By now we have gained a comprehensive picture of the thematic diversity that ancient Egyptian medicine has to offer. For me personally, however, one topic in particular stands out: craniocerebral trauma or traumatic brain injury. This may sound surprising, but if you spent 5 years doing scientific research on this topic and write a doctoral thesis on it, you probably can't think otherwise. 😉
Craniocerebral trauma is the term used to describe a variety of injuries to the brain, ranging from mild concussions and brain contusions to severe contusions of the tissue, which are often also associated with brain haemorrhages and skull fractures. In Germany, about 270,000 people are admitted to hospital every year with traumatic brain injuries, and about 6,000 people die from them every year. Between the ages of 15 and 24, craniocerebral injuries even account for about 12 % of deaths. The people who survive severe and moderate trauma often struggle with an almost endless list of permanent impairments. No two injuries are the same, and the localisation of the damage in the brain in particular is crucial for the further course of the disease. Most patients suffer trauma in sports or traffic accidents, but also and especially warlike conflicts have naturally been a risk factor for thousands of years. In ancient Egypt, for example, the pharaoh's dominance was depicted on outer temple walls when he "slew the enemy", i.e. grabbed them by the hair and struck them on the head with a club. Work accidents on large construction sites may also have been a source of danger for craniocerebral injuries.
"Slaying the enemies", exterior wall of the hypostyle hall, temple of Karnak, Sethi I.
Source:
Bilddatenbank der Philosophischen Fakultät, Universität Würzburg.
In addition to the great Papyrus Ebers, which has already been mentioned here many times, there are of course other medical texts. Less well known, but very significant for the topic of craniocerebral trauma, is the Papyrus Smith, which is sometimes also called the "Book of Wounds". It is assumed that the text was actually written down in the time of the Old Kingdom, i.e. around 2300 BCE. Today, however, only a copy of the text has survived, which dates from around 1500 BCE. The papyrus consists mainly of a collection of case studies, the first 10 of which are devoted exclusively to head injuries. Case 8 is particularly interesting here:
If thou examinest a man having a smash of his skull, under his skin of his head [...] his eye is askew because of it, on the side of him having that injury which is in his skull; he walks shuffling with his sole, on the side of him having that injury [...] He discharges blood from both his nostrils and both his ears; an ailment not to be treated.
"Smash of his skull" refers to a head injury where the skull bone is fractured but the skin completely covers the injury and "cracks" in the bone can only be felt through the skin. Such injuries, depending on where they are located, can result in the inability to make eye movements or in the patient having motor deficits in the legs, and would therefore be limping. Associated with a skull base fracture, bleeding from the ears and nose can also occur. Since the deficits occur on the side of the impact injury, one can assume that the Egyptians described a "countercoup" injury here: Since the motor pathways cross in the brain, i.e. the left side of the brain controls the right side of the body, a blow injury on the left side cannot actually cause motor deficits on the left side as well. However, since a blow causes the brain to move to the other side in the skull, sometimes severe damage occurs there as well, which is called a countercoup.
The Egyptians could hardly have known all this, as they obviously did not regard the brain as a particularly important organ - they removed it during mummification and paid no further attention to it. The case studies in Papyrus Smith, however, are consistently well observed and offer detailed descriptions of the different types of injuries. However, the therapeutic means available to the Egyptians could in any case only come close to treating very few superficial injuries. So although, unlike the Egyptians, we now have so much more information about the central importance of our brain, in many cases we can still contribute little more in the way of treatment. "An ailment that cannot be treated" is therefore still the sad reality today in some cases. This makes prophylaxis all the more important to us today: avoiding head injuries, especially repeated concussions in sport, is the be-all and end-all! "Protect your head" - the Egyptians could also have benefited from this wisdom.
More information about concussion and traumatic brain injury can be found at www.schuetzdeinenkopf.de and with ZNS Hannelore Kohl Stiftung.
Literature
J. Stephan, Die altägyptische Medizin und ihre Spuren in der abendländischen Medizingeschichte, Berlin 2011.
Cover Picture
Statue of Ramesses II. with the khepresh crown, Museo Egizio di Torino, Inv.Nr. 1380.
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