Ancient History - 14th Century
History of Otolaryngology Medicine and Surgery
For many centuries medical practices were handed down generation to generation by word of mouth (folklore). The earliest surgical writing, the Edwin Smith Papyrus dating back to about 1600 B.C., described the treatment of a fractured nose - “every "worm" of blood is to be removed, the displaced bone is to be forced back, and the nostrils packed with strips of linen saturated with grease and honey”.
One of the first medical writings dating back to 1550 B.C. was found in an Egyptian tomb at Thebes. Most of the information was "quack" remedies, with spells and incantations. The existence of the auditory or Eustachian tube was recognized in this writing by "the breath of life passes by the right ear, the breath of death by the left ear."
The Hindus document Sanskrit Atharvaveda, dating back to about 700 B.C. contained vague information about the throat such as quinsy (peritonsillar abscess), uvulectomy, and possibly tonsillectomy.
Hindu surgery dating back to the fifth century A.D. described the reconstruction of a new nose from flaps of tissue from the cheek or forehead of the patient. This was done to replace the loss of tissue caused when the nose of the patient was cut off as a punishment for adultery. Leaves from trees were used as patterns for the flaps, and the carving of gourds was used as a means of practicing the surgery.
Around the time of Hippocrates (born 460 B.C.), medicine was no longer considered magic and disease was considered a natural occurrence. Hippocrates is remembered for his noble ethical code, the Hippocratic Oath. His case records present precise detailed information demonstrating his unwavering attention to observation. Hippocrates was probably the first to examine the tympanic membrane and to recognize it as part of the organ for hearing. A sponge method, which Hippocrates used to remove nasal polyps, was used by rhinologists into the late 1800’s.
Aristotle (384-322 B.C.) was a philosopher rather than a physician, however, he provided basic information for anatomy and embryology. He dissected the ear in many animals.
Aulus Cornelius Celsus, a Roman nobleman in 30 A.D., wrote a medical encyclopaedia of eight books. He described the early tonsillectomy. He explained that hardened tonsils resulted from inflammation. To remove them, they needed to be separated all around with the finger-nail and torn out. He advised that if that was not possible, to grasp the tonsils with a hook and to remove them with a knife.
Aretaeus lived about 80 to 160 A.D. His writings are noted for his acute observation and perceptiveness. He made the earliest reference to tracheotomy for relief of suffocation.
Claudius Galenus (Galen) was born in Asia Minor in 131. His knowledge of anatomy came from the dissection of animals - dogs, pigs, and apes. He noted that the auditory nerve connected the outer ear with the brain, and that the outer ear collected the sound. It was Galen who first used the term "labyrinth" in referring to the inner ear. Galen stated that pitted or perforated bone should be removed after making an incision behind the ear. With this in mind, Galen may have been a pioneer of mastoid surgery. Galen said that the larynx was the instrument of the voice. At that time, many believed that the voice was sent forth by the heart.
After the fall of the Western Roman Empire in 476 A.D., there followed centuries of decline known as the Dark Ages.