IELTS Academic Reading Practice Test 407

In 1862 an American antiquities dealer named Edwin Smith bought a roll of papyrus at Luxor, in southern Egypt. Smith had lived in Egypt for many years and had a keen eye for old documents, and he recognised at once that this one was unusual. He kept it for the rest of his life, making notes and beginning a translation that he never completed. After his death in 1906 the roll passed to the New-York Historical Society, and since 1948 it has been held at the New York Academy of Medicine, where it remains. The document is nearly five metres long and is written in hieratic, a cursive form of Egyptian writing used by scribes.

The surviving roll was copied at some point around 1600 BCE, but the text it contains is considerably older. Its language and its assumptions point to an original composed many centuries earlier, perhaps around 3000 BCE, at the very beginning of the Old Kingdom. The copyist appears to have been working from a damaged or archaic source. The back of the roll carries a short magical text of a quite different character, but the front is given over entirely to the surgical cases for which the document is famous.

The papyrus sets out forty-eight cases. They are grouped according to the part of the body affected, beginning with the head and moving down through the neck, the collarbone and the arms. Each case follows the same pattern: a title, a description of the examination, a diagnosis, a verdict and, where appropriate, a treatment. The examination instructions are practical, telling the physician to look at the wound, to feel it, and to ask the patient to move the affected part. Such careful observation of the patient, rather than speculation about the cause of illness, is what makes the text so striking to modern readers.

Every case ends with one of three verdicts. An injury could be described as an ailment that the physician would treat, as one that he would contend with, or as one that should not be treated. The second category is the most interesting, because it covers conditions whose outcome was uncertain: the physician was to attempt treatment but to expect that the patient might die. The third category was reserved for injuries so severe that no intervention could help, and the text is explicit that in these cases the physician should do nothing further. It is, in effect, a system of triage, distinguishing the hopeless from the merely serious.

The most remarkable passages concern the brain. In earlier Egyptian medicine the heart was regarded as the seat of thought and feeling, and the brain was largely ignored. The author of this text, by contrast, recorded the membranes that cover the brain and the fluid beneath them, and noted the folded surface of the organ itself. The scribe also observed that a wound to the skull could leave the patient shuffling one foot as he walked. Modern neurology explains this as damage to the parts of the brain that control movement. Some historians have therefore described the papyrus as containing the first known account of the brain in anything like anatomical terms.

The text also describes the heart as the centre of a system of vessels running through the body, and notes that the physician could feel its beating and assess its strength. Not everything it says would survive later scrutiny. Several of its explanations of how the body works are not supported by modern anatomy, and some of its remedies are unlikely to have done much good. Others may have been more useful than they look. Dressings containing honey are recommended for wounds, and honey has since been shown to inhibit the growth of many kinds of bacteria.

The document became widely known only in the twentieth century. In 1930 the Egyptologist James Henry Breasted, of the University of Chicago, published a facsimile of the whole roll. He added a translation and a commentary, and he enlisted the help of a physiologist, Arno Luckhardt, in interpreting the neurological cases. Breasted's two-volume edition allowed doctors as well as historians to read the text, and it has shaped every subsequent discussion of Egyptian medicine.

The contrast with other Egyptian medical texts is instructive. The Ebers Papyrus, for example, which was written somewhat later, around 1550 BCE, is much longer and is chiefly a collection of remedies, many of them accompanied by spells and incantations. The Smith papyrus contains little of this magic. Its interests are surgical and observational, and its author was concerned with what could be seen and felt rather than with what might be invoked.

The roll ends abruptly. The last case breaks off in the middle of a sentence. This suggests that the surviving text is a copy of a longer work whose final pages were already lost when the copy was made. No further part of the roll has ever come to light, and it is unlikely now that one will. What survives is nevertheless enough to justify the description often applied to the papyrus. It is the oldest surviving surgical treatise in the world, and the earliest document in which medicine is pursued as a matter of observation and record.

A newborn baby's brain weighs around 350 grams, roughly a quarter of the weight of an adult's. By the end of the first year it has more than doubled. By the age of two it has reached about 80 per cent of its final weight, and the remainder of the growth is spread over the following fifteen years or so. Head circumference is measured at every check because it is a rough guide to the growth of the brain inside. Size, however, is the least interesting part of the story. What changes is not only the number of cells but the way they are connected and insulated. The brain of a two-year-old already contains far more connections between its nerve cells than an adult's does, and much of what happens afterwards consists of removing them.

Almost all of the brain's nerve cells, or neurons, are produced before birth, in a burst of cell division that ends shortly before or after delivery. Only a small number are thought to be added later in life, and the role of these new cells is still debated. What the infant brain does instead is wire its neurons together. As a neuron extends its fibres, it forms junctions, called synapses, with other neurons, and the number of these junctions rises steeply during the first two years. Studies of tissue obtained at autopsy suggest that the density of synapses in parts of the cortex climbs to a peak at around one to two years of age and then falls. The overproduction appears to be a strategy for dealing with uncertainty: the brain builds a wide range of possible circuits before it knows which ones the world will require.

The removal of connections is not a defect but the point of the exercise. Connections that are rarely activated are eliminated, while those that are used repeatedly are strengthened, a process usually described as synaptic pruning. It is a form of learning: the brain is not simply growing according to a plan but adjusting itself to the particular language, faces and sounds of its surroundings. Pruning continues through childhood and adolescence, and the pathways it leaves behind reflect the experiences of the child who owns them. An infant who hears two languages keeps the ability to distinguish the sounds of both. One who hears only one gradually loses the capacity to hear distinctions that its own language does not use.

