The Evolution of Medicine

By Andrew Olearchyk and Renata Olearchyk

The book entitled «The Evolution of Medicine» was composed using a novel approach of presenting in a chronological order the theoretical and clinical medicine from the prehistoric times to the 20th century and the beginning of the 21st century, based on the significant contribution of the known, less known and unknown individuals. Dedicated for medical students and physicians.

• Language: English
• Publisher: AuthorHouse
• Release date: Aug 23, 2020
• ISBN: 9781728361185

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© 2020 Andrew & Renata Olearchyk. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 08/21/2020

ISBN: 978-1-7283-6119-2 (sc)

ISBN: 978-1-7283-6118-5 (e)

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CONTENTS

ABOUT THE AUTHORS

ANNOTATION

FOREWORD

PREHISTORIC MEDICINE

ANCIENT (ARCHAIC) MEDICINE

MEDIEVAL MEDICINE

THE RENAISSANCE

THE 17TH HCENTURY

THE 18TH CENTURY

THE 19TH CENTURY

Аnatomy, histology and embryology

Physiology

Biochemistry

Міcrobiology and immunology

Pathology

Genetics and immunology

Physics and radiology

Pharmacology

Internal mediсine. Medicine

Аnesthesiа

Surgery

Gynecology and obstetrics

Diseases of the skin (dermatology)

Diseases of the eyes (oculistics, ophthalmology)

Neurology

Psychiatry and psychology

Health Welfare

THE 20TH CENTURY AND THE BEGINNING OF THE 21TH CENTURY

Аnatomy, histology and embryology

Physiology

Biochemistry

Міcrobiology and immunology

Pathology

Genetics and immunology

Physics and radiology

Pharmacology

Internal medicine. Medicine

Аnesthesiology

Surgery

Gynecology and obstetrics

Pediatrics

Dermatology

Оphthalmology

Neurology

Psychiatry and psychology

Rehabilitation

Forensic medicine

Space biology and medicine

Medical statistics

Health care

REFERENCES

ABBREVIATIONS

ABOUT THE AUTHORS

Andrew S. Olearchyk (1935 – ), Medical Doctor (MD), graduated from the Medical University of Warsaw (1961), 1st degree specialist in anesthesia (1964) and general surgery (1965), Poland; Diplomate of the American Board of Surgery (АBS, 1976-86) and the American Board of Thoracic (and Cardiac) Surgery (ABTS, 1983-2023), Fellow of the American College of Surgeons (FACS, 1984 –) and Honorary Member of the Association of Cardiovascular Surgeons (ACVS) of Ukraine (1996–). Authored 214 scientific works, including 204 papers, five monographies and five books.

Renatа Мaria Оlearchyk, nee Sharan (1943 – 2019), Master of Arts (MA), graduated from the Department of Sociology of the University of Pennsylvania with the degree of Bachelor of Arts (BA, 1965), and from the Department of Sociology and Anthropology of the Brown University with the degree of MA (1968) and Philosophiae Doctor (PhD) Candidate, the United States of America (USA). Аuthored 12 scientific works, including seven papers, three monography and two books. – Memory Eternal!

ANNOTATION

Olearchyk A.S., Olearchyk R.M. The Evolution of Medicine. Book Publ. «AuthorHouse», Bloomington, IN 2020. – Pages (p.) 660.

The book entitled «The Evolution of Medicine» was composed using a novel approach of presenting in a chronological order the theoretical and clinical medicine from the prehistoric times to the 20th century and the beginning of the 21st century, based on the significant contribution of the known, less known and unknown individuals. Dedicated for medical students and physicians.

FOREWORD

The work by Andrew and Renata Olearchyk «The Evolution of Medicine» is an extension of their’s previous writing entitled «Concise History of Medicine» (1991)¹ and «Basic Science and Clinical History of Medicine» (2016)².

The prominent personalities, physician-scientists and others, the known, less known and unknown, who have made a significant contribution to the development of theoretical or clinical medicine are identified by the first, middle and last name, birth date, birth and death dates, nationality or country of origin and specialty. Some of them were connected to two or more countries. When the national origin of the particular individual was not clear or debated, we added to his data the place of birth and death. In some instances those date were not available.

The chronology of events was followed by the era (epoch) and traditional lay-out of branches of the theoretical and clinical medicine as clearly outlined in the «Contests», and within a particular epoch or branch of medicine by the person’s birth date. Difficulties to properly place a person chronologically when the birth data was not available, but in those instances we were guided by chronology of their description, discoveries or innovation.

When the name of a particular individual had to be added further in the text for the second or more times within this same branch of medicine it was marked by his first and last name followed by direction «above», or with exemption – «below». If the name of a particular person had to be added further in the text for the second or more times in the different branch of medicine or different era, then it was marked by his first and last name, birth and death date, that era and branch of medicine, without repeating its nationality and specialty.

We omitted the information of the cited individuals about family affairs, education, professional positions, memberships or prizes. It is because in this concise review we concentrated only on their descriptions, discoveries and innovations which benefit humanity. The other reason for that is to give the reader an opportunity to further enlarge his knowledge in chosen specialty while reading our work.

Medicine is the science and the art of the diagnosis,

prevention and treatment of diseases.

PREHISTORIC MEDICINE

As defined by paleopathology, Prehistory extends from the Paleozoic Era 600 million (mln) years ago to the discovery of the calendar and the invention of writing circa (c.) 4000 Before Christ (BC)³.

The remains of animals from the Paleozoic Era (600-225 mln. years ago) and of humans from the Paleolithic Period (3 mln years ago – 10,000 BC) revealed bone injuries and diseases. A femur of Homo erectus (c. 1.5 mln years ago – 250,000 BC) showed a tumor or re-growth after trauma.

The prehistoric people have the experience with electric current observing lightning, creating fire by rubbing one stone against the other. The electrical phenomena are intimately involved in such processes as heart beat, muscle action and nerve transmission.

In the near-by village of Mauer, 10 km south-east from the city of Heidelberg (founded in the 5th century), Germany (area 357,168 km²), one of the oldest known human bone part – mandible, named «Mauer1» of the oldest known specimen of the genus Homo sapiens, that is the «Haidelberg Man» who died 600,000 ± 40,000 years ago, was found in 1907 by Otto Schoetensack (1850 – 1912) — German physician and anthropologist.

In Prehistoric Ukraine (area 603,628 km²), the lower Paleolithic sites of the Acheulean (500,000 – 100,000 BC) and Mousterian (100,000 – 40,000 BC) Periods were discovered (1975) near the village of Koroleve on the Tysa River)⁴, Vynohradiv Region, Zakarpatska Oblast (area 12,777 km²)⁵.

Neanderthal Homo sapiens – intelligent humans (100,000 – 35,000 BC), suffered from an inflammation of a joint (arthritis). Remains of a Neanderthal adult male and one-year-old child from the middle Mousterian Period were also found in the Kyik-Kobe cave, Crimea (area 26,100 km²), Ukraine.

In the capital of Ukraine, Kyiv (founded 482) on the Dnipro River⁶, a man first appeared in during the late Paleolithic’s early Magdalenian Periods (Kyrylivka settlement, 18,000 BC).

