Refer to: Buck BA: Ancient technology in contemporary surgery(Information). West J Med 136:265-269, Mar 1982

Ancient Technology in

Information

Contemporary SurgeryBRUCE A. BUCK, MD, Twin Falls, Idaho

Archaeologists have shown that ancient man developed the ability to producecutting blades of an extreme degree of sharpness from volcanic glass. Thefinest of these prismatic blades were produced in Mesoamerica about 2,500years ago. The technique of production of these blades was rediscovered 12years ago by Dr. Don Crabtree, who suggested possible uses for the blades inmodern surgery. Blades produced by Dr. Crabtree have been used in experi-mental microsurgery with excellent results. Animal experiments have shownthe tensile strength of obsidian produced wounds to be equal to or greater thanthat of wounds produced by steel scalpels after 14 days of healing. We havebeen able to demonstrate neither flaking of glass blades into the wounds norany foreign body reaction in healed wounds. Skin incisions in human patientshave likewise healed well without complications.

The prismatic glass blade is infinitely sharper than a honed steel edge, andthese blades can be produced in a wide variety of shapes and sizes. It is there-fore suggested that this type of blade may find an appropriate use in specialareas of modern surgery.

TWELVE YEARS AGO a technique was developedthat allowed the manufacture of knife blades in-finitely sharper than those in current surgical use.In these days of rapidly advancing technology,this fact might be of no more than passing interest.What is of interest, however, is the fact that this"new" technology of blade manufacture was buta rediscovery of a technique practiced up to 1million years ago by ancient man. The materialfrom which these blades were formed was stone.This article will attempt to trace the rediscoveryof these remarkable cutting instruments, postulate

From the Department of Surgery, Magic Valley Memorial Hos-pital; Herrett Museum, College of Southern Idaho, and SRI,Twin Falls, Idaho.Repnnt request to: Bruce A. Buck, MD, 496 C Shoup Avenue

W., Twin Falls, ID 83301.

ancient uses and perhaps suggest a place for thistechnology in the practice of contemporarysurgery.

HistoryWe are all familiar with the stone instruments

made for many centuries by cultures the worldover before the availability of metals. These in-struments range from the crude scrapers of 3million years ago to exquisite spear points andarrowheads, which date from 14,000 years agointo the early 1900's in North America. Untilvery recently, many myths and mysteries haveshrouded the method of manufacture of theseartifacts. The first opportunity to learn sophisti-cated flint-knapping (the manufacture of tools

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from stone) from a "stone-age man" came in1911, when a starving Indian presented himselfto civilization in Northern California.' Fortu-nately, he was befriended by Professors Water-man, Kroeber and Gibson of the University ofCalifornia Anthropology Department, and histechniques of flint-knapping were carefully studied.During this same era, others were attempting toduplicate the varying ancient technologies thathad produced different types of instruments inNorthern America and elsewhere in the world.2'3Ishi, the last "wild Indian," died in the Universityof California Museum in San Francisco in 1916.Twenty years later, Professors Kroeber and Gib-son had an assistant named Don Crabtree work-ing in their lithic laboratory. He was pursuing aninterest in lithic technology that began when hewas a child collecting artifacts near his SouthernIdaho home. Largely self-taught, he developed askill in the art of flint-knapping which few havematched. His major contributions, however, werethe result of his approach to this science and art.He became one of the world's primary authoritieson experimental archaeology.4 His scholarly studyof stone artifacts proceeded through a logical de-ductive process to a rediscovery of the ancienttechniques used to produce them. He was there-fore able to duplicate for the first time many ofthe feats of ancient man. Indeed, Professor Bordesof Universite de Bordeaux, suggested that Ameni-can archaeology be divided into pre-Crabtree andpost-Crabtree periods. Though Dr. Crabtreetraveled widely in his later years, he maintainedhis residence near Kimberly, Idaho, and accom-plished most of his experimental work in his homelaboratory.

Despite the use of many natural materials andvarying techinology worldwide, the irregular flakededge is the hallmark of those artifacts with whichwe are all familiar. There exists, however, anentirely different facet of lithic technology whichis less well known. This technology consists of theability to remove a long (up to 12-inch), ex-tremely sharp blade from a core of obsidian (vol-canic glass) in a single maneuver. The resultingblade is basically flat and triangular or trapezoidalin cross section (Figures 1 and 2). The glassblade can be produced in many shapes and sizes.These blades differ from the familiar spear pointin that the cutting edge is absolutely straight, andis formed by a single fracture line. The two paral-lel cutting edges are extremely sharp, the edgesthemselves measuring approximately 30 angstroms

in thickness. The comparison between this edgeand that of a new razor blade is shown in Figure3. At a magnification of 10,000 times, the razorblade edge appears essentially flat, whereas theedge of the glass blade remains a definite sharpangle. Similar types of blades, and the "cores"from which they were detached, have been foundin archaeological sites in France dating back35,000 to 1 million years.5 This type of blade isalso attributed to the Northwest Indians of NorthAmerica, and was described by Ishi, the "wildIndian" of Northern California. The high pointof this technology, producing thin pressure-flakedblades, was reached in Mesoamerica, where it wasperfected approximately 2,500 years ago. Theseblades were described three centuries ago by theearly Spaniards of Mexico and Guatemala. In-deed, there is mention of the Aztecs shaving theSpaniards with similar instruments.,

Figure 1.-Prismatic blades produced by Dr. Crab-tree. Shown with obsidian "core" found in archaeologicsite in Mesoamerica.

