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History of Plastic Surgery

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 Asia4,5.

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 philosophy13,14. 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.

References

  1. Restak, richard (2000). “fixing the brain”. mysteries of the mind. washington, d.c.: national geographic society. isbn 0-7922-7941-7. oclc 43662032. n.d.
  2. Prioreschi, plinio. “possible reasons for neolithic skull trephining”. perspect biol med. 1991. 2: 296–303. n.d.
  3. Faria, miguel a. “neolithic trepanation decoded- a unifying hypothesis: has the mystery as to why primitive surgeons performed cranial surgery been solved?”. surgical neurology international. surg neurol int 07-may-2015;6:72. retrieved 2 june 2015. n.d.
  4. First evidence of brain surgery in bronze age harappa, current science, vol 100, no 11, 10 june 2011 n.d.
  5. Kenneth a. r. kennedy, god-apes and fossil men: paleoanthropology of south asia n.d.
  6. Lawrence, christopher (2008). “surgery”. in lerner, k.lee; lerner, brenda wilmoth. scientific thought: in context. in context. 1. detroit: gale. isbn 978-1-4144-0299-4. lccn 2007051972 n.d.
  7. Stern, ludwig christian (1875). ebers, georg, ed. papyros ebers: das hermetische buch über die arzeneimittel der alten ägypter in hieratischer schrift, herausgegeben mit inhaltsangabe und einleitung versehen von georg ebers, mit hieroglyphisch-lateinische n.d.
  8. Silverberg, robert (1967). the dawn of medicine. putnam. retrieved 1 december 2012. n.d.
  9. Albert r. jonsen, the new medicine and the old ethics, harvard university press, 1990, p122 n.d.
  10. Sarah boslaugh (2007), encyclopedia of epidemiology, volume 1, sage publications, isbn 978-1412928168, page 547, quote: “the hindu text known as sushruta samhita is possibly the earliest effort to classify diseases and injuries” n.d.
  11. Bhishagratna Kaviraj KL (1907). An english translation of the sushruta samhita in three volumes, (volume 1, 2 and 3, archived by university of toronto) 1907.
  12. Adams, francis (1891), the genuine works of hippocrates, new york: william wood and company. n.d.
  13. Garrison, fielding h. (1966), history of medicine, philadelphia: w.b. saunders company. n.d.
  14. Willis ra. pathology of tumours. 3rd edition. london: butterworths, 1960. n.d.
  15. Major, ralph h. (1965), classic descriptions of disease, springfield, illinois. n.d.
  16. Johansson, ingvar; lynøe, niels (2008). medicine and philosophy: a twenty-first century introduction. walter de gruyter. p. 27. n.d.
  17. Rosenthal, theodore: aulus cornelius celsus, his contributions to dermatology. arch dermatol.1961;84(4):613–618. n.d. Doi: 10.1001/archderm.1961.01580160077013.
  18. Andreas vesalius (1543). de humani corporis fabrica, libri vii (in latin). basel, switzerland: johannes oporinus. n.d.
  19. Mair, victor h. (1994). “the biography of hua-tuo from the ”history of the three kingdoms. in victor h. mair. the columbia anthology of traditional chinese literature. columbia university press. pp. 688–696. n.d.
  20. Edward gibbon chapter 2. fall in the west. the history of the decline and fall of the roman empirehttp://www.ccel.org/ccel/gibbon/decline/files/volume1/chap2.htm n.d.
  21. Glen bowersock, “the vanishing paradigm of the fall of rome” bulletin of the american academy of arts and sciences 1996. vol. 49 no. 8 pp 29–43. n.d.
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