A Paleolithic drawing of a mammoth, found in El Pindol cave in Spain (area 505,992 km²) and drawn in red ochre, is an anatomic illustration, showing a leaf-shaped dark area at the shoulder, and in all likelihood is intended to depict the heart.

The American Indians probably migrated to Northern America (area 24,709,000 km²) from Northern Asia across the Bering Straight (c. 38,000 BC – c. 18,000 BC), reached the southern tip of South America (area 14,840,000 km²; 6000 BC). Their physicians, or «medicine men» – shamu, witch doctors or sorcerers, religious helpers or ministers of worship, cared for the sick, introduced the leaves of the coca plant (Erythroxylon coca) – a strong stimulant containing alcaloid cocaine which they have been chewed, snored for recreation or recovery of one’s health or strength and used for local (topical) anesthesia during operations on the skin and mucous membranes. They also introduced curare and quinidine, cured tropical «intermittent fever» with the tincture of the cinchona (Cinchona pubescens) tree bark which contains quinine, set up broken bones and on occasion formed a curing society at the time of the pre-Inca and the Inca civilization and empire (area 2,000,000 km² in 1527)⁷.

Trepaning of the skull, also known as (a.k.a.) trepanation, trephination, trephining (in Greek – «trypanon», meaning borer), making a bur hole, or craniotomy is a prehistoric surgical procedure in which a hole is drilled or scraped in the human skull in order to expose the dura mater – a thin most external membrane of three layers of the meninges covering the brain and spinal cord, in the belief it will cure epileptic seizures, migraine and certain mental disorders⁸,⁹.

The earliest known trepanations were performed in North America by the Indians, in Ukraine and in France (area, metropolitan 551,697 km², total 674,843 km²).

Аlso, during the pre-Inca and the Inca civilization and empire, the Indians performed trepanations of the skull under local anesthesia with a mixture of the coca leaves and saliva, using stone instruments, with 50% long-term survival.

The practice of trephination of the scull with survival on the banks of the Dnipro River in Mesolithic times dates to approximately 12,000 BC.

The clear examples for trephining of the skull was identified from a Neolithic burial site near the town of Ensischeim (known from the Old Neolythic era), the Haut-Rhin Departament (area 3,525 km²) in the Grand Est Region (area 57,533 km²) of France, dating to 6,500 BC, 5100 BC and 4900 BC were well preserved skeletal remains of an approximately 50-year-old man whose cranium showed clear evidence of two bur holes. One burr hole had fully healed, and the other partially so, indicating the subject survived the operation.

In the Neolithic Period (c. 10,000 – c. 3000 BC) peoples shifted from food-gathering to food-producing, and one can assume that medical herbs were among the plants grown. The Neolithians are known to have suffered from tuberculosis of the spine. At approximately that time (c. 10,000 BC) the first known surgical instruments were believed to be developed¹⁰, and the health care providers in Europe and Peru continued to perform surgical procedures, including craniotomy which showed healing of the bones edges, indicating a recovery (c. 8000 BC).

ANCIENT (ARCHAIC) MEDICINE

It extends from the beginning of recorded time by calendar and writing (c. 4000 BC) to the fall of Rome (founded 753 BC) — the capital of the Roman Empire (area 6,500,000 km² in 117) and of Italy (area 301,338 km²), in 476.

A few northern wise men named Abarys (3000 BC – 1000 BC) were spreading in Ukraine the traditions of northern Paleolithic shamans (priestly sorcerers) and pagan priests.

The oldest medical text written in southern Mesopotamia (4000 BC - 539 BC)¹¹ is a collection of cuneiform tablets, known as «Physicians Collection of Empiric Prescription» (Summer, c. 2,700 BC). It contained, among others, a reference to tuberculosis, attacks of epilepsy, extract from the willow tree bark and other plants rich in salicylic acid used to treat pain, fever, inflammation, and infection.

The god Еа, the Lord of Water (Babylonia, 2000 BC.) was the first great cosmic ancestor of physicians. His grandson Nabu, ruled over all science, including medicine, and to him temples were erected at the developed medical schools.

The healing god, Ningishzida, was depicted with a double-headed snake which since then became the emblem of the medical profession.

The code of Hammurabi (Babylonia, c. 1790 BC) contains the earliest known regulation of the practice of medicine. Among other causes which allowed to return of the purchased slave were epileptic attacks. It stated, «If the doctor, in opening an abscess, shall kill the patient, his hand shall be cut off».

Medical knowledge in Egypt (area 1,001,450 км²; 4000 BC – 642 AD) was condensed in papyruses and the «Hermetic Collection».

The first images of tracheostomy, id est (i.e.), incision and entrance into the trachea through the skin and fascia in the middle of the anterior neck, are carved on the two Egyptian stone slab (stele) dating back to c. 3600 BC, and artificial teeth were created c. 3500 BC in Egypt.

Since the Early Kingdom (3000-2800 BC) Egyptians performed catheterization of the urinary bladder with bronze, gold or silver instruments, and by the 3rd century BC, dilatation of the urethral strictures with an S-shaped catheter.

The Egyptians had experience with electricity dating back to 2,750 BC through the electric fish that can generate electric field (electrogenic) or detect electric fields (electroreceptive), and were aware of shock from the electric fish. They called this fish the «Thunder of the Nile»¹², and the «protector» of all other fish.

The god Тhoth was a physician to the gods, a patron god of physicians and scribes. He later was replaced by Imhotep (с. 2650 – c. 2600 BC), a historic personage, who became the chief healing god of Egypt and was bestowed with a divine father, the god Ptah.

Egyptians linked the anatomical and physiological makeup of the body to a system of channels («metu») with the heart as its center. The spead of a person’s heart beat was related to his physical condition. The brain was recognized as the sensory and motor center.

Medical classification was based on symptoms and signs.

Degeneration with arteriosclerosis and atherosclerosis/atheromatosis (AS) and calcifications of aorta (Ao), coronary, carotid, iliac and femoral arteries were common in ancient Egypt¹³.

The treatment consisted of a vast pharmacopea. Specially, selected mold (mould), extract from the willow tree bark and other plant were used to treat pain, infection and inflammation

Gigantism, a.k.a. giantism (in Greek – «gigos», meaning «giant», plural – «gigantes») and acromegaly (in Greek – «acron» + «megas» meaning «large») are rare diseases caused by a benign tumor, a.k.a. as pituitary gland (hypophysis) adenoma (95%) within the lateral wings of the anterior portion of the hypophysis of the brain which produces a chronic excess of growth hormone (GH) or human growth hormones (HGH) or somatotropin – a peptide that stimulate growth, cell reproduction and regeneration in humans and animals, and insulin-like growth factor-1 (IGF-1). While both gigantism and acromegaly have a similar etiology (cause of diseases) and pathology (in Greek – «pathos» meaning experience, suffering, «-logia» meaning to study of), gigantism occurs in childhood, and acromegaly occurs in adulthood.

Hyperfunction of GH and IGF-1 leads to the development of excessive enlargement due to thickening of the bones and soft tissues of the skull, face, jaw, long bones, hand, feet and organs.

The condition is accompanied in some patients by diabetes mellitus (DM) and typically loss of vision laterally in one, or both visual fields (bitemporal hemianopsia) due to pressure or infiltration of the medial fibers by tumor at the cranial II (optic) nerve chiasm, or optic chiasma (in Greek – «chiasma» meaning crossing, decussation), located in the forebrain at the base of the skull before the Turkish seat (sella turcica).

