THE WISDOM OF THE ANCIENTS

'Physicians of all men are most happy;
what good success soever they have the world proclaimeth,
and what faults they commit, the earth covereth.'

Francis Quarles

What unusual use did ancient Egyptians find for crocodile dung?

Bizarrely, crocodile dung was used as a contraceptive device in ancient Egypt. While the ancient Egyptians had a fairly complex and advanced system of medicine involving herbal drugs, poultices, laxatives, suppositories, surgery, bone-setting, ophthalmology, and even a system of health insurance, the vast majority of Egyptian treatments were totally ineffective, and sometimes even quite harmful. For example, one Egyptian cure for impotence contained 39 separate exotic ingredients, none of which would have had any useful effect.

Using crocodile dung as a method of contraception may sound pretty daft, but it was probably effective to some degree. The dried dung was used as a pessary, which would be inserted into the vagina. The idea was that it would soften as it reached body temperature, and thus form a secure, impenetrable barrier against the cervix. Cervical caps of this type are used as contraception today, although thankfully they tend not to be made of dung. Furthermore, the acidity of the crocodile dung would probably have acted as a mild spermicide, offering some additional protection.

Nonetheless, putting crocodile dung into your body in any form is not to be recommended. Dung is full of bacteria, parasites, and other germs, so there is a considerable risk of infection. It's also just plain gross. Other traditional pessaries down the ages have been made from elephant dung, tree sap, halves of lemon, cotton, wool, and natural sea sponges, and each of them was probably only about as effective as the others.

Which society believed dead mouse paste could cure toothache?

In ancient Egypt, one recommended cure for toothache was to apply a dead mouse to the tooth or gum. Alternatively, the patient could mash the mouse into a paste, and mix it with other ingredients before applying it.

The ancient Egyptians weren't alone is extolling the benefits of mouse poultices. In Elizabethan England, one cure for warts was to cut a mouse in half, and apply it to the offending pustule. The Elizabethans also ate mice, either fried, or baked in pies. As well as curing warts, mice were also believed to remedy whooping cough, measles, smallpox, and bed-wetting.

How do you remove a brain?

From around 3500 BC onward, the ancient Egyptians developed a complex system of mummification, preserving the corpses of their dead by drying them out, removing the internal organs, and wrapping the corpse in bandages. This practice may well have been inspired by the natural mummification which took place when bodies were buried in the arid Egyptian desert. Having observed that a body could be perfectly preserved after death, the Egyptians seem to have developed a belief that preservation of the body was necessary, if the spirit was to survive in the afterlife. They believed that the soul consisted of three separate spirits, and one of these, Ka, was intimately bound up with the physical body. Unless the body was preserved in this world, the Ka could not survive in the next.

The mummification process was a complex, painstaking ritual. The body would be taken to Ibu, the 'place of purification', and washed in the waters of the Nile. It would then be taken to Per-Nefer, the 'house of mummification', to be embalmed. First, the brain would be removed and discarded, as it was thought to be unimportant. Then, a small slit was cut along the left side of the body, through which the internal organs were removed, to prevent the body from decomposing from the inside. The kidneys would be discarded, presumably because the Egyptians thought they served no useful purpose. The heart was left in the body, as it was considered to be the centre of a person's being. The rest of the organs would be kept in jars, and placed in the coffin, as the Egyptians believed the reincarnated spirit would need them in the next life. For the same reason, the wealthy would be buried with their important possessions, jewellery, precious metals, sacred charms, amulets, books of spells, furniture, clothing, food, and even their mummified pets. The corpse would then be stuffed with incense and other material, to return it to a lifelike shape. The body would then be completely covered with salty 'natron' powder, for around 35–40 days, to dry it out, after which it would be restuffed, and then carefully wrapped in bandages.

When European explorers began to take a fresh interest in the Egyptians' lavish tombs in the 19th century, they were faced with a number of mysteries. One of these was the question of how the Egyptians had managed to remove the brains of their dead. There was no evidence of damage to the mummies' craniums, and yet the brains had been completely removed. How was this possible? The answer was simple: they went in through the nose. The embalmers would use a long wire with a hook on the end, which they would force through the nose, to scrape out the brain, chunk by chunk. Once all the brain matter had been removed, the inside of the skull would be washed, again via the nasal cavity.

