.
• Splint — A rigid support bound to an injured limb to hold a broken bone still while it heals. [1]Smith, G. Elliot. “The Most Ancient Splints.” British Medical Journal, 1908. Splints of wood bound in linen found at Naga ed-Deir.
• Papyrus — A writing material made from the papyrus plant that grew along the great river. Medical texts in Kemet were written on papyrus rolls. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.
• Hieratic — The flowing cursive form of Kemetic writing. Physicians wrote their texts in hieratic with black ink and red ink. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.
• Diagnosis — Deciding what is wrong with a patient after examining them. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.
• Prognosis — Predicting how an injury or illness will turn out. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.
• Cauterization — Using heat to seal blood vessels and stop bleeding. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.[8]Felkin, Robert W. “Notes on Labour in Central Africa.” Edinburgh Medical Journal, April 1884. The cesarean birth at Kahura in 1879.
• Cesarean section — Delivering a baby through a cut in the mother’s abdomen and womb. [8]Felkin, Robert W. “Notes on Labour in Central Africa.” Edinburgh Medical Journal, April 1884. The cesarean birth at Kahura in 1879.
• Bunyoro — A kingdom in the region that is now western Uganda in East Africa. [9]Davies, J.N.P. “The Development of ‘Scientific’ Medicine in the African Kingdom of Bunyoro-Kitara.” Medical History 3, no. 1 (1959). Medicine in Bunyoro.

The Full Lesson

Part 1 — The Proof Left Behind

In 1903, archaeologists working at Naga ed-Deir found something remarkable: ancient bodies with broken limbs, still bound in splints of wood and wrapped in linen. The anatomist Grafton Elliot Smith studied them. He called them the most ancient splints known. [1]Smith, G. Elliot. “The Most Ancient Splints.” British Medical Journal, 1908. Splints of wood bound in linen found at Naga ed-Deir.

There is more proof at Saqqara, the great burial ground of the kings and nobles of Kemet. There stands the tomb of Ankhmahor, a high official who served King Teti more than four thousand three hundred years ago. People call it the Physician’s Tomb. [2]Kanawati, Naguib, and Mahmoud Hassan. The Teti Cemetery at Saqqara, Vol. II: The Tomb of Ankhmahor. Warminster: Aris & Phillips, 1997. The Physician’s Tomb and its medical reliefs.

Ankhmahor was not a doctor. His tomb earned that name because of what is carved on its walls. The walls show medical procedures, including the oldest known image of a circumcision, performed with flint knives. Beside the carving are the words of the man performing it: “Hold him fast. Do not let him faint.” [2]Kanawati, Naguib, and Mahmoud Hassan. The Teti Cemetery at Saqqara, Vol. II: The Tomb of Ankhmahor. Warminster: Aris & Phillips, 1997. The Physician’s Tomb and its medical reliefs.

"Hold him fast. Do not let him faint."

Part 2 — The Surgical Papyrus

The physicians of Kemet did more than carve pictures. They wrote their knowledge down. One of their texts has survived: a scroll more than four and a half meters long. The copy we have was written around 1600 BCE. It may copy a text that is even older. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.[4]“Edwin Smith Papyrus.” Encyclopaedia Britannica. Its date, its purchase in 1862, and its translation.

Today it is called the Edwin Smith Papyrus. That name does not come from the physicians of Kemet who wrote it. Edwin Smith was an American dealer who bought the scroll in 1862 in Waset, now known as Luxor. [4]“Edwin Smith Papyrus.” Encyclopaedia Britannica. Its date, its purchase in 1862, and its translation.

The papyrus describes forty-eight cases. Most of them are injuries to the head, the neck, the chest, and the spine. Each case follows the same order: the examination, the diagnosis, then the verdict. The physician would say one of three things: an ailment I will treat, an ailment I will contend with, or an ailment not to be treated. Then came the treatment. This is the same order a doctor follows today: examine, diagnose, decide, treat. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.

"Examine. Diagnose. Decide. Treat."

Part 3 — Treating the Wound

The papyrus tells the physician how to close a wound: stitch it. If the stitching loosens, draw the wound together with two strips of linen. On the first day, bind the wound with fresh meat. Fresh meat helps stop bleeding. After the first day, treat the wound with grease and honey every day until the patient recovers. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.

Modern science has confirmed that honey fights bacteria. Hospitals today use medical honey on some wounds. [11]Mandal, Manisha D., and Shyamapada Mandal. “Honey: Its Medicinal Property and Antibacterial Activity.” Asian Pacific Journal of Tropical Biomedicine 1, no. 2 (2011). Honey’s antibacterial action.

The papyrus also lists treatment with heat, called cauterization. Today surgeons still cauterize. They use electric current instead of fire. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.

"Treat the wound with grease and honey every day until the patient recovers."

Part 4 — Bones and Joints

The physicians of Kemet set broken bones and bound them in splints, just like the ones found at Naga ed-Deir. [1]Smith, G. Elliot. “The Most Ancient Splints.” British Medical Journal, 1908. Splints of wood bound in linen found at Naga ed-Deir.[3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.

The Edwin Smith Papyrus also explains how to fix a dislocated jaw. Put your thumbs on the ends of the two branches of the jawbone inside the mouth. Put your fingers under the chin. Then make the jaw fall back so it rests in its place. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.

More than a thousand years later, the Greek physician Hippocrates described a very similar method. Doctors today still put a dislocated jaw back by pressing it down and back. [7]British Dental Journal, 2015. Article on Case 25 of the Edwin Smith Papyrus and the reduction of a dislocated mandible (doi:10.1038/sj.bdj.2015.438). The papyrus method and the later Hippocratic method.

