In the fourth Star Trek movie, “The Voyage Home,” Kirk, Spock, and Dr. (Bones) McCoy travel back in time to the year 1986. There, in a San Francisco hospital, McCoy watches in horror as a surgeon prepares to operate. The invasive technique looks absolutely barbaric to Bones, whose technology is vastly superior.

Just imagine if ol’ Bones had gone back even further, to least 7,000 years ago, when Neolithic people had begun to practice “cranial trephination” – in other words, drilling into the skull.

Perhaps the earliest known surgical procedure, the operation consisted of removing a piece of the skull to expose the dura mater, the tough fibrous membrane forming the outer envelope of the brain. If the dura mater was not penetrated, the patient had a fair to good chance of surviving – and in fact, archeological evidence of skulls examined showed various degrees of healing, indicating survival. Considering the danger of severe bleeding, shock, edema, infection – and the complete lack of anesthesia – the results are amazing.

Skull trephination was independently practiced in many areas of the world, with the highest concentration of activity in Peru and Bolivia. Evidence for it is also found in Europe, Asia, New Zealand, some Pacific Islands, and North America.

Neolithic “trephinators” used a sharp-edged flint scraper or knife, while ancient Peruvians used bronze or obsidian knives, and covered the wound with a shell, gourd or piece of silver. Later, bow drills were adopted which produced neater, circular holes. The operation was carried out for both medical and mystical reasons and ancient peoples believed the practice would cure epileptic seizures, migraines, and mental disorder. If it didn’t kill you first, I suppose.

Cataract surgery was pioneered in the 8^th century BC by an Indian medical practitioner named Shushruta, who discovered sight could be restored by moving the eye lens with the cataract out of the field of vision. He did this by poking a needle into the eye as described here:

“The patient sat opposite on the ground so that the doctor was at a comfortable height for doing the operation on the patient's eye. After having taken bath and food, that patient had been tied so that he could not move during the operation.

The doctor warmed the patient's eye with the breath of his mouth. He rubbed the closed eye of the patient with his thumb and then asked the patient to look at his knees. The patient's head was held firmly. The doctor held the lancet between his fore-finger, middle-finger and thumb and introduced it into the patient's eye towards the pupil, half a finger's breadth from the black of the eye and a quarter of a finger's breadth from the outer corner of the eye. He moved the lancet gracefully back and forth and upward. There was a small sound and a drop of water came out.

The doctor spoke a few words to comfort the patient and moistened the eye with milk. He scratched the pupil with the tip or the lancet, without hurting, and then drove the 'slime' towards the nose. The patient got rid of the 'slime' by drawing it into his nose. It was a matter of joy for the patient that he could see objects through his operated eye and the doctor drew the lancet out slowly. He then laid cotton soaked in fat on the wound and the patient lay still with the operated eye bandaged.”

Yes, I imagine I’d be joyful too after snorting eye slime, while wearing a fat-soaked bandage. Or not.

Nearly a thousand years ago, when Spain was part of the Islamic empire, Abu al-Qasim Khalaf bin 'Abbas el-Zahrawi (Albucasis) was busy pioneering a number of surgical procedures and innovative surgical instruments. His use of catgut for internal stitching is still practiced in modern surgery and he invented the scalpel, curette, retractor, surgical spoon, sound, surgical hook, surgical rod, and specula. However, although he developed numerous useful tools for surgery, sometimes there was no substitute for a little hand work, as described in this treatment:

“If the last bone of the coccyx, which is the sacrum of the tail, breaks, introduce the thumb of your left hand into his anus and reset the bone with other hand in whatever way is possible and affords the best setting…if you perceive a fragment in the fracture, cut down upon it, remove it, and dress the wound as before said, until it heals.”

Hippocrates, the ancient Greek father of modern medicine and author of the Hippocratic Oath, was the first to believe that disease had a rational cause, and therefore a rational cure. Borrowing from knowledge gathered from China and India, he developed the concept that bodies had four types of humors - blood, phlegm, black bile, and yellow bile - and theorized that disease caused imbalance in these fluids. Hippocrates believed that disease could be cured if balance was restored.

If patients were too hot (with fevers, coughs, headaches, or even some forms of heart disease), it was thought that draining out some blood could cool them down. The art of bloodletting continued for hundreds of years, and flourished during the Dark Ages, when medical research stagnated and the physicians of the time were monks and priests.

In 1163, the Catholic church issued an edict preventing monks and priests from bloodletting, and the practice was picked up by the new class of barber-surgeons who could give you a “short back and sides” as well lance veins. The French master barber-surgeon Ambroise Pare suggested five different reasons for bloodletting:

Lessen the abundance of blood.

Diversion - open the vein on the right arm to reduce bleeding in the left nostril.

Draw down – open the ankle vein to draw down menstrual flow (which would really put ME on the rag, I can tell you).

Open a vein to breathe out fevers.

Draw blood to prevent disease.

Bloodletting continued to be practiced all the way until the late 1800s. But the symbol of the barber-surgeons endures to this day: the red and white striped pole. The pole represents the stick patients would grab onto while having their veins sliced, the white stripes represent the bandages they would wear after, and the red stripes symbolizes their blood, of course.

Think about that next time you debate whether or not to tip your hairstylist.

Humans have had to deal with unwanted pregnancies since ancient times, and have experimented with various techniques to achieve it. One of the oldest, abortion induced by physical trauma, was depicted in bas-relief sculptures in Angkor Wat in Cambodia dating from the 9^th to 12^th centuries. Curiously, massage abortion is still widely practiced in Southeast Asia, and across Indonesia to the Philippines.

Massage abortion does not involve any vaginal manipulation or surgery, but there’s nothing gentle about it, and the pregnancy must be sufficiently advanced for it to succeed. The person performing the abortion puts increasing pressure on the abdominal wall above the uterus, using fingers, elbows, feet or even a tool such as a pestle used for pounding rice. The pressure is continued until vaginal bleeding begins. Some abortions occur within minutes, but sometimes the procedure is continued for much longer and occasionally leads to internal hemorrhage.