On Roman Surgery

Roman surgical instruments found at Pompeii

There were many types of surgery known to the Romans and many types of instrument. The lifestyle of many people led to problems requiring surgery. In the pastime of hunting wild animals, a fall from a horse would result in broken limbs or severe wounds. Farmers and those who owned a business that was a hazardous occupation, such as a blacksmith were commonly in need of treatment for wounds sustained in the course of their work. Minor cuts would be treated with compresses made from vinegar.

The tools of the surgeon bear a certain resemblance to our current day instruments. Forceps, syringes, scalpels, bone saws. These were made by specialist manufacturers that could meet the fine tolerances and sharpness required for the surgeon's implements.

One doctor buried in Wroxeter had his instruments placed alongside him in his coffin, so aiding archaeologists in identifying individual items.

Trepanning

If there is one procedures done in ancient times that most awes (or horrifies) modern observers, and among the surgical procedures, it is trephination — cutting holes in the skull to relieve pain and pressure — that most often steals the spotlight. The process was well known, having been explicated early on by Hippocrates himself. (You can see ancient Roman trephined skulls at the Museo Preistorico ed Etnographico Luigi Pigorini on Piazza Marconi in Rome). Other skull procedures were also developed, particularly those concerned with the reduction of depressed cranial fractures — if your skull was pounded in, it could be fixed.

One of the most common problems was a head injury were the skull was fractured and a piece of bone had broken away and was pressing on the brain. Depending on which part of the head was injured, the symptoms would have ranged from persistent headaches to fits and mood swings.

The process of trepanning was meant to cure this complaint. This involved opening the wound and removing the offending section of bone. As there was no anesthetic the operation would have been painful to say the least. Bodies uncovered showing signs of this operation and also had evidence of new bone had grown over the gap left by the operation. There was no doubt trepanning was an effective operation, which is why it was so popular.

Internal Work

Thoracic surgery was rarely attempted, except for procedures to remove arrows and other projectiles and to close abdominal wounds. Roman practitioners could surgically reduce limb fractures when non-surgical methods failed, and they knew about (but rarely attempted) tracheal procedures to restore breathing and reconstruct tracheal openings. Roman surgeons did internal and external suturing and tied ligatures around blood vessels and used cauterization to stop bleeding. This was particularly important in amputations, which might be carried out to prevent spread of infection, tumors, gangrene, or in the case of industrial accidents, or war injuries. An ancillary profession, the construction of limb prostheses, was soon established

Injuries in War (Trauma Cases)

It was war injuries, of course, that really advanced Roman surgery. If you were lucky, your military unit would have a good medicus/chirurgus who could patch you up before you bled to death, and if you were really lucky he might retire to the same colonia that you were pensioned off to. (Chirurgus was really a corruption of the Greek word for surgeon, which transliterates into English as “cheirourgos”. The pure Latin phrase for surgeon was actually “medicus vulnerarius”, which means, literally, “wound doctor”) Roman military surgeons were, in fact, only rivaled by specialist arena surgeons, who repaired valuable gladiators.

Plastic Surgery

Roman surgeons were also adept at several forms of minor plastic surgery. They did facial and other repairs, removed growths, etc. The most common operation appears to have been male de-circumcision. Reversal of genital mutilation, which might have been the result of religious observance or mischance, was an important procedure which one would seek in order to avoid embarrassment when appearing naked at the baths or in the gymnasia.

Surgical Tools and Medical Implements used in ancient Rome

Archaeological sites have produced many implements used in ancient Roman surgery — some dating to 460 BC. This is the timeline Hippocrates wrote The Oath — a pledge still taken today by doctors to perform to their fullest ability.

Roman Medics studied Medical texts by Hippocrates, who came from the Greek Island of Cos and is generally regarded as the “Father of Medicine.” Actually, he was only one of a longstanding line of medical practitioners, but his personal popularity ensured that his treatises were saved by his followers while those written by his predecessors, which nobody saved, were lost to the coming ages.

A Roman Military Hospital Reveals its secrets

Recently, a military hospital at Baden has produced a large collection of medical tools. A stone mural of Roman legion depicts a fellow solider helping another remove probably an arrow from his leg with a pair of pinchers. Some soldiers were skilled in medical while still serving in the army. The negative realm of Roman medicine started in its early history.

Instruments Discovered

Here are some examples of surviving Roman medical instruments.

Scapels

Scalpels, made of steel or bronze were used to make incisions. Scalpels could be made of either steel, bronze, or a combination of the two metals—such as a steel blade and a bronze handle. Ancient scalpels had almost the same form and function as their modern counterparts do today. The two long steel scalpels that make up the first and third columns of the accompanying image are examples of the most ordinary type of scalpel from antiquity. These long scalpels could be used to make a variety of incisions, but they seem to be particularly suited to making either deep or long cuts. The four bronze scalpels which make up columns two and four are generally referred to as “bellied scalpels.” This variety of scalpel was another favorite of physicians in antiquity since the shape of its handle allowed more delicate and precise cuts to be made.

