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  • Edwin Smith Surgical Papyrus

  • -The Edwin Smith Surgical Papyrus, dating from the seventeenth century BC, is one of the oldest of all known medical papyri,. illustrating the teachings of the Father of Medicine Imhotep
    -It differs fundamentally from the others in the following ways:

    -The seventeen columns on the recto comprise part of a surgical treatise, the first thus far discovered in the ancient Orient, whether in Egypt or Asia. It is therefore the oldest known surgical treatise.

    -This surgical treatise consists exclusively of cases, not recipes. The treatise is systematically organized in an arrangement of cases, which begin with injuries of the head and proceed downward through the body, like a modern treatise on anatomy.

    -The treatment of these injuries is rational and chiefly surgical; there is resort to magic in only one case out of the forty-eight cases preserved.

    Each case is classified by one of three different verdicts:
    1. Favorable
    2. Uncertain
    3. Unfavorable. The third verdict, expressed in the words, 'an ailment not to be treated,' is found in no other Egyptian medical treatise.

    -This unfavorable verdict occurring fourteen times in the Edwin Smith Papyrus marks a group of cases (besides one more case) which the surgeon cannot cure and which he is led to discuss by his scientific interest in the phenomena disclosed by his examination."

    According to Breasted, the Edwin Smith Papyrus is a copy of an ancient composite manuscript which contained, in addition to the original author's text (3000-2500 BC), a commentary added a few hundred years later in the form of 69 explanatory notes (glosses). It contains 48 systematically arranged case histories, beginning with injuries of the head and proceeding downward to the thorax and spine, where the document unfortunately breaks off. These cases are typical rather than individual, and each presentation of a case is divided into title, examination, diagnosis, and treatment. There is a definite differentiation between rational surgical treatments and the much less employed medico- magical measures. Significantly, trepanation is not mentioned.

    Of the 48 cases described in the Edwin Smith Papyrus, 27 concern head trauma and 6 deal with spine trauma.3 Of the 27 head injuries, 4 are deep scalp wounds exposing the skull, and 11 are skull fractures.

    "The latter, according to our present day terminology would be classified as follows: two compound linear fractures; four compound depressed fractures; four compound comminuted fractures; and one comminuted fracture without external wound. The symptoms and signs of head injury are given in considerable detail. Feeble pulse and fever are associated with hopeless injuries and deafness as well as aphasia are recognized in fractures of the temporal region."

    Case 1 - a wound in his head penetrating to the bone of his skull
    Examination: If you exam a man1 having a wound in his head, while his wound does not have two lips, penetrating to the bone of his skull, (but) not having a gash, you should palpate his wound (or, you should lay your hand upon it); should you find his skull uninjured, not having a perforation; a split, or a smash in it.
    Treatment: you should bind it with fresh meat the first day and treat afterwards with grease, honey and lint every day until he recovers.
    Gloss: "you examine=est a man,": counting any one like counting things with a bushel. (For) examining (h't, literally "measuring") is like one's counting a certain quantity with a bushel, (or) counting something with the fingers, in order to know. It is measuring (h't ) things with a bushel which -- one in whom an ailment is counted, like measuring (h't ) the ailment of a man, in order to know the action of the heart. There are canals (or vessels, mt ) in it (the heart) 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 (h't ) 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" (h'.t ) regarding his wound because of the vessels (mt.w ) 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 measure it in order to know that is befalling therein.
    "while his wound does not have two lips,": his wois narrow, not wide ; without gaping of one (lip) from the other.
    "penetrating to the bone of his skull, (but) not having a gash": there is a gaping of the flesh, although --------- over the bone of his skull, without gaping of one (lip) from the other, being narrow, not wide.

    Case 2 - a gaping wound in his head, penetrating to the bone.

    Examination: If you examinest a man having a gaping wound in his head, penetrating to the bone, you should lay your hand upon it and you should palpate his wound. If you findest his skull uninjured, not having a perforation in it...

    Diagnosis: you should say regarding him: "One having a gaping wound in his head. An ailment which I will treat."

    Treatment: you should bind fresh meat upon it the first day; you should apply for him two strips of linen, and treat afterward with grease, honey, and lint every day until he recovers.

    Gloss: As for: "Two strips of linen," it means two bands of linen which one applies upon the two lips of the gaping wound in order to cause that one join to the other.

    Case 3 - a gaping wound in his head, penetrating to the bone and perforating his skull.

    Examination: If you examine a man having a gaping wound in his head, penetrating to the bone, and perforating his skull; you should palpate his wound; should you find him unable to look at his two shoulders and his breast, and suffering with stiffness in his neck...

    Diagnosis: you should say regarding him: "One having a gaping wound in his head, penetrating to the bone, and perforating his skull, while he suffers with stiffness in his neck. An ailment which I will treat."

    Treatment: Now after you has stitched it, you should lay fresh meat upon his wound the first day. you should not bind it. Moor (him) at his mooring stakes until the period of his injury passes by. you should treat it afterward with grease, honey, and lint every day, until he recovers...

    Gloss: As for: "Moor (him) at his mooring stakes," it means putting him on his customary diet, without administering to him a prescription.