Chronic excess of GH production induces the development of cardiomyopathy (CM) characterized by biventricular hypertrophy of the heart, myocardial necrosis, lymphocytic infiltration and interstitial fibrosis in about 3% of patients, congestive heart failure (CHF), hypertension (HTN), coronary artery disease (CAD), or ischemic heart disease (IHD), arrhythmias and cardiac valve disease.

Those patients has an average 10-year reduction of life expectancy compared to the general population, and at least a doubling of standardized mortality rates.

Treatment is surgical removal of not large pituitary tumor using endonasal transphenoidal approach or transphenoidal approach, stereotactic radiosurgery, and/or pharmacological with the somatostatin analogue or GH receptor antagonist, radiation therapy, and control of cardiovascular risk factors. With the adequate treatment life expectancy is typically normal.

The oldest case of gigantism, although in a mild form, was that of Sanakht or Hor-Sanatht [? – intered in the large mastabaK2 (meaning «house for eternity» or «eternity house»), village of Beit Khallaf, 10 km west of the city of Girga in the Sohag Governorate (area 1,547 km²) on the west bank of the Nile River in the Upper Egypt] — Egyptian King (Pharaoh) who reigned 18 years, or less, beginning 2650 BC [3rd Dynasty during Old Kingdom (2800-2250 BC)]. He was a very tall men who would have stood at around 187 cm (or even 198 cm) tall. His skull was very large and capacious, cranial index unusually broad and almost bradycephalic (in Greek – meaning «short» and «head»), that is the shape of his skull was shorter than typical. However, his overall cranial features were close to those of dynastic period of Egyptial skulls. The jaw had a trace of thickness. The long bones of the skeleton attested to a fierce growing up which is obvious sign of gigantism. The proportion of his long bones were tropically adapted like those of most other ancient Egyptians, especially those from prehistoric period.

Pharaoh Sanakht was really huge, much taller than other Egyptians of that time, who would have been closer to 160 cm on average. While the Egyptian royalty were generally taller on average 170 cm, the highest being Ramesses or Ramsess II (1303 – 1213 BC ) — New Kingdom Pharaoh of Egypt of the 19th Dynasty, who reigned between 1279 and 1213 BC, and whose height was 175 cm, because of better nutrition and stronger health than commoners. However, pharaoh Sanakh was much taller than all the others.

By c. 2500 BC Egyptian physicians had developed a systematic treatment of diseases. They introduced circumcision, pressure control of bleeding, adhesive tape, splinting and fixation of fractures, sewing up wounds, cautherization with a fire-drill, drainage of abscesses, surgical removal of an appendix (appendectomy), wiring of teeth, dental prostheses, contraception and embalming.

The earliest reference to circumcision during transition from boyhood to adulthood dates back to around 2400 BC, including a flint-knife circumcision and the use by a surgeon of «the ointment is to make it acceptable», likely refering to some form of topical and antiseptic agents.

A statue of swollen limbs of Nebhepetre Mentuhoten II (? – 1995 BC) — Pharaoh of the 11th Dynasty (reigned c. 2061 BC – 2010 BC) indicates that as early as c. 2000 BC the inhabitants of the Nile River Valley suffered from filariasis, a parasitic disease caused by infection with roundworms of the Filarioidea type which spread by blood-feeding black flies and mosquitoes. The adult forms usually stay in the skin and realease early larval form, known as microfilariae, which penetrate the lymphatic vessels and the lymphatic nodes (LN), subcutaneous (SC) tissue and serous cavities of the joints, thorax and abdomen. But the most common is lymphatic filariasis which in its chronic stage may cause a huge swelling (elephantiasis) of the limps, usually the lower extremities and the scrotum, as evidenced by a statue of Mentuhopen II.

The Edwin Smith papyrus (c. 1600 BC)¹⁴ describes 48 cases, mostly of body trauma (wounds, joint dislocations, bone fractures, penetrating wound of the cervical esophagus) and tumors, its surgical treatment, excluding a breast cancer with the conclusion that «there is no treatment». There are some sections on gynecology and cosmetics on the verso.

The Ebers papyrus (1550 BC)¹⁵ mention angina pectoris, a sign of an insufficient blood flow to the heart muscle causing myocardial ischemia – a principal sign of CAD. It describes asthma or bronchial asthma (in Greek- «aazein», meaning «sharp breath»), a paroxysmal, often allergic disorder of respiration characterized by bronchospasm, wheezing, and difficulty in expiration, treated by drinking of incense mixture of «kyphi», including six ingredients (cassia, cinnamon, mastic, mint, henna and mіnosa). It also describes symptoms of the slowly progressing chronic neurological disorder of the central nervous system (CNS) in the older population, resembling paralysis agitant, or shaking palsy, characterized by tremor at rest, shaking, muscular stiffness or rigidity, slowness, or limitation of movement (hypokinesis), difficulty in walking and postural instability, also inconsistency, fearfulness and anxiety, dementia, depression, behavioural, emotional, sensory, sleeping and thinking problems. It also contain description of epileptic attacks, and tracheostomy.

The Ebers papyrus mention a xerographic (in Greek – «xenos», meaning «foreign» or «strange»), or heterologous split-thickeness skin graft (STSG), which include the epidermis and part of the dermis harvested from animal (frog) to cover the wound of a patient.

Probable, both those papyruses were composed by Іmhоtеp (Іmhоtеp (c. 2650 – c. 2595 BC; above).

Аs evidenced by the carved images on a stele from the 18th Dynasty (1403-1365 BC), the Egyptians were familiar with poliomyelitis, or infantile paralysis, as depicted by children walking with canes and adults with withered lower extremities.

The Pharaoh Merneptah or Mereptah, the forth ruler (1213 BC – 1203 BC) of the 19th Dynasty died at young age with a bald head, obese abdomen and arteriosclerosis / atheromatosis (AS) of the Ao.

The rectum (in Latin – rectum intestinum, meaning straight bowel) is the terminal portion of the large bowel, about 12 cm in length, which begins at the end of the sigmoid colon in the rectosigmoid junction at the level of the 3rd sacral vertebra or the sacral promontory, ends in the anorectal ring at the level of the puborectalis sling¹⁶ or the dentate line. Consist of the pelvic and perineal divisions.

The anal canal (in Latin – ring), the lower end of the gastrointestinal (GI) tract situated between the rectum and anus, below the the level of the pelvic diaphragm in the anal triangle of the perineum, in between the right and left ischioanal fossa, is divided in three parts. The upper two third of the anal canal, located above the dentate (pectinate) line is lined by tunica mucosa of simple columnar epithelim The lower one-third of the anal canal, located below the pectinate line is divided into two zones separated by the white line into the zona hemorrhagica lined by stratified non-keratinized epithelium, and the zona cutanea lined by stratified keratinized epithelium.

