Ancient surgery
Galen
In vain and violent Rome, a new medical revolution was about to begin. The demand for Greek physicians was greater than ever, and one in particular rose to the top. Claudius Galen (c. AD 130-c. 200), the greatest surgeon of antiquity, would be responsible for huge leaps in virtually every medical discipline.
Gladiators
Whenever the Romans conquered a territory, coliseums would soon spring up. One of the largest was at Pergamum in Asia Minor (now Bergama, Turkey). Here, every week, a crowd of 20,000 would come to watch paired-off slaves try to kill each other.
These gladiators were valuable and their owners wanted to protect their investments. Since even the winners could be terribly injured, doctors were in great demand, and the best were almost always Greek. For a young Alexandria-educated, ambitious Greek physician in AD 157, few jobs could have been better than resident surgeon at the Pergamum coliseum. That position was filled by Claudius Galen.
Galen’s gladiator period was crucial to what he would accomplish later. It was as close as he could get to vivisection – dissection of the living. Galen would certainly have been able to see and feel, through the gladiators’ wounds, parts of the internal human anatomy to which others did not have access.
The surgeon and the emperor
According to Galen, not one of the gladiators died during his time as surgeon to them, and from his descriptions of the operations he undertook on their behalf, it is likely that this statement is true. But besides being an excellent physician, Galen was a great showman and self-promoter. It didn’t take long for his name to become known in the highest circles. In AD 161, at the age of 32, he felt it was time to move on.
There was only one place Galen could move on to. When he got to Rome, he became nothing less than resident surgeon in the great Colosseum. But he aspired to even higher things – and soon became doctor to the philosopher emperor Marcus Aurelius.
Marcus Aurelius wanted to wean his subjects away from superstition. He encouraged Galen to disseminate his scientific approach to surgery through public lectures and anatomical demonstrations (using animals). The Greek was as eager as the emperor to spread his scientific way of thinking. He became an extraordinarily prolific medical writer, producing perhaps as many as 600 books on every aspect of medical theory and practice that then existed.
Galen was, however, also extremely arrogant and unpleasant, using his learning and verbal skills to bludgeon opponents into submission. When he abruptly left Rome in 166 to spend three years in Pergamum, he claimed it was because he feared assassination. Oddly enough it was only his contempt for Herophilus and especially Erasistratus (see Alexandria) that led him to write at length about them, so that they have been able to take their rightful places in medical history.
Changing fashion
Despite his personality defects, Galen almost single-handedly created a golden age of medicine and surgery. During his time, cosmetic and reconstructive surgery became ever more daring.
The eye is incredibly difficult to operate on even today. Before Galen, the only operations that would be attempted on it were cataract removals. However, after Galen, surgeons would try to cure squints, droopy eyelids and eye infections.
And eyes were only part of it. Fashions were changing. Under Marcus Aurelius, wars had been banished to the empire’s frontiers, while in Rome itself, there were new obsessions, including the human body. This led to an increasing amount of cosmetic surgery. ‘It’s interesting that a number of these so-called plastic surgeries have got something to do with the genitalia,’ remarks Lawrence Bliquez, professor of classics at the University of Washington.
Ripples through the empire
The destruction of the library at Alexandria coincided with the end of the Roman empire. One of the reasons for Rome’s decline and fall was a lack of central authority – the long-distance networks simply fell apart. And the same thing happened with medicine. It was not that medicine wasn’t still practised, but there was no longer a great centre.
And when the centre of medical knowledge disappeared, the loss rippled through the empire. Everywhere great medical works disappeared, either deliberately destroyed or simply lost to time.
‘We shouldn’t forget,’ says Heinrich von Staden, professor of classics and the history of science at Princeton University, ‘that, despite the enormous wealth of medical literature that we have from antiquity, and the enormous wealth of archaeological finds, we have only a tiny fragment of what was written, what was buried by time. So we know very little, given what once was there.’
Saved by the Arabs
Of Galen’s 600 books, for instance, just 20 survive, and those are with us only because they were rescued by Arab physicians. As they conquered the Middle East, the Arabs captured and preserved some ancient medical texts, and from the 9th century, Galen was translated into Arabic on a massive scale.
Unfortunately translations of Galen’s revolutionary work on anatomy did not reach the Western world until the late Middle Ages. Even more unfortunately, many of his other theories (none of which had any medical validity) and his huge number of remedies (none especially useful) were used by doctors for centuries, becoming the medical equivalent of holy writ. In fact, they later became part of Church dogma. The egotistical Galen would probably have been pleased to know that he effectively held back the advancement of medicine for centuries.
The Arab physicians became famed for their skill, and their own writings entered the medical canon. However, they rarely practised invasive surgery. As for the Western Christians, they abolished surgery in both knowledge and practice: it was pagan and it was a sin.
An end and a beginning
So the end of the great library at Alexandria and of the Roman empire marked the end of progress in Western medicine and, in particular, surgery, for hundreds of years.
It wouldn’t be until the end of the Middle Ages, with the coming of the Renaissance, that the knowledge of the ancients would be rediscovered. Anatomy would gradually be accepted, new discoveries in wound treatment would be made on the battlefield and, finally, the doors to new surgical techniques and practices would swing open.
