By John Murphy| in blog post September 2019 MDLinx / Comments & Edits by Dr. Saleeby
Some primeval medical treatments are still used today—including some that haven’t fundamentally changed much since their ancient introduction. (And we’re not talking about questionable cures like mercury, bloodletting and application of leeches.) These are everyday remedies that you probably encounter all the time without being fully aware of their longstanding history.
Let’s take a look at these ancient medicines and medical practices still used today.
Aspirin
Way back in Ancient Greece, Hippocrates may have told his patients: “Take two pieces of willow bark and call me in the morning.” And he was right to do so. The bark of the willow tree contains one of the oldest medicinal remedies in human history. In its modern form, we call it aspirin (ASA).
More than 3,500 years ago, the ancient Sumerians and Egyptians used willow bark as a traditional medicine for pain relief. Centuries later, its benefits were advocated by Hippocrates in Greece and Pliny the Elder in Ancient Rome. But it wasn’t until the mid-1800s that scientists refined willow bark into the medicinal compound salicin. And it wasn’t until the turn of the 20th century that scientists at Bayer turned salicin into acetylsalicylic acid (ASA), which they dubbed aspirin (“the wonder drug that works wonders”).
Today, aspirin is perhaps the most commonly used drug in the world. It’s the focus of 700 to 1,000 clinical studies each year, with applications beyond its traditional uses as an analgesic (anti-pain) and antipyretic (anti-fever). It’s now prescribed to prevent secondary heart attacks & strokes, and has shown promise for reducing the risk of certain types of cancer. However, recently published research papers in prestigious medical journals are going against the thousands of papers over the decades that heralded ASA as a good agent to prevent heart attack events. Matter of fact several papers have been published in 2019 that are stating the risk of bleeding is outweighing the benefit of preventing a heart attack. It is very interesting to note that ASA is pennies a dose and with that out of the way, once only has the option of prescribing rather expensive alternatives. Who is benefiting here with this new ASA-bashing?
Sutures
The history of suturing may go back tens of thousands of years, when primitive man (or woman) invented the eyed needle. But, the first account on record of a surgical suture was around 3000 BC in Ancient Egypt. Accordingly, the oldest known suture is in an Egyptian mummy dating from 1100 BC.
In 500 BC, Indian physician Sushruta wrote a detailed medical text that described how to perform various surgeries (ranging from anal fistula repair to rhinoplasty), and described the sutures used to complete these procedures. Instruments included triangular, round-bodied, curved, and straight needles, and suture materials came from flax, hemp, bark fiber, and hair.
Roman physician Galen—who was known to suture the severed tendons of gladiators—was the first to describe gut sutures in the 2nd century AD, though he also advocated the use of sutures made of silk. Around 1000 AD, Avicenna of Persia invented the first monofilament suture with the use of pigs’ bristles.
Fast-forward to Revolutionary-era America when Philip Syng Physick (the “Father of American Surgery”) introduced absorbent sutures made of catgut to replace the silk and flax sutures of the day. Around 1870, Joseph Lister invented antiseptic sutures (catgut soaked in a carbolic acid solution). Catgut was likely not from our feline pets but rather gut from cow or pig sources. During the Civil War between the States, suture was mostly silk or cotton and when supplies were low in the Confederacy, they resorted to horse hair. Boiling the tail hair of horses make it more pliable, strong, (and unbeknownst to them sterilized it in the process) and less reactive to skin than other material.
These days, silk and gut sutures are still available, but many now come from man-made materials such as nylon, polypropylene, and polymers. Other closure techniques such as staples and Dermabond (superglue) may be taking over much of the role of plain suture.
Cataract surgery
If you think that the eyes were too valuable and fragile for the Ancients to cut into, you’d be wrong. In the 6th century BC, good ol’ Sushruta of India documented the standard cataract surgical procedure called couching. This involves poking a sharp or blunt instrument into the eye to dislodge the cataract, where it falls into the eye’s anterior chamber, out of the patient’s line of vision. Amazingly, couching was the only method of cataract removal until as recently as the mid-18th century—and it’s still practiced in remote parts of the world today.