The blood supply to the rectum and the anus from the superior rectal artery, a branch of the inferior mesenteric artery (IMA), the middle rectal artery, a branch of the internal iliac artery (IIA), and the lower rectal (hemorrhoidal) artery, a branch of the lower pudental artery from the IIА. The venous return is formed in the subcutaneous, submucosal and subfascial plexuses, with flow away of the venous blood via the superior rectal vein into the portal vein system, the middle and the inferior rectal vein into the inferior vena cava (IVC) system. The most prominent venous plexuses of the submucosal layer are built in the form of cavernous bodies which are widely anastomosed with arteries and arterioles¹⁷. The cavernous bodies are located at the numericals 3, 7 and 11 of the face of a clock in the supine patient. Therefore, in the wall of the rectum there are porto-caval anastomoses which may form hemorrhoids (in Greek –hemo = blood, rео = flow), also called piles.

Internal hemorrhoids, located above the pectinate line lack of pain and temperature receptors, but are prone to prolapse, while external hemorrhoids, located below pectinate line are sensitive to pain and temperature. Internal hemorrhoids are classified into four grades depending on the degree of prolapse:

The first known mention of hemorrhoids which affect the sedentary people between 45 and 65 years of age, more common among the wealthy and constipated, is from a 1700 BC Egyptian papyrus. The Egyptian physicians treated hemorrhoids with acacia leaves, ground, filtered and cooked, then smear of a fine linen there with and placed on the anus.

Acute paraproctitis is a bacterial purulent inflammation of the cellular tissue surrounding the rectum, occurring usually in patients with diabetes mellitus (DМ) and lowered resistence to infection as a result of depressed immune system¹⁸. The most common cause is the hematogenous or lymphonenous spreads of infection from neighbouring organs, surrounding cellular tissue, from infected one or all the 6-8 anal gland present in each of anal crypt, from trauma, rarely with formation of an abscess.

According to localization there are subcutaneous, submucosal, ischiorectal, retrorectal and pelvirectal acute paraproctitis. Acute ischiorectal paraproctitis is usually associated with transsphincteric or extrasphincteric¹⁹, while retrorectal and pelvirectal with an extrasphincteric route for rectal fistula.

The symptom are acute pain in the rectal region, tenderness during defecation, fever, an infiltrate in the anal region or on the buttocks.

In the early stages acute paraproctitis should be treated conservatively, otherwise in the case of an abscess formation surgical intervention is necessary. Subcutaneous, submucosal and transsphicteric ischiorectal abscesses should be incised and drained (I & D) over the fluctuation areas around the anus with excision of the internal opening of the anal canal, i.e., the anal crypt, while retrorectal and pelvirectal abscesses should be I & D through the skin or mucous membrane from the side of the rectum. Undrained pararectal abscess may penetrate the rectal wall.

In general, anal / rectal fistulae, a tubular purulent tracts arise on the basis of an acute infection in the tissue surrounding rectum and anal canal²⁰.

Anal / rectal fistulae depending on relationship with the internal and external sphincter muscles are divided into:

(1) Extrasphinteric fistulae which begin at the rectum outside the dentate line, or sigmoid colon, proceed downwards, through the levator ani muscle and open into the skin surrounding the anus.

(2) Suprasphincteric fistulae begin between the internal and external sphincter muscles, extend above and cross the the puborectalis muscle, proceed downwards between the puborectalis and levator ani muscles, and open 2.5 cm or more away from the anus.

(3) Transsphincteric or «horseshoe» fistulae begin between the internal and external sphincter muscles or behind the anus, cross the external sphincter muscle, may take a «U» shape and form multiple external opening a 2.5 cm or more away from the anus.

(4) Intersphincteric fistulae begin between the internal and external sphincterr muscle, pass through the internal sphincter muscle, and open very close to the anus.

(5) Submucosal fistulae pass superficially beneath the submucosa and do not cross either sphincter muscle.

Consevative treatment of chronic paraproctitis (anal / rectal fistulae) include sitz baths, warm compresses with 20% ethyl alcohol and antibiotics. Surgical treatment is indicated for chronic and recurrent fistulae.

The surgical approach to anal / rectal fistulae was initiated in Egypt by the use of a seton (in Latin – «seta» meaning «bristle») – a drain made of gauze for infrasphincteric and submucosal fistulae and a seton stitch for more complicated transsphincteric and suprasphincteric fistulae.

The use of the seton stitch require passing a surgical-grade cord through the fistula tract, so that the cord creates a loop that joint up outside the fistula. The cord provides a path that allows the fistula to drain continuously while it is healing, rather than allowing the exterior of the wound to close over. Keeping the fistula tract open helps to prevent the trapping of puss or other infectious debris in the wound. The seton can be tied loosely or tightly, with different material, depending on the anatomical location and surgical requirerement. It might be lied loosely as a palliative measure to avoid painful and septic exacerbations, or as temporary measure before surgical excision. It may be tied with more tension and tightened periodically, cutting through tissue inside the loop while scaring behind the loop, fnally «pulling out» the completely healed fistulous tract without operation.

The papyrus contain the first description of examination, diagnosis and treatment of mandible fractures.

While Herodotus (c. 484 BC – c. 425 BC) — Greek historian, «father of history», refered to Egyptians as the «healthiest of all men», Pliny the Elder (23 AD - 79 AD) — Roman writer, naturalist and philosopher, called Egypt «the motherland of disease». The fact is that the Egyptians recognized and treated a great variety of illnesses.

In Ukraine the famous Trypilian culture was created (4000 BC – 2000 BC).

In Ukraine-Scythia (the 7th - 3rd century BC) herbal medicine and some surgical procedures were in common use. The sorcerer - physicians Abarys the Hyperborean (hyperborean = «the extremely northern») — likely descendant of the northern shamans and sorcerers of the 3000-1000 BC, Anakharsys (c. 610 BC – 535 BC) and Toxar or Toxarys (c. 650 BC – 575 BC), used medical herbs to increase blood coagulability, to treat ulcers and to induce anesthesia (poppy seeds, hen-bane, mandragor). Bathhouses were widespead.

Scythian physicians performed teeth pulling, debridement, suturing with horse hair and bandaging of the wounds, phlebotomy, reduction of dislocations (luxations) and fractures, amputation of extremities, trepanations, embalming and mumifications.

Меdea (6th BC – 1st century BC) — a mythical princess of the Kingdom of Colchida on the Eastern Black Sea shores (the 4th century BC – the 2nd century AD) and Scythian physician who discovered the dye for dyeing the gray hair.

The Scythia Northern Black Sea shores were under the rule of Mithridates VI (134 BC – 63 BC) — King of the Pontus Empire on the Southern Black Sea shores (291 BC - 63 BC) who left a legacy in the Scythian culture as an experimentor with poisons (mithridatism) and anti-poisons (mithridatica, mithridatium) which he described in his treatise «Теriak».

The Scythians are also the inventors of trousers.

North Macedonia (area 25,000 km²) and South Macedonia (area 34,177 km²) is populated since 270,700 BC, its recorded history begins since 808 BC and the Argead dynasty since 750-700 BC.

During the reign of Alexander the Great (356 BC – 323 BC) — the second King of Macedonia (336 BC – 323 BC), tоurniquets made from strips of bronze or leather were used to surround and apply pressure onto the proximal extremity to stanch (staunch) the bleeding of wounded soldiers.

Greece (area 131,957 km²) originated from the Aegean or Myceanean civilization (3000-1100 BC).