    Case 4 - a gaping wound in his head, penetrating to the bone, and splitting his skull.

    Examination: If you examine a man having a gaping wound in his head, penetrating to the bone, and splitting his skull, you should palpate his wound. Should you find something disturbing therein under your fingers, and he shudders exceedingly, while the swelling which is over it protrudes, he discharges blood from both his nostrils and from both his ears, he suffers with stiffness in his neck, so that he is unable to look at his two shoulders and his breast...

    Diagnosis: you should say regarding him: "One having a gaping wound in his head, penetrating to the bone, and splitting his skull; while he discharges blood from both his nostrils and from both his ears, and he suffers with stiffness in his neck. An ailment with which I will contend."

    Treatment: Now when you find that the skull of that man is split, you should not bind him, (but) moor (him) at his mooring stakes until the period of his injury passes by. His treatment is sitting. Make for him two supports of brick, until you known he has reached a decisive point. you should apply grease to his head, and soften his neck therewith and both his shoulders. you should do likewise for every man whom you find having a split skull...

    Gloss: As for "(Until) you known he has reached a decisive point," it means (until you known whether he will die or he will live; for he is (a case of) "an ailment with which I will contend."

    Case 5 - a gaping wound in his head, smashing his skull.

    Examination: If you examinest a man having a gaping wound in his head, penetrating to the bone, and smashing his skull; you should palpate his wound. should you find that smash which is in his skull deep and sunken under your fingers, while the swelling which is over it protrudes, he discharges blood from both his nostrils and both his ears, and he suffers with stiffness in his neck, so that he is unable to look at his two shoulders and his breast...

    Diagnosis: you should say regarding him: "One having a gaping wound in his head, penetrating to the bone, and smashing his skull, while he suffers with stiffness in his neck. An ailment not to be treated."

    Treatment: you shalt not bind him (but) moor (him) at his mooring stakes, until the period of his injury passes by...

    Case 6 - a gaping wound in his head, penetrating to the bone, smashing his skull, and rending open the brain of his skull.

    Examination: If you examinest a man having a gaping wound in his head, penetrating to the bone, smashing his skull, and rending open the brain of his skull, you should palpate his wound. 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 infant's crown before it becomes whole-when it has happened there is no throbbing and fluttering under your fingers until the brain of his (the patient's) skull is rent open-and he discharges blood from both his nostrils, and he suffers with stiffness in his neck...

    Diagnosis: you should say concerning him: "An ailment not to be treated." Treatment: you should anoint that wound with grease. you shalt not bind it; you shalt not apply two strips upon it: until you known that he has reached a decisive point.

    Gloss: As for: "Smashing his skull, and rending open the brain of his skull," (it means) the smash is large, opening to the interior of his skull, (to) the membrane enveloping his brain, so that it breaks open his fluid in the interior of his head....

    Case 7 - a gaping wound in his head penetrating to the bone and perforating the sutures of his skull.
    Examination: If you examinest a man having a gaping wound in his head, penetrating to the bone, and perforating the sutures of his skull, you should palpate his wound, (although) he shudders exceedingly. you should cause him to lift ; if it is painful for him to open his mouth, and his heart beats feebly ; if you observe his spittle hanging at his two lips and not falling off, while he discharges blood from both his nostrils and from both his ears; he suffers with stiffness in his neck, and is unable to look at his two shoulders and his breast.
    First diagnosis: you should say regarding him: "One having a gaping wound in his head, penetrating to the bone, and perforating the sutures of his skull; the cord of his mandible is contracted; he discharges blood from both his nostrils and from both his ears, while he suffers with stiffness in his neck. An ailment with which I will contend."
    First treatment: Now as soon as you findest that the cord of that man's mandible, his jaw, is contracted you should have made for him something hot until he is comfortable, so that his mouth opens. you should bind it with grease, honey, and lint, until you known that he has reached a decisive point.
    Second examination: If then, you findest that the flesh of that man has developed fever from wound which is in the sutures of his skull, while that man has developed ty' from that wound, you should lay hand upon him. should find his countenance is clammy with sweat, the ligaments his neck are tense, his face ruddy, his teeth and his back, the odor of the chest of his head is like the bkn (urine) of sheep, his mouth is bound, and both his eyebrows are drawn, while his face is as if he wept.
    Second dia: you should say regarding him: "One having a gaping wound in his head penetrating to the bone, perforating the sutures of his skull ; he has developed ty', his mouth is bound, and he suffers with stiffness in his beck. An ailment not to be treated."
    Third examination: If, however, you findest that that man has become pale and has already shown exhaustion.
    Third treatment: you should have made for him a wooden brace with linen and put into his mouth. you should have made for him a draught of w'h-fruit. His treatment is sitting, placed between two supports of brick, until you known he has reached a decisive point.
    Gloss: "Perforating the sutures of his skull," means what is between shell and shell of his skull; and that the sutures are (composed) of hide.
    "The cord of his mandible is contracted," means a stiffening on the part of the ligament at the end of his ramus, which are fastened to his temporal bone, that is at the end of his jaw, without moving to and fro, so that it is not easy for him to open his mouth because of his pain.
    "The cord of his mandible," means the ligaments which bind the end his jaw. as one says, "the cord" of a thing in (or as) a splint.
    "His countenance clammy with sweat," means that his head is a little sweaty as (we say), "A thing is clammy."
    "The ligaments of his neck are tense" means that the ligaments of his neck are stretched stiff by reason of his injury.
    "His face is ruddy" (tms'), means that the color of his face is red, like the color of tms' fruit.
    "The odor of the chest of his head is like the bkn of sheep," means that the odor of his crown is like the urine of sheep. "The chest of his head," it means the middle of his crown next to his brain. The likening of it is to a chest.
    "His mouth is bound, and both his eyebrows are drawn, while his face is as if he wept." means that he does not open his mouth that he may speak, both his eyebrows are distorted, one drawing upward the other drooping downward, like one who winks while. his face weeps.
    "He has become pale has already shown exhaustion, means becoming pale, because he is (a case of) "Undertake him do not desert him," in view of the exhaustion.

