March 4, 2019History of Medicine
The great Greek philosopher and scientist Aristotle believed that our consciousness, imagination and memory was rooted in the human heart. It was a belief he shared with the ancient Egyptians, whose Book of the Dead endorses carefully preserving the heart of a mummy, but recommends scooping out and discarding the brain. Today, the supreme role of the heart lives on only as a metaphor for our intuitive, emotional selves.
There is evidence, however, that Egyptians knew about the importance of the brain. The Edwin Smith Papyrus, dating back to 1700 BCE, is the earliest known medical text in history. The papyrus discusses the brain, the meninges, the spinal cord and cerebrospinal fluid. It contains details of 48 medical cases, including seven that deal directly with the brain, which indicate that the Egyptian author knew the brain controls movement. However, the serious cases of brain injury are described in the papyrus as untreatable.
Trepanation is perhaps the oldest neuro-surgical procedure for which there is archaeological evidence, and in some areas may have been quite widespread. At one burial site in France dated to 6500 BCE, 40 out of 120 prehistoric skulls found had trepanation holes. Many prehistoric and premodern patients had signs of their skull structure healing, suggesting that many of those subjected to the surgery survived. Another skull with a trepanation hole was found at burial site Chalaghantepe (Agdam Rayon, Azerbaijan) dated to the 5th millennium BCE. More than 1,500 trephined skulls from the Neolithic period (representing 5 to 10% of all Stone Age skulls) have been uncovered throughout the world - from Europe, Siberia, China and the Americas. Most of the trephined crania belong to adult males, but women and children are also represented. A cow skull dating to 3400-3000 BCE upon which trepanation had been performed was discovered in France
Ancient Egypt and neuroscience documented in The Edwin Smith Surgical Papyrus
This remarkable papyrus, bought in 1862 by the American Egyptologist Edwin Smith in Luxor, Egypt, is an ancient Egyptian surgical treatise. It is the oldest known medical document; written in the Middle Egyptian hieratic script, it contains 377 lines of text on the recto (front) and 92 on the verso (back). It is a textbook of surgery, containing systematic and highly detailed descriptions, diagnoses, treatments and prognoses of 48 neurosurgical and orthopedic cases. The papyrus, which is named after Edwin Smith, is now housed in the New York Academy of Sciences. Twenty-seven of the cases documented in the Edwin Smith papyrus are head injuries, and 6 are spinal injuries. Each of them is investigated rationally and deductively, with only one of the 48 cases being treated with magic. Although ancient civilizations are generally regarded as primitive, the Smith papyrus demonstrates that the ancient Egyptians had highly advanced knowledge of medicine. Many of the surgical procedures and concepts described in the document are still in use today, and it seems that the ancient Egyptians had knowledge of neuroanatomy that was as detailed and advanced as that of modern medicine. The papyrus even contains a prescription for a wrinkle remover containing urea, an ingredient of modern anti-wrinkle creams. The cases documented in the Smith papyrus are presented in a format that is very similar to that used by modern physicians. Each case begins with a medical history and physical investigation of the patient, whose wound is categorized as an ailment I can treat, an ailment I shall contend with, or an ailment which not to be treated. Patients with untreatable ailments were given palliative care by the surgeon. Case 25 describes the treatment for a dislocated jaw, in exactly the same way that medical students today are taught to treat the injury:
If thou examinest a man having a dislocation in his mandible, shouldst thou find this mouth open and his mouth cannot close for him, thou shouldst put thy thumbs upon the ends of the two rami of the mandible in the inside of his mouth and thy two claws [meaning two groups of fingers] under his chin, and thou shouldst cause them to fall back so they rest in their places.
Analysis of the writing style reveals that the papyrus is a copy made by a scribe around 1,600 BCE (17th Dynasty). The original document was written circa 3,000 BCE (3rd Dynasty), and has been credited to Imhotep, the real father of medicine, who lived some 2,000 years before Hippocrates. (In fact, it is believed that the ancient Greeks knew of the contents of the Edwin Smith papyrus, and used them as a basis for their writings on science and medicine.) The Smith papyrus was translated into English in the 1920's by James Henry Breasted, who noted that it contained the earliest known use of the word ?brain'.
A reading of the Smith papyrus reveals the similarity between ancient Egyptian and modern diagnostic procedures. During an examination, the patient was asked questions by the surgeon, who then counted the patient's pulse and inspected wounds for inflammation. This was followed by careful observation of the patient's general appearance, during which the surgeon noted the color of the eyes and face, the condition of the skin, the quality of nasal secretions and the stiffness of the limbs and abdomen. The papyrus also contains the first descriptions of the cerebrospinal fluid, meninges and the surface of the brain, including the gyri and sulci, as well as a description of sciatica. Breasted writes about how the author of the papyrus described his observations: 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. He also notes that the author was well aware that damage to certain parts of the brain could affect the function of the body:
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. Thus, the author associated aphasia with fractures of the temporal lobe, and recognized that quadriplegia, priapism and urinary incontinence could occur as a consequence of cervical spinal cord injury.
