PROLOG: I do like to write. I have written eight books and numerous essays including peer-reviewed scientific articles. I think my reasons to write are similar to any artistic endeavor, to get recognition, to impart knowledge, scholarship, gentility, enlightenment, and civility, among the many motivations. But when my writings call forth hate, disrespect, lack of intellect, or are targeted for censorship, and my name is listed for future punishment by the evolving “thought police,” my reasons are not fulfilled and, in fact, become perverted into something I reject and is not why I like to write. I am delighted to have people comment on my writings with support or intellectually stated opposition. I like a good discussion. That makes it worthwhile. When the opposition is hateful, threatening, or nonsensical, it is a turnoff. Yet I still want to write! For the time being, I am going to turn it back to writings that tell a tale or aim to educate. I have been a professor in my past life, so I believe I can deliver on that. One of my last books was on the history of surgery; We Stand On the Shoulders of Giants, whose target audience were surgeons in training, and which has had a modicum of commercial success. As my first effort, I am going to serialize that book and put out one chapter a week. It is not full of “doctor talk” and tells the very human story of how we learned to use the knife on our fellow humans to cure, to help, and to ease suffering. It is readable for general audiences, and I hope you find that interesting. If you want it all at once, you can buy it through Amazon.com. Once in a while, if some really juicy political point comes around, I may not be able to resist commenting again and just expect and learn to tolerate the hateful comments and assure a place on AOC’s Enemies of the People list following in my parent’s footsteps.
AND NOW: THE EARLY YEARS
When did humans decide to start whittling on other humans, not as a means to harm, but as a means to cure? We don’t really know when surgery made its debut, but we do have evidence that some 8,500 years ago Homo Sapiens decided to open other Homo Sapiens’ skull bones, for reasons that are shrouded in the fog of history. It could have been earlier, as there is no trace left from flesh that long ago, but there are trephination holes in the calvarium of skulls that were found in northern France from 6500 BCE. These were very precise, perfectly round, and not only done intentionally, but with great care. These also show evidence of healing, as the holes they made started to have remodeled bone at the edges, proving these people survived their “operation,” at least for enough time for the bone to
reshape itself, which would suggest several years. We have known that Neanderthals used stone tools to kill, and butcher their fellow species, by finding knife marks, as well as teeth marks on bones, and opening marrow cavities to extract it, as long ago as 100,000 years, but that was not for benevolent purposes, and these beings did not survive those assaults. The
trephination holes, however, were clearly meant to alleviate some real or imagined maladies, perhaps releasing blood clots, or evil spirits, that created mental aberration in their “patients.”
In ancient Peru, similar skulls were unearthed, and not only were holes made, but means of closing the openings were created with, at first, the bone that had been excised, but later with very precisely made gold plates that fit perfectly into the defect, without falling into the brain. I have seen them in the Gold Museum in Lima, but they were from later times, perhaps 500 years, or thereabout. They were more successful than similar efforts, just a couple of hundred years ago, during our Civil War, when almost no one survived that kind of insult, because of wound infections and sepsis. The Incas used very sharp obsidian glass knives (Tumi knives), sharper than modern scalpels, and likely had the use of topical anesthesia provided by the indigenous coca leaves, to keep their patients from having pain. How they prevented infection remains a mystery.
To the left is a pendant I purchased for my wife, of an Incan ceremonial Tumi knife, at that museum in Lima, Peru. It was also used to open the chest, to harvest hearts for their human sacrifices.
The Code of Hammurabi, inscribed in a large rock with cuneiform writing, is of the Babylonian era in 1754 BCE. It outlined all manner of laws, that included a code of conduct, from a means of establishing a fair price to pay an ox-cart driver to transport an amphora of wine or oil, to what a surgeon could charge to set a bone or open an abscess. Even back then, there was a price to pay. If the surgeon caused a patient to lose an eye, the surgeon had both his hands cut-off in retribution. Now the law just takes the surgeon’s bank accounts to settle the claim and leaves his hands so he can continue to pay off his debts.