The principal god was Apollo’s son, Asclepios (Aesculapius) of Thessaly. He was usually depicted with his sons, Machaon and Podalirios, the patron gods of surgeons and physicians, and with his daughters, Hyegeia and Panacea, goddesses of health and remedies. Asclepios became a god after his death.

The Greek experience with electic current was by noting that amber attached small object when rubbed with fur, and this phenomenon they named «electron» (in Greek – «amber»).

Homer (8th – 7th century BC)²¹ — Greek poet, in his poem «The Іliad» was the first to use word asthma (Ancient medicine. Egypt) and depicted the wounds of the heart, inflicted by a spear during the battle with a subsequent sudden cardiac death (SCD) from hemorrhage (c. 450 BC). Particularly, Sarpedon — son of Zeus — king of gods and chief god of the heaven, thunder and lightning and of Laodamia, king of Lycia in the south-west coastline of Asia Minor / Anatolia (area 756,000 km²), died of a spear impalement of the heart from the hand of his opponent Patroclus, during the Troyan War (c. 1300 – 1190 BC) near the north-west coastline of Anatolia.

The healing temples of Asclepios originated about the 6th century BC, either in Thessaly, Tricca or Epidauros (c. 360 BC). There were about 200 such temples. Offices of the physicians were situated close to them. Majority of illnesses treated in their temples were of psychic origin and the effectiveness of the cure was based on faith.

Аcmean (5th century BC) — Greek medical scientist, a representative of the Cretan School, in his work «Concerning Nature» concluded that the brain was the organ of the mind and was responsible for thought, memory and sensation.

To prevent illnesses, Pythagoras (c. 530 BC) — Greek philosopher, recommended diet, exercise, music and meditation.

The concept atom was introduced into science by Аnaxagoris (c. 500 BC – 428 BC) — Greek philosopher, mathematician and astronomer, Leucippos (c. 500 BC – 440 BC) — Greek philosopher, who assumed the interminable possibility of planets in the Universe, and Democritus (c. 460 BC – c. 360 BC) — Greek philosopher, the founder of the atomic hypothesis for explanation of the the surrounding world, considered the possibility of existencе of the unlimited quantity of unique worlds.

In Corinth (the 4th century BC), a communal latrine provided continuous running water beneath the seats for waste removal.

The founder of the dogmatist school, Diocle of Crystus (4th century BC) — Greek physician, performed animal dissections, e.g., on mules.

Еmpedocles (c. 493 BC – 443 BC) — Greek philosopher, poet, physician and and political figure, stated that breathing occurs not only through the nose and the mouth, but also through respiratory pores in the skin.

The father of medicine, Hippocrates (Hippocrates, II, 460 BC, Cos – 377 BC, Larisa, Thessaly)²² — Greek physician, was the last descendent of seventeen generations of physicians who practiced in Athens, and travelled to Egypt, Ukraine-Scythia, Asia Minor and the Middle East.

Hippocrates’ theories of medicine were summarized in «Corpus Hippocraticum» or «Hippocratic Collections», indicating he believed in facts, applied logic and reason in medicine and showed that diseases have only natural causes. The princіples of his method were «to observe all, to study the patient rather that the disease, to evaluate honestly and assist nature».

He considered phthisis (tuberculosis) of the lungs – consumption or wasting disease the most common illness of those times.

In his work «Of the Epidemics» (written 400 BC) Hippocretes mentioned infecious disease named «еpidemiс of the parotid glands», or «еpidemic parotitis», or mumps, wherein he described swelling of the parodid glands and testicles.

Hippocrates was the first to use the term asthma (Ancient medicine. Egypt) in reference to the medical condition caused by spasm of bronchi which according to him more likely occur in tailors, anglers, and metal workers.

He described the pericardium as a smooth mantle surrounding the heart and containing a urine-like fluid, showed that the aortic valve (AV) opened one way into the aorta (Аo).

Then he ntroduced the types of temperament (choleric, melancholic, phlegmatic and sanquine), laid the foundations of etiology, clinical diagnosis and prognosis.

Hippocrates noted a turtle-back nail («unquis Hippocratis», or «Hippocrates’ nail»), a thickened soft tissues of the finger’s distal phalanges without permanent bony changes («clubbed fingers», «drumstick fingers», or «digiti Hippocratici») in chronic diseases of the heart, lungs and liver; pulmonary edema; a sound of succussion (a splashing noise) from air-fluid collection inside the pleural cavity on a sudden motion of the torso, by shaking or during percussion of the chest («succussio Hippocratis»); melena (Hippocrates black disease).

He placed the origin of epilepsy in the brain, suggesting it is a congenital disease, thus could be treated («About the sacred disease»).

Depicted an altered features of the face in advanced terminal conditions («facies Hippocratica»).

Particularly, he described a congenital heart disease (CHD) in children and younger adults²³ characterized by dyspnea, a latent or evident cyanosis, «clubbed fingers», edema of the lower extremities and bouts of weakness or faintness; and a disease complex consisting of arthritis, uretritis and conjunctivitis.

Hippocrates established the diagnosis of pulmonary hypertrophic osteopathy by describing that «drumstick fingers» were a sign of a severe disease of the lungs.

In «Aphorism» (Section II, No. 41) he defined sudden cardiac death (SCD) as «Those who are subject to frequent and severe fainting attacks without obvious causes die suddently».

Hippocrates treated his patients with proper diet, fresh air, changing climate, attention to habits and living conditions. His favorite diet was a barley gruel and his favorite medicine – honey. He used medical herbs, emetics, laxatives and enemas.

His patients who underwend surgical procedures or operations were were anesthesized with opium and mandragora.

Hippocrates treated wounds by surgical debridement, that is removal of damaged tissue or foreign object, cautheterization if needed, irrigation, application of a tar, and coverage by dressing.

He burred holes in the skull (trepanation) to release the pressure caused by trauma or tumors.

Hippocrates performed incision and drainage (I&D) of abscesses with knife or scalpel to removed puss.

Tumors were catheterized using blazed steel rod.

He developed the principles of desmurgia («mitra Hippocratis») and orthopedics by reducing and fixing bone fractures on the «Hippocrates bench»; described the method for the reduction of the anterior dislolation of the shoulder joint by adduction of the arm with a longitudinal traction and gentle external rotation while contertraction was performed by placing his own heel of the foot into the axilla (Hippocrates method); and re-approximatd and immobilized fractured bones using circumferential wires and external bandaging.

Thoracic empyema or empyema thoracic is a collection of infected purulent material in the pleural cavity, generalized or localized (encapsulated) which spreads from infection of the lung, deep posterior space of the neck, thoracic spine and subphrenic abscess via diaphragmatic fenestrationі, from spontaneous or instrumental perforation of the esophagus, from penetrating chest trauma and after elective thoracic procedures.

Hippocrates distinguished between noninfected collection of pleural effusion (hydrothorax) and empyema thoracic on the basis of clinical manifestations, such as fever, mild during the day and increasing at night, dry nonproductive cough, the hollow eyes and the red spots on the cheeks, by auscultation hearing the «succussio Hippocratis» when patient was shaked by the shoulders or the torso. As for hydrothorax he wrote: «When applying the ear on the ribs, during a certain time you hear a noice like boiling vinegar, which suggests that the chest contains water and no pus». He predicted that «Patients with pleurisy who, from the beginning, have sputum of different colors or consistencies die on the third or the fifth day, or they become suppurative by the eleventh day».

