History of Spine Surgery in the Ancient and Medieval Worlds

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History of Spine Surgery in the Ancient and Medieval Worlds

Posted 03/31/2004

Tait Goodrich, M.D., Ph.D.

Abstract and Introduction

Abstract

There is a paucity of surviving texts from ancient and medieval times that

can shed light on the early development of spine surgery. Nevertheless, the

author reviews many of the available books and fragments and discusses early

developments in the field of spine surgery from the point of view of

physicians' personalities, general themes, and actual surgical practices.

For purposes of an overview and to highlight changing trends in spine

surgery, he divides the paper into four eras of medicine: 1) Egyptian and

Babylonian; 2) Greek and early Byzantine; 3) Arabic; and 4) medieval.

Introduction

The early development of surgery of the spine is rather sparse from the

point of view of literature. Very few writings from the ancient world have

survived. Ancient medicine, compared with its modern successor, lacked

several essentials such as an understanding of anatomy, recognition of the

concept of disease, and comprehension of the origin of illness in an organic

system. The failure to grasp these vital principles retarded the practice of

medicine and of surgery itself. The practice of neurosurgery and surgery of

the spine did not really develop as a discrete specialty until the 20th

century. Despite these limitations I will review some of the existent

materials that deal with the development of spine surgery in ancient and

medieval worlds.[20]

For the ancient physician, the fear of operating was a real one, especially

when one had to deal with the central nervous system. Two centuries before

the birth of Christ, King Hammurabi of Babylon (1955­1912 BC) introduced a

set of equitable laws that dealt with matters of everyday life such as

marriage, slavery, land purchase, and, of course, medicine. The penalties

established in this codex for making surgical errors led surgeons in that

period to approach patients with some trepidation. In Hammurabi's Code there

are nine paragraphs devoted to the physician; one in particular deals with

the operator who carries a bronze knife (scalpel) for wound care:

If a physician makes a wound and cures a freeman, he shall receive ten

pieces of silver, but only five if the patient is the son of a plebeian or

two if he is a slave. However it is decreed that if a physician treats a

patient " with a metal knife for a severe wound and has caused the man to

die‹his hands shall be cut off " (Code of Hammurabi).

In this paper I will discuss early developments in the field of spine

surgery from the point of view of personalities, themes, and actual surgical

practice as revealed in literature surviving from ancient and medieval

worlds. For purposes of an overview and to highlight the changing trends in

spine surgery over the entire period, I have divided this paper into the

following eras: 1) Egyptian and Babylonian medicine, the embryonic period;

2) Greek and early Byzantine medicine, the historical origins of spine

surgery; 3) Arabic medicine, the prescholastic period; and 4) medieval

medicine, the period of medical scholasticism.

(see this url for the rest of the article...)

http://www.medscape.com/viewarticle/468452?mpid=26870