A Brave Admission 3600 Years Ago: Do Not Touch This; There Is No Treatment
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Day 10 (A History of Cancer in 365 Days Series)
History’s First Cancer Diagnosis and a Physician’s Brave Admission: ‘Do Not Touch This’ (Edwin Smith Papyrus, Case 45)
Ancient Egyptian medicine usually brings spells, amulets and prayers to the gods to mind. Yet when we unroll a papyrus dating from the 1600s BC, we encounter a remarkably modern, dispassionate and rational surgeon.
In the Edwin Smith Papyrus, Case 45is the earliest known text in human history to describe cancer (or tumors) as a ‘clinical disease’. There is no magic in this text; only observation, touch and a painful truth.
Today, we travel back 3600 years to witness what an ancient physician felt while examining a breast tumor, the diagnosis he made, and the famous ‘There Is No Treatment’ verdict that entered medical history.
The Edwin Smith Papyrus contains 48 cases and systematically surveys the human body from head to toe (a capite ad calcem). Each case follows a standard template:
- 1. Title: What the disease is (‘Instructions concerning tumors with swellings in the breast’).
- 2. Examination: Begins with ‘If you examine a man...’. Findings from observation and palpation are listed.
- 3. Diagnosis: Describes the disease using the formula ‘You should say concerning him...’.
- 4. Decision (Verdict): The ancestor of modern ‘triage’. There are three options:
- A disease I will treat.
- A disease I will contend with (Observation).
- A disease not to be treated (Hopeless).
Case 45: Breast Tumors and the ‘Haemat Fruit’
The title of Case 45 reads: ‘Instructions concerning tumors with swellings in the breast (bulging tumors).’ The text describes how the surgeon examines the tumor so vividly that even an oncologist reading these lines today can picture the patient.
Diagnosis at the Ancient Surgeon’s Fingertips
1. Temperature Test
The surgeon touches the mass and notes: ‘It is very cool, with no heat at all inside it.’ This observation is crucial. Infections (abscesses) are warm and red, whereas cancer is cold and hard. The ancient physician succeeded in distinguishing infection from a tumor.
2. The Haemat Fruit Metaphor
He uses a striking comparison to describe the hardness of the mass: ‘Under your hand it is like a green haemat fruit (an unripe, hard pomegranate).’ The mass is hard, attached to the tissue (fixed), and contains no fluid (pus).
The Physician’s Verdict: ‘There Is No Treatment’
At the end of Case 45, the surgeon delivers his famous verdict: ‘Do not touch this. There is no treatment.’
Is This Helplessness or Wisdom?
This statement reflects profound medical knowledge and ethics, rather than helplessness. The surgeon understood that such hard, cold masses (cancers) could not be cut out, and that using a knife would make the patient die sooner or suffer. It is history’s first example of ‘medical futility’ and the principle of ‘First, Do No Harm’ in medicine.
Debunking a Myth: Did the Egyptians Cauterize Cancer?
Popular culture often claims that ‘the Egyptians treated cancer by burning it with fire’. This mistake arises from confusing two cases in the papyrus.
| Case 39 (Abscess/Cyst) | Case 45 (Tumor/Cancer) |
|---|---|
|
|
The Egyptians could distinguish benign infections from malignant tumors and applied different protocols to each.
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