The First Cut – Pt 1

Last week I had further foot surgery and am currently laid up, with limited mobility. This got me thinking about the history of  surgery, and reminded me of a joke I read in one of Isaac Asimov’s books:

The Oldest Profession

A doctor, an engineer, and a lawyer were in their favorite watering-hole discussing who among them had the oldest profession.

The doctor said, “According to the bible, on the sixth day God took a rib from Adam and used it to create Eve making him the first surgeon. Therefore, medicine is the oldest profession.”

The engineer replied, “Yes, but before that, God created the heavens and earth out of Chaos, surely a feat of engineering. So, mine is the oldest profession.”

The lawyer smiled, then spoke up. “True. But who do you think created the chaos?”

That always made me laugh (and it’s a perfect excuse to have a cheap dig at lawyers!)–but what about the real history of surgery?


pic147We tend to think of surgery as a relatively modern invention, dating back only a century or two, but the truth is far different. The first signs of attempted surgeries show up in the fossil record and cave paintings as early as 7,000 years ago (5,000 B.C.) when trepanations (drilling or grinding holes in the skull) were carried out to treat a variety of maladies by relieving pressure inside the skull. Despite the complete lack of scientific knowledge of disease, anesthesia or sterile techniques, these interventions had a survival rate of perhaps as much as fifty percent–possibly a testament to the hardiness of the human species.

history-of-plastic-surgeryEgyptian medicine made use of quite modern-looking techniques to deal with a number of medical problems. In 2,600 B.C. remains of a jaw from a tomb showed evidence of an operation to drain a tooth abscess.Then there’s the Edwin Smith Papyrus, which dates back 3,500 years (1,600 B.C.) and documents forty-eight different treatments for dealing with injuries, fractures, wounds, dislocations and tumors. The papers also describe using surgical sutures, use of natural antiseptics, treatment of spinal and cranial injuries, and also anatomical descriptions including the first references to breast cancer.

sushrutfAround 2,600 years ago (600 B.C.) Sushruta, an amazing Indian physician, wrote a treatise that documented over 1120 illnesses, 700 medicinal plants as well as surgical techniques of making incisions, probing, extraction of foreign bodies, cauterization, dentistry, prostate gland removal, hernia surgery, caesarean section, hemorrhoids, perforated intestines, fracture management, and the use of prosthetics. If that wasn’t enough, it also describes a number of dislocations and fractures, classification of eye diseases including cataract surgery, along with their treatment!

hippocratesThen there was Hippocrates, known as the “Founder of Western Medicine.” Around 2,400 years ago (400 B.C.) he taught that wounds should be washed in boiled, filtered water, that a doctor’s hands should be kept clean and he was the first to recognize the difference between benign and malignant breast cancers. He also taught that medicine should be approached using scientific methods and proposed that diseases had natural causes. He formulated the basic rules of medical treatment that are still the basis of medical ethics to this day.

Around 200 years later (208 B.C. ) Hua Tuo, a Chinese physician, was the first person documented to make use of an anesthetic during surgery. His anesthetic was made by combining wine and cannabis, something his clients no doubt enjoyed!

The Fall of Rome and rise of the Christian Dark Ages ended much of the advance in scientific surgical development and knowledge in Europe (along with other scientific knowledge). This lasted until the advent of the Black Death and subsequent Renaissance (around 1350), during which European scholars actively sought out medical and scientific knowledge from Byzantine and Muslim sources.

It’s quite incredible how many of the medical principles and procedures we now take for granted were already formulated by this point in history. In fact, most of the poor outcomes at this time were attributable to three things, the lack of sterile conditions, limited understanding of germ theory and patient trauma from limited anesthetics.

Next week I’ll look at the “new age” of medicine, from the 1400s through to the 20th century and beyond.



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