Surgery in ancient Rome
History
Roman medical practices, including surgery, were borrowed from the Greeks, with many Roman surgeons coming from Greece. In the 2nd century CE, Galen, a Greek physician advanced Roman surgical knowledge by combining Greek and Roman medical knowledge.[1] Aulus Cornelius Celsus was a Roman encyclopedist notable for his work De Medicina. The text describes operations such as tonsillectomies and cataract surgery. Alongside these surgeons and doctors, Soranus of Ephesus introduced technology such as the birthing chair.[2] Surgeons were attracted to ancient Rome due to the potential for success and wealth.[3] Doctors learned through private courses from other doctors, their relatives, in the city of Alexandria, or through self-teaching. Charlatans and malpractice were common in ancient Rome, as any individual, regardless of their training or qualifications could practice medicine.[4] This resulted in the general public becoming distrustful of doctors. Higher-quality surgeons often served the upper classes.[1] According to Celsus the perfect surgeon would be a younger man with strong and steady hands, sharp eyes, a strong spirit, and a strong sense of empathy and compassion. Surgery was rare in ancient Rome, it was rare for a patient to recover, and the procedure was dangerous.[5] Most surgical procedures were limited to skin lacerations or amputations.[6]
Tools
Cupping vessels
Cupping vessels were round suction cups usually made of bronze or horns.[7][8] They were made of different materials and had different designs and purposes. Bronze vessels were also used. They usually contained burning lint and were closed at one end and open at the other. Horn cups had small foramens at the ends and cavities closed off with wax. Cups had holes that were placed over injured areas and sweat glands. Following this, the tool would be used to draw out pus and "vicious humor."[9] Cupping vessels were also used to aid bloodletting.[10][11] First, heat was applied to the area to warm it up. Then, the skin was cut with a scalpel, following this, the cup would be fastened to the area to draw blood.[12][13][14] Larger cupping devices were used for larger parts of the body, such as the back. Smaller cups were used for smaller parts of the body, such as the arms or the neck.[15]
Chisels and raspatories
Raspatories, also called rugines, were made of a blade fixed to a
Drills and levers
In ancient Rome, there were two kinds of surgical drills. One type was driven by a leather cord, the other type used a guard and a collar. This was designed to stop the instrument from penetrating too deeply into the bone. It was thought that this would minimize the risk of
Saws and trephines
Saws were primarily used to cut through bone. In one procedure for treating gangrene, a band was used to retract the skin to prevent the saw from tearing through the flesh. Then the saw could amputate the infected limb. Trephines were in the form of a circular saw. Doctors believed it needed to be frequently removed from the skull and placed in cold water during an operation. This was designed to alleviate the "heat" in the "bone." Trephines were used to saw the bone to the meninges thus treating injuries to young people's heads.[25]
Forceps
Bone forceps were used to extract injured bones from the body.[26] They were common tools, despite the Roman preference for using fingers instead of tools to fix bone injuries. Bone forceps were primarily used for instances in which pieces of bone were too small for fingers to remove.[27][28][29] They would also cut off broken parts of the skull, or even drill through to the brain. Another kind of forceps, called Epilation forceps was primarily used to remove hair.[15] Polypus forceps were used to remove polyps or tumors from the nose.[30]
Tumor vulsellums, also known as Myzons, were toothed forceps that were used to remove tumors. In one procedure, they were used to "seize" the
Pharyngeal forceps were made of fishbones and they were used to remove entities from the pharynx.[31] Varix extractors were a type of forceps used to extract varicose veins, which is a medical condition characterized by abnormally large veins.[32] This procedure would be conducted by mapping out the locations of the afflicted veins, then the skin would be held and divided. Following this the extractor would hold and cut the skin, allowing for the veins to be removed.[33] Tooth and stump forceps were used to extract teeth. This operation, and hence these tools were rarely employed due to how dangerous the operation was.[34]
Probes and curettes
Probes and curettes were used to mix and apply medication to the skin or to lift tissue.[15] When pushed into the fistula they were used to measure their dimensions. Roman probes had parts known as the nucleus. The nucleus was used primarily to apply medication. Sodium hydroxide was applied to the nucleus, which would then be used to burn out the eyelid. Wax was warmed on the nucleus of the probe, and then it was used to apply pomade to the face.
