Healing the body

Someone in Egypt, about three thousand six hundred years ago, sat with a reed pen and two inks, black and red, and copied a manual for treating wounds. It begins at the top of the head and works downward: the skull, the face, the nose, the jaw, the throat, the collarbone, the shoulder, the spine.

Each case follows the same steps. If you examine a man with a gaping wound in his head, feel it with your fingers; look at what you find; say what it is. Then comes a judgement in three forms: an ailment I will treat, an ailment I will contend with, or an ailment not to be treated. The writer was not afraid to admit what could not be healed.

To learn to cut, the text says, the student should first practise on things that are not alive: on gourds and cucumbers, on a leather bag filled with water, on the hide of an animal with its hair still on, on the stems of lotus flowers. Only then should the knife touch a patient.

This civilization gathered its knowledge of the body into verse and prose in Sanskrit. The compendium names instruments, sharp and blunt; it tells how to set bones, draw out arrows, drain a wound, stitch skin, and, when a nose has been cut off, how to shape a new one from a flap of the cheek.

Long before the word vaccine, people had learned to fight smallpox with smallpox. In China a little powdered scab was blown into the nose; in Bengal travelling inoculators scratched the skin; in West Africa and in Ottoman towns, a blade or a needle carried the matter of a mild case into a healthy arm. Those treated usually had a light illness and were safe for life. Some died of it.

The knowledge travelled. An English ambassador's wife watched it in Adrianople and had her children treated. In Boston, a man named Onesimus, held in slavery by a minister, explained how it had been done to him in Africa; in the terrible summer of 1721 a doctor tried it on his own son.

Before this morning, the best a surgeon could offer was speed. Patients were held down, given alcohol or opium, and cut while they were awake; the fastest operators were the most admired.

On 16 October 1846, under the dome of a hospital in Boston, a young man named Gilbert Abbott sat in the operating chair with a tumour on his neck. A dentist, William Morton, arrived late with a glass flask. Abbott breathed from it and fell into a heavy sleep. The surgeon, John Collins Warren, made his incision. When he woke he said, by one account, that it had felt as if his neck had been scratched.

It began, as many things in this archive do, with something that went wrong. A dish of bacteria left on a bench in a London hospital during a summer holiday grew a patch of mould. Around the mould, the bacteria had died.

Alexander Fleming noticed it, kept the mould, gave its juice a name and wrote it up. Then, for ten years, little happened. The substance was fragile and hard to collect.

Four letters, A, T, G and C, and a rule: A faces T, G faces C. That is the whole alphabet.

In the spring of 1953, in a laboratory in Cambridge, two men took plates of metal cut in the workshop, one for each base, and clamped them on rods around a central pole, turning each rung a little on the one below, until the whole thing twisted upward like a spiral staircase and every piece fitted.

On a Saturday afternoon in December, a young woman and her mother crossed a road in Cape Town after stopping at a bakery. A car struck them both. The mother died on the road. The daughter, Denise Darvall, was twenty five, and by evening the doctors at the hospital on the hill knew she would not wake.

In the same hospital lay a man whose heart was failing, Louis Washkansky. Her father was asked. He thought about his daughter for a few minutes and said yes.

For three thousand years at least, this civilization lived with a disease that covered the body in blisters, killed about a third of those it struck in its worst form, and left survivors scarred or blind.

In the spring of 1796, a country doctor in Gloucestershire took matter from a sore on a milkmaid's hand, a sore of cowpox, a mild disease of cattle, and scratched it into the arm of a boy of eight. Weeks later he exposed the boy to smallpox. Nothing happened. From the Latin word for cow came a new word, vaccine.