TRAUMATIC BRAIN INJURIES
Medical Research in Biblical Times from the Viewpoint of Contemporary Perspective
Liubov Ben-Nun
Ben-Gurion University of the Negev Liubov Ben-Nun Professor Emeritus
Faculty of Health Sciences, Dept. of Family Medicine Beer-Sheva, Israel
People have suffered from traumatic brain injuries for thousands of years. This research evaluates these injuries as described in the Bible from the viewpoint of contemporary medicine, analyzing epidemiology, types, mechanisms, and various objects that can cause traumatic brain injuries, complications, and management. All biblical texts were examined and three characters were found who suffered from traumatic brain injuries: Sisera, the commander in chief of King Yabin's Canaanite army, who was stabbed with a tent nail by Jael; Abimelech - a brave soldier who fought his enemies during most of his life, but was brought down by a simple stone cast by a woman; and Goliath, the giant from Gath who was defeated by a simple ancient weapon – a stone which was cast by David at his forehead.
NOT FOR SALE
2012
TRAUMATIC BRAIN INJURIES
Ben-Gurion University of the Negev Liubov Ben-Nun Professor Emeritus Faculty of Health Sciences, Dept. of Family Medicine , Beer-Sheva, Israel
Published by: B.N. Publication House, Israel First Edition 2009 Second Edition 2012
E-Mail:
[email protected] Graphics and Cover: Ilana Ben-Nun
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Distributed Worldwide
2012
NOT FOR SALE
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Medical Research in Biblical Times from the Viewpoint of Contemporary Perspective
CONTENTS MY VIEW PREFACE FOREWORD INTRODUCTION THE GLASGOW COMA SCALE THE BIBLICAL STORY: SISERA AND JAEL EPIDEMIOLOGY OF TRAUMATIC BRAIN INJURIES PENETRATING BRAIN INJURY TYPES OBJECTS THAT CAN CAUSE BRAIN INJURY BRAIN INJURY CAUSED BY NAIL PATHOPHYSIOLOGY OF BRAIN INJURY MECHANISM OF SISERA'S BRAIN INJURY TEMPORAL BONE INJURY ASSESSMENT OF SISERA'S CONSCIOUSNESS SUMMARY OF SISERA'S BRAIN INJURY THE BIBLICAL STORY: ABIMELECH - TALK AND DIE BRAIN INJURY MECHANISM ASSESSMENT OF ABIMELECH'S STATUS MILD HEAD TRAUMA CLASIFICATION OUTCOME PENETRATING BRAIN INJURY CAUSED BY STONE CT FOR MILD HEAD TRAUMA SUMMARY OF ABIMELECH'S INJURY THE BIBLICAL STORY: DAVID AND GOLIATH TRAUMATIC BRAIN INJURY MILITARY BRAIN INJURY FACIAL INJURIES FRONTAL SINUS FRACTURE ETHMOID BONE FRACTURE ORBITAL BONE FRACTURE FRACTURE OF NASOETHMOID-ORBITAL BONES FRONTAL LOBE TRAUMATIC INJURY PENETRATING BRAIN INJURY CAUSED BY STONE GOLIATH'S LEVEL OF CONSCIOUSNESS ACROMEGALY BONE CHANGES IN ACROMEGALY GOLIATH AND ACROMEGALY SUMMARY OF GOLIATH'S INJURY PROGNOSTIC FACTORS IN PENETRATING BRAIN INJURY MANAGEMENT OF TRAUMATIC BRAIN INJURIES CONCLUDING REMARKS
7 8 9 11 13 16 17 27
48 51 53 57 58 59 60 62 63
82 83 84 86 93
109 112 113 114
121 125 127 139
ABBREVIATIONS AIS BMD CDC CI CT CSF ED ENT ER ICA ICH ICP ICU IGF-I ISS GCS GOS GOSE GH FST HAIS JTTR LOC MRI NTDB OR PTSD PTA PTCI PBI SAH SBP TBI
Abbreviated injury scale Bone mineral density Centers for Disease Control and Prevention Confidence interval Computed tomography Cerebrospinal fluid Emergency department Ear, nose, throat Emergency room Internal carotid artery Intracranial hypertension Intracranial pressure Intensive care unit Insulin-like growth factor-I Injury severity score Glasgow Coma Scale Glasgow Outcome Scale Glasgow Outcome Scale-Extended Growth hormone Forward Surgical Team Maximum Abbreviated Injury Score in the head region Joint Trauma Theater Registry Loss of consciousness Magnetic resonance imaging National trauma databank Odds ratio Posttraumatic stress disorder Posttraumatic amnesia Posttraumatic cerebral infarction Penetrating brain injury Subarachnoid hemorrhage Systolic blood pressure Traumatic brain injury
7 L. Ben-Nun
Traumatic Brain Injuries
