The third branch of medicine is the one that treats patients with the hand [i.e., surgery]. … This type of treatment does not disregard drugs and diet, but achieves most with the hand, and the results it obtains are more obvious than those in any other branch of medicine. (Celsus, On Medicine 7 Proem).
It is not easy to explain surgical procedures in writing (Hippocrates, On Joints 33).
If he delays and gives it time, a doctor cures an illness more often than he does by operating on it (Euripides, frg. 1072).
A wise doctor does not chant magic spells when faced with an ailment requiring surgery (Sophocles, Ajax 581).
A wound from a sharp instrument is easier to treat than a wound from a blunt instrument (Celsus, On Medicine 5.26).
Whereas the purpose of the medical art is to restore people’s bodies from an abnormal condition to their normal one, castration aims to do just the opposite. Since, however, we are often compelled by those in authority to carry out this procedure, however unwilling we may be, I feel obliged to give a brief account of how it should be done. There are two methods, by crushing and by excision. Here is how to perform castration by crushing. When they are still infants, children are made to sit in a basin of warm water. Then, when their bodies are relaxed and they are still in the basin, you squeeze their testicles with your fingers, until they dissolve and disappear and you can no longer feel them. Here is how to perform castration by excision. The person to be castrated should be laid on his back on a bench. Grasp his scrotum, including his testicles, with the fingers of your left hand, and pull it tight. Make two straight incisions with a scalpel, one for each testicle. When the testicles jump out, excise them by cutting all round them, leaving only the very thin tissue that linked them when they were in their natural condition. This method is preferable to castration by crushing, since those whose testicles have been crushed occasionally have sexual desires, presumably because some part of their testicles was overlooked during the process of crushing them (Paul of Aegina, Medical Compendium 6.68).
Marcus Agrippa [who radically influenced the course of Western history by defeating Antony and Cleopatra at Actium] suffered dreadfully from gout during the last years of his life. When he could no longer tolerate the pain, he decided that it was worth being without the use of his legs and of all feeling in them, provided that he could also be without the awful pain; and so, trusting in the appalling expertise of one of his doctors, but without the god Augustus knowing anything about his intention, he plunged his legs into hot vinegar during an exceptionally severe attack (Pliny, Natural History 23.58).
Mandrake juice is drunk as an antidote to snakebites and as an anaesthetic before surgery or injections, but care must be taken with the dosage: one whiff of it is enough to send some people to sleep (Pliny, Natural History 25.150).
Many people are cowards when they have to face the necessary treatment with the iron blade, and fear the pain involved in the cure more than they fear the damage that will come if they do not receive attention. So, come on then, let us give some comfort to those made hesitant by the thought of pain, and let us make those who are suffering better able to face bravely up to the treatment. Let the surgeon have a light hand, so that he can make the incision easily, and let him also have a sharp blade, for bluntness is a cause of great pain. … It is good to anoint the iron blade that inflicts the wound before thrusting it into the wound. We should say “Ta Ta” three times and also spit and recite a certain Latin phrase included in the fifth pentagon facing the signs of the chromatic scale, a tipped over alpha followed by a mark and a reversed gamma followed by two marks. The pain will then stop. Let the sons of doctors take care of the wound, since the patient will offer himself unflinchingly to their touch (Africanus, Cestoi 1.4)
A surgeon should be fairly young, with strong and steady hands, ambidextrous, with good eyesight, eager to cure his patient, but detached enough not to want to hurry or to cut less than is necessary. He has to perform his task as if the patient’s screams had no effect on him (Celsus, On Medicine 7 Introduction).
The surgeon, whether he is seated or standing, should adopt a position that is comfortable for him, with a good view of the part of the body being operated on, and taking advantage of the light. There are two sorts of light, natural light and artificial light. We have no control over natural light, but over artificial light we do. Either sort of light can be used in two ways: either directly or obliquely. Oblique light is not used much in surgery, but, when it is, the amount that is suitable is easy to judge. With natural light, as far as it is available and appropriate, turn the part of the body being operated on to a position where the light is brightest – except with regard to parts of the body that should remain hidden, and that it is improper to look at. In such cases, the body part should face the light, and the surgeon should face the body part (but not so as to cast a dark shadow on it); in this way, the surgeon can see to operate, but the part operated on is not exposed to view (Hippocrates, In the Surgery 3).
A doctor was once called on to treat a king’s daughter, and could not do so without surgery. So, while putting a dressing on a swelling on her breast, he applied a scalpel that he had hidden in a sponge. The girl would have resisted the treatment if it had been administered openly, but she tolerated the pain because she was not expecting it. Sometimes, deception is the only way to achieve a cure (Seneca, On Anger 3.39).
