Traditionally, wars have been the proving ground of surgeons and new types of surgery. Early surgeons developed methods to anesthetize their patients and tools to operate effectively. Because there was no global communication, many surgical advances remained geographically isolated. The Western tradition of medicine developed independently of traditions in India, South America, and elsewhere, although traders and others reported some medical advances.
One of the earliest operative practices was trepanation, or the making of a hole in the head. Evidence of trepanation is present in skulls of individuals who lived as long ago as 10,000 B.C. in areas ranging from Northern Africa to Tahiti, France, and Peru. Ancient surgeons appear to have performed trepanation for reasons ranging from the relief of pressure on the brain, due to head injury, to the release of demons. The practice is still used in some cases to relieve pressure on the brain.
Ancient Egyptians also practiced surgery. According to the Smith Papyrus, a document written about 1600 B.C., Egyptians were well acquainted with a variety of surgical problems. They set broken collarbones using splints, treated medical problems ranging from tumors to fractures, and treated wounds with an adhesive plaster.
Surgery was also mentioned in the Code of Hammurabi, the code of law developed in 1760 B.C. during the reign of the Mesopotamian King Hammurabi. The code called for strict discipline of surgeons. Surgeons who caused the death of a free man in surgery were to have their right hand amputated as punishment, while surgeons who damaged a slave had to repay the owner for the value of the slave.
Greeks and Romans used surgery as a last resort. The Greeks used herbs mixed in wine or water to dress and clean wounds, and performed surgical procedures ranging from trepanation to the cauterization of blood vessels.
The Greeks used a number of natural anesthetics, including opium and the mandrake, a plant which can have a narcotic affect. A first century Greek physician in Nero's army wrote that after using mandrake, patients receiving surgery "do not apprehend the pain, because they are overborn with dead sleep." The Greeks also developed anatomical studies based on the dissection of human bodies. Dissection for the advance of medical knowledge was forbidden during the Roman Era and during the Middle Ages, and was not revived until the fifteenth century.
The Romans developed many new surgical procedures. Roman surgeons used dilators to take barbed arrows out of wounds, amputated limbs, performed plastic surgery, and developed techniques for removing bladder stones, hernias, and cataracts.
Surgery also flourished in the first century A.D. in India. Medical texts document the practice of operations ranging from tonsillectomy to plastic surgery. Certain practices sound familiar, such as the use of an operating room, the use of various types of forceps, and the use of anesthesia to reduce pain. One anesthetic used was burning hemp, the plant used today in the drug marijuana. Indians also fumigated the area where surgery was to take place to reduce infection.
Other practices suggest a far different place and time, including the use of large black ants as clips for tears in the intestines. As India continued to develop its medical tradition, the Middle Ages descended on Western Europe, casting a cloud of religious fervor over surgery, science, and the development of medicine as a whole.