Chapter 3. THE DAWN OF SURGERY
The animal
kingdom exhibits numerous forms of social support, many of which lay the
groundwork for rudimentary medical practices. Insects like bees, fish such as cichlids,
amphibians like bullfrogs, reptiles like crocodiles, and most birds and mammals
demonstrate care for their offspring. Lions and wolves feed injured kin, while
buffalo and flocking birds collectively defend against predators. Marine
mammals assist struggling companions to the surface for air, and elephants help
free trapped herd members from mud or aid them in standing. These behaviors
hint at the origins of altruism, a trait that extends to early medical
instincts.
Animals
also engage in self-medication and basic healing. Birds employ various
techniques to combat ectoparasites, while moths, ants, and fruit flies consume
natural remedies for ailments. Chimpanzees incorporate medicinal plants into
their diets, using them passively as healing foods or actively to treat
injuries and infections. Dogs instinctively immobilize fractured limbs, lick
wounds to clean them, and seek anti-parasitic plants when infested with worms.
Grooming among related animals or mutual parasite removal across species serves
as a form of treatment. A striking example involves a male Sumatran orangutan
who applied sap and a paste made from Fibraurea tinctoria leaves to a facial
wound, protecting it from insects while the lysozyme in his saliva and the
plant’s compounds prevented infection and promoted healing. Chimpanzee
communities lick each other’s wounds and place insects into injuries, possibly
for therapeutic purposes. Capuchin monkeys rub odorous substances on one
another, likely as a mutual anti-parasitic treatment. Ants clean and disinfect
wounds with antimicrobial saliva, immobilize partially severed limbs, and even
amputate damaged legs to reduce infection risks, a behavior that mirrors human
altruism despite being driven by the need to remove dead tissue.
Humanity’s
need for healthcare dates back to prehistory, with urgent surgery emerging as a
critical skill. Early humans faced injuries from extreme temperatures, rugged
terrain, falls from trees or cliffs, rockslides, predator attacks, and
conflicts with rival groups. Burns, frostbite, cuts, muscle tears, fractures,
and dislocations were common, yet not always fatal. Non-vital organs like eyes,
ears, or extremities were frequently affected, prompting attempts at
self-diagnosis and self-treatment for minor issues such as bruises, abrasions,
small wounds, foreign bodies, sprains, ligament tears, subluxations, and
hairline fractures. These efforts mark the roots of surgical specialties,
including traumatology, burn care, ophthalmology, vascular surgery,
maxillofacial surgery, abdominal surgery, thoracic surgery, neurosurgery, and
otolaryngology.
The
earliest recorded lethal injury among human ancestors is that of “Lucy,” a
female Australopithecus afarensis who lived in Ethiopia around 3.2 million
years ago. Her remains reveal death from multiple fractures, internal ruptures,
and hemorrhages caused by a fall, likely from a tree. Such injuries were not
uncommon among early hominins, whether fruit-gatherers or mountain-dwellers.
For instance, two Australopithecus sediba individuals suffered fatal trauma
after falling into a 5–10-meter-deep cave in South Africa’s Malapa site about 2
million years ago. Falls from heights exceeding 6.61 meters often cause severe
head, chest, or abdominal injuries, offering little chance of survival for
these early hominins.
Many
injuries, however, were survivable, with some healing spontaneously. A healed
heel bone fracture in an Australopithecus africanus, found in South Africa’s
Sterkfontein Caves (dated 2.8–2.01 million years ago), suggests prolonged care
by group members. The individual required immobilization for months, likely
supported by a makeshift splint crafted from bark, vines, and sticks, and
relied on others for food and mobility. This case highlights early social
support and basic medical intervention, akin to modern orthopedic
immobilization, though without advanced tools like plaster casts or surgical
fixation.
Another
example comes from Java, where a Homo erectus femur, dated 540,000–430,000
years ago, shows a massive ossification at the attachment site of the adductor
brevis muscle. This likely resulted from a hematoma or chronic microtears,
causing pain and limited mobility. The individual, unable to hunt or climb
effectively, probably depended on group support and sought natural pain relief,
as evidenced by the years-long growth of the osteophyte.
Homo
heidelbergensis fossils also indicate care for the injured. A teenager from
Italy’s Venosa-Notarchirico site (661,000–614,000 years ago) survived chronic
femoral inflammation for over four months, implying community aid. In Spain’s
Sima de los Huesos (530,000 years ago), a child’s skull with craniosynostosis
and an elderly individual’s deformed pelvis and spine suggest they were cared
for despite severe disabilities, as their conditions limited hunting or
mobility.
Neanderthals
(Homo neanderthalensis), thriving 500,000–30,000 years ago, exhibited profound
care for vulnerable group members, including children with severe pathologies.
Their medicine was sophisticated, reducing mortality and enhancing
adaptability, which supported their dispersal and evolution. Most Neanderthals
sustained serious injuries, with 79–94% of populations affected, 37–52%
experiencing severe trauma, and 13–19% disabled before adulthood. At Iraq’s
Shanidar Cave (55,000–45,000 years ago), fossils reveal extensive care.
