Traumatic Brain Injuries in the Ancient Egypt: Insights from the Edwin Smith Papyrus^[*]

Abstract

Background Traumatic brain injury (TBI) is probably as old as human beings. The Edwin Smith Papyrus is the first treatise describing the treatment of patients with TBI and allows insights into the medical examination and treatment of head-injured patients in ancient Egypt.

Method Clinical, diagnostic, and therapeutic principles in the treatment of TBI in ancient Egypt were analyzed.

Results Methodically, cases and the presentation of each case are neatly classified within the papyrus. The papyrus contains the first description of the brain, pulsations, contusions as the result of TBI, the dura, and cerebrospinal fluid, revealing a more or less sophisticated knowledge of cerebral anatomy. Furthermore, ancient physicians examined wounds, fractures, signs of basal skull fractures, and associated neurological or infectious symptoms, and classified the injury pattern according to their prognosis. Therapeutic options at this time seemed to have been limited.

Conclusions The Edwin Smith Papyrus reveals asthonishing observation skill when considering the methods and limits of acient times. These physicians were able to recognize many symptoms of TBI and assign them a prognostic value.

Keywords

Edwin Smith Papyrus - Ancient Egypt - traumatic brain injury

^* This article was originally published online in Central European Neurosurgery on January 23, 2012 (DOI:10.1055/s-0031-1275746)

• References

• 1 Atta HM. Edwin Smith Surgical Papyrus: the oldest known surgical treatise. Am Surg 1999; 65 (12) 1190-1192
• 2 Brawanski A. Die Fälle 1–8 des Papyrus Edwin Smith. Studien zur Altägyptischen Kultur (SAK) 2001; 29: S7-S39
• 3 Breasted JH. The Edwin Smith Surgical Papyrus. Chicago: Univ. Chicago Press; 1930
• 4 Feldman RP, Goodrich JT. The Edwin Smith Surgical Papyrus. Child Nerv Syst 1999; 15 (6–7) 281-284
• 5 Gurdjian ES. The treatment of penetrating wounds of the brain sustained in warfare. A historical review. J Neurosurg 1974; 40 (2) 157-167
• 6 Hardman JM, Manoukian A. Pathology of head trauma. Neuroimaging Clin N Am 2002; 12 (2) 175-187 , vii
• 7 Kshettry VR, Mindea SA, Batjer HH. The management of cranial injuries in antiquity and beyond. Neurosurg Focus 2007; 23 (1) E8
• 8 Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006; 21 (5) 375-378
• 9 Leon-Carrion J, Dominguez-Morales MR, Martin JM , et al. Epidemiology of traumatic brain injury and subarachnoid hemorrhage. Pituitary 2005; 8 (3–4) 197-202
• 10 Meyerhof M. Über den Papyrus Edwin Smith, das älteste Chirurgiebuch der Welt. Deutsche Zeitschrift für Chirurgie 1931; 231: 645-690
• 11 Miller RL. Tetanus after cranial trauma in ancient Egypt. J Neurol Neurosurg Psychiatry 1997; 63 (6) 758
• 12 Minagar A, Ragheb J, Kelley RE. The Edwin Smith surgical papyrus: description and analysis of the earliest case of aphasia. J Med Biogr 2003; 11 (2) 114-117
• 13 Sanchez GM, Burridge AL. Decision making in head injury management in the Edwin Smith Papyrus. Neurosurg Focus 2007; 23 (1) E5
• 14 Stiefel M, Shaner A, Schaefer SD. The Edwin Smith Papyrus: the birth of analytical thinking in medicine and otolaryngology. Laryngoscope 2006; 116 (2) 182-188
• 15 Summers CR, Ivins B, Schwab KA. Traumatic brain injury in the United States: an epidemiologic overview. Mt Sinai J Med 2009; 76 (2) 105-110
• 16 Westendorf W. Papyrus Edwin Smith – Ein medizinisches Lehrbuch aus dem Alten Ägypten. Bern, Stuttgart: Verlag Hans Huber; 1966
• 17 Wilkins RH. Neurosurgical classic. XVII. J Neurosurg 1964; 21: 240-244