As an alternative to couching, French surgeon Jaques Daviel introduced extracapsular cataract surgery in 1748. Around the time of the Civil War Dr. Hugh McGuire [father of famed Dr. Hunter H. McGuire (Gen Stonewall Jackson’s surgeon)] was an accomplished eye surgeon and had blacksmiths of the day create cataract knives and spoons for surgery. In the early 20th century, Irish ophthalmic surgeon Henry Smith popularized the intracapsular technique, which freed the lens capsule from the attached zonules. But it wasn’t until World War II that ophthalmologist Harold Ridley invented a way to replace the eye’s natural lens with an artificial one. Dr. Ridley, serving as a military surgeon, noticed that shards of the windshield material from fighter planes didn’t cause the expected foreign body reaction when lodged in patients’ eyes. Using this material (a polymethylmethacrylate/glass hybrid), he invented the first intraocular lens. But it was another three or four decades before the idea really took hold.
In the late 1960s, ophthalmologist Charles Kelman introduced phacoemulsification—a method that uses ultrasound energy to break apart the hardened cataract. Today, modern cataract surgery continues to improve with the use of femtosecond laser for more precise and safer surgery.
Morphine
Morphine—the active ingredient in opium—is still obtained from harvesting the poppy plant (Papaver somniferum) through a method that has remained fundamentally unchanged for more than 8,000 years.
Carved tablets from Mesopotamia dating to 6000 BC mention the medicinal properties of opium, calling it the “plant of joy.” Ancient Egyptian, Greek, Roman, Indian, and Chinese medical texts refer to the medicinal uses of the poppy plant. In the Renaissance, both Swiss alchemist Paracelsus and English physician Thomas Sydenham created tinctures of opium they each called laudanum.
In 1804, German apothecary Friedrich Sertürner was the first to isolate the active narcotic ingredient from opium. He called the substance “morphium” after Morpheus, the Greek god of dreams. This substance was six times stronger than opium, and Sertürner himself became addicted to it. (Soon after, French chemist J.L. Gay-Lussac changed the name to “morphine.”) With the invention of the hypodermic syringe in the 1850s, morphine became widely popular. As a new & effective pain reliever during the Am. Civil War and the Crimean War that preceded it, it proved very useful in saving many wounded from excruciating pains from the modern weapons that tore apart limbs. And after the Civil War there were quite a lot of Americans on both side that were addicted to morphine. This addiction was referred to as the Soldier’s Disease or Army Disease. So, it wasn’t too long before its harms—as well as that of opium—became apparent. In 1914, the United States declared morphine a controlled substance. This was a decade before the molecular structure of morphine was even identified (an achievement in 1925 that earned British chemist Sir Robert Robinson the Nobel Prize in Chemistry in 1947).
Today, even in light of the current Opioid Crisis, morphine (Morphine Sulfate) remains one of the most commonly used opioid analgesics for controlling severe pain. There were even two wars between Britain and China over opium: The First & Second Opium Wars of the mid-1800s.
Tracheostomy
This operation is one of the oldest, easiest, and most valuable surgical procedures in history—but surprisingly, it was very rarely performed throughout the centuries. Tracheostomy didn’t come into routine use until the beginning of the 19th century. And even then, it was indicated for only a few conditions.
Although tracheostomy was depicted by the Ancient Egyptians as early as 3600 BC, credit for its invention has been historically attributed to Greek physician Asclepiades of the 2nd century BC. The first successful tracheostomy on record didn’t occur until the 2nd century AD—in a sheep.
Another 14 centuries went by until the first recorded successful operation in a human in 1546. During those long years, medical authorities had maintained that cartilaginous tissue of the throat would not rejoin after incision. Still, despite Renaissance-era refinements in the operation—such as making a vertical incision and the use of a double-lumen tube—fewer than 30 successful cases were reported in the following 200 years.
Then, in 1833, French physician Armand Trousseau reported that he had performed the operation 200 times and had saved more than 50 children with advanced diphtheria.
“This report convinced the doubters and detractors of the operation, and tracheostomy became widely acceptable to the medical profession,” wrote the authors of an article on the history of tracheostomy. Dr. Trousseau also invented a tracheal dilator, which is still in use today. Throughout the centuries, tracheostomy was primarily used to bypass airway obstruction. Other purposes—to clear secretions from the airway or to deliver oxygen to the lungs—didn’t come about until the 20th century.