    Case 8 - smash in his skull under the skin of his head.

    Examination: If you examinest a man having a smash of his skull, under the skin of his head, while there is nothing at all upon it, you should palpate his wound. should you find that there is a swelling protruding on the out side 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...

    Diagnosis: you should account him one whom something entering from outside has smitten, as one who does not release the head of his shoul fork, and one who does not fall with his nails in the middle of his palm; while he discharges blood from both his nostrils and from both his ears, and he suffers with stiffness in his neck. An ailment not to be treated. Treatment: His treatment is sitting, until he gains color, and until you known he has reached the decisive point....

    Gloss: As for: "He walks shuffling with his sole," he (the surgeon) is speaking about his walking with his sole dragging, so that it is not easy for him to walk, when it (the sole) is feeble and turned over, while the tips of his toes are contracted to the ball of his sole, and they (the toes) walk fumbling the ground. He (the surgeon) says: "He shuffles," concerning it.

    Case 9 - wound in his forehead, smashing the shell of his skull.
    Examination: If you examinest a man having a wound in his forehead, smashing the shell of his head.
    Treatment: you should prepare for him the egg of an ostrich, triturated with grease and placed in the mouth of his wound. Now afterwards you should prepare for him the egg of an ostrich, triturated and made into poultices for drying up that wound. you should apply to it a covering for physician's use; you should uncover it the third day, and find it knitting together the shell, the color being like the egg of an ostrich.
    That which is to be said as a charm over this recipe:
    Repelled is the enemy that is in the wound! Cast out is the evil that is in the blood,
    The adversary of Horus, on every side of the mouth of Isis.
    This temple does not fall down;
    There is no enemy of the vessel therein.
    I am under the protection of Isis ;
    My rescue is the son of Osiris.

    Now afterwards you should cool it for him with a compress of figs, grease, and honey, cooked and cooled, and applied to it.

    Case 10 - wound above his eyebrow.
    Examination: If you examinest a man having a wound above his eyebrow, penetrating to the bone, should palpate his wound, and draw together for him the gash with stitching..
    Diagnosis: you should say concerning him: "One having a wound above his eyebrow. An aliment which I will treat."
    Treatment: Now after you have stitched it, you should bind fresh meat upon it the first day. If you findest that the stitching of this wound is loose, you should draw it together for him with two strips (of plaster), and you should treat it with grease and honey every day until he recovers.
    Gloss: "Two strips of linen," it means two bands of linen, which one applies to two lips of the gaping wound, in order to cause one (lip) be joined to the other.

    Case 11 - break of the column of his nose.
    Examination: If you examinest a man having a break of the column of his nose, his nose being disfigured, and a depression being in it, while the swelling that is on it protrudes, and he has discharged blood from both his nostrils.
    Diagnosis: you should say concerning him: "One having a break of the column of his nose, an ailment which I will treat."
    Treatment: you should clean it for him with two plugs of linen. you should place two (other) plugs of linen saturated with grease inside his two nostrils. you should put him at his mooring stakes until the swelling is reduced (lit. drawn out). you should apply stiff rolls of linen by which his nose is held fast. you should treat him afterward with grease, honey, and lint, every day until he recovers.
    Gloss: "The column of his nose.": the outer edge of his nose as far as its side(s) on the top of his nose, being the inside of his nose between his two nostrils.
    "His two nostrils,": the two sides of his nose extending to his two cheeks, as far as the back of his nose; the top of his nose is loosened.

    Case 12 - a break in the chamber of his nose.
    Examination: If you examinest a man having a break in the chamber of his nose, and you findest his nose bent, while his face is disfigured, and the swelling which is over it is protruding.
    Diagnosis: you should say concerning him: "One having a break in the chamber of his nose. An ailment which I will treat."
    Treatment: you should force it to fall in, so that it lies in its place, and clean out the interior of both his nostrils with two swabs of linen until every worm of blood which coagulates inside his two nostrils comes forward. Now afterwards you should take two plugs of linen saturated with grease and put them into his two nostrils. you should place two stiff rolls of linen, bound on. you should treat him afterwards with grease, honey, and lint every day until he recovers.
    Gloss: "A break in the chamber of his nose,": the middle of his nose as far as the back, extending to the region between his two eyebrows.
    "His nose bent, while his face is disfigured,": his nose is crooked and greatly swollen throughout; his two cheeks likewise, so his face is disfigured by it. not being in its customary form, because all the depressions are filled with swelling, so that his face looks disfigured by it.
    "Every worm of blood which coagulates in the inside of his two nostrils,": the clotting of blood in the inside of his two nostrils, likened to the n'r,t worm, which subsists in water.