He treated surgically thoracic empyema by opening it at the site where pain or swelling were most evident using knife, cautery or trephination of a rib. Noted that when «the pus flows pale and white, the patient survives, but if it is mixed with blood, muddy and foul smelling, he will die». After removing pus he cleaned the lung surfaces, daily irrigated the empyema cavity with «warm oil or wine», and packed it with a strip of linen cloth to prevent air from entering the space. When the empyema had healed, the wound in the chest wall was closed with metal rods.

Of the two common carotid arteries (CCA), the right CCA arises from the brachiocephalic trunk (BCT), i.e., innominate artery (IA) that originates at the junction of the ascending aorta (AA) and the aortic arch, i.e., transverse aorta (TA), and the left CCA originates distally to the BCT from the TA. Both CCA’s ascend up in the the anterior portion of the neck forming the carotid bulb where they divide into the internal carotid artery (ICA) and external carotid artery (ECA). The ICA enters the base of the skull through the carotid foramen into the cranial cavity supplying the blood to the middle ear, brain, hypophysis and orbit. The ECA supply the blood to the neck, face and scalp.

It has been known since ancient times that applying pressure to the CCA, or the carotid bulb (in Greek – «carotid» means to stupefy, or place into a deep sleep) causes unconsciousness.

He operated on the anal and rectal disorders, treated hemorrhoids with a rubber band ligation or by transfixing their base with a needle and then tying them with very thick woolen thread until they drop off. Then he placed the patient on a course of treatment with Hellebore (Helleborus orientalis) – herbaceous or evergreen perennial floweing plant.

After his predecessors, Hippocrates with aim to treat surgically anal fistulae also used a seton drainage and a seton stitch²⁴.

Hippocrates’motto was «As to disease, make a habit of two things: to help, or at least not to harm». He originated «The Hippocratic Oath».

During the 430 BC plague epidemic in the city of Athens (oldest human presence in the Cave of Schist dated between the 11th and 7th millennium BC), it was noted that the people who contracted plague but survived were often protected from getting this same infection again, apparently because survivors developed immunity against reinfection.

It was Plato (c. 429 BC – 347 BC) — Greek thinker, who envisioned an ideal state which would provide for the health of its citizens and would prevent poverty and overpopulation.

Among the first to separate arteries and veins was Praxagroas of Cos (c. 340 BC) — Greek physician, but he believed that both contained air.

During the first half of the 6th century BC, Diokles of Carystos distinguished pneumonia from pleurisy, intestinal cramps from obstruction and recognized fever as a symptom.

The founder of comparative anatomy, Aristotle (382 BC – 322 BC) — Greek scientist encycolopedist, philosopher and logician, described the punctum saliens (the first sign of the embryo), the early development of the heart and the great vessels, the beating of the embryo’s heart, distinguished the cardiac valves, named the Ao and traced the course of the urether.

Representatives of the Alexandria School (331-30 BC) in the city of Alexandria (founded in 331 BC), Egypt, Herophilus (300 BC – 250 BC) and Erasistratus (300 BC – 240 BC) — Ancient Greek physicians, practised systematic cadaver dissections (autopsy).

Аrchineges (c. 287 – c. 212 BC) — Greek polymath (mathematician, physicist, engineer, inventor and astronomer), described a technique of amputation with the proximal use of a tourniquet and a temporary occlusion of the main proximal vessels to control bleeding.

The medicine of China (area 9,706,961) is based on the work of Fu Tsi (c. 2900 BC) — Chinese scientist, who originated the pa ku symbol, a basic ying-yang (female-male) dichotomy of the universe and formulated the eight trigraphs of all possible combinations of the two; of Shen Nung (c. 2800 BC) — Chinese physician, who compiled the «Pen tsao» – the first medicinal herbal; and of the Yellow Emperor / Huang Ti (reign, с. 2698 BC – c. 2598 BC) — Chinese physician, who authored the «Nei Ching» («Cannon of Medicine»), covering all phases of health and illnesses, its’ prevention and treatment (including acupuncture). It stated that «All blood is under the control of the heart» and «the blood current flows continuously in a circle and never stops», аnd abserved that «A superior physician helps before the early budding of disease».

All six sons of Huang Ti were born «cutting open a body», i.e., by Caesarean section (C-section), a surgical procedure performed through the lower abdominal horizontal incision in the midline along the «linea nigra» («black line») or suprapubic transverse incision below the hair line and above the Hills (dimples) of Venus (in Latin – «mons veneris)²⁵ and a transverse incision on the anterior lower pregnant uterus, to deliver alive baby, when the natural vaginal delivery would put the baby and mother at risk, e.g., obstructed labour, twin pregnancies, high blood pressure (BP) in the mother, breech presentation, abnormal location of the placenta and twisted umbilical cord, or on dying mother to save the child.

In league with Taoism which emphasized living in harmony with the nature, Chinese medicine focused on prevention of diseases.

Specific duties and organization of physicians were outlined in the «Institution of Chou» (c. 1050 BC – 255 BC).

The most important diagnostic sign was the pulse, as outlined by Pien Ch’iao (410 BC – 310 BC) — Chinese physician, in the «Secrets of of the Pulse». The Chinese physicians determined the pulse rate of their patients in reference to their own respiration.

Extensive occlusive arteriosclerosis (AS) of coronary arteries of the heart was found in a 50-year-old Chinese noble woman Lady Dai²⁶ who suffered from angina pectoris, with risk factors being the type A personality²⁷, sedentary life style, obesity, diabetes mellitus (DM) and hypertension (HTN). She was treated with herbal medicines containing cinnamon, magnolia bark, and peppercorns. The cause of death in 163 BC was an acute myocardial infarction (MI) due to occlusion of the left anterior descending (LAD) artery.

Small-pox (variola major) was introduced in China from the south-west in the 1st century AD, and was endemic from that time until it was eradicated from the country in the early 1960s²⁸.

Inoculation of small-pox was introduced in China between 1000 and 1010 AD and variolization has been practiced since the Sung dynast (1023-55). The method consisting in griding up the scales and introducing them into the nostrils. Vaccination was started on a limited scale in 1803, but until 1951 disease continued much of illness and death.

Noteworthy accomplishments of Chinese clinicians include:

Tsang Kung (c. 200 BC) — Chinese physician, who described gastric cancer, aneurysm and rheumatism;

Chang Chung-Ching (150 AD – 219 AD) — Chinese herbal physician, wrote a treatise on «Тyphoid and other Fevers»;

Hua To (110 AD - 207 AD) — Chinese surgeon, developed anesthesia and furthered knowledge of anatomy;

Ge Hong or Ko Hung or Zhichuan (283 AD – 343 AD) — Chinese physician, Daionist and alchemist, described beri-beri disease due to insufficiency of vitamin (avitaminosis) B1 with multiply inflammations of nerves (polyneuritis) that causes weakness, lack of appetite, irritability, paralysis and very high probability of death, inflammation of the liver (hepatitis), plague, smallpox and variolization, wrote «The Handbook of Prescriptions for Emergency Treatment» (340) in which outlined preparation of a sweet worm wood plant (Artemisia annua) for the treatment of «intermittent fever» (malaria), by steeped extraction in a low-temperature (cold) water;

Shu Szu-Мiaо (581 AD – 682 AD) — Chinese physician, wrote a medical treatise called «A Thousand Golden Remedies» and headed a committee which produced the «Collection on Pathology».

