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 p272  Chirurgia

Article by William Alexander Greenhill, M.D., Trinity College, Oxford
on pp272‑275 of

William Smith, D.C.L., LL.D.:
A Dictionary of Greek and Roman Antiquities, John Murray, London, 1875.

CHIRURGIA (χειρουργία), surgery. The practice of surgery was, for a long time, considered by the ancients to be merely a part of a physician's duty; but as it is now almost universally allowed to be a separate branch of the profession, it will perhaps be more convenient to treat of it under a separate head. It will not be necessary to touch upon the disputed questions, which is the more ancient, or which is the more honourable branch of the profession; nor even to their to give such a definition of the word chirurgia as would be likely to satisfy both the physicians and surgeons of the present day; it will be sufficient to determine the sense in which the word was used by the ancients; and then, adhering closely to that meaning, to give an account of this division of the science and art of medicine, as practised among the Greeks and Romans, referring to the article Medicina for further particulars.

The word chirurgia is derived from χείρ the hand, and ἔργον a work, and is explained by Celsus (De Med. lib. VII. Praefat.) to mean that part of medicine quae manu curat, "which cures diseases by means of the hand;" in Diogenes Laërtius (III.85) it is said to cure διὰ τοῦ τέμνειν καὶ καίειν, "by cutting and burning;" nor (as far as the writer is aware) is it ever used by ancient authors in any other sense. Omitting the fabulous and mythological personages, Apollo, Aesculapius, Chiron, &c., the only certain traditions respecting the state of surgery before the establishment of the republics of Greece, and even until the time of the Peloponnesian war, are to be found in the Iliad and Odyssey. There it appears that surgery was almost entirely confined to the treatment of wounds; and the imaginary power of enchantment was joined with the use of topical applications (Il. III.218, XI.515, 828, 843, &c. &c.). The Greeks received surgery, together with the other branches of medicine, from the Egyptians; and from some observations made by the men of science who accompanied the French expedition to Egypt in 1798, it appears, that there are documents fully proving that in very remote times this extraordinary people had made a degree of progress of which few of the moderns have any conception: upon the ceilings and walls of the temples at Tentyra, Karnack, Luxor, &c., basso-rilievos are seen, representing limbs that have been cut off with instruments very analogous to those which are employed at the present day for amputations. The same instruments are again observed in the hieroglyphics, and vestiges of other surgical operations may be traced, which afford convincing proofs of the skill of the ancient Egyptians in this branch of medical science (Larry, quoted in Cooper's Surg. Dict.).

The earliest remaining surgical writings are those of Hippocrates, who was born B.C. 460, and died B.C. 357. Among his reputed works there are ten treatises on this subject, only one of which however is considered undoubtedly genuine. Hippocrates far surpassed all his predecessors (and indeed most of his successors) in the boldness and success of his operations; and though the scanty knowledge of anatomy possessed in those times prevented his attaining any very great perfection, still, we should rather admire his genius, which enabled him to do so much, than blame him because, with his deficient information, he was able to do no more. The scientific skill in reducing fractures and luxations displayed in all his works, De Fracturis, De Articulis, excites the admiration of Haller (Biblioth. Chirurg.), and he was most probably the inventor of the ambe, an old chirurgical machine for dislocations of the shoulder, which, though now fallen in disuse, for a long time enjoyed a great reputation. In his work De Capitis Vulneribus he gives minute directions about the time and mode of using the trephine, and warns the operator against the probability of his being deceived by the sutures of the cranium, as he confesses happened to himself (De Morb. Vulgar. lib. V p561, ed. Kühn). The author of the Oath, commonly attributed to Hippocrates, binds his pupils not to perform the operation of lithotomy, but to leave it to persons accustomed to it (ἐργάτῃσι πρήξιος τῆσδε); from which it would appear as if certain persons confined themselves to certain operations.

