Chapter 2
HISTORY OF SURGICAL PROCEDURES
When Will and Ariel Durant wrote their Story of Civilization
In thousands of pages and eleven large books, 'twas a massive publication
But using my art of brevity, I'll write this medical history, as I should,
And only use eight pages...’cause, damn’ I'm really good!
Let us look through a mythical telescope back to the earliest days of creation and see what we can conjure up about the ability of primordial creatures to take care of themselves. Imagine some slimy thing crawling across the ocean floor, getting bitten by another slimy thing or somehow becoming injured. Our little creature had two outlooks: dying or somehow repairing the damage and surviving, albeit probably for a shorter period of time. Now we can postulate that the repair took place, most assuredly without conscious understanding by Mr. Slime, either by secretion of some internal healing substance or by an instinctual reaction by the organism which caused it to repair the injury. Sound farfetched? Well, maybe, but this same process is going on millions and millions of years later throughout the animal kingdom of today. Creatures have some inherent ability to heal themselves without conscious awareness, and this type of healing has led to the eventual development of present day medicine and surgery. Big step in reasoning, you may say. Possibly, but it leads us to that day millions of years ago when man first became able to reason, even at the most fundamental level.
When a “lower” species was cut or injured, it depended on the body to heal itself. Blood flowed from a wound until the blood vessel went into spasm and allowed the coagulation system to form a clot. Then one day a primordial humanoid found he could stem the flow of blood by applying pressure to the bleeding site...and surgery was born! He then showed his discovery to his cohabitants, who showed it to their offspring, and so on through the ages.
The beast of the forest that injured itself and developed an abscess, somehow knew through instinct to chew upon the area until it opened and drained. Drainage, even today, is the treatment of an abscess or locked in infection. But it took the conscious intellectual human mind to look at the abscess on a limb and know that it must be poked with a sharp stick in order to drain and allow him to survive.
And because man could not understand the reasoning behind his sickness he probably attributed it to spirits, spells (put upon him by other people, animals or demons), or the unknown and thereby began to perform incantations along with his early surgical and medical exploits. So now let us put away this mythical scope and jump to the dawn of civilization. We know that, in ancient Peru, France, and Britain, human skulls have been discovered showing that trephining or trepanning was done, which consisted of making a one- to three-inch hole in the skull. This apparently allowed evil humors to get out, and scientists examining the skulls say that the “patient” often lived long after the procedure! This practice may still exist among some primitive peoples of the world. So we can look at aboriginal or South American tribal cultures and possibly see what the prehistoric or primitive man used for healing. This included vegetable drugs, binding wounds and removing foreign objects (such as sticks or arrows!), and also included charms, talismans and incantations. A great deal of early medicine was done by the “medicine men” and witch doctors with much of the result being the effect of fear or belief, such as we see in placebo effects even today.
Now, in reviewing medical and surgical history, there are great gaps highlighted by the masters of each age, usually individuals who collected the history of medicine to that date and wrote it down as their own treatise. Surgical care progressed very slowly over the early millennia and over the last several centuries. To give you a brief background of historical highlights is to give you the names of the individuals who made these compilations in the early periods and to note the innovators and geniuses of the last five hundred years who made the sentinel achievements whereby medicine and surgery took giant steps forward.
Let us start with the invention of writing and the information found on clay tablets, which we call the Code of Hammurabi, apparently written by a Babylonian king 3800 years ago. One such pillar tablet is preserved in the Louvre Museum in Paris and gives rules about treatment and also the punishment of physicians whose patients die in the course of treatment —they would have their hands cut off! (Fortunately, our rules are somewhat less severe today.) And in ancient Babylon the sick were placed in the street for anyone to offer help or information about treatment (the first curbside consultations!). Sacrifice and incantation was a major part of medicine.
Moving on to ancient Egypt we find the name Imhotep, a chief minister of King Zoser, who not only designed the pyramid but was an early “healer” and became immortalized as the Egyptian God of Healing. The Edwin Smith and Ebers Papyri discovered in the eighteen hundreds in Egypt, gave voluminous information about treatment, incantations, and notably a long treatise on the care of wounds and battle injuries.
In India we find ancient writings, two to four thousand years old, about a medical system called Ayurveda, mostly spiritual; this was followed from 800 B.C. through the first millennium A.D. by the more advanced ideas of two individuals, Caraka (an internist) and Susruta (a surgeon) with writings about wounds, tumors, and abscesses as well as medical diseases. Early Hindu surgeons drained abscesses, removed simple tumors and did crude treatment of fractures and sewing up of wounds.
In China, the culture extends back several thousand years with traditional Chinese Medicine and its dualistic theory of the Yin (female, dark and passive the earth) and the Yang (male, light and active the heavens) principles. The human body was made up of five elements (fire, water, earth, metal and wood) and these, with balances between yin and yang, determined health or illness. The Chinese described tying off (ligation) of arteries, the presence and importance of the pulse, and said the body consisted of five organs: heart, lungs, liver, kidney and spleen. We all have heard about acupuncture; the Chinese also used hydrotherapy (i.e., cold baths for fever) and had a great pharmacopoeia of herbal medicines, many of which are still used today, such as castor oil, camphor, and iron for anemia.
Western Medicine progressed slowly over several thousand years from Early Greece with Asculapius slowly drifting away from the supernatural. By the fourth century B.C., Hippocrates, often called the father of medicine, had written his “Aphorisms” (the best known being the first: “Ars Longa, Vita Brevis Art is long and life short”) with many descriptions of observations and diagnosis, but only the most basic in the way of surgical intervention. He left us the famous Hippocratic Oath, which has been stated by graduating medical students for many years. I include it for you to peruse, since it is universally known about, but rarely seen.
“I swear by Apollo the Physician, and Asclepius, and Health and Allheal, and all the gods and goddesses...to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and to relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation, and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and to those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion... Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females and males, of freemen and slaves. Whatever, in connection with my professional practice or not in connection with it, I see or hear, in the life of men which ought not to be spoken of abroad, I will not divulge, as reckoning that all should be kept secret.”