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Stone artifacts of course do not deteriorate,and are found in abundance in the oldest archae-ologic sites. Pottery is less durable, and bone evenless so. Nonetheless, definite evidence for bonesurgical procedures (amputation, trephination)has been discovered in Neolithic sites.78 However,the form and condition of soft tissue at the timeof death can only be a subject of conjecture yearslater. Therefore, though the availability in ancient

times of instruments capable of soft tissue surgicaloperations is now well established, the uses towhich these instruments were put can only beinferred. Undoubtedly, they were used for prac-tical, religious and decorative purposes. Thereare many accounts of scarification among Ameri-can Indians well into the last century. This prac-tice is also widely distributed among the primitivetribes of the world today. Since the Aztecs (1,300

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Figure 2.-Diagrammatic repre-sentation of obsidian "core," andblades produced from this core.(Courtesy Idaho State University.)

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Figure 3.-Left, edge of prismatic glass blade. Right, edge of new stainless steel razor blade. Bothedges are magnified 10,000 times by scanning electron microscope. (Courtesy of Anderson Pace.)

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to 1,500 AD) are known to have possessed thefinest obsidian instruments, and are also knownto have practiced human sacrifice as a religiousrite, it is probable that they used obsidian bladesto accomplish the donor portion of the modernheart transplant procedure. Whether or not at-tempts at curative surgical procedures followedthe availability of suitable instruments is, of course,difficult to prove. Ongoing studies by Semenov9may soon shed some light on this question. Heand his co-workers have shown that obsidian knifeedges are deformed microscopically in a predic-table fashion, depending upon the type of materialthat has been cut by the blade. This microscopic"fingerprinting" of blades found in ancient sitesmay one day elucidate the purposes for whichthese knives were used.

Materials and MethodsThe production of obsidian blades has been

superbly described by Crabtree'0-'4 and will not bedetailed here. Meticulous preparation of an obsid-ian core is required, following which many bladescan be produced in a relatively short time by aworker with the requisite skill. Dr. Crabtree pro-duced blades up to 12 inches in length, andexperimentally produced extremely fine micro-blades from obsidian, other lithic materials andmany types of commercial glass.

Dr. Crabtree suggested in 1968 that modernsurgeons might well look to glass blades for cer-tain procedures.'5 He suggested, however, that"the surgeon who pioneers the use of such bladesmay be accused of reverting to caveman tactics."When faced with a surgical procedure himself in1975, he convinced us to try an obsidian bladefor the skin incision. Half of the incision wasmade with obsidian, and half with a standard No.10 surgical scalpel. The obsidian knife was indeedsharper, and healing of the two extremities of theincision was identical. Several subsequent surgicalprocedures on physician volunteers scheduled forelective procedures have similarly produced nor-mal healing and no complications. Because of thetheoretic possibility of flaking of the stone blades,thereby leaving foreign material in the wound,these instruments have not been used on tissuesother than skin and subcutaneous fat in humansin our institution.

In order to address the .question of compara-bility of wound healing, several studies with ex-perimental animals have been carried out. Ourinitial studies involved skin incisions, microvas-

cular anastomoses and peripheral nerve incisionswith prismatic glass blades. These procedureswere carried out on anesthetized rabbits under10 to 25 power magnification. The glass instru-ments did these functions admirably, and we couldfind no problems with wound healing in theseanimals.A second group of experiments involved the

examination of healed skin incisions made on theventral surface of rabbits. A series of 2 to 3 cmincisions were made in such a way that there werepaired longitudinal incisions equidistant from theventral midline. Each pair of incisions was han-dled identically, with the only variable betweenthe two being the cutting instrument. A No. 15scalpel blade was used to produce one of the pairof incisions, and an obsidian blade to produce theother. Therefore, each animal served as its owncontrol. The variables tested on individual pairsof incisions were staple closure, silk suture closureand subcutaneous hematoma at the time of closure.At 14 days the healed incisions appeared identical,and there were no clinical wound complications.The skin containing each incision was excised andthen examined in two ways.

First, a 1 cm length of each healed wound wasstressed by gradually applying a measured dis-tracting tension to the wound. The applied forcerequired to dehisce the obsidian-produced scarswas 1.1 to 2.5 times that required for the scarsproduced by steel knives. These tests includedincisions closed with each of the variables men-tioned above.

