Crime and Punishment in Ancient Surgery: An Examination of Assyrian and Egyptian Physicians

The history of surgery is a fascinating collection of knowledge from various civilizations dating back up to four thousand years. Some of the oldest writings on surgery and surgeons’ duties date back to the Hammurabi code and Egyptian papyri. The role of the surgeon, particularly, has always had a somewhat peculiar distinction from that of other physicians. 

In reality, the physician sphere rarely interacted or overlapped with the surgeon sphere of practice, and responsibilities and rewards assigned to the two groups were frequently completely different. We sought to examine and compare the scope of practice, risks, rewards, and punishments of surgeons in Ancient Assyria and Ancient Egyptian times.

The responsibilities of the surgeon were, interestingly, somewhat similar to those of surgeons now. Surgeons were responsible for evaluation of ailments that were considered mechanical in nature. Ophthalmologic surgeries are noted as being done as early as 3500 BC for 10 shekels, whereas members of the ruling class would frequently pay significantly reduced, and sometimes almost none, of the ordained fees. Other responsibilities for Assyrian surgeons included management of bowel obstructions. 

Descriptions of surgeons “opening the bowels” to let impacted contents spew out are described in these texts. While it is unclear whether these were enterotomies or early ostomies, the concept of decompression is delineated. Conservative management of bowel obstructions and impactions is also described by what appears to be orogastric lavage with ointments and oils, and later, enemas as well. Keeping patients nil per os (NPO) is also described, with various medicinal shrubs and herbs provided “without food”.