    Case 13 - a smash in the nostril.
    Examination: If you examinest a man having a smash in his nostril, you should place your hand upon his nose at the point of this smash. Should it crepitate under your fingers, while at the same time he discharges blood from his nostril and from his ear on the side of him having that smash; it is painful when he opens his mouth because of it; and he is speechless.
    Diagnosis: you should say concerning him: "One having a smash in the nostril. An ailment not to be treated."

    Case 14 - a wound in his nostril.
    Examination: If you examinest a man having a wound in his nostril piercing through, should you find the two lips of that wound separated from each other, you should draw together that wound with stitching.
    Diagnosis: you should say concerning him: "One having a wound in his nostril, piercing through. An ailment which I will treat."
    Treatment: you should make for him two swabs of linen, and you should clean out every worm of blood which has coagulated on the inside of his nostril. you should bind it with fresh meat, the first day. when its stitching loosens, you should take off of him the fresh meat. and you should bind it with grease, honey and lint every day until he recovers.
    Gloss: "A wound in his nostril, through," means, that the two lips of his wound are soft, opening on the inside of his nose, as one says: "pierced through" concerning soft things.

    Case 15 - a perforation in his cheek.
    Examination: If you examinest a man having a perforation in his cheek, should you find there is a swelling, protruding and black, and diseased tissue upon his cheek.
    Diagnosis: you should say concerning him: "One having a perforation in his cheek, an ailment which I will treat."
    Treatment: you should bind it with ymrw and treat it afterward with grease and honey every day until he recovers.

    Case 16 - a split in his cheek.
    Examination: If you examinest a man having a split in his cheek, should you find that there is a swelling, protruding and red, on the outside of that split.
    Diagnosis: you should say concerning him: "One having a split in his cheek, an ailment which I will treat."
    Treatment: you should bind it with fresh meat the first day. His treatment is sitting until its swelling is reduced (lit. drawn out). you shalt treat it afterward with grease, honey, and lint every day until he recovers.

    Case 17 - a smash in his cheek.
    Examination: If you examinest a man having a smash in his cheek, you should place your hand on his cheek at the point of that smash. Should it crepitate under your fingers, while he discharges blood from his nostril, and from his ear on the side of him having that injury; and at the same time he discharges blood from his mouth, while it is painful when he opens his mouth because of it.
    Diagnosis: you should say concerning him: "One having a smash in his cheek, while he discharges blood from his nostril, from his ear, and from his mouth, and he is speechless. An ailment not to be treated."
    Treatment: you should bind with fresh meat the first day. His relief is sitting until its swelling is reduced (lit. drawn out). you shalt treat it afterwards with grease, honey, and lint every day until he recovers.

    Case 18 - a wound in his temple.
    Examination: If you examinest a man having a wound in his temple, it not having a gash while that wound penetrates to the bone, you should palpate his woun. should you find his temporal bone uninjured, there being no split, (or) perforation, (or) smash in it.
    Diagnosis: you should say concerning hi: "One having a wound in his temple. An ailment which I will treat."
    Treatment: you should bind it with fresh meat the first day, and you should treat afterward with grease, and honey every day until he recovers.
    Gloss: "A wound, not having a gash, while it penetrates to the bone,": the wound is contracted, reaching as far as the bone, (though) there is no gash in it. He speaks of (its) narrowness, his wound not having two lips.
    "His gm' (temple),": the region thereof between the corner of his eye and the orifice of his ear, at the end of his eye and the orifice of his ear, at the end of his mandible.

    Case 19 - a perforation in his temple.
    Examination: If you examinest a man having a perforation (thm) in his temple, a wound being upon it, you should inspect his wound, saying to him: "Look at your two shoulders." Should his doing so be painful (even though) his neck turns around (only) a little for him, while his eye in the side of him having that injury is blood-shot.
    Diagnosis: you should say concerning him: "One having a perforation in his temple --- while he suffers with stiffness in his neck, An ailment which I will treat."
    Treatment: you should put him at his mooring stakes until the period of his injury passes by, and you should treat with grease, honey, and lint every day until he recovers
    .
    Gloss: "His two eyes are blood-shot," means that the color of his two eyes is red like the color of s's-flowers. The "Treatise on what pertains to the Embalmer" says concerning it: "His two eyes are red with disease like an eye at the end of its weakness."

    Case 20 - a wound in his temple, penetrating to the bone, and perforating his temporal bone.

    Examination: If you examinest a man having a wound in his temple, penetrating to the bone, and perforating his temporal bone, while his two eyes are blood shot, he discharges blood from both his nostrils, and a little drops; if you puttest your fingers on the mouth of that wound and he shudder exceedingly; if you ask of him concerning his malady and he speak not to you; while copious tears fall from both his eyes, so that he thrusts his hand often to his face that he may wipe both his eyes with the back of his hand as a child does, and knows not that he does so...

