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No. 1743:
The First Cut

Today, we cut into a human body. 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.

I've been thinking about ancient surgery -- in the stone age, in Mesopotamia, in all the shadowy past of our cuttings into the human body. Now: if you've ever watched an operation, one moment stood out over all others. It was the first incision.

Can anything be as willful or terrifying as consciously breaking into another person's body? Yet healers have been cutting into the body since long before recorded history.

I have trouble visualizing the state of mind that a person has to achieve to do that for the first time, or for the hundredth, with or without anesthesia. So, for guidance, I turn to contemporary surgeon, Richard Selzer. In his book, The Exact Location of the Soul, Selzer addresses that question.

"With a blend of arrogance and ignorance, the surgeon makes his incision ... ," he says. Later in the book, he elaborates:

I am still struck with a kind of dread that it is I in whose hand the blade travels ... that yet again this terrible steel-bellied thing and I have conspired for a most unnatural purpose, the laying open of the body of a human being.

If that's the voice of a modern surgeon, when did we first undertake this unnatural laying open of the body. Historian of ancient medicine, Guido Majno, offers two candidates for the first surgery. Both appeared about the same time as agriculture. One was done, not on humans, but on bulls. Castration turned bulls into oxen, which then became practical beasts of burden.

The other early operation is a huge surprise. It is no less than brain surgery. Majno traces a twelve-thousand-year history of surgeons cutting through the human skull -- in Europe, Africa, Asia and the Americas. These operations, once written off as ceremonial magic, were likely used most often to vent serious head wounds.

That's not to say magic was absent. I expect it took a belief in magic to undertake anything so radical. As one reads Selzer, the line between magic and technology is still blurred. When he gives advice to young surgeons, he tells neophytes to be in awe -- awe of what they're doing and awe of the older surgeon.

But Selzer chiefly tells the new surgeon to be in awe of the scalpel -- of the mystical act of making that first cut. The four-thousand-year-old code of Hammurabi, on the other hand, merely stipulates steep payments for eye surgery, and punishments for bungled operations -- no talk of magic there.

It is Selzer, speaking from the present day, who says, "Poised above the patient the surgeon is like a priest." But he also makes a remark that reflects his connection to the patient: "when a surgeon makes an incision," he says, "it is a self-inflicted wound."

Thus my search for Neolithic origins of surgery brings me to the modern surgeon. Whatever doctor, whatever age -- when the first cut is made, all surgery might as well be the first surgery.

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

(Theme music)

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

R. Selzer, The Exact Location of the Soul: New and Selected Essays. New York: Picador USA, 2001.

I am grateful to Seattle actor Megan Cole and Roberta Bivins from the UH History Department, for suggestions and counsel.

Nineteenth-century surgery with early use of anesthesia

Nineteenth-century surgery with early use of anesthesia