Anaesthetic, Surgery and Prosthetics in the Ancient World
Most people will think of anaesthetic as a modern invention and assume that prior to the 19th century surgery was administered with a ‘grin and bear it’ philosophy. This wasn’t the true picture, Greeks had access to opium through their use of poppies. The earlier cultures of Sumeria and Babylonia had noted that opium had anaesthetic properties. As with so many other aspects (from philosophy to the alphabet) this knowledge was to head west.
An early example of this is the mysterious drug Homer calls nepenthe (Od.4.220ff). It’s a drug Helen mixes with wine to mellow the emotional state of Menelaus and his guests (including Telemachus). Its effects seem potent, disabling the emotional state of the guests and promoting a more relaxed one.
There is debate as to whether the drug used may have been an opiate. What is more certain is that the connection between poppies and sleep was readily acknowledged in ancient times. The Greek god of sleep, Hypnos, is often featured with poppies - indeed the cave he was supposed to reside in was surrounded by them.
Opiates may have been mild pain relief but it was certainly welcome as the Greeks weren’t averse to practising quite advanced surgical techniques. Homer not only describes anatomically precise deaths but also the battlefield surgery which must have been a realistic feature of any battle.
Homer frames these episodes with detail that suggest he had sound medical knowledge. From Menelaus’ relief upon inspecting his arrow wound to Idomeneus’ announcement that healers are worth an army of men there is a subtext of the worth of surgeons and surgical understanding.
Homer’s writing sits neatly alongside a discovery made in Abdera (Thrace), dating to the middle of the 7th century BC. The remains of a woman were discovered with what seemed like an injury on the rear of the skull consistent with a lead shot from a sling. This wasn’t necessarily what made it so interesting, remains with battle wounds are quite common. What made this different was that this injury had been successfully operated on.
The detail of the surgery appears to be quite complex, rather than trepanning the cranial bone had been scraped and the bone fragments successfully removed. Judging from the recovery growth (usually shown by bone smoothness surrounding any wound or damage) around the area it has been estimated that the woman had lived for 20 years or so following the surgery.
Perhaps this resets the notion of Greek medicine as something treated with simple salves and chants. The later workings of Hippocrates detailed how to treat head wounds such as this and the fact that this knowledge predated him suggests that medical knowledge in the Aegean was more advanced than many had thought.
So far we’ve seen that medical knowledge could be applied to trauma injuries sustained in battle. War was a vehicle which advanced medical knowledge with its endless injuries and patients who had nothing to lose. In the later Roman Empire the camp doctor and camp hospital was a central element to an army marching or at rest.
Ever wonder why cancer is called cancer? Or why, in particular, the zodiac sign is so called? The etymology appears to come from Hippocrates (460-370 BC), who thought that cancerous growths often resembled crabs and termed these karkinos. Treating the tumour and symptoms was as much as the Greeks could do – it wasn’t till the Roman period that we have a recorded excision of a tumour.
Archigenes was a Greek living in the overlap of the first and second centuries AD. His work on cancer stressed early diagnosis and, if needed, surgery. The surrounding blood vessels were tied and a ligature applied to the tumour before being removed. The immediate area was then cleaned and any tumour material removed. A poultice of leek, bread and salt would then be applied.
It wasn’t just Archigenes who worked on cancer – the renowned medic Galen (129- 200 AD) also worked using a similar technique, though he seems to have used cauterisation to remove the remnants of the tumour – something that was ahead of its time.
As the Paralympics are almost upon us, looking into the history of prosthetics seems somewhat apt. The first real evidence of ancient prosthetics was found in Capua, in a grave dating to 300BC – the chap who lay in the grave had a fake leg. Not simply a cliché pirate stump but quite an ornate prosthetic with supports for the stump of the upper leg it had to support. That it existed in southern Italy in this period suggests this was a shared and well developed technology.
Perhaps the most famous prosthetic of antiquity belonged to Marcus Sergius Silvus, a Roman veteran of the 2nd Punic war (218-201BC) who had an iron hand. His hand was not simply ornamental, it was functional too as it was able to fix to his shield when he fought, a prosthetic that was really ahead of its time!
All of these medical examples show us that medicine and surgery was moving into a place where it could be utilised to enhance and treat non-threatening illnesses. This collided with a period in history where excess and looks were supremely important - The Roman Empire.
The Roman Empire facilitated medical research in a number of ways. It brought wars by the bucket-loads, allowing surgeons plenty of practice. As it absorbed other cultures it allowed new approaches and ideas to intersect. It also allowed a class of people to be able to access surgery for purely aesthetical reasons. They may be to lose weight (evidence suggests that early plastic surgeons performed breast reduction surgery on overweight men in 1st century AD) or, as we are about to see, for something you probably wouldn’t expect. Reverse circumcision.
Leaving a tip.
Greeks weren’t fans of circumcision. More to the point the Greeks weren’t keen on the glans (I suggest any googling of this is done with some discretion). For those of you not so well versed in the anatomical nomenclature of the male genitals, the glans is the end of the male member that can be covered by the foreskin if a penis is uncircumcised - its outline has been an inspiration for crude graffiti since time began. Figures which did show exposed glans on Greek vases were the uncivilised and bawdy (e.g. satyrs) or the comically grotesque character in Greek plays.
Greek men went to great pains, quite literally, to ensure their glans were concealed. Athletes or simply those exercising in the palaestra as well as men in general situations would use kynodesme (dog ties) - small leather strips used to tie a knot at the end of the foreskin so it wouldn’t retract.
( a Greek male at exercise with knyodesme - Triptelemos Painter 480 BC)
The Romans didn’t adopt and absorb all the Greek mores but they did agree on this one. Of course, this now presented the circumcised chap with a significant hurdle to cross. Rome was equally as visual in terms of the body beautiful as Greece had been and, as you may well know, baths were the social hub where men met for business or to network. Naked.
How then, might a businessman from the east or new arrival to Rome settle in? The answer was to reverse the circumcision process. This could be done in two ways, both equally as interesting. The first would be to use weights called Judeum Pendum – they would be attached to the shaft – pulling the skin down and creating a new foreskin. The second, more eye-watering, option was detailed by Celsus in the 1st century AD. Without going into too much detail it involved cutting around the base of the penis to create a sleeve which was moved upwards – a more painful and violent version of Monica’s fake foreskin for Joey if you will (a little nod to any Friends fans out there). For those of you with strong stomachs click here to read how the operation would work.
The medical experience of antiquity was something that encompassed a wide array of developed techniques and ones which were still in their infancy. We tend to have a narrow view of it, thinking purely of prayers and sacrifices. But as you can see the Romans and Greeks shared more with us than we may at first consider.