    Diagnosis: you should say concerning him: "One having a wound in his temple, penetrating to the bone, and perforating his temporal bone; while he discharges blood from both his nostrils, he suffers with stiffness in his neck, and he is speechless. An ailment not to be treated."

    Treatment: Now when you findest that man speechless, his relief shall be sitting; soften his head with grease, and pour milk into both his ears.

    Case 21 - a split in his temple.
    Examination: If you examinest a man having a split in his temple, should you find a swelling protruding on the outside of that split, while he discharges blood from his nostril and from his one ear having that split, and it is painful when he hears speech, because of it.
    Diagnosis: you should say concerning him: "One having a split in his temple, while he discharges blood from his nostril and his ear having that injury. An ailment with which I will contend."
    Treatment: you should put him at his mooring stakes until you known he has reached a decisive point. zzzzz

    Case 22 - a smash in his temple.

    Examination: If you examinesa man having a smash in his temple, you should place your thumb upon his chin and your finger upon the end of his ramus, so that the blood will flow front his two nostrils and from the interior of his ear having that smash. clean it for him with a swab of linen until you see its fragments (of bone) in the interior of his ear. If you callest to him and he is speechless and cannot speak...

    Diagnosis: you should say concerning him: "One having a smash in his temple; he discharges blood from his two nostrils and from his ear; he is speechless; and he suffers with stiffness in his neck. An ailment not to be treated."...

    Gloss: As for: "you see its fragments in the interior of his ear," it means that some of the fragments of the bone come away to adhere to the swab which was introduced to clean the interior of his ear.

    Case 23 - a wound in his ear.
    Examination: If you examinest a man having a wound in his ear, cutting through its flesh, the injury being in the lower part of his ear, and confined to the flesh, you should draw it together for him with stitching behind the hollow of his ear.
    Diagnosis: you should say concerning him: "One having a wound in his ear, cutting through its flesh. An ailment which I will treat."
    Treatment: If you findest, the stitching of that wound loosen and stick in the two lips of his wound, you should make for him stiff rolls of linen and pad the back of his ear therewith. you should treat it afterwards with grease, honey, and lint every day until he recovers.

    Case 24 - a fracture in his mandible.
    Examination: If you examinest a man having a fracture in his mandible, you should place your hand upon it, should you find that fracture crepitating under your fingers.
    Diagnosis: you should say concerning him: "One having a fracture in his mandible, over which a wound has been inflicted, ! -------! and he has fever from it. An ailment not to be treated."

    Case 25 - a dislocation in his mandible.
    Examination: If you examinest a man having a dislocation in his mandible, should you find this mouth open and his mouth cannot close for him, you should put your thumb(s) upon the ends of the two rami of the mandible in the inside of his mouth, and your two claws (meaning two groups of fingers) under his chin, and you should cause them to fall back so that they rest in their places.
    Diagnosis: you should say concerning him: "One having a dislocation in his mandible, An ailment which I will treat."
    Treatment: you should bind it with ymrw, and honey every day until he recovers.

    Case 26 - a wound in his lip
    Examination: If you examinest a man having a wound in his lip, piercing through to the inside of his mouth, you should examine his wound as far as the column, of his nose. you should draw together that wound with stitching.
    Diagnosis: you should say concerning him: "One having a wound in his lip, piercing through to the inside of his mouth. An ailment which I will treat.
    Treatment: Now after you have stitched it you should bind it with fresh meat the first day. you should treat it afterwards with grease and honey every day until he recovers.
    Gloss: "A wound in his lip, piercing through to the inside of his mouth," means that the two lips of wound are soft, opening to the inside of his mouth. One says: "Pierced through" (ysdb ) concerning soft things.

    Case 27 - a gaping wound in his chin.
    Examination: If you examinest a man having a gaping wound in his chin, penetrating to the bone, you should palpate his wound. If you should find his bone uninjured, not having a split, (or) perforation in it.
    Diagnosis: you should say concerning him: "One having a gaping wound in his chin, penetrating to the bone. An ailment which I will treat."
    Treatment: you should apply for him two strips on that gash. you should bind it with fresh meat the first day, and you should treat it afterwards with grease, honey and lint every day until he recovers.

    Case 28 - a wound in his throat.
    Examination: If you examinest a man having a gaping wound in his piercing through to his gullet; if he drinks water he chokes and it come out of the mouth of his wound; it is greatly inflamed, so that he develops fever from it; you should draw together that wound with stitching.
    Diagnosis: you should say concerning him: "One having a wound in his throat, piercing through to his gullet. An ailment with which I will contend.".
    First treatment: you should bind it with fresh meat the first day. you should treat it afterwards with grease, honey, and lint every day, until he recovers.
    Second examination: If, however, you findst him continuing to have fever from that wound.
    Second treatment: you should apply dry lint in the mouth of his wound, and moor (him) at his mooring stakes until he recovers.

    Case 29 - a gaping wound in a vertebra of his neck.

    Examination: If you examinest a man having a gaping wound in a vertebra of his neck, penetrating to the bone, and perforating a vertebra of his neck; if you examinest that wound, and he shudders exceedingly, and he is unable to look at his two shoulders and his breast...