The names of several persons are preserved who practised surgery as well as medicine, in the times immediately succeeding those of Hippocrates;​a but, with the exception of some fragments, inserted in the writings of Galen, Oribasius, Aëtius, &c., all their writings have perished. Archagathus deserves to be mentioned, as he is said to have been the first foreign surgeon that settled at Rome B.C. 219 (Cassius Hemina, apud Plin. H. N. XXIX.6). He was at first very well received, the jus Quiritium was conferred upon him, a shop was bought for him at the public expense, and he received the honourable title of Vulnerarius. This, however, on account of his frequent use of the knife and cautery, was soon changed by the Romans (who were unused to such a mode of practice) into that of Carnifex. Asclepiades, who lived at the beginning of the first century B.C., is said to have been the first person who proposed the operation of bronchotomy, though he himself never performed it (Cael. Aurel. De Morb. Acut. I.14, III.4); and Ammonius of Alexandria, surnamed Λιθοτόμος, who is supposed to have lived rather later, is celebrated in the annals of surgery for having been the first to propose and to perform the operation of Lithotrity, or breaking a calculus in the bladder, when found to be too large for safe extraction. Celsus has minutely described his mode of operating ( De Med. VII.26 §3 p436), which very much resembles that lately introduced by Civiale and Heurteloup, and which proves, that however much credit they may deserve for bringing it again out of oblivion into public notice, the praise of having originally thought of it belongs to the ancients. "A hook," says Celsus, "is to be so insinuated behind the stone as to resist and prevent its recoiling into the bladder, even when struck; then an iron instrument is used, of moderate thickness, flattened towards the end, thin, but blunt; which being placed against the stone, and struck on the further end, cleaves it; great care being taken, at the same time, that neither the bladder itself be injured by the instrument, nor the fragments of the stone fall back into it." The next surgical writer is Celsus, who lived at the beginning of the first  p273 century A.D., and who has devoted the four last books of his work, De Medicina, and especially the seventh and eighth, entirely to surgical matters. It appears plainly from reading Celsus, that since the time of Hippocrates surgery had made very great progress, and had, indeed, reached a high degree of perfection. He is the first author who gives directions for the operation of lithotomy ( De Med. VII.26 §2 p432), and the method described by him (called the apparatus minor, or Celsus's method) continued to be practised till the commencement of the sixteenth century. It was performed at Paris, Bordeaux, and other places in France, upon patients of all ages, even as late as a hundred and fifty years ago; and a modern author (Allan On Lithotomy, p12) recommends it always to be performed on boys under fourteen (Cooper's Dict. of Prac. Surg., art. Lithotomy). He describes ( VII.25 §3 p428) the operation of Infibulatio, which was so commonly performed by the ancients upon singers, &c., and is often alluded to in classical authors (See Juv. VI.73, 379; Senec. apud Lactant. Divin. Instit. I.16; Mart. Epigr. VII.82.1, IX.28.12, XIV.215.1; Tertull. De Corona Mil. 11). He also describes ( VII.25 §1 p427) the operation alluded to by St. Paul (1 Cor. vii.18) περιτετμημένος τὶς ἐκλήθη: μὴ ἐπισπάσθω. Compare Paulus Aegineta (De Re Med. VI.53), who transcribes from Antyllus a second method of performing the operation.

The following description, given by Celsus, of the necessary qualifications of a surgeon, deserves to be quoted:— "A surgeon," says he (lib. VII Praefat.) "ought to be young, or, at any rate, not very old; his hand should be firm and steady, and never shake; he should be able to use his left hand with as much dexterity as his right; his eye-sight should be acute and clear; his mind intrepid, and so far subject to pity as to make him desirous of the recovery of his patient, but not so far as to suffer himself to be moved by his cries; he should neither hurry the operation more than the case requires, nor cut less than is necessary, but do every thing just as if the other's screams made no impression on him."

Perhaps the only surgical remark worth quoting from Aretaeus, who lived in the first century A.D., is that he condemns the operation of bronchotomy, and thinks "that the wound would endanger an inflammation, cough, and strangling; and that if the danger of being choked could be avoided by this method, yet the parts would not heal, as being cartilaginous" (De Morb. Acut. Cur. I.7 p227, ed. Kühn).

Omitting Scribonius Largus, Moschion, and Soranus, the next author of importance is Caelius Aurelianus, who is supposed to have lived about the beginning of the second century A.D., and in whose works there is a good deal relating to surgery, though nothing that can be called original. He rejected as absurd the operation of bronchotomy (De Morb. Chron. III.4). He mentions a case of ascites that was cured by paracentesis (Ibid III.8), and also a person who recovered after being shot through the lungs by an arrow (Ibid. III.12).

Galen, the most voluminous and at the same time the most valuable medical writer of antiquity,​b is less celebrated as a surgeon than as an anatomist and physician. He appears to have practised surgery at Pergamus, but upon his removal to Rome (A.D. 165), he entirely confined himself to medicine, following, as he says himself (De Meth. Med. VI.20), the custom of the place. His writings prove, however, that he did not entirely abandon surgery. His Commentaries on the Treatise of Hippocrates, De Officina Medici, and his treatise De Fasciis, shows that he was well versed even in the minor details of the art. He appears also to have been a skilful operator, though no great surgical inventions are attributed to him.

