Because of this demographic switch of spinal injuries, physicians are nowadays facing more complex diagnostic and therapeutic work ups. Although injuries reported in the papyrus still occur today, the distribution of spinal injuries now ranges from children to octogenarians, with the latter group readily increasing.

As the “study population” of the papyrus most likely included young and healthy male warriors or construction workers, Egyptian physicians probably seldom dealt with other significant, physical prognostic factors influencing treatment decision-making. Moreover, the most significant symptoms were explicitly considered as important prognostic factors in the postulation of the treatment verdicts. With a number of causal relations described in the spinal injury cases the Edwin Smith papyrus excels in rationality. It was not until the first half of the twentieth century when survival rates increased dramatically because of the introduction of specialized care, prevention of complications and the discovery and use of antibiotics. Most of the patients died a relative short period after the injury because of pneumonia, urinary tract infections or other complications related to autonomic dysfunction. A possible explanation for this is that patients with spinal cord injury usually had a poor prognosis. Given the devastating effects of spinal cord injury on survival outcomes, details about injuries to the spinal column and their prognostic value were apparently not considered significant enough to be reported. Interestingly, in these two cases significant symptoms related to injuries of the spinal column are not described at all. While all of the spinal injury cases in the papyrus cover injuries to the spinal column, two cases focus on the signs and symptoms of concomitant injury to the spinal cord. The papyrus contains the first known categorizations of spinal column and spinal cord injuries and covers important clinical prognostic factors which were considered in the treatment decision-making process as reported by the writer. Although the first documented signs of spinal column injuries are-from a modern perspective-fairly non-specific, symptoms of spinal cord injuries have been documented accurately in the scroll. The cases covered by the papyrus are not likely to represent individual ancient cases, but rather a series of accurately described clinical scenarios based on the clinical knowledge of highly experienced and educationally minded Egyptian physicians. The papyrus excels in rationality, even more so when considering it originated at the time when written language itself was a recent invention and medicine was at its birth. The scroll can be characterized as a well-structured teaching manual guiding a physician’s differential diagnostic process and treatment-decision-making for a range of diagnoses. To recapitulate, the Edwin Smith papyrus is a unique treatise containing the oldest known descriptions of signs and symptoms of injuries of the spinal column and spinal cord. This order of provided information suggests that the documented cases are not chronological descriptions of the diagnostic work-up of an individual case, but rather accurate, post hoc descriptions of the most significant signs and symptoms of the diagnosis under study. In line with this “In case of”-approach is the finding that in the “Significant symptoms” section the main diagnosis is always reported prior to the underlying clinical signs and symptoms. This means that other (prognostic) factors than the diagnosis under study were not considered in the treatment decision-making. From another, more modern, point of view the starting fragment may also be interpreted as: “In case of”. From this perspective, one may assume that the cases under study deal with relatively young, healthy male patients. It has been suggested that the cases described in the papyrus predominantly concern patients who sustained their injuries during battles or construction work. Interestingly, no further characteristics of “the man” or cases under study are provided. The “Significant symptoms” section of the cases mostly starts as: “If you examine a man for…”.

Edwin smith papyrus text