One type of probe consisted of a rod rounded off at one end. Another type was slender with enlarged ends. It was used
Ear probes, also known as ear specilla, were made of a narrow scoop and an enlargement at each end. These tools had no nucleus or tip. They could also be used as curettes. Their primary purposes was cutting the interior of the chalazion and applying medications or liquids. The sharp end of the ear probe was used to treat fistula. A large ball of wood would be saturated with water and wrapped around the probe. Once squeezed, the liquid would drip onto the ear canal, which was thought to extract entities from the canal. A larger version of the ear probe, possibly with a slight enlargement at the ends, was used for treating wounds.[40] This would be done through an incision behind the ear, following this the ear scoop was used to remove the objects. A common symptom of this procedure was dullness of hearing, often preceded by persistent headaches. Scabs and ulcers were other common side effects. To treat this, they were typically fomented with warm water, or verdigris drenched in honey, leek juice, and niter in mead. Following this, water was used to wash the ears. This tool could also be used as a curette.[41]
Scalpels
Scalpels were tools made of a steel blade and a bronze handle. The bronze handle could be round, square, horizontal, or trapezoidal. Some scalpels had handles made of copper alloys with grips, dissectors, and an iron blade. This design was used to maximize efficiency. A slot was placed at one of the ends to connect to the steel blade. On the other end of the handle was connected to a leaf-shaped spatula. This spatula functioned as a blunt tool for dissection. A groove or a long and narrow indentation was located near the end of the handle. Alternatively, a cylindrical roll perforated with a hole could be used instead. Threads, wires, rolls, and perforations were used to attach the blade to the handle. Handles would have been decorated with moldings or inlay.[42] The blade was made detachable to allow for cleaning and the usage of several blades.[43] There were a variety of kinds of blades. One was straight, sharp, and pointed. Another was curved with sharp or blunt points.[44] Blades were secured to the handles using simply sockets or key-hole shaped sockets using an alloy known as solder. The scalpel had great flexibility and performed a wide variety of functions, such as tearing away muscle and tissue during amputation,[23][45][46] severing the umbilical cord, removing nasal polyps, mastectomies, making incisions, cutting through bone, and hernia repair.[47]
Specula
The rectal
Spoon of Diocles
The Spoon of Diocles also called the Dioclean kyathiskos was an ancient medical tool allegedly designed by Diocles of Carystus for removing arrowheads.[52][53] It was a long bronze or iron tool with two hooks ending a curved scoop with a hole and a perforation. This tool would be pushed under and then between the arrow and the flesh.[54][55] The head of the arrow would be caught in the hole, and the scoops would cover the barbs. Thus, when the arrow was dragged out the flesh would not be pierced.[56] This instrument may have not existed.[57][58][54] It is only mentioned by Celsus, who was a Roman physician, and no other writers.[58][59]
Catheters
Strigils
This tool was used for scraping off dirt, perspiration, and oil to cleanse the body. The strigil was most commonly used by male athletes, although in other cultures such as the Etruscans it was used by a wider variety of people.[63] They could also be used as burial goods and these tools are commonly depicted on works of art.[64][65] It generally consisted of a curved metal blade, and a metal handle.[66] Other materials that could be used included bronze, iron, and reeds.[67][64]
Knives and needles
Another kind of knife, known as the polypus knife, was sharply pointed and shaped like a myrtle leaf. The knife was used to cut around
Hooks
Obstetrical hooks may have existed in ancient Rome.[72] These hooks were smooth and had short points, which were inserted into the ears, eyes, mouths, and forehead to extract children.[72][73] Sharp hooks were used to hold open incisions, removing tissue, fixing and retracting wounds, raising blood vessels, removing tonsils, transfixing the pterygium, and for dissection.[47] Blunt hooks were used to stretch adhesions near the eye and to pierce lips.[74] Traction hooks were used to remove the fetus during especially tough labor. These hooks were smooth and round, with a short point. Once the head presented itself, the hook was inserted into the area and then used to extract the child. This procedure needed to execute carefully and gently. If it was not then there was an increased risk of death. It was common practice to use two hooks at once in these procedures. Another kind of hook, known as a decapitator, was used to decapitate the fetus during an abortion.[75]
Other tools
In ancient Rome saws could be used to amputate limbs for surgical purposes.
