History of rib fracture management

Abstract

The occurrence of injury in everyday life and in battle makes it likely that ancient surgeons were familiar with chest wall injuries. Although communities were primarily rural, urban centers of several thousand people were present in Sumer (present-day Iraq) as early as 4000 BCE and in Egypt by 3500 BCE (Gabriel, Man and wound in the ancient world. Potomac Books, Washington, D.C., 2012). Multilevel dwellings, temples, canals, bridges, and extensive walls were built. Both the Sumerians and the Egyptians had a professional military with battalions of foot soldiers and fighting units including chariots and archers. Rib fractures, flail chest, and open chest wounds occurring during farming, construction projects, and conflicts were surely similar to what surgeons treat today (Dupras et al., Int J Osteoarchaeol 20:405-23, 2010). Sumerian tablets dating to 3000 BCE provide the first written descriptions of medical care (Gabriel, Man and wound in the ancient world. Potomac Books, Washington, D.C., 2012; Majno, The healing hand: man and wound in the ancient world. Harvard University Press, Cambridge, MA, 1975). Asu, Sumerian general practitioners, used hot water, oils, wine, and honey to cleanse and dress wounds. They were aware of the risk of infection, ummu (hot thing). The Sumerians had medical corps accompanying their armies in the field.