Second, a portion of each healed wound wasprocessed for examination of microscopic sections.All sections were evaluated in a blind fashion by asingle pathologist. After 14 days of healing, allsections examined had a thin, well-organized scar.There was no evidence for included foreign bodyor foreign body reaction. The wounds producedby obsidian were indistinguishable from thoseproduced by the honed steel edge after this heal-ing period.

DiscussionThe evolution of surgical instrumentation has

always been of interest to those of us engaged inthe field of surgery. Our concept of this evolutiontraditionally has been concerned with the periodof time covered by recorded history, and there-fore has concerned itself with the evolution ofmetal instruments. Archaeologists, however, havenow shown us conclusively that stone cutting

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blades of a quality equal to and surpassing thatof steel blades in common usage today wereavailable to ancient man up to a million yearsago. The uses to which these remarkable bladeswere put is largely conjecture, since proceduresupon soft tissue, animal and human, do not leavea record for us. However, there is direct evidencethat such blades were used for ceremonial pur-poses (scarification) in North America, and thatthey were used for shaving in Mesoamerica. Itdoes not seem unreasonable to assume that, dur-ing 1 million years of experimentation, theseinstruments might have been used to cut humantissue in an attempt to cure.The recent advent of experimental archaeology

has now provided us with the ability to reproduceproducts of the acme of ancient lithic arts. Weonce again have access to glass blades of infinitevariety, and extreme sharpness. Though experi-mental work to date is limited, we feel that theseblades, properly used, are safe for surgical pro-cedures in humans.

In most fields of surgery, of course, a modicumof sharpness suffices, and one feels comfortablewith the convenience of the modem disposablesteel blade. However, in many specialized areas,scalpel blades and razor blades leave much to bedesired. Examples that come to mind are thedebridement of nerve ends for repair, microvas-cular surgery, fine plastic work on thin skin (bleph-aroplasty, for example) and ophthalmologic sur-gery. Though one with faith in modem technologycannot imagine that instruments equal to thesevarious tasks cannot be produced today, the factremains that no honed metal edge has matchedthat of the glass blade to date. Also, it is probablethat production of prismatic glass blades, usingminor modifications of ancient techniques, willbe cheaper than the attempt at duplication of

these cutting edges in steel. Our initial animalwork in microscopic surgery with glass bladesmade by Dr. Crabtree leads us to feel that this isan area that should be further explored.

ConclusionIt is of historical interest to note that ancient

man in several areas of the world had access tocutting blades of volcanic glass which were sharperthan the surgical instruments of today. It is alsopostulated, though it has not yet been proved,that these instruments might have helped to initi-ate the field of surgical treatment. Experimentalarchaeology has shown us how to reproduce theseblades, and initial animal experimention leads usto believe that they are safe in surgical use. Inthe near future it may be shown that there is aplace in the modem surgical armamentarium forthis descendant of ancient lithic technology.

REFERENCES1. Kroeber T: Ishi in Two Worlds. Berkeley and Los Angeles,

University of California Press, 19812. Wilson T: Arrowheads, spearheads and knives of prehistoric

times. Report of US National Museum for 1897, 1899, pp 811-9883. Holmes WH: Handbook of Aboriginal American Antiquities,

Part I: Introductory-The Lithic Industries. Bur Am EthnologyBull 1919; 60

4. Crabtree DE: Man's oldest craft revisited. Curator 1970;XIII: 179-198

5. Bordes F, Crabtree DE: The corbaic blade technique andother experiments. Tebiwa 1969; 12:1-21

6. McCurdy GG: The obsidian razor of the Aztecs. Am Anthro-pol 1900 Menasha; 2:417-421

7. Bick EM: The Classic Source Book of Orthopedics: Primi-tive Man and Ancient Practice. Clin Orthop 1979 Mar-Apr; 139:2-16

8. Candis RF, et al: Prehistoric trephination of the frontalsinus. Ann Otol Rhinol Laryngol 1981; 90:186-189

9. Semenov SA: Prehistoric Technology. London, Cory, Adamsand MacKay, Ltd, 1964, pp 13-15

10. Crabtree D: An Introduction to Flintworking. Pocatello,Idaho State University Press, 1972

11. Crabtree D, Butler D: Notes on experiments in flint-knap-ping-1: Heat treatment of silica materials. Tebiwa 1964; 7:1-6

12. Crabtree D: Notes on experiments in flint-knapping-3: TheFlint-knapper's Raw Materials. Tebiwa 1967; 10:8-24

13. Crabtree D: A stoneworker's approach to analyzing andreplicating the Lindenmeier folsom. Tebiwa 1966; 9:3-39

14. Crabtree D: Notes on experiments in flintknapping-4:Tools used for making flaked stone artifacts. Tebiwa 1967; 10:60-70

15. Crabtree D: Mesoamerican polyhedral cores and prismaticblades. Am Antiquity 1968; 33:446-478

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