Surgery in ancient Rome

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. 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. This resulted in the general public becoming distrustful of doctors. Higher-quality surgeons often served the upper classes. Most surgical procedures were limited to skin lacerations or amputations. == Tools ==

Cupping vessels Cupping vessels were round suction cups usually made of bronze or horns. 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." Cupping vessels were also used to aid bloodletting. 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. 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. Bone levers were ancient steel tools shaped like rods with flattened and curved tips resembling stone cutters. They were used to level fractures, extract teeth, and realign broken bones. 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. Forceps Bone forceps were used to extract injured bones from the body. 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. 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. 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. 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. Probes and curettes Probes and curettes were used to mix and apply medication to the skin or to lift tissue. The blade was made detachable to allow for cleaning and the usage of several blades. There were a variety of kinds of blades. One was straight, sharp, and pointed. Another was curved with sharp or blunt points. 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, severing the umbilical cord, removing nasal polyps, mastectomies, making incisions, cutting through bone, and hernia repair. Specula The rectal speculum also called the catopter was a dual-bladed surgical instrument in ancient Rome. Feminine specula were used to dilate vaginas. These specula were sized according to the age of the patient, and it was ensured that it was not larger than the urethra. To open the vagina, an assistant would turn a screw, expanding the blades, and therefore the vagina. Rectal specula were used to examine the bowels and its damaged parts. In the Republic these tools were made of copper and tin, by the Empire these tools began to be made of silver, as this material was less brittle. Specula also had rounded mirrors with handles. The surgeon, or another person, usually a slave would hold these mirrors. 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. 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. This instrument may have not existed. painful urination, and difficulty urinating. Another procedure involved injecting a piece of thread with wool wrapped around it into the pipe of the tool. Then it was dipped in oil and used to make an incision into the perineum. 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. They could also be used as burial goods and these tools are commonly depicted on works of art. It generally consisted of a curved metal blade, and a metal handle. Other materials that could be used included bronze, iron, and reeds. These hooks were smooth and had short points, which were inserted into the ears, eyes, mouths, and forehead to extract children. 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. Osteotomes were used to cut away at bone and remove membranes. Thigh tourniquets would stop bleeding and prevent the venom from spreading. Another common tool was bronze or iron cross-bladed scissors. During surgeries spatulas could also be used. Although they were primarily used to produce and apply medicine. Ancient Roman surgical tools called phlebotomes were used in operations known as phlebotomies. This tool is one of the most commonly mentioned tools in Ancient Roman medical literature. Despite this, there are no detailed descriptions of the phlebotome. This likely stems from the commonality of the instrument. Due to its popularity, doctors and writers assumed all readers would already be familiar with its appearance and usage. Hemispathions were used to divide the fistula. Syringes in ancient Rome had a variety of uses. Nasal syringes were made of two bronze or horn pipes that were used to inject liquids into the nostrils. Ear syringes were also common tools. They were used to remove unhealthy substances from the ears, and clean the ears, the bladder, the vagina, and the foreskin. Cannulae were used to heal ascites and empyema. This was done by using the bronze cannulae to make an incision into the abdomen and the peritoneum. Cauteries were common ancient surgical tools with a variety of types. Cautery knives were used to remove cancers such as malignant polyps as well as hydroceles. Cauteries could also remove eschars in the spleen, and hernias. It was also used to treat hemorrhoids, diseases of the liver, and trichiasis. The lithotomy scoop was a long and slender semicircular tool used to extract calculi. Enemas were usually made of long silver tubes with perforations attached to a pig's bladder. This bladder was filled with horse milk and closed with a cord. To treat dysentery, enemas were injected into the body's orifices, such as vaginas, bladders, or uteruses. In this operation, cannulae were inserted into the body. These cannulae had circles of small holes to prevent ascariasis, a disease caused by a parasitic roundworm. == Techniques ==

