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Egypt the Cradle of the Neurosciences

By Gonzalo M. Sanchez, M.D.
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I first became curious about the Edwin Smith Surgical Papyrus when I was a neurosurgical resident at New York University-Bellevue Hospital. Considered the foundation of the neurosciences, this ancient document deals primarily with head and neck injuries. Many years passed. Still, I often turned to the Papyrus' various cases when I needed special material for professional presentations.

One day, when I was reviewing cases seven and eight, I suddenly was struck by the objectivity, the interest and the frustration of that author of 4,600 years ago. I felt the unknown doctor's deep sense of obligation to record findings, tests, results or lack thereof. Medical experience had enlarged my horizons, and the papyrus author's scientific dedication leapt out. The curiosity I'd felt at Bellevue deepened.

Ancient Egypt came into existence, flourished and declined over a 3,000-year period that ended 1,700 years ago. Difficult as it is to grasp the enormity of that span, it's inspiring to witness the beginning of recorded history, when human acts, medical concepts and technical skills were being translated into practical realities and put in writing. In Egypt, the long, technical development of medicine was born.

Ancient Egyptian civilization for a long time was hidden in the mystery of hieroglyphs. But after Jean François Champollion broke the hieroglyphic code on Sept. 14, 1822, many papyri have been translated. In the medical field, there are 14 important ones surviving. Of those, the Edwin Smith Surgical Papyrus is the most objective, most scientific, and most clear.

Edwin Smith, of Connecticut, had acquired the papyrus in Luxor in 1862. The document dated back to the 17th century B.C., being itself a copy. The original was produced between 3000 B.C. and 2500 B.C.. Smith knew enough hieratic (form of ancient Egyptian language) to recognize the papyrus's character as a medical treatise. In 1906, Smith's daughter gifted the document to the New York Historical Society.

In 1920, the New York Historical Society asked Henry Breasted, from the Oriental Institute at the University of Chicago, to translate and publish the Edwin Smith papyrus. A renowned scholar, Egyptologist and linguist, Breasted did not have a medical background and found the proposed daunting. As he writes in "The Edwin Smith Surgical Papyrus," his 1930 book, "There was no comprehensive glossary of the highly specialized words employed by the ancient Egyptian in pathology, physiology, anatomy, surgery, etc."

The injuries discussed in the Edwin Smith papyrus are organized in a style similar to our current texts but written as memoranda. Injuries are analyzed systematically from trivial to grave and from the head down. Of neurological interest, there are 27 cases of head injuries, six cases of cervical injuries and one case of a lower spine injury. The document stops in the middle of case 48, where the scribe stopped copying.

Regarding the document's structure, Breasted states: "The facts in each given case of injury are observed, listed and marshaled before the mind of the observer, who then makes rational conclusions based on the observed facts. ... Inductive reasoning after experiment appears also for the first time, and there is evidence of the fundamental transformation occurring in medicine. ... Recognition of natural causes, conditions and processes are distinguished from demoniacal possession."

Breasted further observes: "In discussing injuries affecting the brain, we note the surgeon's effort to delimit his terms as he selects for specialization a series of common and current words to designate three degrees of injury to the skull indicated in modern surgery by the terms 'fracture,' 'compound fracture,' and 'compound comminuted fracture,' all of which the ancient commentator carefully explains. Like the modern scientist, he clarifies his terms by comparison of the things they designate with more familiar objects: the convolutions of the brain he likens to the corrugations on metallic slag, and the fork at the head of the ramus in the human mandible he describes as like the claw of a two-toed bird; a puncture of the cranium is like a hole broken in the side of a pottery jar, and a segment of the skull is given the name of a turtle's shell."

Henry Breasted notes that the word "brain" occurs for the first time in human history in case six. Other anatomical firsts are descriptions of the meninges, brain pulsations, the cerebrospinal fluid and the anterior fontanelle. Descriptions of physiological features about the nervous system are also numerous. In Breasted's words, "The observation of effects on the lower limbs of injuries to the skull and brain, noted by the ancient surgeon with constant reference to that side of the head which has been injured, shows an astonishingly early discernment of localization of function in the brain." Similarly, it is clear that the ancient physician was aware of the consequences of cervical injuries: limb paralysis, bladder incontinence and priapism.

In the papyrus, each case is discussed in the following manner: first comes the title; second, the examination; third, the diagnosis (verdicts or prognosis accompany the diagnosis and are labeled favorable or unfavorable, and a decision is issued on whether to proceed with treatment); fourth, treatment; finally, any necessary glosses. The order of clinical-case presentation shows why Egyptian physicians are considered responsible for the tone of authority and the pattern that have characterized subsequent medical textbook presentations.

Interestingly, neurological and surgical progress was tied to war, because ancient Egyptians' religious beliefs forbade human dissection and disfigurement of the head and face. (The practice of trephination in ancient Egypt was exceptional and short-lived.)

It is generally accepted that Egypt's golden age of medicine peaked in 1280 B.C. and declined with the decline of the empire. Unfortunately, because many documents have been lost to thievery, the Alexandria Library fires, and careless destruction by locals and foreigners alike, we will never know the full extent of the ancient Egyptians' medical knowledge.

As many as 2,200 years passed from the time the original Edwin Smith Surgical Payrus was written until further nervous system studies took place. Greece's medical leadership began in the fifth century B.C. with Hippocrates and continued into the fourth century B.C. with Herophilus and Erisastrus (in Alexandria).

Interestingly, the prominent Greek physicians received some, if not all, of their education in Egypt, and they all produced major neurological discoveries. It would take almost 400 years before Galen, the most illustrious Roman physician, would further the development of the neurosciences. From then, it was still 1,200 years until the beginning of the modern era of neurosciences in the 15th and 16th centuries, with da Vinci, Andreas Vesalius and Ambrose Pare.

Progress has continued steady, with vertiginous pace, in the 20th century.

Breasted's enthusiasm lives on.

Reproduced as a news service to the AFRIKAN DIASPORA by the Restoration Movement International---

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