Ancient surgery
Alexandria
In Alexandria, Herophilus and Erasistratus were permitted to dissect living criminals
With Alexander the Great’s new empire, the West was connected to the East and the South for the first time. The enquiring minds of the Greeks now had access to the rich medical traditions of Egypt and India, of the great physician Skar and of Sushruta, India’s first surgeon. Precisely what Alexander’s armies brought back from India isn’t certain, but all learning, including surgical knowledge, advanced rapidly at about this time.
Twenty-three centuries ago, on virgin land on the Mediterranean coast of Egypt, Alexander established his Egyptian capital: Alexandria. After his death in 323 BC, his successor as ruler of Egypt, Ptolemy, was determined to make the city the most important in the Greek world. And as part of this, it became a great centre of science where medicine could flourish.
The library and the museum
Ptolemy sent agents all over the Greek world to acquire new texts, and visiting ships were obliged by law to leave their manuscripts to be copied. As Alexander himself had wished, a great library was built to house them all. Over half a millennium, it gathered together some 700,000 volumes, including the most comprehensive body of medical texts in ancient history.
In addition, the Ptolemy family established a museum – ‘house of the Muses’ – a publicly funded research institute. Thanks to this and the great library, the development and teaching of scientific knowledge flourished as never before.
Research and anatomy
‘Hippocratic medicine is very interesting,’ says Lawrence Bliquez, professor of classics at the University of Washington, ‘but with the appearance of On Medicine by the Roman writer Celsus [c. 25 BC-AD 45], we have much more developed medicine and much more developed surgery.
‘What’s happened in the meantime? Alexandria has happened. The museum has opened, and the ruling Ptolemy family is very liberal in their support of all sorts of research endeavours – medicine, literature, everything.
‘For a good 50-year period, we have people such as Herophilus of Chalcedon and Erasistratus of Iulis permitted to perform not only anatomical operations on corpses but also, if we’re to believe Galen, vivisection.’
Dissection
Physicians came to Alexandria from all over the Mediterranean world to teach and to study. Recently the remains of the original Ptolemaic university were uncovered. It’s an enormous site and, over 2,000 years ago, would have offered thousands of scholars the opportunity to learn in its oval lecture rooms where the great physicians of the day would have come to teach anatomy.
The key to anatomy was dissection, which in most early cultures was taboo. However, attitudes began to change when the philosophers Plato and Aristotle decided that the body was worthless after the soul left it at death. As a result, in liberal Alexandria sometime in the 3rd century BC, a young physician named Herophilus was given permission to dissect human bodies. His findings revolutionised all kinds of surgery.
Anatomical distinctions
According to Heinrich von Staden, professor of classics and the history of science at Princeton University, ‘Prior to Herophilus, no one had ever done systematic dissection of human cadavers. Herophilus achieved a remarkably detailed knowledge of the entire human body.
‘For example, he demonstrated the anatomical distinction between arteries and veins, and perhaps most important, he discovered the nerves. In addition, he made the distinction between motor and sensory nerves, distinguished between four coats of the eye, discovered the ventricles of the brain and described them quite accurately.’
Most of today’s understanding of the body comes straight from Herophilus and the discoveries he made 2,000 years ago. ‘After him,’ says Professor von Staden, ‘the dissection of humans was not done again for another 15 centuries in any culture in any part of the world.’
A bigger taboo
But it wasn’t just the dissection of cadavers. Herophilus was allowed to break an even bigger taboo: carving up living humans – condemned criminals.
‘Systematic experimentation by vivisection is the cutting open of living human beings to observe the functions of the internal parts in a living being,’ explains Professor von Staden. ‘The justification for this was said to be that, no matter how well one gets to know the dead body, it is different from the living body.’
Natural causes
As horrific as these experiments were, they did give Herophilus and his students an unprecedented understanding of the human body – of the nerves, for instance, and the brain. The brain’s importance was recognised for the first time, again greatly reducing the dominant beliefs in spirits and magic.
‘Herophilus did not base his practice on the belief that diseases are sent to humans by gods as punishment or as rectification of some kind of moral or political disorder,’ says Professor von Staden. ‘Rather he based it on the belief that diseases have natural causes, which most of the Hippocratic doctors believed as well, and therefore diseases had to be addressed by secular, scientific means. His discoveries may have been the largest single step forward ever taken in medicine.’
Plotting the stars
At the beginning of the 3rd century AD, surgery was enjoying a golden age. While Rome, the cultural and political capital, benefited most from these advances, Alexandria remained the seat of medical learning.
All that science revolved around the museum and the great library with its 700,000 scrolls. Here was where the circumference of the earth was measured, where the stars were plotted, where Herophilus recorded that the brain, not the heart, was the centre of thought. But fast approaching was the end of both this golden age and the library itself.
The end
It is likely that Alexandria’s museum was destroyed during a revolt in AD 295. There is a growing consensus among historians that the library suffered from several destructive events, but the deliberate burning of the city’s pagan temples by Christians in the late 4th century was probably the most severe and final one.
Today, near where the old library once stood, there’s a new one, the largest in Africa – the $230 million Bibliotheca Alexandria. In it, you will find the only remaining papyrus from the ancient library. Written in ancient Greek, this fragment is part of an index of some of the scrolls that were once held by the library.