Techniques
Abortion
There were surgical procedures for abortion in ancient Rome,[90] but they were rarely used, and most abortions were conducted using herbs or other drugs.[91] When surgery was used, it involved the use of surgical instruments to penetrate the mother. Usually this procedure ended the death of both the fetus and the mother.[92] Soranus of Ephesus wrote that purging, carrying heavy weights, and the injection of olive oil into the vagina or uterus, were all procedures used to carry out abortions.[93][94]
Amputations and dissections
Amputations were used to treat gangrene.[95] Ancient Roman surgeons utilized tools known as "blunt dissectors" to expose "vessels." Blunt dissectors were also involved in another procedure designed to treat headaches and ophthalmia. This operation began by shaving the patient's hair off. Then, a warm headband or fomentation was placed around their neck. Following this, ink was used to map the "vessels." The surgeon would then proceed to use their fingers to stretch the skin, and then an assistant would make an incision. To finish the procedure, hooks and dissectors were used to expose the "vessels." Blunt dissectors were usually leaf-shaped, and possibly with hexagonal handles.[96] Another kind of dissector was curved dissectors. They were used to dissect lips that had been incised with a hook. One of these dissectors, which was stored in the National Archaeological Museum in France, was made of an ornamented handle with a small hook at one end. On the other was a leaf-shaped dissector.[97]
Bloodletting
Caesarean section
During a Roman Caesarean section the doctors would make an incision into the abdomen and uterus of the mother.[101] Following this, the baby was removed.[102] This practice could also be conducted on dead mothers to remove the babies from their corpses.[103] It was rare for doctors to perform this operation, as it bore a high mortality rate. According to Roman religion the god Asclepius was born by a Caesarian section.[104] Roman historians Suetonius and Pliny the Elder also record Julius Caesar as being born through a Caesarian section.[105] The veracity of these claims is debated.[106]
Cataract surgery
Cosmetic surgery
Modern cosmetic surgery has origins in the ancient Greco-Roman world.[111] Roman surgeons were capable of repairing damaged ears, noses, and lips.[3][112][113] Celsus discussed rhinoplasty techniques in his De Medicina.[114] Ancient rhinoplasty involved the grafting of a new nose onto the old one.[115][116] Burns were treated using vinegar, ashes, cork, bran, or honey.[117] To treat both, skin grafting was used.[118][119] Galen, alongside Celsus, described the use of cheek reconstruction to heal facial injuries.[120]
Hernia treatment
Hernia repair was done using trusses and bandages. Roman surgeons would conduct an operation designed to treat hernia. Usually, it was only used to treat small hernias belonging to young patients. It consisted of an incision into the scrotum. A tool known as the crow bill or the corvus was used to open the scrotum and cure the hernia.[121] Another process involved using two blocks of wood to clamp the hemiscrotum, causing the sac to be inflamed, thus reducing its size. It also could be treated by removing the testicles and ligating the scrotum.[122] Ligatures could also be used during these operations to avoid bleeding.[109] The ancient Romans had treatments for umbilical hernia, a medical condition in which the abdominal wall behind the navel is damaged.[123] Before this procedure, the patient was laid on their back to cause the hernia to fall back into the abdomen. Afterwards the navel was placed between two rods with their ends tied together, then a needle was placed inside of the protrusion.[124]
Lithotomy
The ancient Romans practiced lithotomy, a surgical procedure to remove calculi.[125] Usually, they were only conducted on individuals younger than 14. This was because the more developed prostate of older people enhanced the difficulty of the operation. One way this procedure could be practiced is by cutting through the bladder until the surgeon reached the perineum. An assistant held the patient in a lithotomy position, exposing their perineum. Two fingers were placed into the patient's rectum and against the perineum.[126] Another procedure involved the usage of a scoop at the end of a probe to remove objects such as stones or beans and kidney stones.[127][128][129]
Neurosurgery