A goitre (in Latin – gutteria, struma) is a swelling of the neck or larynx resulting from diffuse hyperplasia (thyromegaly), uninodular or multinodular, inactive or active (hyperfunction, hyperthyroidism) or toxic goitre of the thyroid gland (TG) due to in 90% by iodine salt deficiency.

Toxic goitre is characterized by triad of hyperthyroidism, goiter and bulging of eyeballs (exophtalmus), include cardiac arrhythmias, increasesd pulse rate, weight loss despite of increased appetite, intolerance to heat, profuse sweating, apprehension, weakness, tremor, diarrhea, vomiting, eyelid retraction, stare, elevated basal energy expediture (BEE), and elevation of the blood serum protein-bound iodine level. Prevalent in fresh water and lake countries due to lack of iodine. May be related to malfunction of the immune system. Female to male ratio is 4:1, onset in third or fifth decade of life.

As outlined by Zhen Quan (c. 541 AD – 643 AD) — Chinese physician, in his book «Gu jin lu fang» confirmed that Chinese physicians of the Tang Dynasty (618AD - 907 AD) successfully treated patients with goiter by using the iodine-rich thyroid gland of animals such as ship and pigs – in raw pills or powdered form²⁹.

Among the drugs we have adopted from Chinese medicine are: rhubard, iron for anemia, castor oil, kaolin, aconite, camphor, Cannabis sative, Chaulmoogra oil for leprory, Ephedra vulgaris, ginseng and Rauwolfia serpentina for hypertension (HTN).

The Chinese also introduced hydrotherapy.

In in the southwestern region of Pakistan (area 881,913 km²) – Balochistan (area 347,190 km²) during the Mehrgarh culture / period (7500 -2500/2000 BC) an ancient proto-dentistry was practiced by regularly shaping cavities of molar teeth with concentric ridges drilled into them.

The chief cities of the Indus Valley civilization (3300-1300 BC) were the ancient Moenjro-daro, called «mound of death» (built с. 2600 BC – abandoned c.1900 BC, an archeological site since 1922) and and the ancient Harappa (emerged c. 2600 BC) on the Indus River³⁰, which were located in the region of today’s Pakistan and northwestern India (area 3,287,263 km²). These cities had streets laid out in a rectangular pattern, well built and ventilated brick buildings, some with bathrooms, a drainage system which ran from the houses to the brick-linen sewers. Some houses had rooms built around a courtyard. The cities had public baths, sewers and shuttes for collection of trash. Their settlements were abandoned as a result of floods and drought.

Buddism (the 6th century BC) in India forbade the taking of life, taught compassion and stressed the need for the development of charity hospitals.

Sushruta (c. 600 BC) — Indian surgeon, known as the main author of «The Compendium of Sasruta» («Sasruta-samhita»), described more than 120 surgical instruments, including the spatula (tongue depressor), the speculum, forceps, scissors, scalpels, saw, needles, syringes, catheters and trocar; reconstructed the injured ears and congenital cleft lip (harelip), removed thyroglossal cysts and sinuses (Sushruta operation), mentioned tracheostomy, ligated hemorrhoids with a rubber band or by transfixed their base with a needle and then tied them with very thick woolen thread until they drop off, emphysized the necessity of wound cleanliness. As the Egyptians physicians and Hippocrates with aim to treat surgically anal fistulae he also used a seton drainage and seton stitch.

The «wandering scholar physician» of Ancient Ukraine, Middle Asia and India, Caryk (Caraka), a.k.a., or nom de guerre Charaka which in Ukrainian means «dear (little) tsar» (c. 300 BC, Ukraine –?) — the chief co-author of a treatise «Ayurveda» («The Science of Renaissance») where he described the man nature, childbirth, methods to preserve and to restore the healthy human race, the first to propose the concept of hereditarity, digestion, metabolism and immunity against diseases. Mentioned epilepsy. Proposed to apply to the skin leeches for bloodletting to treat inflammation and pulmonary edema. Charaka’s qualifications for a nurse included knowledge of drugs, cleverness, devotion and purity (mind and body).

In «Ayurveda» there is mentioning of a very alkaline «kshara» extract made from ashes of pricky chaff-flower, or devil’s horse whip (Achyranthes aspara) – a tropical plant, given to people to drink in a highly diluted form as a remedy for worms, indigestion, kidney stones, skin diseases and obesity. It is also administered topically in a less diluted form, to treat diseases of the anus and rectum like hemorrhoids, rectal prolapse, and to try to control infection after anal fistulectomy, excision of pilonidal sinus, after draining perirectal abscesses, to treat infected wounds in general.

Dermoid cyst, pilonidal (in Latin – pilus = hair, nidus = nest) or sacrococygeal cyst, sinus, fistula or abscess are tubules covered by multilayered (stratum) flat epithelium near or on the median natal cleft of the buttock, often containing hair or skin debris and opens to the outside with one or several openings³¹. They are itchy and often very painful, and typically occur between the ages 15 and 35.

The possible causes is a congenital pilonidal dimple, ingrowing hair, excessive horseriding, sitting and increases sweating and pressure on the coccygeal region. Occassionaly it affect the navel, armpit or gеrnital region.

Treatment include hot compresses, application of depilatory cream and antibiotics. In more severe cases pilonidal cyst or sinuses should be, after impregnation with 1% solution of methylene blue, incised and drained (I&D); excised in the form of the oval flap of tissue together with pilonidal sinus tract, sewing the wound with the deaf stitch or sewing underneath the edges of the wound to the bottom; cut with the scalpel a slit into abscess or cyst and sutured the edges of the slit to the surrounding skin to form continuous surface from the interior to exterior surface for drainage and healing (marsupialization); or excised with a reconstructive flap technique such as a «cleft lift» or Z-plasty procedure.

C. 272 BC Chanakaya — Indian teacher, philosopher, economist, jurist and royal advisor, performed C-section on the royal woman who was pregnant near the term of delivery of a baby, but dying from drug overdose, to save the child.

King Asoka (273 BC – 232 BC) built hospitals for humans and for animals and supplied them with healing herbs.

The laws of Manu (200 BС – 200 AD) contained an oath for graduating physicians, and rules for physicians and patients.

At medical examination, the patient, his sputum, vomitus, urine and stool were checked. The pulse was an important diagnostic and prognostic sign.

Physicians recognized fever, cough, constipation, diarrhea, dropsy (edema), seisures, ascites, abscesses, tumors, skin diseases, consumption or phthisis (pulmonary tuberculosis) with hemoptysis as being the «king of diseases», leprory and smallpox.

Gymnastic and breathing exercises were regarded as being important in the maintenance of good health.

Pharmacopea contained 500 to 700 herbs, including Rauwolfia serpentina. In use were emetics, purgatives, enemas, sneezing powders, inhalations, leeching, cupping, bloodletting, plague and smallpox isolations and variolization.

Snakebites were treated by the proximal application of a tourniquet, then making a cut to connect the punctures, suctioning the wound and plastering it.