MY VIEW MEDICINE IN THE BIBLE AS A RESEARCH CHALLENGE This is a voyage along the well-trodden routes of contemporary medicine to the paths of the Bible, from the time of the first man to the period of the People of Israel. It covers the connection between body and soul, and the unbroken link between our earliest ancestors, accompanied by spiritual yearning and ourselves. Through the verses of the Bible flows a powerful stream of ideas for medical research combined with study of our roots and the Ancient texts. It would not be too adventurous to state that if there is one book in the world that all Jews are proud of, that is the Book of Books, the greatest classic among all literary works, whose original language is not Greek or Latin, but the Hebrew that I and other Israelis speak every day, our mother tongue, the language of Eliezer Ben Yehuda. The Bible exists as evidence in the Book of Books, open to all humankind. For thousands of years it has been placed before us, still as fresh as before, the history of peoples who have disappeared and of the Jewish people, which has survived with its Holy Text that has been translated into hundreds of languages and dialects, and remains our eternal taboo. Many people ask me about the connection between the Bible and medical science. My reply is simple: the roots of science are buried deep in the biblical period and I am just the archeologist and medical researcher. This scientific medical journey to the earliest roots of the nation in the Bible has been and remains moving, exciting and enjoyable. It has created a kind of meeting in my mind between the present and those Ancient times, through examining events frozen in time. Sometimes it is important to stop, to look back a little. In real time, it is hard to study every detail, because time is passing as they appear. However, when we look back we can freeze the picture and examine every detail, see many events that we missed during that fraction of a second when they occurred. The Book of Books, the Bible, is not just the identity card of the Jewish, but an essential source for the whole world.
8 L. Ben-Nun
Traumatic Brain Injuries
PREFACE The purpose of this research is to analyze the medical situations and conditions referred to in the Bible, as we are dealing with a contemporary medical record. These are scientific medical studies incorporating verses from the Bible, without no interpretation or historical descriptions of places. Fundamentally, this Research is constructed purely from an examination of passages from the Bible, exactly as written. The research is part of a long series of published studies on the subject of biblical medicine from a modern medical perspective. This is not a laboratory research. The Research is built entirely on a secular foundation. With due to respects to people faith, this Research takes a modern look at medical practices. Each to his own beliefs.
9 L. Ben-Nun
Traumatic Brain Injuries
FOREWORD People have suffered from TBIs for thousands of years. Even today, injury to the brain is the leading factor in mortality and morbidity. The devastating personal, social, and financial consequences of TBI are compounded by the fact that most people with TBI are young and previously healthy. Over the past 30 years, mortality from severe TBI for patients who survive to the hospital has been reduced from nearly 50% to approximately 25%. Most of the pathologic processes that determine outcome are fully active during the first hours after TBI, the decisions of emergency care providers are crucial (1). TBI results from an impact with the skull with/without lesion of the brain but at least a short-term neurological disorder. All other injuries to the skull should be called concussion. The duration of unconsciousness defines the severity of TBI. Patients with TBI should be admitted to a surgical ward. Those retaining consciousness and with GCS scores of 15 might be allowed to go home if under surveillance. With GCS of