Shanidar 1, a male, survived multiple fractures, orbital damage, and a partial
arm amputation—possibly intentional—for over a decade, reaching old age with
debilitating conditions. Shanidar 3’s rib shows a wound from a thrown weapon,
while Shanidar 4 and 5 healed from rib and cranial injuries, respectively.
A young
Neanderthal from France’s La Roche à Pierrot (36,000 years ago) recovered from
skull fractures without infection, despite likely brain trauma and symptoms
like pain, nausea, and disorientation requiring weeks of care. This suggests
Neanderthals developed surgical skills, at least for treating skin and bone
injuries. Dental tartar analysis from Spain’s El Sidrón cave reveals
Neanderthals consumed medicinal plants like yarrow and chamomile, as well as
penicillin-producing fungi and poplar, which contains salicylic acid, a natural
pain reliever. These plants offered anti-inflammatory, antiseptic, and sedative
effects, likely used to treat wounds and reduce infections.
Neanderthals
gained anatomical knowledge by butchering hunted animals, applying insights to
human bodies. At Shanidar, an amputation may have been performed to remove a
non-viable arm, possibly crushed by falling rock. The procedure likely involved
cutting through dead tissue below a fracture to minimize pain and blood loss,
using stone or bone tools and possibly plant-based analgesics. Post-operative
care included cleaning the wound, applying raw meat or moss dressings, and
using honey or herbs for healing, sustaining the patient for weeks.
Neanderthal
medicine, possibly pioneered by a skilled individual at Shanidar, reflects
advanced social and intellectual capacities. Their care for the injured, like
Shanidar 1, who lived to 35–50 despite disabilities, underscores their
humanism. Compared to early Homo sapiens, who averaged 30–39 years,
Neanderthals’ medical practices extended lifespans, preserving valuable
knowledge.
The
earliest confirmed surgery on modern humans—an amputation of a man’s lower
leg—occurred 31,000–30,000 years ago on Borneo’s Liang Tebo site. Other
evidence includes trepanned skulls from Morocco (13,000–11,000 years ago), Iraq
(8,920 years ago), and Ukraine (8,020–4,783 years ago), as well as dental
drilling in Pakistan (9,000–7,500 years ago) and Italy (14,160–13,820 years
ago). Amputations and mastoidectomies appear in Europe by 5,500–4,500 years
ago, often with signs of healing, indicating surgical proficiency.
Surgery
arose from anatomical knowledge gained through palpation, wound inspection, and
rituals like cannibalism and mummification. In Spain’s Gran Dolina (780,000
years ago), Homo antecessor remains suggest marrow extraction, while
cannibalism persisted in Europe (23,500–13,500 years ago) and China (8,000–4,500
years ago). Chile’s Chinchorro culture (8,475–1,720 years ago) mastered
mummification, revealing detailed anatomical understanding, though its
application to medicine is unclear.
Mesopotamian
medicine, emerging in Sumer by 4,000 BCE, evolved through Akkad, Babylon, and
Assyria. Military doctors likely served in garrisons, and hospitals existed by
2,000 BCE. Sumerian medicine, initially empirical, grew mystical by 1,700 BCE.
The physician Lulu practiced in Ur around 2,700 BCE, and surgical tools like
bronze knives were used by 2,500 BCE. Procedures included wound cleaning,
cauterization, and abscess drainage, but Hammurabi’s Code (circa 1,760 BCE)
imposed harsh penalties for surgical errors, stifling progress.
Egyptian
medicine, dating to 3,300 BCE, blended science with religion. By 2,750 BCE,
surgical procedures like bone setting and circumcision were depicted, with
metastases treated by 2,400 BCE. Operations peaked in the Old Kingdom
(2,613–2,181 BCE) but declined later due to religious taboos against dissection.
Mummification provided anatomical insights, yet these were underutilized.
Notable figures like Hesy Re, a dentist under Djoser (2,630–2,611 BCE),
highlight Egypt’s specialized medical roles.
In the Levant, Israelite medicine lagged, dominated by priests who prioritized ritual over science. Surgeons performed circumcisions and basic procedures, but prohibitions on dissection limited advancements until the Hellenistic period.
Retelling done by Grok, an artificial intelligence developed by xAI.
Author:
Arkhipov S.V. – candidate of medical sciences, surgeon, traumatologist-orthopedist.
Citation:
Архипов С.В. Дети человеческие: истоки библейских преданий в обозрении врача. Эссе, снабженное ссылками на интерактивный материал. 2-е изд. перераб. и доп. Йоэнсуу: Издание Автора, 2025.
Arkhipov S.V. Human Children: The Origins of Biblical Legends from a Physician's Perspective. An essay with references to interactive materials. 2nd revised and expanded edition. Joensuu: Author's Edition, 2025. [Rus]
Purchase:
PDF version is available on GooglePlay & Google Books
Keywords
ligamentum capitis femoris, ligamentum teres, ligament of head of femur, history, first patient, injury, damage, Bible, Genesis
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