What the ancients knew of the fatal anatomic consequences of wounding of the lower thorax.

One of the most important lessons concerning the relevance of human anatomy to surgical diagnosis to be taught to medical students and first-year surgical residents concerns their sometimes poorly understood relationship of the structure of the lower thoracic cavity to the organs within the upper abdominal cavity. To make this indelibly clear, in surgical anatomic and clinical lectures given during the past 20 years, I have chosen to present the earliest Biblical examples of the ancient's knowledge of this critical relationship as regards wounds of the thorax specifically given to injure the liver and thus to produce a rapid and certain death. The first two concern the technique of assassination used by the warring factions of the House of King Saul and the followers of the House of David, which resulted in his succeeding to the kingship of Israel after the death of King Saul in the 10th century BC. The second example is the coup de grâce administered in 30 AD to the crucified Jesus by a Roman centurion to hasten His death. In all three cases, the evidence, in the first two cases explicit and in the third strongly implied, is that the executioners knew that a stab wound of the lower thorax on the right would lead to a rapid death by exsanguination because "the liver was suspended there." The importance of this understanding, made indelible by these examples discussed herein, is to insure the recognition by any medical student or surgical resident that any penetrating wound of the lower thorax may imply a much more serious injury to an intra-abdominal organ, and this must be rapidly and fully investigated.