T hroughout history, man has attempted to cause harm to his fellow man, both in battle and in sport. 1 Written evidence cites medical treatment of facial injuries more than 4500 years ago, circa 3000 BC, in the Edwin Smith Surgical Papyrus. Due to the translation of this papyrus, we have the first descriptions of the surgical management of facial trauma, including the treatment of mandibular and nasal fractures. 2 Each of the cases was investigated rationally and deductively, and although many of the surgical procedures and concepts described in the document were simple, some 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. Our interest in the historical treatment of facial injures was stimulated by this papyrus, and we embarked upon investigating the management of such injuries in the Renaissance period. In our manuscript, we present the translations of 3 cases of facial injuries treated by surgeons in the Renaissance and attempt to draw parallels with contemporary management of facial injuries.
Case 1Our first case is a 16-year-old male, who was destined to be the King of England. In 1403, Henry, Prince of Wales (later King Henry V of England) was struck in the face by an arrow at the Battle of Shrewsbury. 3 The contemporary surgeon presenting the case, John Bradmore, describes the arrow as entering "next to the nose, on the left side" and also says that the arrow entered "sideways," although the precise meaning of this is unclear. He notes that it entered to a depth of 6 inches and that after the shaft was removed, presumably by his previous surgical attendant, the arrowhead was lodged "in the rear part of the head bone." The prince was transferred to the Royal Castle at Kenilworth, 4 a distance of over 50 miles, which must have taken at least a day at contemporary speeds of travel. Henry was seen by a variety of doctors and surgeons, but attempts to encourage the arrowhead to dislodge using "potions and other cures" were unsuccessful.Bradmore, at this stage, explored the wound with a series of probes, covered in clean linen cloth, which had been soaked in rose honey. He increased the length and diameter of his probes until he was sure the wound had been fully dilated. He fashioned a concave-headed clamp, which could be placed inside the socket of the arrowhead before being screwed open (Fig. 1). This permitted careful removal of the foreign body. After this, he washed out the wound with wine, probably using a rudimentary syringe, and packed the cavity with linen strips, which had previously been soaked in water, honey, barley flour, and turpentine. He ordered the changing of packs twice daily, and as the wound healed, this was reduced to alternate-day dressings. The wound was fully healed by day 20.From historical records it is known that Henry went on to make a recovery sufficiently full to permit him to lead an active (and particularly violent) life, despite its premature end, at the age of 35, after s...