"Make the jaw fall back so it rests in its place."

Part 5 — The Heart and Its Vessels

Another great medical scroll survives. Today it is called the Ebers Papyrus. Once again, the name does not come from Kemet. Georg Ebers was a German scholar who acquired it in 1873, in Waset. It was written around 1550 BCE. It is about twenty meters long. It holds about seven hundred remedies. [5]“Ebers Papyrus.” Encyclopaedia Britannica. Its date, its remedies, its treatise on the heart, and its acquisition in 1873.

It also contains a treatise on the heart. It says the heart has vessels going to every limb of the body. It says that when a physician lays his fingers on the body, he is examining the heart, because the heart speaks out of the vessels of every limb. In other words, the pulse you feel in the body comes from the heart. [5]“Ebers Papyrus.” Encyclopaedia Britannica. Its date, its remedies, its treatise on the heart, and its acquisition in 1873.[6]“The Papyrus Ebers.” Document held in CDC Stacks (cdc:72351). The treatise on the heart and vessels, with an English translation of its passage on the pulse.

Greek physicians wrote about the pulse more than a thousand years later. [13]Nutton, Vivian. Ancient Medicine. 2nd ed. London: Routledge, 2013. Greek physicians’ later study of the pulse.

"The heart speaks out of the vessels of every limb."

Part 6 — Surgery in Bunyoro

This knowledge did not stay in Kemet, and it did not end in ancient times. In 1879, a British medical missionary named Robert Felkin traveled to East Africa. At a place called Kahura, he watched a healer from the kingdom of Bunyoro perform a cesarean birth. [8]Felkin, Robert W. “Notes on Labour in Central Africa.” Edinburgh Medical Journal, April 1884. The cesarean birth at Kahura in 1879.[9]Davies, J.N.P. “The Development of ‘Scientific’ Medicine in the African Kingdom of Bunyoro-Kitara.” Medical History 3, no. 1 (1959). Medicine in Bunyoro.

The healer gave the mother banana wine to dull the pain. He washed his hands and the mother’s abdomen — first with banana wine, then with water. His assistant used a red-hot iron to stop the bleeding. The healer closed the wound with thin iron pins and string, and covered it with a paste of roots. Mother and child both recovered. [8]Felkin, Robert W. “Notes on Labour in Central Africa.” Edinburgh Medical Journal, April 1884. The cesarean birth at Kahura in 1879.

At that time, a cesarean birth in Europe often killed the mother. The first one in Europe where mother and child both survived had happened only three years earlier. When Felkin reported what he saw, some doctors in Britain refused to believe it. [10]deCosta, Caroline. “Banana Wine and Cross Dressing.” O&G Magazine 15, no. 2 (2013). Felkin’s report and Porro’s 1876 operation in Padua.[12]“A Cesarean Section in Uganda in 1879.” Hektoen International, May 2023. The procedure Felkin described and the doubt it met in Britain.

This was not luck. This was written down. Studied. Passed on. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments.[5]“Ebers Papyrus.” Encyclopaedia Britannica. Its date, its remedies, its treatise on the heart, and its acquisition in 1873.[8]Felkin, Robert W. “Notes on Labour in Central Africa.” Edinburgh Medical Journal, April 1884. The cesarean birth at Kahura in 1879.

"This is the origin."

Critical Thinking Discussion Questions

1. The tomb of Ankhmahor is called the Physician’s Tomb even though he was not a doctor. [2]Kanawati, Naguib, and Mahmoud Hassan. The Teti Cemetery at Saqqara, Vol. II: The Tomb of Ankhmahor. Warminster: Aris & Phillips, 1997. The Physician’s Tomb and its medical reliefs. What can carvings and tomb art tell historians that written texts cannot?
2. Each case in the Edwin Smith Papyrus ends with a verdict: treat, contend with, or do not treat. [3]Breasted, James Henry. The Edwin Smith Surgical Papyrus. 2 vols. Chicago: University of Chicago Press, 1930. The forty-eight cases, their verdicts, and their treatments. Why would it matter for a physician to admit that some injuries could not be treated?
3. The Edwin Smith Papyrus and the Ebers Papyrus are named after the men who bought them, not the physicians who wrote them. [4]“Edwin Smith Papyrus.” Encyclopaedia Britannica. Its date, its purchase in 1862, and its translation.[5]“Ebers Papyrus.” Encyclopaedia Britannica. Its date, its remedies, its treatise on the heart, and its acquisition in 1873. How do names like these shape the way people think about who created knowledge?
4. Some doctors in Britain refused to believe Robert Felkin’s report from Bunyoro. [12]“A Cesarean Section in Uganda in 1879.” Hektoen International, May 2023. The procedure Felkin described and the doubt it met in Britain. Why might they have doubted it, and what does that suggest about how African knowledge was treated?
5. Which practice in this lesson do you think connects most clearly to medicine today? Explain your choice.

Quiz — The Origin

Part A: Select the best answer and check your work instantly. Part B: Write in complete sentences.

Part A — Multiple Choice

Part B — Short Answer

Extension Activity

Read the Case: The full Edwin Smith Papyrus was translated into English by James Henry Breasted in 1930. It is free to read online from the University of Chicago. Choose one of the forty-eight cases. Then describe three things: (1) what injury the case describes, (2) what the physician is told to look for during the examination, and (3) which verdict the physician gives — treat, contend with, or do not treat. Then write two to three sentences explaining how that case compares with the way a doctor would handle the same injury today.