Message #115119

[Bianca]

In many cases the treatment was beyond the capability of the time and the surgeon simply states that this is "… an ailment not to be treated", i.e. with a very poor prognosis. Nevertheless he meticulously describes the physical findings of such injuries as in case 31, "Dislocation of a Cervical Vertebra", where he writes if "… thou find him unconscious of his two arms and his two legs on account of it, while his phallus is erected … and urine dribbles from his member without him knowing it … ; it is a dislocation of a vertebra of the neck extending to his back-bone …" This is the world’s first known description of quadriplegia.

In case 6, "A Gaping Wound in the Head With Compound Comminuted Fracture of the Skull and Rupture of the Meningeal Membranes", we get the first description the brain and its gyri, and the meninges. "If thou examinest a man having a gaping wound in his head, penetrating to the bone, smashing his skull, and rending open the brain … , thou shouldst palpate that smash which is in his skull like those corrugations [i.e. gyri] which form in molten copper, and something therein throbbing a fluttering under the fingers …" The pulsation of the brain is described and later the author observes that its absence is a very serious sign (which indeed it is, representing serious brain compression).

In case 8, "Compound Comminuted Fracture of the Skull Displaying No Visible External Injury", the ancient surgeon articulately describes hemiplegia (paralysis on one side of the body) secondary to a head injury: "Shouldst thou find that there is a swelling protruding … while his eye is askew because of it [conjugate deviation of the eyes], on the side of him having that injury which is in his skull; and he walks shuffling with his sole on the side of him having that injury which is in his skull ...", the author further states, "thou shouldst account him one whom something entering from outside has smitten …" It appears here that he may be trying to differentiate hemiplegia caused by an "outside" injury as opposed to similar findings that may occur from an "inside" cause such as a stroke.

In other parts of the text the ancient surgeon describes suturing lacerations, and treatment of infection and wounds with nonstick dressings and hyperosmotic agents (animal grease and honey respectively). In case 39 it is suggested that an abscess that "… arises in his breast dries up as soon as it opens of itself." In other words, as my old surgery professor said, "Pus under pressure should be punctured." The text appears to differentiate between breast tumors and infections, describing the former in case 45, "Bulging Tumors on the Breast", as "… very cool, there being no fever at all therein when thy hand touches them; they have no granulation, they form no fluid, they do not generate secretions of fluid, and they are bulging to thy hand." Is this the first description of a breast cancer?