    Diagnosis: you should say concerning him: " One having a wound in his neck, penetrating to the bone, perforating a vertebra of his neck, and he suffers with stiffness in his neck. An ailment with which I will contend."

    Treatment: you should bind it with fresh meat the first day. Now afterward moor (him) at his mooring stakes until the period of his injury passes by.

    Case 30 - a sprain in a vertebra of his neck.

    Examination: If you examinest a man having a sprain in a vertebra of his neck, you should say to him: "look at your two shoulders and your breast." When he does so, the seeing possible to him is painful.

    Diagnosis: you should say concerning him: "One having a sprain in a vertebra of his neck. An ailment which I will treat."

    Treatment: you should bind it with fresh meat the first day. Now afterward you should treat with ywrw and honey every day until he recovers.

    Gloss: As for: "A sprain" he is speaking of a rending of two members (although) it (=each) is (still) in its place.

    Case 31 - a dislocation in a vertebra of his neck.

    Examination: If you examinest a man having a dislocation in a vertebra of his neck, should you find him unconscious of his two arms and his two legs on account of it, while his phallus is erected on account of it, and urine drops from his member without his knowing it; his flesh has received wind; his two eyes are bloodshot; it is a dislocation of a vertebra of his neck extending to his backbone which causes him to be unconscious of his two arms and his two legs. If, however, the middle vertebra of his neck is dislocated, it is an emissio seminis which befalls his phallus.

    Diagnosis: you should say concerning him: "One having a dislocation in a vertebra of his neck, while he is unconscious of his two legs and his two arms, and his urine dribbles. An ailment not to be treated."

    Gloss: As for: "A dislocation in a vertebra of his neck," he is speaking of a separation of one vertebra of his neck from another, the flesh which is over it being uninjured; as one says, "It is wnh," concerning things which had been joined together, when one has been severed from another.

    Case 32 - a displacement in a vertebra of his neck.
    Examination: If you examinest a man having a displacement in a vertebra of his neck, whose face is fixed, whose neck cannot turn for him, and you should say to him: "Look at your breast and your two shoulders," and he is unable to turn his face that he may look at his breast and his two shoulders.
    Diagnosis: you should say concerning him: "One having a displacement in a vertebra of his neck. An aliment which I will treat."
    Treatment: you should bind it with fresh meat the first day. you should loose his bandages and apply grease to his head as far as his neck, and you should bind it with ymrw. you should treat it afterwards with honey every day, and his relief is sitting until he recovers.
    Gloss: "A displacement in a vertebra of his neck," he is speaking concerning a sinking of a vertebra of his neck to the interior of his neck, as foot settles into cultivated ground. It is a penetration downward.

    Case 33 - a crushed vertebra in his neck.

    Examination: If you examinest a man having a crushed vertebra in his neck and you findest that one vertebra has fallen into the next one, while he is voiceless and cannot speak; his falling head downward has caused that one verte bra crush into the next one; and should you find that he is unconscious of his two arms and his two legs because of it...

    Diagnosis: you should say concerning him: "One having a crushed vertebra in his neck; he is unconscious of his two arms and his two legs, and he is speechless. An ailment not to be treated."...

    Gloss: As for: "His falling head downward has caused that one vertebra crush into the next," it means that he has fallen head downward upon his head, driving one vertebra of his neck into the next.

    Case 34 - a dislocation in his two collar-bones.
    First examination: If you examinest a man having a dislocation in his two collar-bones, should you find his two shoulders turned over and the head(s) of his two collar-bones turned toward his face.
    First diagnosis: you should cause (them) to fall back, so that they rest in their places. you should bind it with stiff rolls of linen; you should treat it afterward with grease and honey every day, until he recovers.
    Second examination: If, however, you should find his two collarbones having a rupture (or the tissue) over it, penetrating to the interior.
    Second diagnosis: you should say concerning him: "An ailment which I will treat." (Scribal error )
    Gloss: "A dislocation in his two collar-bones" means a displacement of the heads of his sickle-bone's). Their heads are attached to the upper bone of his breast to his throat, over which is the flesh of his gorge, that is the flesh that is over his bosom. Two canals are under it: one on the right and (one) on the left of his throat and of his bosom; they lead to his lungs.

    Case 35 - a break in his collar-bone.
    Examination: If you examinest a man having a break in his collar-bone and you should find his collar-bone short and separated from its fellow.
    Diagnosis: you should say concerning him: "One having a break in his collar-bone. An ailment which I will treat."
    Treatment: you should place him prostrate on back, with something folded between his two shoulder-blades; you should spread out with his two shoulders in order to stretch apart his collar-bone until that break falls into its place. you should make for him two splints of linen, and you should apply one of them both on the inside of his upper arm. you should bind it with ymrw, and treat it afterward with honey every day, until he recovers.

    Case 36 - a break in his upper arm.
    Examination: If you examinest a man having a break in his upper arm, and you findest his upper arm hanging down, separated from its fellow.
    Diagnosis: you should say concerning him: "One having a break in his upper arm. An ailment which I will treat."

