Historical introduction

From the time of mankind's earliest writings there are records of abnormalities of consciousness, and in many of these there is reference to outcome. Some of the most vivid descriptions are reviewed in an excellent book by Courville (1955).

The Edwin Smith Papyrus can be regarded as the first known medical textbook, being an incomplete copy of a work probably written during the period 2500–3000 BC (Breasted 1930). It contains a series of case histories and case 22 describes an individual who suffered a head injury and who was ‘unable to speak’. The outcome in this patient can be guessed from the conclusion that is written ‘an ailment not to be treated’.

Within the Hippocratic writings can be found many references to disorders of consciousness and outcome. For example, within the Hippocratic Aphorisms there is reference to coma as evidenced by the comment ‘in cases of concussion of the brain produced by any cause the patients of necessity lose their speech’. Hippocrates clearly recognized the importance of being able to predict outcome with the sentence ‘It seems to be highly desirable that a physican should pay much attention to prognosis’. The poor outcome of coma is referred to in a number of case descriptions such as case one in book one of Epidemics: ‘The patient on the fifth day of the fever developed delirium, lost his voice, [presumably lapsed into coma] and then died’ (Chadwick & Mann 1950).