The «Indian method» of plastic and reconstructive surgery, that is closure of the body defect using the flap on one pedicle, cut from the skin, which is located along the body defect³². The flap on one pedicle can be used to cover the bodily defects of triangular, quadrangular and rouded forms. When needed a rotation, transposition torsion is made, in which the flap designed to cover a defect is displaced in relation to the mean point of its axis with the angle from 30⁰ to 180⁰. The Indian surgeons reconstructed the nose by a flap of skin taken from the forehead with its pedicle at the root of the nose or from the cheek («Indian rhinoplasty»). They also performed plastic reconstruction of the auricle (auricula) of the ear and of the lips.

Other surgeons extracted teeth, stitched wounds, ligated bleeding vessels, incised and drained (I&D) abscesses, tapped the abdomen for ascites, extracted foreign bodies, excised tumors, «couched» cataracts (an ancient method where the cataract is simply pushed down out of the line of sight), amputated extremities, repaired hernias, removed bladder stones, performed anal fissurectomy, corrected abnormal fetus presentation, carried out caesarean section and removed dead fetuses through the vagina.

Аppareantly, іn Slovenia (area 20,055 km²) in 4500 BC decaying tooth cavities were filled with beesvax.

Originated in Palestine / Israel (Prehistoric medicine) «Good Samaritan Law» has among others, a legal application to physicians. It offer a legal protection to people who give reasonable assistance to those who are, or who they believe to be ill, in peril, or otherwise incapacitated. They take their name from a parable found in «The Bible»³³, attributed to Jesus Christ (Prehistoric medicine), and refered as the «Parable of the Good Samaritan» (Luke 10-25-37) which records the aid given by a traveller from area known as Samaria³⁴ to another traveller from the same area, namely Jew who has conflicting religious and ethnic background and who has been beaten and robded by bandits. Jews and Samaritans were generally enemies.

The Hebrews (1900’s BC - 200’s) according to the «Таlmud» (formed in the course of many centuries – 4th cenrury BC), pioneered public health by promoting personal and social hygiene, recognized hereditary bleeding at circumcision, reduced dislocations and incised imperforate anuses. Rescue breathing on a child was carried out by Elijah («The Bible», 1 King. 17:17-22). During the Egyptian captivity (c. 1300 BC) the Hebrew midwives, utilized the expired air method to revive newborn³⁵.

The «Таlmud» instructed that a boy must not be circumcised if he had two brothers who died due to complications arising from their circumcision, and Moses ben Maimon, know as Maimonides (1135/38 – 1204) — Jewish philosopher, astronomer and physician, said that this excludes paternal half-brothers.

The Ethruscan civilization of Apennine Peninsula (spanning 1000 km from north to south, area 134,337 km², the highest elevation Mount Corno Grande 2,912 m) of Southern Europe, endured from the time of the earliest Etruscan inscription c. 700 BC until the 1st century BC. Etruscans removed and treated wounded men from the battlefield, introduced golden teeth and bridges, and for public health built the sewer system.

The Romans (754 BC - 746 AD) made great strides in public health by advancing a system of water supply (aqueducts), sanitation, gymnasiums and public baths. Aqueducts carried 1.1 bln liters of fresh water to Rome each day.

The Roman physicians used tourniquets made of strips of bronze or leather to control bleeding from the wounded extremities, specially during its amputations.

Аsclepiades (124/129 BC - 40 BC) — Greek physician who flourished in Rome where he established Greek medicine, introduced Democritus’s atomic theory to medicine (Ancient medicine. Greece). According to this teaching it is the lack of harmony or the irregular movement of atoms which causes disease. Asclepiades’s method of treatment were diet, friction, bathing, exercise, emetics and bloodletting. He invented tracheostomy to help children in asphyxia from croup, resuscitated a dead man back to life and established humane treatment for the mentally ill. His principle was: «Treat with hope, fast and pleasantly».

The association of marshy land with diseases was recognized by Marcus T. Varro (116 BC – 27 BC) — Roman scolar and writer, who said that swampy land contains (harbors) «certain minute animals invisible to the eye, breed there, and born of the air reach the inside of the body by the way of the mouth and cause disease». He advised against building near swamps.

The first description of lymphatic filariasis with elephantiasis belongs to Тіtus L. Carus (99 – 95 BC - 55 BC) — Roman poet and philosopher, who saw it among the dwellers at the coast of the Nile River ща of Egypt [Nebhepetre Mentuhotep II (? – 1995 BC.)].

The Romans created the position of the archiater, the chief physician of their empire. The sick and the injured were treated in offices or homes of physicians or infirmaries.

As early as 40 BC the Romans recognized dementia praecox (imbecility, idiotism) as «being out of one’s mind».

Beginning with the reign of Augustus (27 BC – 14 AD) — founder of the Roman Principate (30 BC – 284 AD) and the first Roman emperor (27 BC – 14 AD), wounded soldiers were treated in the military valetudinaria. Public physicians were appointed to attend the poor and modern-in-design hospitals were built as evidenced by one excavated near the city of Düsseldorf (settled in the 7th and 8th centuries, the first written mention dates back to 1135) in Germany.

The Roman physicians counted the pulse rate using a float-regulated windlass.

The medical encyclopedist Aulus C. Celsus (c. 25 BC – c. 50 AD)³⁶ — Roman medical encyclopedist, known for his extant medical book «De Medicina octo libro» (Rome 1478), a primary source of history of medicine, pathology, diseases, anatomy, diet and pharmacy, surgery and orthpedics, where he described four cardinal signs of an inflammation («rubor et tumor cum color et dolor») and hemorrhagic shock as «When much blood is lost, the pulse becomes feeble, the skin extremely pale, the body covered with a malodorous sweat, the extremities frigid, and death occurs speedily». To treat pleural effusion (exudate) or empyema thoracis, he described the performance of segmental rib resection that included the use of a trocar and then metal cannula for drainage (15 AD) ³⁷. He also described psoriasis, a chronic skin disease characterized by dry red patches covered by scales which occurs especially on th scalp, ears, genitalia and the skin over bony prominence.

Heron of Alexandria (10 AD – 70 AD) — Greek mathematician and engineer, invented a syringe-like device to control delivery of air or liquid. He also noted that air partially filled a closed tube with one end in a container of water will expand or contract depending on the position of the water / air interface, and move along the tube. This observation led some 500 years later to the construction of the termometer.

Saint (St) Luke (?– c. 84), the «beloved physician» became the new patron of physicians.

That jaundice is due to the common bile duct (CBD) obstruction was suggested by Aretaeus of Cappadocia (30 AD – 90 AD) — Greek physician who practiced in Rome and Alexandria. He also provided accurate description of diabetes mellitus (DM).

There was a House of Surgery (c. 62-79 AD) in in the city of Pompei (founded in the 7th - 6th century BC).

The forefather of obstetrics, Soranus Ephesus (98 AD – 138 AD) — Greek physician from the city of Ephesus / Izmir (built in 10th century BC) in Asia Minor on the coast of the Aegean Sea (700 km x 400 km, surface area 214,000 km²), since 129 BC under reign of the Roman Republic, who practiced in Alexandria and in Rome, described the podalic version of the fetus in the transverse position, maneuvers to prevent laceration of the perineum at childbirth, caesarean section after a mother’s death to save the child, ligation of the umbilical