Engines of Our Ingenuity

No. 1117:
HISTORY OF THE WOUND

by John H. Lienhard

Click here for audio of Episode 1117.

Today, we look for the history of the wound. The University of Houston's College of Engineering presents this series about the machines that make our civilization run, and the people whose ingenuity created them.

How long have we been helping our bodies to heal their wounds? Guido Majno looks at that question in his book, The Healing Hand. To answer it, we need to know how flesh responds when it's wounded. First, blood flows into the neighborhood of the wound, carrying white cells, antibacterial proteins, and liquid to flush out foreign matter. And so forms the battleground of inflammation.

If the level of infection is low, white cells clean up the mess and special repair cells, called fibroblasts, begin to fill in the wound and draw it closed. Then, very slowly, flesh rebuilds itself and replaces the scarlike fibroblast structure.

Of course that's a best-case scenario. When the body has to wage full-scale war against infection, healing is slower and permanent scarring -- even loss of members -- can result. The purpose of medical intervention is to avoid infection and arrange the wound to hasten healing.

We'd think wounds would be the focus of the earliest medical work. But, when anthropologists study our ancestors' bones and surviving stone-age societies, they offer some surprises. For example, we find little, if any, use of sutures and no knowledge of tourniquets. On the other hand, most late stone-age people did skull surgery -- probably to relieve certain head pains and possibly as part of forgotten religious rites.

Suturing is a fairly obvious means for closing wounds, but it also lets in infection. Even today, stitches are a poor idea when a wound is infected. While they didn't suture, some ancients used resin adhesives to close wounds.

The tourniquet seems obvious once we know how blood moves in our bodies. But without that knowledge we had only compresses and cauterization until medieval times. Many people bled to death.

Medicine has been a small but ever-present part of the written record since the earliest hieroglyphs. But those old tablets say far more about herbal medicine than surgery. Herbs were a princely art. Surgery was only a skill -- not a proper topic for writing.

Still, the 3700-year-old Code of Hammurabi offers clues about surgery when it sets doctors' fees. On the one hand, it says,

If a physician ... has opened the eye-socket of [an aristocrat] with a bronze lancet and has saved the ... eye, he shall receive ten shekels of silver.

On the other hand, it warns,

If a physician ... [should destroy] the aristocrat's eye, they shall cut off his hand.

We've taken wounds seriously for a long time. Once we start looking for evidence, we see clinical dimensions everywhere -- even in the Lamentations of Jeremiah, cries:

I am wounded at the sight of my people's wound; ...
Is there no balm in Gilead, no physician there? ...
You have tried many remedies, all in vain;
No skin shall grow over your wounds.

I'm John Lienhard, at the University of Houston, where we're interested in the way inventive minds work.

(Theme music)


Majno, G., The Healing Hand: Man and Wound in the Ancient World. Cambridge, MA: Harvard University Press: 1975.

I've used Majno's translation of lines from Chapters 8 and 46 of Jeremiah. These lines do not match the King James or Revised Standard translations. However, Majno has been assiduous in going to primary texts throughout his book and may also have done so here.


The Engines of Our Ingenuity is Copyright © 1988-1997 by John H. Lienhard.
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