Bone Hooks

Hooks, long thin metal instruments were used as probes and the maneuvering small pieces of tissue more easily. Hooks were another common instrument used regularly by Greek and Roman doctors. The hooks the ancient doctors used came in two basic varieties: sharp and blunt. Both of these types of hooks are still used by modern surgeons for many of the same purposes for which the ancient doctors first used them. For instance, blunt hooks were primarily used as probes for dissection and for raising blood vessels. Sharp hooks, like those pictured in the accompanying image, were used to hold and lift small pieces of tissue so that they could be extracted and to retract the edges of wounds.

Bone Drills

Bone drills, looking like wine cork screws were used to remove diseased bone tissue from the skull and extract sizable foreign objects such as a weapon from a bone. Bone forceps were used to extract small pieces of bone that would be otherwise difficult to remove with fingers.

Bone Forceps

In the case of impaction of the foetal cranium, the head may be opened with a sharp instrument and the pieces of the skull removed with bone forceps. Paul Aigenita (VI.xc) wrote that in a depressed fracture of the skull fractured bone is to be removed in fragments, with the fingers if possible, if not, with a bone forceps.

Vectis or Bone Levers

This instrument, called a vectis by the Romans, was a bone lever used for levering a fractured bone into place or raising a depressed bone. The surfaces at the ends were ridged for better gripping. From what Galen says, these instruments were used for levering fractured bones into position and may have been used for levering out teeth.

Paul of Aegina, a writer of the sixth and seventh centuries AD who compiled medical knowledge from ancient times, wrote a description of a bone lever:

...on the first day before inflammation has come on, or about the ninth day after inflammation has gone off, we may set [bones] with an instrument called the lever. It is an instrument ... about seven or eight fingers breadth in length, of moderate thickness that it may not bend during the operation, with its extremity sharp, broad and somewhat curved.

Vaginal Speculum

One of the most spectacular, if fearsome looking, Roman medical instruments is the vaginal dilator or speculum (dioptra). It comprises a priapiscus with 2 (or sometimes 3 or 4) dovetailing valves which are opened and closed by a handle with a screw mechanism, an arrangement that was still to be found in the specula of 18th-century Europe. Soranus is the first author who makes mention of the speculum specially made for the vagina. Graeco-Roman writers on gynecology and obstetrics frequently recommend its use in the diagnosis and treatment of vaginal and uterine disorders, yet it is one of the rarest surviving medical instruments. Specula are large and readily recognizable and should not have suffered the same degree of destruction as thin instruments, such as probes, scalpels and needles. As a source of bronze, however, they may have been more subject to recycling than the smaller instruments.

Rectal Speculum

The earliest mention of the rectal speculum is to be found in the treatise on fistula by Hippocrates (iii.331): “Laying the patient on his back and examining the ulcerated part of the bowel by means of the rectal speculum...”

Male Catheter

Catheters, long metal tubes, like those we have today were used to help open up a blocked urinary tract infections. (owwwwwwwwwwwwww!)

Probes or Curettes

The scope of the cyathiscomele in medical art is evidently, like the flat spathomele, to act occasionally as a sound, but mainly to mix, measure and apply medicaments. Some are adapted for use as curettes. The large numbers in which this instrument occurs would itself indicate that it was used for lay as well as medical purposes.

Uvula Crushing Forceps

These finely toothed jawed forceps were designed to facilitate the amputation of the uvula. The procedure called for the physician to crush the uvula with forceps before cutting it off in order to prevent hemorrhaging.

Spathomele or Spatula

Almost every medical writer mentions the spathomele. It consists of a long shaft with an olivary point at one end and a spatula at the other. It was a pharmaceutical rather than a strictly surgical instrument. The olive end was used for stirring medicaments, the spatula for spreading them on the affected part.

The spathomele was also used by painters for preparing and mixing their colors. The very large numbers in which they are found would indicate that their use was not confined to medical men.

Bone Saw

Original bone saw above with repro (which shows how a handle was mounted) below
(these are thumbnails)

photo used with kind permission of Paul Eliott

The bone saw was used to cut through bones in amputations, which the Romans knew prevented gangrene.

Hippocates, in the 5th century BC originally put forward the use of ligatures to tie off ‘bleeders’ and he also advocated application for vascular gangrene.

Heliodus and Archigenes, two roman surgeons, advocated amputation for gangrene and also for injuries, tumours and other various deformities.

At the cellular level the healing process starts almost immediately, but a few days after amputation there is a no observable signs of healing. After more than a week the ends of the bone and diaphysis (mid-shaft) will undergo vascular erosion. After two weeks an endosteal callus will form on the end of the shaft that will eventually narrow and obliterate the medullary cavity. This basically means that a rough bony callus will start to cover the marrow cavity of the bone.  Eventually the rough new bone growth will eventually smooth over and give the shortened end of the diaphysis a rounded appearance (Aufderheide & Rodriguez-Martin 1998).