Ancient Roman doctors were capable of performing neurosurgery on depressed skull fractures.[130][131] Celsus believed that this surgery should be conducted with as little bone removed as possible. Galen disagreed, he wrote that doctors should elevate the bones and the bone fragments using forceps.[132] During this operation a hole was drilled into the skull. Roman doctors believed this would cure headaches and relieve pressure.[23] Flat chisels were used to cut away at overlying edges, and trepans were used to carve holes into interlocking bones.[133]
Sutures, ligatures, and contractions
Celsus describes the ligature technique for treating hemorrhoids. He also mentions that after the surgery patients suffered from urinary retention, which is the inability to fully empty the bladder.[134] Galen believed that surgeons should choose to amputate, instead of sawing into healthy bones. He also wrote that to stop bleeding, pressure should be used instead of ligatures.[109][135] Surgical techniques like tracheal intubation and tracheotomy date back to Ancient Rome.[136] The ancient Roman writer Aulus Gellius described a technique that functioned similarly to bariatric surgery. Which is conducted to reduce the weight of obese individuals. In this technique the surgeon would forcefully contract the stomach, thus limiting the passage of food.[137] Catgut sutures were used by the ancient Romans as early as the 2nd century CE.[138][139][140] They also used sutures with metallic hooks.[109] Celsus discusses other kinds of suturing techniques in his medical literature. He wrote that the wounds were to be stitched up. Roman doctors used linen, wool, silk, hair, and clips to seal wounds.[141][142][143]
Tonsillectomies and mastectomies
The ancient Romans practiced tonsillectomies.[144][145][146] Roman surgeons would use their fingers or a blunt hook to separate the tissue by the tonsils. Vinger mouthwash was used to induce hematopoiesis, or the stable production of blood cells.[147] Following the surgery, the tonsils were cut out. It was common for patients to profusely bleed following the procedure. Roman surgeons usually would also remove the vulva. To treat breast cancer, the Romans had an operation similar to a mastectomy. It would remove the pectoral muscles of the sufferer. Galen wrote that doctors should cut through healthy tissue around the infected tissue, ensuring that all cancerous material was removed.[148] This operation could also be used as a punishment. For example, Agatha of Sicily was a Christian saint who had her breasts cut off.[149]
Tooth extraction
It is unclear which Roman profession or professions would have performed dentistry. There may have been medical specialists trained to perform dental procedures, it is also possible that dentistry was practiced as a subset of other professions, such as barbery. Tooth extraction is an oral surgical procedure conducted to remove teeth. In ancient Rome, it may have been practiced by specialists who were not associated with any other medical professionals in ancient Rome. This practice required teeth to be extracted softly to avert the danger involved.[150] This danger also resulted in the practice becoming rare. Ancient literature describes another process dedicated to extracting teeth. In this process, the tooth would be grabbed and rocked until it could be removed with hands. Another practice involved cutting the gum and bone surrounding a tooth and then extracting it. Celsus recommended that physicians should also extract the bone near the teeth and that they should refuse to extract children's teeth unless they were preventing adult teeth from growing.[151][152]
Other techniques
The ancient surgeon
References
- ^ a b Barry, Krause. Ancient Roman medical instruments. Antiques & Collecting Magazine.
- ^ ISBN 978-1-84110-181-1.
- ^ ISBN 978-3-540-46241-5.
- .
- ^ Westphalen, N (July 2020). "Roman Warfare, Ships and Medicine". Journal of Military & Veterans' Health. 28 (3). Italy: 16.
- .
- ^ Belfiglio, Valentine (January 1, 2014). "Treatment of Flesh Wounds in the Roman Army (27 B.C.–A.D.476)". International Journal of Interdisciplinary Social Sciences: Annual Review: 5.
- ^ Milne 1907, p. 101.
- ISBN 978-1-78297-235-8.
- ISBN 978-1-4668-9014-5.
- ISBN 978-1-4456-4573-5.
- ISBN 978-0-7020-5834-9.
- ISBN 978-1-107-29213-0.
- ^ Milne 1907, p. 101-102.
- ^ a b c d "Surgical Instruments from Ancient Rome". University of Virginia Claude Moore Health Services Library. 2007. Retrieved 16 September 2014.
- ^ Milne 1907, p. 121-126.
- ^ Milne 1907, p. 148-149.
- ^ Milne 1907, p. 126-130.