    Treatment:
    you should place him prostrate on his back, with something folded between his two shoulder-blades; you should spread out his shoulders, in order to stretch apart his upper arm until that break falls into its place. you should make for him two splints of linen, and you should apply one of them to the inside of his arm, and the other of them to the underside of his arm. you should bind it with ymrw, and treat afterward with honey every day until he recovers.

    Case 37 - a break in his upper arm, with a wound on it.
    Examination: If you examinest a man having a break in his upper arm, on which a wound has been inflicted, and you findest that break crepitates under your fingers.
    First diagnosis: you should say concerning him: "One having a break in his upper arm, on which a wound has been infected. An ailment with which I will contend."
    First treatment: you should make him two splints of linen; you should bind it with ymrw; and you should treat it afterwards with grease, honey, and lint every day until you known that he has reached a decisive point.
    Second examination: If, however, you findest that wound which is over the break, with blood issuing from it, and piercing through to the interior of his injury.
    Second diagnosis: you should say concerning him; "One having a break in his upper arm, over which a wound has been inflicted, piercing through. An ailment not to be treated."

    Case 38 - a split in his upper arm.
    Examination: If you examinest a man having a split in his upper arm, and you should find the swelling protruding, on the outside of that split, which is in his upper arm.
    Diagnosis: you should say concerning him: "One having a split in his upper arm. An ailment which I will treat."
    Treatment: you should bind it with ymrw; you should treat it afterwards with honey, every day until he recovers.

    Case 39 - tumors with prominent head in his breast.
    Examination: If you examinest a man having a tumor with prominent head in his breast, and you findest that the swellings have spread with pus over his breast, and have produced redness, while it is very hot therein, when your hand touches him.
    Diagnosis: you should say concerning him: "One having tumors with prominent head in his breast, and they produce cysts of pus. An ailment which I will treat with the fire-drill."
    Treatment: you should burn him over his breast and over those tumors which are on his breast. you should treat him with wound treatment, you should not prevent its opening of itself, that there may be no mnh-w in his wound (sore?). Every wound (sore?) that arises in his breast dries up as soon as it opens of itself.
    Gloss: "Tumor with prominent head in his breast." means that there are swellings spreading over his breast because of his injury; they produce pus and redness on his breast; (as) it is said: "It is like parti-colored things whose product is pus.

    Case 40 - a wound in his breast.
    Examination: If you examinest a man having a wound in his breast, penetrating to the bone, perforation the manubrium of his sternum, you should press the manubrium of his sternum with your fingers, (although) he shudders exceedingly.
    Diagnosis: you should say concerning him: "One having a wound in his breast, penetrating to the bone, perforating the manubrium of his sternum. An ailment which I will treat."
    Treatment: you should bind it with fresh meat the first day; you should treat it afterward with grease, honey, and lint every day, until he recovers.
    Gloss: "The manubrium of his sternum," ( means) the upper head of his sternum; it is like it were a porcupine.

    Case 41 - a diseased wound in his breast.
    Examination: If you examinest a man having a diseased wound in his breast, while that wound is inflamed and a whirl of inflammation continually issues from the mouth of that wound at your touch; the two lips of that wound are ruddy, while that man continues to be feverish from it; his flesh cannot receive a bandage, that wound cannot take a margin of skin; the granulation which is in the mouth of that wound is watery, their surface is not and secretions drop therefrom in an oily state.
    Diagnosis: you should say concerning him: "One having a diseased wound in his breast, it being inflamed, and he continues to have fever from it. An ailment which I will treat."
    Treatment: you shalt make for him cool applications for drawing out the inflammation from the mouth of the wound:
    a. Leaves of willow, nbs'-tree ksnty. Apply to it.
    b. Leaves of ym'-tree, dung. hny-t', ksnty, Apply to it.

    you shalt make for him applications for drying up the wound:
    a. Powder of green pigment wsb-t, thn.t, grease. Triturate bind upon it.
    b. Northern salt, ibex grease. Triturate; bind upon it:

    you shalt make for him poultices: Red spnn, garden tongue, d'r.t, sycamore leaves. Bind upon it. If the like befalls in any member you shalt treat him according to these instructions.
    Gloss: "A diseased wound in his breast, inflamed," it means that the wound which is in his break is sluggish, without closing up; high fever comes forward from it, its two lips are red, and its mouth is open. The "Treatise on what pertains to a wound" says concerning it: "It means that there is very great swelling; and inflamed' is said concerning the height" (of the fever).
    "A whirl of inflammation in his wound," means a whirl of inflammation which circulates through the interior of his entire wound.
    "Its two lips are ruddy," means that its two lips are red like the color of the tms'-tree.

    "His flesh cannot receive a bandage," means that his flesh will not receive the remedies because of the inflammation which is in his flesh.
    "While heat continually issues (new) from the mouth of his wound at your touch" (means) that heat comes froth from his wound at your touch; as it is said that a thing which has come forward entirely, has issued (nsw).

    Case 42 - a sprain in the ribs of his breast.
    Examination: If you examinest a man having a sprain in the ribs of his breast, and he suffers in the ribs of his breast, not having a dislocation, and it is not broken while that man continues to suffer with it and shudders exceedingly.
    Diagnosis: you should say concerning him: "One having a pain in the ribs of his breast. An ailment which I will treat."
    Treatment: you should bind it with ymrw; you should treat it afterwards with honey every day until he recovers.
    Gloss: "Ribs of his breast," means the bones of his sternum being spine) like as it were a spine-roast.

