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This is the second of five articles reviewing the historical origins of some of the more commonly used surgical instruments and takes ''time out'' to remind current surgeons about the surgical pioneers on whose shoulders they now stand and whose inventions they now use.
T HROUGHOUT THE PREHISTORIC era, cutting tools used by primitive societies have evolved from the use of human teeth and nails for minor procedures such as division of the umbilical cord to the use of plant, animal, and mineral substitutes.1 These primitive ''knives'' were made of perishable materials such as acutely sharp leaf margins, sticks, and bamboo or consisted of unmodified stones such as volcanic glass and other siliceous rocks.1 According to archeological studies, the knife was the first tool to be developed some time during the Mesolithic period (approximately 8000 B.C.). Neolithic skulls show signs of ancient neurosurgery involving trepanation, which is the removal of bone from the skull through drilling. Historians believe that the procedure was widely performed to release the evil spirits that caused headaches, madness, and epilepsy.2
Hippocrates was the first to describe the surgical knife as a broad cutting blade with a single edge and a sharp, straight point, which he first used to drain an empyema.2, 3 Galen once described the shape of Hippocrates' single-edged blade as that of a woman's breast.2, 3 After the deaths of Galen and the other great surgeons in the second century A.D., advancements in medicine and surgery were soon halted because religious fanaticism dominated the period known as the Dark Ages.2-4 Fortunately, the stagnation of surgical innovation that prevailed in Medieval Europe led to the dawn of the Golden Age of Islamic medicine and surgery.4 Among all medical disciplines, Islam's most valuable contributions were to the field of surgery throughout the 10th to 13th centuries.4 Muslim surgeons such as Abu'l Qasim bin Abbas az-Zahrawi (936 to 1013), also known as Albucasis and considered by some to be the father of modern surgery, developed numerous previously unknown surgical instruments and further perfected existing tools such as the scalpel. 4 Translations of his 30-volume encyclopedia entitled Kitab al-Tasrif sparked a similar revolution in Western surgery and influenced the likes of Guy de Chauliac and Ambroise Paréof France during the 14th...