Antyllus, who lived some time between Galen and Oribasius, is the earliest writer whose directions for performing bronchotomy are still extant, though the operation (as was stated above) was proposed by Asclepiades about three hundred years before. Only a few fragments of the writings of Antyllus remain, and among them the following passage is preserved by Paulus Aegineta (De Re Med. VI.33):— "Our best surgeons have described this operation, Antyllus particularly, thus: 'We think this practice useless, and not to be attempted where all the arteries and the lungs are affected; but when the inflammation lies chiefly about the throat, the chin, and the tonsils which cover the top of the windpipe, and the artery is unaffected, this experiment is very rational, to prevent the danger of suffocation. When we proceed to perform it, we must cut through some part of the windpipe, below the larynx, about the third or fourth ring; for to cut quite through would be dangerous. This place is the most commodious, because it is not covered with any flesh, and because it has no vessels near it. Therefore, bending the head of the patient backward, so that the windpipe may come more forward into view, we make a transverse section between two of the rings, so that in this case not the cartilage, but the membrane which incloses and unites the cartilages together, is divided. If the operator be a little fearful, he may first divide the skin, extended by a hook; then, proceeding to the windpipe, and separating the vessels, if any are in the way, he must make the incision.' Thus far Antyllus, though thought of this way of cutting, by observing (when it was, I suppose, cut by chance) that the air rushed through it with great violence, and that the voice was interrupted. When the danger of suffocation is over, the lips of the wound must be united by suture, that is, by sewing the skin, and not the cartilage; then proper vulnerary medicines are to be applied. If these do not agglutinate, an incarnant must be used. The same method must be pursued with those who cut their throat with a design of committing suicide."1

Oribasius, physician to the Emperor Julian (A.D. 361), professes to be merely a compiler; and though there is in his great work, entitled Συναγογαὶ Ἰατρικαί, Collecta Medicinalia, much surgical matter, there is nothing original. The same may be said of Aëtius and Alexander Trallianus, both of whom lived towards the end of the sixth century A.D., and are not famous for any surgical inventions. Paulus Aegineta has given up the fifth and sixth books of his work, De Re Medica,  p274 entirely to surgery, and has inserted in them much useful matter, the fruits chiefly of his own observation and experience. He was particularly celebrated for his skill in midwifery, and female diseases, and was called on that account, by the Arabians, Al‑Kawabeli, "the Accoucheur," (Abul-pharj, Hist. Dynast., p181, ed. Pococke). Two pamphlets were published in 1768 at Göttingen, 4to. by Rud. Aug. Vogel, entitled De Pauli Aeginetae Meritis in Medicinam, imprimisque Chirurgiam. Paulus Aegineta lived probably towards the end of the seventh century, A.D., and is the last of the ancient Greek and Latin medical writers whose surgical works remain. The names of several others are recorded, but they are not of sufficient eminence to require any notice here. For further information on the subject both of medicine and surgery, see Medicina; and for the legal qualifications, social rank, &c., both of physicians and surgeons, among the ancient Greeks and Romans, see Medicus.

The surgical instruments, from which the accompanying engravings are made,​c were found by a physician of Petersburg, Dr. Savenko, in 1819, at Pompeii, in Via Consularis (Strada Consulare), in a house which is supposed to have belonged to a surgeon. They are now preserved in the museum at Portici. The engravings, with an account of them by Dr. Savenko, were originally published in the Revue Médicale for 1821, vol. III p427, &c. They were afterwards inserted in Froriep's Notizen aus dem Gebiete der Natur-und‑Heilkunde, for 1822, vol. II n26, p57, &c. The plate containing these instruments is wanting in the copy of the Revue Médicale in the library of the College of Surgeons, so that the accompanying figures are copied from the German work, in which some of them appear to be drawn very badly. Their authenticity was at first doubted by Kühn (De Instrum. Chirurg., Veteribus cognitis, et nuper effossis, Lips. 1823, 4to.), who thought they were the same that had been described by Cayardi in his Catal. Antiq. Monument. Herculani effos., Nap. 1754, fol. n236‑294; when, however, his dissertation was afterwards republished (Opusc. Academ. Med. et Philol., Lips. 1827, 1828, 8vo vol. II p309) he acknowledged himself to be completely satisfied on this point, and has given in the tract referred to, a learned and ingenious description of the instruments, and their supposed uses, from which the following account is chiefly abridged. It will, however, be seen at once, that the form of most of them is so simple, and their uses so obvious, that very little explanation is necessary.