There are three reasons why a doctor should conceal his treatment. … The third reason for concealment is when the patient is cowardly and weak. Then you should dissemble and say: I will operate tomorrow, but now I am going to foment the part or to treat it with hot water or with sponges dipped in hot pitch”. Make him think that that is what you are going to do and then take him unawares by making your incision. In no other cases should concealment be used (From the notes by Ali ibn Ridwan to Galen, On Hippocrates’s In the Surgery 18b.686K)
Examples of substances that close wounds: Boiled honey, egg white, frankincense, myrrh, glue (and specifically fish glue), gum (especially gum arabic), snails ground up with their shells, spiders’ webs for slight wounds (Celsus, On Medicine 5.2).
Why does a wound heal more readily if inflicted by a bronze instrument rather than by an iron one? Is it because bronze is smoother, and so rips the flesh less and inflicts a smaller wound? Or is it because, even though iron has a sharper blade, bronze cuts more easily and less painfully? One thing is sure: bronze has healing qualities, and this gives the recovery process a strong beginning. Since the medicine is applied at the very moment the wound is inflicted, healing starts that much more quickly (Pseudo-Aristotle, Problems 863a).
Nothing hinders the healing process more than frequent changes of medication. A wound never closes if the doctor experiments with different ointments (Seneca, Letters 2.3).
Arzes, one of Belisarius’s bodyguards, was hit by a Gothic archer between his nose and his right eye. The point of the arrow went in as far as the back of his neck, but without coming out again, and the rest of the shaft projected from his face, quivering as he rode along. … The doctors wanted to draw the missile out of Arzes’s face, but for a long time they hesitated anxiously. They were not concerned about his eye, which they assumed could never be saved; rather they were afraid of causing the death of an important member of Belisarius’s retinue by boring through all the many membranes and sinews in that part of his head. But then Theoctistus, one of the doctors, exerted pressure on the back of Arzes’s neck to try to find out if he felt acute pain there. When Arzes said that he did, he announced “Then you’ll recover, and your eye won’t be damaged”. He based this assertion on the fact that the point of the arrow had penetrated so far that it was very near the skin. He cut off as much of the arrow as was sticking out, and threw it away. Then he cut open the skin at the back of Arzes’s neck, at the spot where the pain was the most intense, and extracted the point of the arrow without any difficulty, bringing out the rest of the missile, including the three barbs that were now projecting from the back of his neck. And so Arzes was saved from any lasting injury, with not even a scar on his face (Procopius, On the Wars 6.2).
The person who intended to assassinate the Thessalian Prometheus [a nickname for Jason, the particularly evil tyrant of Pherae] struck a tumor and cut it open, thus saving the man’s life and bringing him relief. Likewise, it often happens that abusive comments spoken in anger or hatred cure some evil that lurks unnoticed or neglected in the soul of the person being criticized (Plutarch, How to Benefit from One’s Enemies 89c).
In the schools of rhetoric, students practiced composing and delivering speeches on sometimes rather unusual topics. The eighth of the Major Declamations attributed to Quintilian has a medical setting:
Twin brothers, whose mother and father were still living, fell sick. The doctors who were consulted said that they were both suffering from the same illness. The other doctors despaired of saving them, but one said that he could save one twin if he were allowed to examine the other twin’s internal organs. With their father’s permission, he cut one of the children open and examined his internal organs. The other twin was cured, but their father was accused by their mother of maltreatment.
One short extract from this long declamation will suffice to give an impression of its tone and quality:
The butcher picked up his weapon, but not so that his right hand might immediately press the wound home once and for all; gently and gradually splitting the boy open and keeping his pain under control, he held his soul in suspense at the border between life and death. Here is the encouraging way in which he addressed the boy as he lay on the verge of death: “Bear up bravely, submit with endurance, your brother will be cured. There is no reason why you should pass out in fear and pain. Don’t exhaust your entrails with screaming, don’t shake them up with gasping and groaning, or another person’s hope of a cure will be lost.”
The wretched boy endured the merciless and random exploration throughout in his chest when it had been opened up. Do you imagine that the doctor was content to learn what he needed to know from his first sight of the dissected body? The organs were lifted out several times, and handled, and pulled apart. The doctor’s hands caused more damage than his knife. The father stood beside the doctor, gaping at his son’s exposed entrails. He urged the doctor not to hurry as he tossed about in his bloody hands the dripping core of his son’s life, he bade him probe deeper, more carefully, he asked questions, he hesitated, he argued, he agreed, he absorbed the commentary on his son’s death. Meanwhile, the unfortunate mother, prostrate at the closed doors and using her whole body to break in on the secret and gory procedure, screamed just as if she were lying on her son’s funeral pyre or his grave.