Bizarrely, it seems that a similar technique may well end up having a dramatic effect on modern-day brain surgery. Until recently, the usual procedure for removing a brain tumour at the base of the skull was to remove either part of the skull, or part of the facial skeleton. Either method would cause dramatic blood loss and risk of infection, as well as considerable discomfort and scarring. However a new procedure, which is called Endoscopic Transnasal Brain Surgery, involves inserting an endoscope through the nose, and guiding it directly to the site of the tumour. The endoscope contains a tiny video camera, which transmits live images into the operating theatre. The endoscope also incorporates specially designed surgical tools, which can be used to dissect and remove the tumour. Because this new technique is far less damaging, it can reduce the recovery time after surgery to a matter of days, whereas conventional procedures take weeks or even months to heal.

When was plastic surgery invented?

Surprisingly perhaps, plastic surgery has been around for more than 3,000 years. In India, records have been found detailing ancient procedures for repairing a broken nose, and suturing to avoid scarring. Around 500 BC Hindu doctor named Susrata developed a procedure to repair noses which had been cut off as a punishment for adultery (for some reason, it was determined that the interloper in the marriage was most at fault, so it was this third party who would lose their nose). Susrata found a way to repair this shameful injury, which was of course intended to cause the maximum social stigma, by taking skin from the cheek or forehead.

In 1597 Italian doctor Gasparo Tagliacozzi improved the procedure by lifting a skin flap from the arm and stitching it on to the nose, while it was still simultaneously attached to the arm. Once the graft had taken hold, the flap would be cut free from the arm. There was considerable demand for nose surgery in Europe from the 15th century onwards, due to the dreadful effects of syphilis, which could cause sufferers to lose their nose.

However, before the development of effective anaesthetics in the 1840s, any kind of surgery was incredibly painful, not to mention dangerous, so the idea of plastic surgery for purely cosmetic reasons was unthinkable. Interestingly, the word 'plastic' in the context of plastic surgery doesn't mean artificial, and nor does it refer to the materials used. Instead, it comes from the Greek word 'plastikos' which means to mould or shape, in the same sense that ceramics and sculpture are known as the 'plastic arts'.

Do doctors give an oath vowing never to perform euthanasia, abortion, or surgery of any kind?

Hippocrates (c. 460–377 BC) is regarded as the father of modern medicine. He was born on the island of Cos, and he and his followers published a great number of medical texts, which formed the foundation of Western medicine until the Enlightenment. Hippocrates was the first doctor to reject the prevailing superstitious belief that illness was caused by the gods. Instead, Hippocrates argued that illness was the product of the patient's environment, diet, and lifestyle, and that therefore professional physicians could bring about natural means of healing, without requiring the intervention of the gods. The Hippocratic school left behind around 60 works, which are known as the Hippocratic corpus, and which formed the basis of medicine until the nineteenth century.

To address concerns about the ethics of medical practice, Hippocrates and his followers produced a detailed oath, to demonstrate the physician's devotion to his art, and to the patient. It is in this oath that the first principle of Hippocratic medicine is outlined: 'primum non nocere', which means 'to do no harm'. A version of this oath is still taken by the majority of doctors today. However, when people refer to the Hippocratic Oath nowadays, they often mean the principle that anything told to the doctor must be treated as confidential, and it is true that this is one of the principles of the oath. However, the oath also contains a number of other points. Here is the original oath in full:

I swear by Apollo the healer, by Aesculapius, by Health and all the powers of healing, and call to witness all the gods and goddesses that I may keep this Oath and Promise to the best of my ability and judgement.

I will pay the same respect to my master in the Science as to my parents and share my life with him and pay all my debts to him. I will regard his sons as my brothers and teach them the Science, if they desire to learn it, without fee or contract. I will hand on precepts, lectures and all other learning to my sons, to those of my master and to those pupils duly apprenticed and sworn, and to none other.

I will use my power to help the sick to the best of my ability and judgement; I will abstain from harming or wronging any man by it.

I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing. Neither will I give a woman means to procure an abortion.

I will be chaste and religious in my life and in my practice.

I will not cut, even for the stone, but I will leave such procedures to the practitioners of that craft.

Whenever I go into a house, I will go to help the sick and never with the intention of doing harm or injury. I will not abuse my position to indulge in sexual contacts with the bodies of women or of men, whether they be freemen or slaves.

Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one.