[image ALT: An engraving of 9 cutting instruments of the most fantastic shapes. They are Roman surgical instruments found in Pompeii. Accompanying text goes thru them in detail.]
	1, 2 Two probes (specillum, μήλη) made of iron; the larger six inches long, the smaller four and a half. 3. A cantery (καντήριον) made of iron, rather more than four inches long. 4, 5. Two lancets (scalpellum, σμίλη), made of copper, the former two inches and a half long, the other three inches. It seems doubtful whether they were used for blood-letting, or for opening abscesses, &c. 6. A knife, apparently made of copper, the blade of which is two inches and a half long, and in the broadest part one inch in breadth; the back is straight and thick, and the edge much curved; the handle is so short that Savenko thinks it must have been broken. It is uncertain for what particular purpose it was used: Kühn conjectures that (if it be a surgical instrument at all) it may have been made with such a curved edge, and such a straight thick back, that it might be struck with a hammer, and so amputate fingers, toes, &c. 7. Another knife, apparently made of copper, the blade of which is of a triangular shape, two inches long, and in the broadest part eight lines in breadth; the back is straight and one line broad, and this breadth continues all the way to the point, which, therefore, is not sharp, but guarded by a sort of button. Kühn thinks it may have been used for enlarging wounds, &c., for which it would be particularly fitted by its blunt point and broad back. 8. A needle, about three inches long, made of iron. 9. An elevator (or instrument for raising depressed portions of the skull), made of iron, five inches long, and very much resembling those made use of in the present day.

[image ALT: An engraving of 10 cutting instruments of the most fantastic shapes. They are Roman surgical instruments found in Pompeii. Accompanying text goes thru them in detail.]
	10‑14. Different kinds of forceps (vulsella). No. 10 has the two sides separated from each other, and is five inches long. No. 11 is also five inches long. No. 12 is three inches and a half long. The sides are narrow at  p275 the point of union, and become broader by degrees towards the other end, where, when closed, they form a kind of arch. It should be noticed that it is furnished with a moveable ring, exactly like the tenaculum forceps employed at the present day. No. 13 was used for pulling out hairs by the roots (τριχολαβίς). No. 14 is six inches long, and is bent in the middle. It was probably used for extracting foreign bodies that had stuck in the oesophagus (or gullet), or in the bottom of a wound. 15. A male catheter (aenea fistula), nine inches in length. The shape is remarkable from its having the double curve like the letter S, which is the form that was re-invented in the last century by the celebrated French surgeon, J. L. Petit. 16. Probably a female catheter, four inches in length. Celsus thus describes both male and female catheters ( De Med. VII.26 §1 p429):— "The surgeon should have three male catheters (aeneas fistulas), of which the longest should be fifteen, the next twelve, and the shortest nine inches in length; and he should have two female catheters, the one nine inches long, the other six. Both sorts should be a little curved, but especially the male; they should be perfectly smooth, and neither too thick nor too thin." 17. Supposed by Froriep to be an instrument for extracting teeth (ὀδοντάγρα, Pollux, IV § 181); but Kühn, with much more probability, conjectures it to be an instrument used in amputating part of an enlarged uvula, and quotes Celsus ( De Med. VII.12 §3 p404), who says, that "no method of operating is more convenient than to take hold of the uvula with the forceps, and then to cut off below it as much as is necessary." 18, 19. Probably two spatulae.

The Author's Note:

1 This operation appears to have been very seldom, if ever, performed by the ancients upon a human being. Avenzoar (p15) tried it upon a goat, and found it might be done without much danger or difficulty; but he says he should not like to be the first person to try it upon a man.

Thayer's Notes:

a Not only right after the time of Hippocrates: see this late Roman inscription found in 2004 in Trevi (Umbria), of a MEDICVS CHIRVRGVS. It will be noted, however, that the inscription appears to state that the surgeon-doctor died at 21, which is a puzzle.

b For a comprehensive catalog of the works of Galen (from Kühn and the TLG), although not the works themselves, see Jost Gippert's Index Galenicus. A few English translations of works by Galen can be found online at Medicina Antiqua.

c Needless to say, both archaeology and the technical means of illustration have advanced since our dictionary. There were at least two very good websites offering nicely identified modern photos of Roman surgical instruments, with good text (Prof. Nancy Demand's "Greek and Roman Surgical Instruments" at Asclepion, and "The Surgery of Ancient Rome" at the Health Sciences Library of the University of Virginia), but with the continued shrinkage of the useful parts of the Web — as opposed to chatter — they have both vanished.

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