Head injuries were characterized in much the same way as they are today:
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.
Case 48 describes Lasegue's sign, a neurological test for lumbar root or sciatic nerve irritation:
Thou shouldst say to [the patient]: ?Extend now thy two legs and contract both again.' When he extends them he contracts them both immediately because of the pain he causes in the vertebra of his spinal column in which he suffers.
From the Smith papyrus we can see that ancient Egyptian doctors also had knowledge of antiseptic technique and antibiotics. Wounds were bound in fresh meat, which has hemostatic properties. Honey, which has antibiotic properties, was applied to wounds, and opiates were administered as analgesics.
Thou shouldst bind [the wound] with fresh meat the first day [and] treat afterwards with grease, honey [and] lint every day until he recovers.
More than four millennia before William Harvey 'discovered' circulation, the ancient Egyptians were aware that the blood circulated around the body in vessels. They had names for all the major blood vessels and knew of their distribution throughout the limbs. They also knew that the heart was at the center of the cardiovascular system. The full extent of the medical knowledge of the ancient Egyptians will never be known. They probably wrote tens or hundreds of thousands of medical texts; only about 10 remain, providing us with a mere glimpse of the medical knowledge of this civilization. Phrenology, was popular in the 1800s when Phrenologists thought that learning everything about someone's character, could be obtained by measuring the shape of his or her skull.
1. 170 BCE - The Roman physician Galen, whose day job was fixing up gladiators, insists that a person's temperament and bodily functions are controlled by the brain. His theories are dominant for the next 1200 years.
2. 1000 CE - The great Islamic surgeon Abu al-Qasim al-Zahrawi describes several treatments for neurological disorders in his 35-volume encyclopedia of medical practices, the Kitab al-Tasrif.
3. 1543 - The first true medical textbook to deal with neuroscience, On the Workings of the Human Body, is published by Andreas Vesalius.
4. 1649 - The French philosopher Ren? Descartes comes up with the influential idea that while the brain may control the body, the mind is something intangible, distinct from the brain, where the soul and thought resides. This concept is still with us, much to the chagrin of many neuroscientists.
5. 1664 - Thomas Willis publishes Anatomy of the Brain, which describes reflexes, epilepsy, apoplexy and paralysis. He uses the term neurology for the first time.
6. 1791 - Italian physiologist Luigi Galvani proposes that nerves operate through electricity.
7. 1837 - J. E. Purkinje is the first man to describe a neuron.
8. 1862 - Paul Broca pinpoints the part of the brain necessary for speech, henceforth known as Broca's area.
9. 1878 - William McEwen performs the first successful modern neurosurgery.
10. 1911 - Aptly named British neuroscientist Henry Head publishes Studies in Neurology.
11. 1929 - Hans Berger invents the EEG (electroencephalography), a device that measures electrical activity in the brain.
12. 1932 - Lord Edgar Douglas Adrian and Sir Charles S. Sherrington win the Nobel Prize for describing how neurons transmit messages.
13. 1938 - Isidor Rabi discovers nuclear magnetic resonance, facilitating the development of magnetic resonance imaging (MRI). Rabi's discovery would go on to win the Nobel Prize in 1944.
14. 1950 - Karl Spencer Lashley determines that memory relies on several sites in the brain working together.
15. 1970 - The Society for Neuroscience is established.
16. 1973 - Candace Pert discovers opiate receptors in the brain.
17. 1974 - A mouse is the subject of the first nuclear magnetic resonance (NMR) scan.
18. 1974 - The first Positron Emission Tomography (PET) scanner is invented, providing visual information about brain activity.
19. 1987 - Prozac is introduced.
20. 1990 - George H. W. Bush declares the last decade of the 20th century as the Decade of the Brain.
21. 1992 - Functional magnetic resonance imaging (fMRI) is first used to map activity in the human brain. Neuroscience booms.
The rapid pace of developments in neuroscience facilitated by modern imaging techniques is astounding. Yet many of the most important questions regarding the brain have yet to be answered. Why do we sleep and dream? How does the chemical and electrical activity in the brain result in consciousness? These and other questions will fuel neuroscience in the 21st century.
Sources: https://neurophilosophy.wordpress.com/2006/07/10/pharaonic-neurosurgery-the-edwin-smith-surgical-papyrus/, by Mo Costandi; NIH.gov; Wikipedia