From Mainz to Modem with Martin in the middle

Given the credo and contributions of Franklin H Martin, whom we honor with this lecture, coupled with the privilege that I have had to serve as editor-in-chief of the Journal of the American College of Surgeons for the past 6 years, it seemed appropriate to select as a theme the dissemination of medical information. The timing for consideration of the subject is fortuitous because last year, 2001, scholars convened in Iraq to celebrate a unique anniversary: the 5,000th anniversary of the first written word. The origins of writing have been traced to the Sumerian civilization, which was based in and around modern Iraq in the third millennium BC. The oldest extant writing comes from tablets found in the ancient city of Uruk, 155 miles southeast of Baghdad. The oldest “document” was neither prose nor poetry, but rather an accounting record of a business transaction, evidence that time has not changed the priorities of societal interests. The first word picture included more than 700 signs. The next step in the evolution of written communication was the introduction of the cuneiform script using sounds to represent objects and ideas. The cuneiform script was in effect up to the first century BC, when it was replaced by the much simpler Aramaic alphabet to structure words as used today. The current status of the written word brings us to this lecture’s somewhat cryptic title, “From Mainz to Modem with Martin in the Middle,” a panoramic consideration of the verbal dissemination of scientific information—past, present, and future. It is certainly fitting that the subject be discussed in a surgical forum because the oldest of all scientific documents is the Edwin Smith Papyrus. That extraordinary dissertation, dating from the 17th century BC, is actually a copy of a manuscript that was originally written during the pyramid age; ie, 3000 to 2500 BC. The document is a surgical treatise that reports 48 cases in logical progression from head to thorax to spine, and in each region, from relatively trivial wounds to more serious ones. Each case is considered in the consistent sequence of examination, diagnosis, and treatment. In the document, the word brain is introduced and “comminuted and compound fractures” are specifically defined. For the first time cauterization is referred to, in this instance as treatment for cancer of the breast, in a man. In the early years, the spread of information came from the pens of monastic scribes, using ink laid down on parchment made from sheep or lamb hide (the word parchment derives from the Latinized adjective for Pergamon, the ancient city in Asia Minor), or on papyrus, the off-shore reeds from the Mediterranean region of Byblos (a Phoenician settlement on the Mediterranean Bay of Jounie, just north of Beirut). The words Bible and bibliography derive from the name of that settlement where the papyrus was gathered. Vellum, the other early material used by scribes, has the same derivation as the word veal because it is made from calf skin. To begin our focus on the dissemination of medical information, it is reasonable to start with the Roman era, and direct attention to Aulus Cornelius Celsus, the most prolific medical writer during the first century AD, who chronicled the previous achievements of the Alexandrian school of Egypt. Celsus was referred to as the “medical Cicero,” and he wrote mainly for the public. There is argument about whether he was a physician, and he was actually more analogous to the current television network medical correspondents. Because Celsus wrote for the public, no subsequent medical writer referred to his work for 1,000 years. In the second century, Galen, who was born in Pergamon, moved to Rome, where he authored more than 500 treatises on diverse subjects that included the treatment of war wounds, and rib and sternal resection. After the Western Roman Empire collapsed, the center of surgical writing shifted to Alexandria in what is known as the Byzantine Period. Subsequently, with the Mohammedan capture of Alexandria and the burning of the famous library of that city, the Arabians rose to a position of dominance in surgical literature. The most notable of these writers were Avicenna and Albucasis. Avicenna’s Canon (Qanan), written early in the 11th Presented at the American College of Surgeons 88 Annual Clinical Congress, San Francisco, CA, October 2002. From the Department of Surgery, University of Rochester Medical Center, Rochester, NY. Correspondence address: Seymour I Schwartz, MD, FACS, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642-8410.