- ^ Milne 1907, p. 133.
- ^ ISBN 978-1-4408-2908-6.
- ^ Milne 1907, p. 135.
- ^ ISBN 978-0-7637-6595-8.
- ^ ISBN 978-1-4042-0556-7.
- ^ "Ancient medicines and bone lever in rare Roman medical kit." Premium Official News, 26 Feb. 2016. Gale OneFile: News.
- ^ Milne 1907, p. 130-131.
- ^ Harvey, Ailsa. "WHAT THE ROMANS TAUGHT US: How ancient Roman technologies have influenced the modern world." How It Works Magazine, no. 161, Feb. 2022, pp. 40+. Gale General OneFile.
- ISBN 978-1-4654-3108-0.
- ISBN 978-1-101-99810-6.
- S2CID 1715543.
- ^ Milne 1907, p. 93-94.
- ^ Milne 1907, p. 94-100.
- ^ "Varicose Veins". National Heart, Lung, and Blood Institute (NHLBI). Retrieved 20 January 2019.
- ^ Milne 1907, p. 135-136.
- ^ Milne 1907, p. 136-138.
- ^ Milne 1907, p. 55-57.
- ^ Milne 1907, p. 58-63, 68.
- ^ Milne 1907, p. 71-73.
- ^ Milne 1907, p. 76-77.
- ^ Milne 1907, p. 83-84.
- ^ Milne 1907, p. 65-69.
- ^ Milne 1907, p. 55, 58-65.
- ISBN 978-1-78297-238-9.
- ^ Milne 1907, p. 24-26.
- ^ Milne 1907, p. 26-28.
- ISBN 978-94-035-0795-8.
- ISBN 978-1-5225-4970-3.
- ^ ISBN 978-1-4654-5893-3.
- ISBN 978-303-056-728-6.
- ISBN 978-93-5090-283-7.
- ^ ISBN 978-1-61970-936-2.
- ^ ISBN 978-1-4808-1770-8.
- ISBN 978-900-437-750-9.
- ISBN 978-1-135-45740-2.
- ^ a b Book Review: The Treatment of War Wounds in Graeco-Roman Antiquity by Christine Salazar, reviewed by Lawrence J. Bliquez; in Bulletin of the History of Medicine, Volume 75, Number 3, Fall 2001 (pages 49, 557-558); 10.1353/bhm.2001.0108;
- ISBN 978-1-136-78219-0.
- ISBN 978-1-4456-5004-3.
- ^ Archaeological Remains as a Source of Evidence for Roman Medicine, by Patricia A. Baker, in Medicina Antiqua, published 2009
- ^ ISBN 978-0-19-049913-6.
- ^ Celsus, p. 321.
- PMID 31509512– via Europe PMC.
- S2CID 194370172– via The Directory of Open Access Journals.
- ^ Milne 1907, p. 143.
- ^ De Puma, Richard. "A Third-Century B.C.E. Etruscan Tomb Group from Bolsena in the Metropolitan Museum of Art". American Journal of Archaeology: 429–40.
- ^ a b Fossey, John M. "The Ritual Breaking of Objects in Greek Funerary Contexts: A Note". Folklore: 21–23.
- ^ Padgett, J. Michael (2002). Objects of Desire: Greek Vases from the John B. Elliot Collection. Record of the Art Museum, Princeton University. pp. 36–48.
- ^ Padgett, J. Michael (2002). Objects of Desire: Greek Vases from the John B. Elliot Collection. Record of the Art Museum, Princeton University. pp. 36–48.
- ^ Boardman, John. "Sickles and Strigils". The Journal of Hellenic Studies: 136–137.
- ^ Milne 1907, p. 39-40.
- ^ Milne 1907, p. 46-47.
- ^ Milne 1907, p. 47.
- ^ Milne 1907, p. 44-46.
- ^ ISBN 978-1-4875-0917-0.
- ISBN 978-0-930405-80-9.
- ^ Milne 1907, p. 86-87.
- ^ Milne 1907, p. 152-154.
- ISBN 978-1-284-14412-3.
- ISBN 978-1-61069-620-3.
- ISBN 978-1-6672-0005-7.
- ISBN 978-0-8261-3139-3.
