Scalpel, Tweezers, Bone Drill: Modern Medicine in Ancient Rome
Doctors are generally held in high esteem today, but the first-century Romans were skeptical, even contemptuous, of physicians, many of whom treated illnesses they did not understand. Poets especially ridiculed surgeons for being greedy, for sexually abusing patients, and especially for being incompetent.
In his “Natural History,” Pliny the Elder, the admiral and scholar who in 79 AD. people and 600 years of Rome.” Their fees were exorbitant, their legal remedies questionable, their bickering intolerable. “Physicians gain experience and conduct their experiments at their peril through our deaths,” he wrote. The epitaph on more than one Roman tombstone read: “A gang of doctors killed me.”
Medical remedies have improved since then—no more broken snails, salted weasel meat, or ashes from cremated dog heads—but surgical instruments have changed surprisingly little. Scalpels, needles, tweezers, probes, hooks, chisels, and drills are as much a part of today’s standard medical toolbox as they were during Rome’s Imperial era.
Archaeologists in Hungary recently unearthed a rare and mind-boggling set of such devices. The items were found in a necropolis near Jászberény, some 35 miles from Budapest, in two wooden boxes and including pliers to pull teeth; a curet, for mixing, measuring and applying medicines, and three copper alloy scalpels fitted with detachable steel blades and inlaid with Roman-style silver. Next to it lay the remains of a man believed to have been a Roman citizen.
The site, seemingly undisturbed for 2,000 years, also yielded a pestle that, judging by the abrasions and medicine residue, was probably used to grind medicinal herbs. Most unusual were a bone lever, for putting fractures back in place, and the handle of what appears to have been a drill, for trepanating the skull and extracting smashed weapons from bone.
Suitable for performing complex operations, the instrumentation provides a glimpse into the advanced medical practices of the first-century Romans and how far doctors may have traveled to provide care. “In ancient times, these were relatively sophisticated tools made from the finest materials,” said Tivadar Vida, director of the Institute of Archeology at Budapest’s Eötvös Loránd University, or ELTE, and leader of the excavation.
Two millennia ago, Jászberény and the surrounding county were part of the Barbaricum, a vast area that lay beyond the borders of the empire and served as a buffer against potential threats from the outside. “How could such a well-rested individual die so far from Rome, in the middle of the Barbaricum,” mused Leventu Samu, a research associate at ELTE and a member of the team on the excavation. “Was he there to heal a prestigious local figure, or perhaps he accompanied a military movement of the Roman legions?”
Similar kits have been found throughout most of the Empire; the largest and most varied was discovered in 1989 in the ruins of a third-century doctor’s house in Rimini, Italy. But the new find has been described as one of the most comprehensive collections of known first-century Roman medical instruments. Until now, the oldest was thought to be a hoard of artifacts unearthed in 1997 from a cemetery in Colchester, England, dating to about AD 70, very early in the Roman occupation of Britain. The most famous set appeared in the 1770s in Pompeii’s so-called House of the Surgeon, which was buried under a layer of ash and pumice during the eruption of Mount Vesuvius.
Colin Webster, a professor of classical languages at the University of California, Davis, and president of the Society for Ancient Medicine and Pharmacology, said the discovery illustrated the porosity of cultural boundaries in ancient times. “Medicine has long been one of the most active vectors for cross-cultural exchange,” he said. “And this finding certainly helps show the physical evidence of these dynamics.”
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The Romans had high expectations of their medical experts. In his treatise ‘De Medicina’ or ‘On Medicine’, the first-century Roman encyclopedist Aulus Cornelius Celsus mused that ‘a surgeon must be youthful or at least young rather than old; with a strong and steady hand that never trembles, and ready to use both the left and the right hand; with vision sharp and clear.” The surgeon must be fearless and empathetic, but unmoved by a patient’s cries of pain; his greatest wish should be to make the patient better.
A majority of these intrepid Roman physicians were Greek, or at least speakers of the Greek language. Many were freedmen or even slaves, which may explain their low social status. The man buried in the Hungarian necropolis was 50 or 60 when he died; whether he was actually a doctor is unclear, investigators said, but he probably wasn’t a local.
“Studying medicine at the time was only possible in a major urban center of the empire,” said Dr. Samu. Doctors were itinerant and medical traditions varied by territory. “Ancient medical writers, such as Galen, advised physicians to travel to learn about diseases common in certain areas,” said Patty Baker, a former head of archeology and classics at the University of Kent in England.
Future surgeons were encouraged to apprentice with licensed doctors, study in large libraries, and listen to lectures in remote places like Athens and Alexandria, a center of anatomical learning. For first-hand experience treating combat wounds, medics were often interned in the military and gladiatorial schools, which may explain the presence of medical devices in the Barbaricum.
“There were no licensing fees and no formal requirements for entry into the profession,” says Lawrence Bliquez, an archaeologist emeritus at the University of Washington. “Anyone can call themselves a doctor.” When his methods were successful, he attracted more patients; if not, he found another career.
Many surgeries were performed in the body orifices to treat polyps, inflamed tonsils, hemorrhoids and fistulas. In addition to trepanning, the more invasive surgeries include mastectomy, amputation, hernia reduction, and cataract coupling. “Surgery was a male domain,” said Dr. Bliquez. “But there were certainly a lot of female midwives, so who can say they didn’t know about surgery, especially when it comes to gynaecology.”
Contrary to myth, cesarean sections did not enter medicine until well after the birth of Julius Caesar in 100 BC. channel. “A hook was used to withdraw the limbs, trunk and head from the birth canal after they had been severed,” said Dr. Baker. “It was a horrific procedure to save a mother’s life.”
Surgery was often the last resort of all medical treatments. “Any tools found in the Barbaricum tomb could have caused death,” said Dr. Baker. “There was no knowledge of sterilization or germ theory. Patients would likely die of sepsis and shock.”
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The tool-laden tomb was discovered last year at a site where remains from the Copper Age (4500 BC to 3500 BC) and the Avar Period (560 to 790 AD) had been found on the surface. A subsequent survey with a magnetometer identified a necropolis of the Avars, a nomadic people who succeeded Attila’s Huns. Among the rows of graves, the researchers discovered the man’s grave, revealing a skull, leg bones and, at the base of the body, the chests of metal instruments. “The fact that the deceased was buried with his equipment is perhaps a mark of respect,” said Dr. Samu.
That’s not the only possibility. Dr. Baker said she often warned her students about interpreting ancient artifacts, asking them to consider alternative explanations. What if, she suggested, the medical devices were buried with the so-called doctor because he was so bad at his practice that his family and friends wanted to get rid of everything related to his poor medical skills? “This was a joke,” said Dr. Baker. “But it was meant to get students thinking about how we can jump to conclusions about objects we find in burials.”