Neurosurgery in Ancient Egypt

The rise of medicine in Egypt can be noted as early as the First Dynasty. Athotis, the second king of the First Dynasty, wrote one of the earliest works, Practical Medicine and Anatomic Book. The Edwin Smith papyrus, dating from the 17th century BC, was discovered in 1862 and is attributed to Imhotop.

The papyrus, dealing with cranial wounds and fractures, is the world's oldest known surgical treatise. It provided a description of the brain and noted correlations between cerebral lesions and loss of movement.

A case of hemiplegia caused by a compound comminuted cranial fracture was documented. Particular attention was paid to cranial base fractures associated with bleeding from the nose and ears. It was noted that fractures of the cervical spine were associated with limb paralysis, neck rigidity, and conjugate eye deviation. The treatment for hemiplegia was applied to one-half of the belly and not to all of the paralyzed side.

In the Ebers papyrus, 12 prescriptions for the treatment of headaches and migraines were presented. Migraine was called "half of the head" and was considered to be a special entity, thus requiring special treatment. Rogers presented two cases of intracranial meningiomas found in ancient Egyptian skulls.

Some ancient Egyptian surgical tools Right: Neurosurgical operation depicted in a drawing from an old Egyptian temple (1500 BC).

Modern Beginning of Neurosurgery in Egypt

The modern history of neurosurgery in Egypt owes much to its early pioneers; the most prominent were Dr. Ahmed Abu Zikry, Dr. Osman Sorour, Dr. Samuel Boctor, Major Dr. Ezzat Tewfik, Dr. Ibrahim Hegazy, and Dr. Ahmed El Banhawy. They played pivotal roles in the foundation of the modern neurosurgical service in Egypt. Having graduated from King Fouad University (now Cairo University) and finding no training facilities in Egypt, they traveled to the United States and Europe to attain proficiency in their chosen field. At that time, neurosurgery was not considered a promising career course, but they nevertheless chose to pursue it.

The first neurosurgical practice in Egypt was begun by Dr. Ahmed Abu Zikry, a general surgeon who studied neurosurgery at the Mayo Clinic for 2 months and the Lahey Clinic for 1 month in 1949. He then worked in the department of general surgery of Cairo University, under the chairmanship of Prof. Ibrahim Fahmy El Miniawy, and cooperated with Profs. Barrada and Guinena, who were the founders of the department of neurology of Cairo University. He had a successful career in general surgery; therefore, he chose to continue as a general surgeon and encouraged his resident, Dr. Osman Sorour, to specialize in neurosurgery.

Dr. Sorour received his master of surgery degree in general surgery from Fouad University and joined the general surgical staff of the medical faculty. He was assisted by Dr. Ismail Shafie (neurology house officer) in thoracic surgical wards. After separation of the service, Dr. Shafie became the first neurosurgical registrar, proceeding to eventually become chairman of the department in 1987.

Dr. Samuel Boctor treated patients in general surgical beds, assisted by Dr. Abdel Hamid El Shawarby (surgical resident), who later became a leader in psychosurgery. In 1956, Dr. Boctor established a neurosurgical department (the first in Egypt), with Dr. Gamal Azab as his registrar. This free service served the northern region of Egypt, with a population of more than 8 million Egyptians and a steady stream of Libyan patients from the eastern border.

Major Dr. Ezzat Tewfik joined the medical corps as a first lieutenant general surgeon, obtained his F.R.C.S. degree in the United Kingdom, and began neurosurgical training in the United Kingdom and Karolinska, Sweden, under the leadership of Dr. Herbert Olivecrona. After returning to Egypt, Major Tewfik practiced in the general surgical ward of the Kobba Military Hospital, mainly treating head injuries and performing a few spinal and brain operations.

Dr. Ibrahim Hegazy worked for the Ministry of Public Health after obtaining his F.R.C.S. degree in the United Kingdom. Dr. Hegazy joined the Ibrahim Pasha University (now Ain Shams University) and was assisted by Dr. Ahmed El Banhawy (M.S.).

Dr. El Banhawy graduated from Cairo University in 1952. After working as a registrar in general surgery, he joined the anatomy department. In addition to his master of surgery degree, he obtained a diploma in neurology and psychiatry. He underwent neurosurgical training in Germany and Oxford, England. In 1964, he assumed the chairmanship of the military neurosurgical department, after Major Ezzat Tewfik was involved in a disabling automobile accident. Dr. El Banhawy was the first Egyptian to document a case of spinal cord bilharzioma. He later became assistant professor at Ain Shams University. In the 1970s, he was appointed dean of the medical school and deputy chairman of the university, before his premature death.

These early pioneers struggled to establish neurosurgical departments, because neurosurgery was a division of the department of general surgery at that time. Furthermore, the general population was mistrustful of new specialties.

Military Neurosurgery

In the middle 1950s, Major Dr. Ezzat Tewfik was uniquely placed to engineer the founding of the military neurosurgical service. His international connections allowed him to establish a neurosurgical department with high standards in the Air Forces Hospital in 1960. After his retirement from the Karolinska Institute in 1961, Prof. Olivecrona traveled to Egypt, with a staff of neurologists, neuroanesthetists, neurophysiologists, neuroradiologists, and nurses, to set up training programs for the Egyptian military. These programs heralded a new era in neurosurgical technology in Egypt, allowing Egyptian doctors to meet European standards. Major Dr. Rushdy Diwan, who had been trained by Dr. Hjelm Quist, practiced modern neuroanesthesia, and intensive care units were introduced. Captain Dr. Fouad El Nadi, who had been trained by Dr. Sjogren, practiced the techniques of percutaneous carotid and vertebral artery angiography, air encephalography, air myelography, and functional stereotactic surgery. Dr. Kamal Kamel was trained in neuropathology by Prof. Zulch. He became the dean and later the rector of Mansoura University. Drs. El Shawarby, Azab, and Salama of the university hospitals and Drs. Abdel Rahim Galal, Sayed El Kashashy, and Mokhtar El Mahdy from the medical corps joined the institutions for various periods.

During this period, Dr. Sayed El Gindi studied for the F.R.C.S. degree in the United Kingdom and continued his training at Brook Hospital (London, England), the Radcliffe Infirmary (Oxford, England) (under Dr. J. Pennybaker), and Oldchurch Hospital (Essex, England) (under Dr. J. Andrew). After his return to Egypt in 1967, Dr. El Gindi worked in the department of neurosurgery of the new Maadi Military Hospital. At that time, a system of collaboration between the universities and the military department was developed. Young residents recruited for military service were attached to the Maadi Military Hospital for a period of 1 year, to continue their training. In addition to working in the military service, Dr. El Gindi was appointed a visiting professor at Mansoura University, to establish the department of neurosurgery. In 1968, he became the chairman of the department of neurosurgery of the Maadi Military Hospital.

In 1959, the Middle East Neurosurgical Society was founded. Dr. Sorour was one of the founding members and was the president for 2 consecutive years. Egyptian doctors joined this society as individuals. It was not until 1967 that the Egyptian Society of Neurological Surgeons was founded .

Egyptian neurosurgeons had the opportunity to gain wide experience in treating war injuries. The vast majority of experience in this field was achieved in the treatment of casualties of the 1973 war. Teams of neurosurgeons from military hospitals and university clinics, together with doctors of allied specialties, actively shared in treating these war casualties.