- ISBN 978-1-7325126-4-1.
- ISBN 978-1-64643-215-8.
- ^ Milne 1907, p. 34-35.
- ^ Milne 1907, p. 38-39.
- ^ Milne 1907, p. 110-114.
- ^ Milne 1907, p. 116-120.
- ^ Milne 1907, p. 146-147.
- ^ Milne 1907, p. 105.
- PMID 20934531.
- ^ Milne 1907, p. 107-108.
- ^ a b Perk, Halûk (April 1, 2007). "Medical Equipment of the Antiquity from the Halûk Perk Collection": 1–15.
{{cite journal}}
: Cite journal requires|journal=
(help) - ISBN 978-0-19-514890-9.
- ISBN 978-1-4408-2908-6.
- ISBN 978-1-135-82509-6.
- ISBN 978-1-57607-092-5.
- ISBN 978-0-313-27645-3.
- ^ Milne 1907, p. 84-85.
- ^ Milne 1907, p. 85.
- ^ Milne 1907, p. 34.
- ^ Milne 1907, p. 32-37.
- ^ Milne 1907, p. 65.
- ISBN 978-1-133-71017-2.
- ISBN 978-0-7613-6522-8.
- ^ "The Truth About Julius Caesar and "Caesarean" Sections". Today I Found Out. 2013-10-25. Retrieved 2022-05-18.
- ISBN 978-1-63747-036-7.
- ISBN 978-0-19-107631-2.
- ^ "The Truth About Julius Caesar and "Caesarean" Sections". Today I Found Out. 2013-10-25. Retrieved 2022-06-02.
- ISBN 978-0-323-35427-1.
- ISBN 978-93-5090-989-8.
- ^ ISBN 978-1-119-10070-6.
- ^ Celsus, p. 351-353.
- ISBN 978-3-13-162861-9.
- OCLC 758684735.
- ISBN 978-0-19-937637-7.
- ISBN 978-0-429-48969-3.
- ISBN 978-1-4262-0650-4.
- ISBN 978-1-250-28033-6.
- ISBN 978-1-4441-1360-0.
- ISBN 978-1-59698-205-5.
- ISBN 978-1-84916-872-4.
- ISBN 978-93-86107-04-6.
- ^ Milne 1907, p. 43-44.
- ISBN 978-3-319-63251-3.
- OCLC 70663705.
- ^ PMID 23344725.
- ^ "Lithotomy". Museo Galileo. November 10, 2010. Archived from the original on November 10, 2010. Retrieved May 20, 2022.
- S2CID 27163679– via PubMed.
- ISBN 978-1-4160-6911-9.
- ISBN 978-1-4654-3663-4.
- ISBN 978-1-888456-03-5.
- ISBN 978-0-387-25844-7.
- ISBN 978-0-7377-7312-5.
- ISBN 978-1-5275-7707-7.
- S2CID 11905716– via PubMed.
- ISBN 978-1-85233-496-3.
- ^ Watson, Beriah André (1885). A Treatise on amputations of the extremities and their complications. P. Blakiston. p. 5.
- ISBN 978-1-4471-5391-7.
- ISBN 978-0-313-38738-8.
- ISBN 9780415368483. Retrieved 21 November 2012.
- ISBN 978-981-336-330-4.
- ISBN 978-1-4408-7125-2.
- ISBN 978-1-4488-7370-8.
- ISBN 978-0-08-100624-5.
- ISBN 978-1-84858-039-8.
- ISBN 978-0-19-512740-9.
- ISBN 978-0-226-16196-9.
- ISBN 978-0-429-01580-9.
- ISBN 978-1-59756-632-2.
- ISBN 978-1-4377-1121-9.
- ISBN 978-1-4613-8563-9.
- ISBN 978-3-030-89563-1.
- ISBN 978-1-317-19465-1.
- ISBN 978-1-61069-896-2.
- ISBN 978-1-4614-8441-7.
- ISBN 978-1-4408-3532-2.
- ^ Milne 1907, p. 79.
Bibliography
- Milne, John (1907). Surgical Instruments in Greek and Roman times. Oxford: At the Clarendon Press. ISBN 978-859-100-771-4.
- Celsus, Aulus. De Medicina.