The second great change is the wrapping of the brain's fibres in myelin, a fatty sheath that allows electrical signals to travel much faster and more reliably. Myelination begins before birth in the spinal cord and in the nerves serving the senses and muscles, and it continues through childhood and adolescence into the twenties. The order in which it happens follows the order in which abilities mature. The pathways carrying sight and hearing are insulated early, and those supporting movement soon afterwards. The connections in the prefrontal cortex, the region behind the forehead that underpins planning and self-control, are among the last to be completed.

Because the brain is shaped by experience, there are periods in which particular kinds of experience have a lasting effect. The classic demonstration came from experiments on kittens carried out by David Hubel and Torsten Wiesel in the 1960s. If one eye was closed for a few weeks after birth, the part of the visual cortex that would normally respond to that eye failed to develop. The loss could not be reversed later. Human language shows a similar, if less rigid, pattern. Research on children who spent their early years in poorly staffed institutions suggests that timing matters. Those moved to foster families before about the age of two tended to develop more typically than those who stayed longer, although many other factors complicate the picture. Such periods are usually called sensitive rather than critical, because later experience can still have some effect.

How far such findings can be pushed is disputed. Some popular accounts claim that the first three years decide a child's intellectual future, and that parents who fail to provide the right stimulation in that window can do little to compensate. Most researchers regard this as an exaggeration. The brain remains capable of change throughout life, and many children who experience early disadvantage go on to do well. It is also unclear how much of the pruning is directed by genes and how much by experience. Nor is it clear how far findings from animals, whose visual systems can be manipulated directly, carry over to children. The picture is further complicated by the fact that different abilities have different timetables, and that a child who is slow to speak may be advanced in other respects.

What the evidence does support is less glamorous than the commercial programmes sold to anxious parents. Adequate nutrition matters a great deal. Iodine deficiency during pregnancy is a well-established cause of impaired mental development, and iron deficiency in early childhood is associated with poorer scores on tests of thinking and memory. Sleep and responsive care from familiar adults appear to matter more than any particular educational toy. The most consistent finding is that talking and reading to children, and answering them when they speak, is associated with better language development. None of this requires expensive equipment, and there is little evidence that the products marketed as boosting intelligence have any lasting effect.

At around eighteen months, in many countries, a young child is brought to a clinic for a routine check. The appointment lasts twenty minutes at most. A health visitor or paediatrician asks the parent a series of questions — does the child point at things, use a dozen words, walk without help? A short questionnaire, filled in while the family waited, may then be scored. On the strength of a few answers the child is referred for a fuller assessment or discharged until the next appointment. Few procedures in child health are so widely used, and few attract so much disagreement.

Screening is not diagnosis, although the two are frequently confused. A screening test is offered to everyone in a defined group, whether or not they have symptoms, in order to separate those at higher risk from those at lower risk. It must therefore be quick, cheap and simple enough to be administered by a nurse or completed by a parent. Assessment is a different activity altogether: it is lengthy, it is carried out by specialists, and it ends with a judgement about what, if anything, is wrong. A positive screen means only that a child ought to be looked at more closely.

The case for identifying difficulties early rests on a simple observation: help given early appears to work better than help given late. Programmes of intensive behavioural and developmental therapy for young autistic children have repeatedly been followed by gains in language and everyday skills. The earlier a programme begins, the larger those gains tend to be. The evidence is not uniform, and much of it comes from small studies, but its direction is consistent. Waiting until a child is obviously failing costs that child months or years in which useful work could have been done.

There is a second argument, made less often and harder to answer. Children are not equally likely to be noticed. A child whose parents are confident, literate and used to dealing with professionals is far more likely to be referred. A child with the same difficulties, whose parents are exhausted, isolated or struggling with the language of the clinic, may never be mentioned at all. A screening programme that reaches every family, in a clinic or at home, is one of the few ways of ensuring that the quiet, disadvantaged child is seen.

Against this, critics point to the imprecision of the tools. A questionnaire completed by a worried parent catches many children who do need help, but it also flags a considerable number who do not. Many children who speak hardly at all at two speak perfectly well at four, and nothing available at the first appointment will reliably tell the two groups apart. Every false result brings anxiety, an appointment, sometimes a wait of several months and occasionally a label that a child carries into school. Yet these are arguments for making the tests better and for arranging rapid follow-up, not for abandoning the exercise.

The evidence for screening the whole population specifically for autism is weaker than campaigners sometimes suggest. In Britain the National Screening Committee, which advises the health service on national programmes, has repeatedly concluded that the case has not been made. No sufficiently large trial, it notes, has shown that children picked up by screening do better in the long run than children identified in other ways. That is a demanding standard, but screening programmes are held to it for a reason: the test is offered to everyone, so the burden of proof lies with those who propose it.

The absence of such a trial is not proof that screening does no good. A two-year-old identified as having a language delay may turn out to have a hearing problem, may turn out to be autistic, or may turn out to have nothing wrong at all. The purpose of the screen is not to name the condition but to start a process. Screening is a beginning, not an answer. To insist that it must deliver a confident diagnosis at the first appointment is to set a standard that no test could meet.

In my view the most serious objection to screening is administrative rather than scientific. A programme that identifies children without providing anywhere for them to go is worse than no programme at all: it creates anxiety, wastes appointments and discredits the whole enterprise. A test that leads nowhere uses up the goodwill of families and of the clinicians who administer it. Where families must wait a year or more to see a speech therapist, a screening test amounts to a promise that the system cannot keep. Where the services exist, the balance of advantage shifts decisively.

The question, then, is not whether to screen but how. Screening at the ages already built into routine child health checks, using a short structured questionnaire and backed by enough therapists to see every referred child within weeks, seems to me plainly justified. It is also the fairest way of finding children who would otherwise be missed. Screening offered as a substitute for those services is not. The measure of a programme is not how many children it refers but what happens to them afterwards.