Egypt was the next world power, exerting its influence from Africa to the far reaches of Asia, with its culture, goods, and gods. Writing was already well established, and a document that was 4.48 meters in length, was bought by Edwin Smith, who was a dealer of antiquities. He acquired this scroll in 1862 in Luxor, Egypt. Hieroglyphics had just been decoded, thanks to one of Napoleon’s officers, who found the Rosetta Stone on one of the Egyptian campaigns. It was a decree of Ptolemy V, written in three languages: Ancient Egyptian in Hieroglyphic Script, Demotic Script, a more modern Egyptian language dating to the 5th Century AD, and Greek. The Rosetta Stone allowed hieroglyphics to be deciphered. The Edwin Smith Papyrus dates to the 16th – 17th Dynasties of the Second Intermediate Period of ancient Egypt, ca 1600 BCE. Where previous writings were based in magic, this one was rational and scientific, with just a few magic spells that could be used as a last resort. It was likely a manual of military surgery, dealing with war injuries, wounds, tumors, and dislocations. The Edwin Smith Papyrus had treatment options for lacerations with wound suture closure, bandages, splints, and controlling bleeding using raw meat which would have factors that promoted blood clotting. Honey was found to prevent infection and is still used today for that purpose. The word “brain” was first used in this document before it was in any other language. It surpassed the medical knowledge described by Hippocrates, who lived a thousand years later.
Egyptian surgical tools were quite sophisticated (see left). The Egyptians were also very knowledgeable in anatomy, as they had that experience from dealing with the dead, by separating the organs for burial into Coptic jars, from the rest of the body.
Later the 1st Dark Age descended on all of that. The Late Bronze Age Collapse, the half-century from 1200 BC to 1150 BC, set back humanity for nine hundred years. The cause is unknown, but likely was climate change related to Vulcanic activity. If you have ever been to the island of Santorini in Greece, you will appreciate that a whole island went up in smoke, and left just a narrow crescent of land for human habitation. Culture, knowledge, medicine, and economies just melted away for centuries.
India, far away from the volcanic mayhem, was not affected by the Bronze Age Collapse. The culture was on par with Egypt. They had medical treatment with herbs, medications, and surgery in 1500 BCE that rivaled anything in Egypt.
Maharishi Sushruta describes drilling decayed teeth and using plants, probably marijuana, for easing pain during procedures. India had the strange custom of punishing people by amputating their noses. Without a nose, individuals are quite disfigured and have a severe shame stigma. Sushruta devised a very sophisticated reconstruction of the nose, from the forehead with a rotation flap.
After a long sleep, Europe woke up. Greeks revived culture, art, science, math, philosophy, and medicine. Hippocrates lived from 460 to 350 BCE (90 years). He denied the theory that disease was because of the god’s punishment of man. He espoused the belief that man’s maladies were the result of diet, living habits, and environmental factors. We owe Hippocrates for the ethical and moral foundations of the medical profession. Although the Hippocratic oath is often modified, and is not in its original form, most doctors have taken a version of the Hippocratic Oath which contains some or all of these principles:
• Avoid causing harm
• Respect your teachers
• Share your knowledge
• Leave the knife to those that are expert craftsmen therein
• Empathize with the sick
• If you don’t know, say so
• Respect privacy (the first version of HIPPA)
• An ounce of prevention is worth a pound of cure
• Treat the person, not the disease
• Do not give poison to the patients, even if they ask
The exact phrase, “Primum non nocere” – “First do no harm,” does not actually appear in the original oath. It is attributed to Thomas Sydenham, the English Hippocrates, and Father of English medicine, who introduced us to opioids, and cinchona bark (quinine) for treating malaria. The emblem of the doctor is the single staff with one serpent coiled around it. That is the staff of Aesculapius. The two snakes coiled around a staff that has wings is the sign for Mercury, the messenger god, the god of business, and thieves.
The staff of Mercury was mistakenly designated as the medical emblem when the US Army was designing uniforms, and a typical government
“Olympian God Dummkopf” picked the wrong emblem.
