Ancient Medicine and Surgery

6500 BC: First documented surgery in the Neolithic period (Late Stone Age) in France. Skulls of humans who survived trepanation (Burr holes) have been found¹. May have been performed due to a head injury, as an attempt to treat mental illness or to bring back the life of prominent members of the group²,³.

3000 BC: Other examples of trepanation and healed broken bones related to the Indus Valley Civilisation in East Asia^4,5.

1600 BC: First written document on surgery: The “Edwin Smith Papyrus” from ancient Egypt. Named after the dealer who bought it in 1862. A scroll of 4.68 meters in lenght, presenting 48 case stories with quite rational medical treatments of injuries, fractures, and tumors⁶.

1550 BC: The Egyptic “Ebers Papyrus”, named after the buyer Georg Ebers. The papyrus consists of 110 pages adding up to 20 meters. Contains 700 magical formulas and remedies. Some of them useful, many of them irrational e.g. on how to turn away evil demons⁷.

1250 BC: Homer describes the Greek god of medicine Asclepius (son of Apollo) and his two sons Podalirius and Machaon. They performed rational treatments i.e. how to administer sedatives, apply wool bandages to wounds or cut out arrowheads⁸. Asclepidius had learned medicine from a centaur and a snake (in Greek snakes were sacred beings of wisdom and healing). Asclepius, therefore, carries a staff with an entwined serpent – the symbol of medicine which still used today⁹.

600 BC: First documented reports on Plastic Surgery. In ancient Indian “Compendium of Suśruta” describes surgical instruments, training, and procedures including a nose reconstruction by a frontal flap¹⁰. The compendium is extraordinary and contains 186 chapters and describes 1.120 illnesses ¹¹.

460-377 BC: Greek physician Hippocrates of Cos, the “father of medicine”. He describes the natural reasons of diseases not being a punishment of God. Hippocrates believed that clinical inspection and observation could lead to a diagnosis¹².

He described breast cancer and established the discipline of medicine distinguishing it from theurgy and philosophy^13,14. He was the first known chest surgeon, describing the removal of breast cancer, abscesses and placement of chest drains¹⁵.

Hippocrates was mistaken that human health and temper were related to the imbalance of “the four bodily humours”: Black bile from the gallbladder (melancholic), yellow bile from the spleen (choleric), phlegma from the brain and lungs (phlegmatic), and blood from the liver (sanguine)¹⁶.

“The Hippocratic Oath” is written by Hippocrates and is still taken today by physicians. The oath outlines the ethical rules a doctor must pursue: To treat patients the best of one’s ability, to preserve patient privacy and to teach the next generation of physicians.

300 BC – 25 BC: During these centuries no further advancement in medicine or surgery was achieved. Most medical practitioners practiced based on the knowledge of Hippocrates – mistakenly trying to restore the imbalance of the four humours.

25 BC – 50 AD: The Roman encyclopedist and physician Aulus Cornelius Celsus who wrote “De Medicina”¹⁷. Description of dermatologic conditions, surgical procedures, and cancer (crab in roman) because of the dilated tortuous veins surrounding breast cancer – like crablegs¹⁷.

129 – 210 AD: Galen of Pergamon, Roman surgeon, who served as personal physician to several emperors and developed anatomy, physiology, pathology, philosophy etc. Galen used catgut for suturing, believed that pneuma (air) was essential for life. Although he wrongly continued to use the theory of the four humours and believed pus (example in an abscess) should not be removed by surgery. The anatomy drawings of Galen based on monkey and pig dissections remained uncontested until 1543 AD when anatomy based on human dissection was published by Andreas Vesalius ¹⁸.

104 – 208 AD: Hua Tuo, a Chinese physician, and surgeon of the Eastern Han dynasty. Hua Tuo was the first in China using wine with boiled cannabis as anesthesia during surgery. He also developed “Wuqinxy” (The five animals) – an exercise based on the animal’s tiger, deer, bear, ape and crane¹⁹. Hua Tuo was personal physician to the warlord Cao Cao, who had him executed when he disobeyed his orders – thereby losing important medical knowledge.

476 AD: The fall of Western Roman Empire. Through centuries Greek and Roman physicians had advanced the scientific medical-surgical knowledge in Europe ^20,21. The development would now stall for a while.