If, therefore, I observe this Oath and do not violate it, may I prosper both in my life and in my profession, earning good repute among all men for my time. If I transgress and forswear this oath, may my lot be otherwise.

(Translated by J Chadwick and WN Mann, 1950)

The highlighted lines do seem to state that takers of the oath will not perform euthanasia, abortion, or surgery, so how do today's doctors reconcile this oath with modern medical practices? The simple answer is that they take an amended version of the oath. The most common oaths taken today are the Declaration of Geneva, the Prayer of Maimonides, the Oath of Lasagna, and the Reinstatement of Hippocratic Oath. All four are based on the Hippocratic Oath, and contain many of the same vows, but each is amended to be more appropriate for modern ethics and medical practices.

Most graduating medical students today take one of these four versions of the Hippocratic Oath before going out into the world to practise medicine. In a survey of the oaths taken in 150 US and Canadian medical schools in 1993, it was found that only 14% forbade euthanasia, 8% prohibited abortion, and only 3% banned sexual contact with patients. The line referring to surgery is usually retained in some form, but in today's oaths it is treated as a metaphor, the purpose of which is to acknowledge that no doctor can maintain expertise in all fields.

Where do maggots come from?

Maggots are the larvae of flies. They emerge from eggs, which have usually been laid directly onto the kind of thing that flies consider to be food, such as rotting animal corpses. However, for centuries people believed that maggots would simply emerge from a corpse, in a process called 'spontaneous generation'. In other words, people believed that living things could be generated from non-living things, without the presence of an egg, larva, or parent. Spontaneous generation was the accepted explanation for the origins of many types of creature for over 2,000 years.

The theory of spontaneous generation was notably advanced by Aristotle (384 BC–322 BC) in his text 'The History of Animals'. Aristotle believed that fleas and maggots emerged spontaneously from rotting flesh, that mice were created by piles of dirty hay, and aphids would magically arise from the morning dew. Of course, some creatures were obviously produced by parents, and Aristotle recognised this, but he thought there was also another class of creatures, which could emerge from non-living things. Astonishingly, this theory of spontaneous generation held sway until as late as the 19th century.

However, with the development of increasingly powerful microscopes, scientists began to observe smaller and smaller life forms, which once again raised the question of generation – were these tiny micro-organisms proof of spontaneous generation, or did they show that there was a whole world of tiny lifeforms about which we knew nothing? A Dutch scientist named Anthony van Leeuwenhoek observed tiny creatures in the microscopes he expertly built for himself, and he called these tiny lifeforms 'animalcules'. Van Leeuwenhoek noticed that living microorganisms would appear in rainwater after just a few days, which raised the question of where they had come from.

In the 18th and 19th centuries, a series of experiments would conclusively answer this question, and in the process they would pave the way for modern, effective medicine. In 1748, John Needham performed a series of experiments on jars of meat broth. Needham believed that boiling the broth would kill any living animalcules, and so when the broths turned cloudy soon afterwards, indicating that they gone off, this confirmed his theory that the animalcules must have spontaneously emerged from the broth. In 1765, Lazzaro Spallanzani carried out a similar experiment, but unlike Needham he sealed the lids of the jars, making them airtight, to prevent any contaminants from getting into the jars after boiling. Because the jars had been sealed, the broth did not produce any microbes, which seemed to disprove the theory of spontaneous generation. However, suuporters of the theory argued that no air had been allowed to reach the broth, and that air was one of the elements which was crucial in somehow facilitating spontaneous generation.

In 1859, Louis Pasteur resolved this difficult impasse, by boiling broth in a specially designed swan-necked flask, which had an extremely long, thin neck which curved downwards. This neck would allow air to reach the broth, but no micro-organisms could navigate the narrow bend. After boiling, the broth in the swan-necked flasks remained free of microbial growth, demonstrating that air alone wasn't sufficient to generate micro-organisms. This elegant experiment, which could be easily repeated and tested by anyone, provided a powerful refutation of the theory of spontaneous generation, and was thus a key moment in the development of what became known as 'germ theory'.

How was Julius Caesar born?

There is an enduring myth that the Roman leader Julius Caesar was born by Caesarian section, and that consequently the operation was named after him, or alternatively that he was named after the operation. This story is widely known, and has even made it into the Oxford English Dictionary. Nonetheless, it is almost certainly false.