Funtabulously Frivolous Friday Five 100: Getting Old

Funtabulously Frivolous Friday Five 100

This week, FFFF is getting old – with its hundredth edition. The jokes are starting to sag, the factual reliability gave way long ago, but there is still a glimmer in its ancient roving eye. And this week the funtabulously frivolous focus is on… old things.

Question 1.

What is the world’s oldest surviving medical text?

Kahun Papyrus

Even in 1900BC, legal disclaimers were amazingly convoluted.

  • The Kahun Gynaecological Papyrus.
  • The Kahun Papyri were discovered near El-Lahun, Egypt in 1889 By Flinders Petrie (grandson of Captain Matthew Flinders, who first surveyed the Australian Coastline).
  • Kahun was an ancient settlement close to the Pyramid of Sensuret II. It was abandoned about 1700 BC.
  • Petrie unearthed about a thousand fragments of papyrus relating to medical, legal and veterinary matters, dating from 1825 BC. The medical texts attribute most ailments to problems of the uterus, and prescribe a variety of vulval poultices and fumigants.
“Treatment for a woman whose eyes ache, who sees not, and has pain in the neck: Thou shalt say as to it, it is discharges of the uterus in her eyes.

Thou shalt fumigate her on fresh incense and fresh fat: fumigate her eyes with the shanks of the legs of bee-eaters; thou shalt make her eat the liver of an ass, raw.”

Hieratic Papyri from Karun and Garob, F Ll Griffith 1898

Question 2.

What is the world’s oldest surgical procedure?

  • Trephination – now known as burrhole craniotomy.
  • The earliest known example is from a Neolithic burial site in Ensiheim, Alsace, France. The man died c 5000 BC at the age of about 50. He had been on the receiving end of two very large trephines, both of which had healed, one completely (see CT recon below). The indication was not known – there are no other signs of trauma or disease. The holes would probably have been made with flint tools.
  • Ancient Mesoamerican, Egyptian, Indian and Chinese civilisations were adept at craniotomy, for a variety of ritual, medicinal, neurosurgical and decorative purposes.
It's a shame Panadol wasn't around c5000BC.

A real shame Panadol wasn’t around c5000BC. Would have saved a lot of bother.

Question 3.

What is the world’s oldest infectious disease?

  • TB  (somewhat contentious answer)
  • Infectious diseases have evolved in parallel with humans. The most ancient evidence is in microbial DNA, rather than gross pathological specimens.
  • Genomic analysis (looking at the number of accumulated random mutations) suggests that currently prevalent strains of TB evolved 25-30 000 years ago. However they are likely to be derived from a 3 million year old progenitor, dubbed M. prototuberculosis. This would make TB far older than bubonic plague, typhoid and cholera, which rely on population density to propagate, and probably emerged in the Neolithic period (from 10 000 BC).
  •  The oldest pathological specimens of TB are in the 9 000-year old skeletal remains of a woman and infant, found in a submerged Neolithic village known as Atlit-Yam off the coast of Israel, in 2008.

Question 4

What is the oldest example of a pre-hospital Emergency Medical Service?

  • Ambulances volantes or flying ambulances.
  • This system was devised by a Napoleonic surgeon, Dominique Jean-Larrey, for the Army of the Rhine in 1793. Ambulances volantes were fast horse-drawn carriages that conveyed medical personnel and supplies to the battlefield, retrieving injured soldiers to field hospitals.

One of the first known occurrences of “le ramping“.

  • Larrey’s other pioneering work included development of the first triage system, a camel-drawn ambulance for desert warfare, and a gruesome pre-anaesthetic mastectomy on Fanny Burney (the prototype female novelist, considered by many to be the mother of English Literature).

Question 5

At what age did the world’s oldest practising doctor hang up her stethoscope?

  • 103.
  • As well as being an amazingly durable paediatrician, Dr Leila Denmark conducted prize-winning research on whooping cough in the 1930s, leading to the development of Eli Lilley’s first pertussis vaccine. The WHO estimates that its modern derivative saves over 800 000 lives each year.
  • In her later years, Dr Denmark ran a solo practice in a farmhouse charging $10 per consultation. She was renowned for a no-nonsense approach and would tell parents of behaviourally disturbed children: “Go look in the mirror. You get apples off apple trees.”
The wonderful Dr Leila Denmark

“Doing what you don’t like is work. Doing what you like is play. I have never worked a day in my life.” Dr Leila Denmark, 1898-2012.

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  1. rfdsdoc says

    this regular series is one of the reasons I keep coming back for more of LITFL!
    thanks Jo!
    Not sure about oldest infectious disease being TB..suspect it would be viral.
    But go the Ambulance Volantes!

    • says

      Thanks for the thumbs up! Without getting too stuck into molecular phylogenetics, most current human viral pathogens evolved in the Neolithic. This isn’t to say that there weren’t microbial infections going back to the year dot -- but they would probably have been different from current diseases (because the human behaviours to which those pathogens had adapted were different). M tuberculosis seems to be our longest-standing microbial enemy, going back to the Palaeolithic.

  2. CAsey says

    LOve that line “You get apples from apple trees”
    Do I have the pluck to use it? Maybe one day….

  3. says

    This oldest series are really interesting, and I never new that TB is one of the oldest infection disease. And Dr Leila’s lines that “Doing what you don’t like is work. Doing what you like is play. I have never worked a day in my life.” is really nice that if you take your work as play you will never be bored. Thanks for sharing nice bit of information.

  4. Sketchitout says

    As always fascinating stuff !
    The oldest surviving medical texts (that I can find reference to) are cuneiform clay tablets unearthed at Ur in Mesopotamia the contents of which were pharmacological in nature listing medical prescriptions from the Sumerians from about 2100 BC .
    The references below are of course secondary : ).
    1. John L Webb : “The oldest medical document” a verbal presentation of a paper to the 55th Annual meeting of the Medical Library association Los Angeles , California June 19th-22, 1956 .
    2.Biggs , Robert D: “Medicine, Surgery and Public Health in Ancient Mesopotamia“, Journal of Assyrian Academic Studies, Vol. 19, no. 1, 2005.

    • says

      Thanks Sketchitout -- I’ve popped in the links.

      It’s amazing how cuneiform was deciphered in the 19th Century after 2 millennia of obsolescence. Apparently the Sumerians used to reuse the clay as a sort of white board, unless it was a particularly important document.

      Webb notes that “In one corner (of the tablet) one may see the winding passage left by an unusually considerate worm, since he did not burrow through that part of the tablet containing writing”.

      Does this count as a medical text though? Although it describes remedies:

      “Pulverize white pear tree bark and the root of the moon-plant; dissolve in beer; let the man drink”

      there is no mention of the maladies for which they should be prescribed.