Abortion There were surgical procedures for abortion in ancient Rome, When surgery was used, it involved the use of surgical instruments to penetrate the mother. Usually this procedure ended in the death of both the fetus and the mother. 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. Amputations and dissections Amputations were used to treat gangrene. 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. 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. Bloodletting Bloodletting or a phlebotomy was a common practice in ancient Rome. It was common for surgeons to use a tool known as the phlebotome or the katias to make an incision into another point, which would cause the wound to bleed at another point. Another process involved putting a burning piece of cloth into the patient's mouth to draw out blood. Alternatively, leeches could be used. Ear scoops would be pressed on the proximal end of the vein. This would obstruct the blood flow, which would allow the phlebotome to be used to discharge blood., who Suetonius, a Roman historian says was born through a Caesarean section. Caesarean section During a Roman Caesarean section the doctors would make an incision into the abdomen and uterus of the mother. Following this, the baby was removed. This practice could also be conducted on dead mothers to remove the babies from their corpses. 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. Roman historians Suetonius and Pliny the Elder also record Julius Caesar as being born through a Caesarian section. The veracity of these claims is debated. Cataract surgery Cataract surgery is a surgery in which cataracts are removed. This kind of surgery has been practiced since 29 CE in Ancient Rome. According to Celsus' description of cataract surgery, surgeons would use their right hand to perform on the left eye, and vice versa. During the procedure a needle was inserted between the pupil and the temple until it "meets resistance." Then, the surgeon would rotate the needle until the cataract had been pushed beneath the pupil. Following the cataract surgery, the patient would be treated with "soothing Medicants" and wool soaked in the white of the egg. The patient would also exclusively drink water and abstain from solid food until they no longer had an inflammation, which was a side effect of the surgery. Cosmetic surgery Modern cosmetic surgery has origins in the ancient Greco-Roman world. Roman surgeons were capable of repairing damaged ears, noses, and lips. Celsus discussed rhinoplasty techniques in his De Medicina. Ancient rhinoplasty involved the grafting of a new nose onto the old one. Burns were treated using vinegar, ashes, cork, bran, or honey. To treat both, skin grafting was used. Galen, alongside Celsus, described the use of cheek reconstruction to heal facial injuries. 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. 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. Ligatures could also be used during these operations to avoid bleeding. 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. Lithotomy The ancient Romans practiced lithotomy, a surgical procedure to remove calculi. 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. 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. Neurosurgery Ancient Roman doctors were capable of performing neurosurgery on depressed skull fractures. 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. During this operation a hole was drilled into the skull. Roman doctors believed this would cure headaches and relieve pressure. holding her severed breasts|219x219px 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. 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. Surgical techniques like tracheal intubation and tracheotomy date back to Ancient Rome. 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. Catgut sutures were used by the ancient Romans as early as the 2nd century CE. They also used sutures with metallic hooks. Tonsillectomies and mastectomies The ancient Romans practiced tonsillectomies. 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. 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. This operation could also be used as a punishment. For example, Agatha of Sicily was a Christian saint who had her breasts cut off. 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. 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. Other techniques The ancient surgeon Dioscorides used Mandragora offcinarum as a painkiller during surgery. Other substances were used, such as opium, henbane, wine, belladonna, and alcohol. Anal fistula were treated by passing probes through the anus, then once it was drawn out, a linen thread was placed into it. Following this the ends of the linen were tied to grip the skin by the fistula. To treat stab wounds in which the intestines fell out of the body, the surgeon would first examine the injuries to the intestines and their color. The large intestine was sutured, and if either intestine was pallid, black, or livid the patient was laid on their back with their hips raised. If the wound was too narrow to allow for an easy replacement of the intestines, the surgeon would cut it until it was "sufficiently wide." If the intestines were too dry, they were coated in water. Following this, an assistant would use their hands or hooks to separate the margins of the wound. Then the skin would be stitched with two rows of stitches. Projectiles were removed by enlarging the wound area with a scalpel, then using a forceps to drag the projectile out. To treat abscesses a scalpel or a spathion was used to make linear incisions. Afterwards, all the skin covering the pus was cut off. Following the surgery, the area was disinfected with honey. Another procedure involved using tongue depressors or spathomeles to depress the tongues of adult patients. Following this, the abscess was opened with a probe or a needle knife. == References ==