SURGERY

A Last Resort


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In his text on how to select a doctor, Galen notes that the

“best physician was the one most capable of treating surgical conditions by means other than the knife, particularly by diet and drugs.”

In a time before antisepsis, surgery was especially dangerous—Galen understood this—and he preferred the least invasive treatment option whenever possible. Scholars now estimate that there were around 120 known operations performed in the Roman Empire including cataract couching, hernia repair, bladder stone extraction, amputation, and varicose vein removal. Surgery was a profession in its own right in the ancient medical world, and patients with certain problems may have sought out surgical specialists for targeted treatment.

A tubular object of greenish, encrusted metal, shaped like a person’s lower thigh and upper calf. The head of a nail or screw juts from the surface.

Modern replica of an artificial leg. Roman original, ca. 300 BCE. Brass and plaster. Copy created in England; original found in a grave at Capua, Italy. L. 40.5 cm; W. 165 cm; Weight 1.75 kg. Science Museum, London: A646752. © The Board of Trustees of the Science Museum. CC BY-NC-SA 4.0.

Galen rarely performed operations himself, so when he did, it indicates that there was little other chance of a patient’s survival. His aversion to surgery was not for lack of training or talent. He had witnessed surgeries as a student, particularly in Alexandria, developed sophisticated suturing techniques during his time treating gladiators, and cultivated skill at cutting when vivisecting animals. The operations that he did perform were daring; he recounts a surgery on a young boy, an enslaved child, in which he removed an infected piece of the rib cage and a putrefied section of the pericardium (the protective membrane enclosing the heart). The procedure exposed the child’s beating heart—“we saw the heart as clearly as we see it when we deliberately lay it bare during [animal] dissection”―and despite Galen’s pessimism at the possibility of the boy’s recovery, he survived and was still alive years later, a fact that Galen boasts about in multiple texts.

Another risky procedure with a surprising positive outcome involved the surgical removal of a piece of a patient’s skull following a head fracture.

An illustration with two people facing each other against a red background. The figure on the left operates on the bald head of the figure on the right, who kneels before him.

Cranial operation for a skull fracture. From Roger Frugardi of Salerno, Chirurgia (early 14th century, Amiens, France), fol. 2r. British Library: Sloane 1977. Photo: British Library.

Although surgery was to be avoided, by his own account Galen nonetheless excelled at it.

There were other procedures more common in Galen’s clinical practice than these high-risk operations. He considered venesection (bloodletting) a good treatment for many serious illnesses that wouldn’t or didn’t respond to diet, drugs, exercise, massage, or purgatives.

An illustration centered on a seated woman, who stretches out her arm. An attendant holds the exposed arm as well as a long, stick-like instrument. Blood squirts from a puncture in the arm and is caught in a small basin held by a kneeling figure. A fourth figure stands to the right.

Bloodletting scene. From Galeni opera varia (15th century), fol. 320r. Sächsische Landesbibliothek – Staats- und Universitätsbibliothek Dresden: Mscr.Dresd.Db.93. Photo: SLUB Public Domain.

Venesection was part of traditional Hippocratic medicine, and by the Roman period the practice was well established. In fact, the procedure was so common that patients sometimes even requested it as part of their routine care: Galen reports that it was a custom in Pergamon for people to be bled every spring. The treatment was believed by Galen and others to be effective against the buildup of toxins in the body, since excess blood might also turn into one of the other humors (yellow bile, black bile, or phlegm), thus triggering a disease-causing imbalance. The procedure was not without risk, and Galen’s descriptions reveal that he occasionally took pints of blood from patients. When performed by less experienced doctors, venesection could be deadly, especially if an artery was sliced in error. Yet Galen’s enthusiastic embrace of bloodletting—in light of his authority for readers in later eras—likely contributed to its ongoing use as a medical treatment well into the eighteenth century.

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