    Case 43 - a dislocation of the ribs of his breast.
    Examination: If you examinest a man having a dislocation of the ribs of his breast, and you findest that the ribs of his breast are projecting and their heads are ruddy, while that man suffers continually with swellings in his two sides.
    Diagnosis: you should say concerning him: "One having a dislocation in the ribs of his breast. An ailment which I will treat."
    Treatment: you should bind it with ymrw; you should treat it afterwards with honey every day, until he recovers.
    Gloss: "A dislocation in the ribs of his breast," means a displacement of the heads of the ribs of his breast (sternum), which are fastened to his breast (sternum).
    "He suffers with swellings in his two sides," means that he suffers in the articulations thereof in his breast (sternum) spreading in his two sides.
    "His two sides," means his two flanks.

    Case 44 - a break in the ribs of his breast.
    Examination: If you examinest a man having a break in the ribs of his breast, over which a wound has been inflicted; and you findest that the ribs of breast crepitate under your fingers.
    Diagnosis: you should say concerning him: "One having a break in the ribs of his breast, over which a wound has been inflicted. An ailment not to be treated."

    Case 45 - bulging tumors on his breast.
    Examination: If you examinest a man having tumors on his breast, and you findest that swelling have spread over his breast; if you puttest your hand upon his breast upon these tumors, and you findest them very cool, there being no fever at all therein when your hand touches him; they have no granulation, they form no fluid, they do not generate secretions of fluid, and they are bulging to your hand.
    Diagnosis: you should say concerning him: "One having tumors. An ailment with which I will contend."
    Treatment: There is no treatment. If you findest tumors in any member of a man, you shalt treat him according to these directions.
    Gloss: "Bulging tumors on his breast." means the existence of swellings on his breast, large, spreading and hard; touching them is like touching a ball of wrappings; the comparison is to a green hemat fruit, which is hard and cool under your hand, like touching those swellings which are on his breast.

    Case 46 - an abscess with prominent head in his breast.
    Examination: If you examinest a man having an abscess with prominent head in his breast: and you findest a very large swelling protruding on his breast, oily, like fluid under your hand, while they produce some clamminess of the surface, and their faces have no ruddiness.
    Diagnosis: you should say concerning him: "One having an abscess with prominent head in his breast.An ailment which I will treat with cold applications to that abscess which is in his breast."
    Treatment:
    a. Sh,t-fruit, ntr.t, ksnty, Triturate, bind upon it.
    b. Fruit of ss, ksnty, mason's mortar, water Triturate, bind upon it.

    If there is resistance to these cooling applications, you should avoid those remedies until all fluid which is in the abscess with a head exudes. you should treat him with wound-treatment, with applications for drawing out the inflammation from the mouth of the wound (sore?) in his breast:

    Case 47 - a gaping wound in his shoulder.
    First examination: If you examinest a man having a gaping wound in his shoulder its flesh being laid back and its sides separated, while he suffers with swelling (in) his shoulder blade, you should palpate his wound, should you find its gash separated from its sides in his wound, as a roll of linen is unrolled, and it is painful when he raises his arm on account of it, you should draw together for him his gash with stitching.
    First diagnosis: you should say concerning him: "One having a gaping wound in his sh, its flesh being laid back and its sides separated while he suffers with swelling in his shoulder blade. An ailment which I will treat."
    First treatment: you should bind it with fresh meat the first day.
    Second examination and treatment: If you findest that wound open and its stitching loose, you should draw together for him its gash with two strips of linen over that gash; you should treat it afterwards with grease, honey, and lint every day until he recovers. If you findest a wound, its flesh laid back, it sides separated, in any member of a man, you should treat it according to these directions.
    Third examination: If however, you findest that his flesh has developed inflammation form that wound which is in his shoulder, while that wound is inflamed, open, and its stitching loose, you should lay your hand upon it. should you find inflammation issuing from the mouth of his wound at your touch, and secretions discharging therefrom are cool like wenesh-juice.
    Third diagnosis: you should say concerning him: "One having a wound in his shoulder, it being inflamed, and he continues to have fever from it. An ailment with which I will contend."
    Fourth examination: If then you findest that man continuing to have fever, while that wound is inflamed.
    Fourth treatment: you shalt not bind it; you shalt moor (him) at his mooring stakes, until the period of his injury passes by.
    Fifth examination: If however, his fever abates and the inflammation in the mouth of his wound dissipates entirely.
    Fifth treatment: you should treat him afterward with grease, honey, and lint every day, until he recovers.

    Case 48 - a sprain of a vertebra in his spinal column.

    Examination: If you examinest a man having a sprain in a vertebra of his spinal column, you should say to him: "Extend now your two legs and contract them both (again)." When he extends them both he contracts them both immediately because of the pain he causes in the vertebra of his spinal column in which he suffers.

    Diagnosis: you should say concerning him: "One having a sprain in a vertebra of his spinal column. An ailment which I will treat." Treatment: you should place him prostrate on his back; you should make for him....