The Edwin Smith papyrus, written by physicians in Egypt around 1700 BC contains a description of 48 medical cases. Several cases discuss the brain, meninges (coverings of the brain), spinal cord, and cerebrospinal fluid for the first time in recorded history.
The 48 cases include:
- 27 head injuries (cases #1-27)
- 6 throat and neck injuries (cases #28-33)
- 2 injuries to the clavicle (cases #34-35)
- 3 injuries to the arm (cases #36-38)
- 8 injuries to the sternum and ribs (cases #39-46)
- 1 injury to the shoulder (case #47)
- 1 injury to the spine (case #48)
The entries were organized as follows:
- Title: description of the type of injury and its location.
- Indication of the examination needed. Types of examination include sensory testing, probing of the wound and movement of the affected body part.
- Classification of the case into one of three types:
- “An ailment which I will treat” – used for injuries that most likely will be cured.
- “An ailment with which I will contend” – used for difficult but not impossible cases. The doctor will try to treat the condition, but the outcome is uncertain.
- “An ailment not to be treated” – the condition cannot be treated at all because the injury is thought to be incurable.
- Treatment of the case. Treatments involve bandages, plasters, stitching, cauterization and splints, and surgical dressings, e.g. honey, grease and lint.
- Case description
Of the 48 cases described, fourteen were considered to be ones not to be treated.
Here are two case examples of head trauma from the Edwin Smith Papyrus
Case Twenty offers an example of a person with head trauma resulting in speechlessness:
Title: Instructions concerning a wound in his temple, penetrating to the bone, (and) perforating his temporal bone.
Examination: If thou 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 thou puttest thy fingers on the mouth of that wound (and) he shudder exceedingly; if thou ask of him concerning his malady and he speak not to thee; 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: Thou shouldst 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 thou findest that man speechless, his [relief] shall be sitting; soften his head with grease, (and) pour [milk] into both his ears.
Case 22 is a case of a person with brain injury caused by a “smash in his temple” also resulting in speechlessness.
Title: Instructions concerning a smash in his temple.
Examination: If thou examinest a man having a smash in his temple, thou shouldst place thy thumb upon his chin (and) thy 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. Cleanse (it) for him with a swab of linen until thou seest its fragments (of bone) in the interior of his ear. If thou callest to him (and) he is speechless (and) cannot speak…
Diagnosis: Thou shouldst 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: “Thou seest 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 cleanse the interior of his ear.