Surgery as practiced by the ancients leaves long heritage

Medical practitioners in antiquity left a wealth of knowledge for doctors of the future: the main principles of the diagnosis of disease and the treatment of injuries have been known since the time of Hippocrates. Stefanos Geroulanos, professor of surgery at Zurich University and director of the intensive-care unit at the Onassis Cardiology Center, said that the first operations were performed in the Neolithic period. «Dozens of skulls have been found with holes drilled in them by various implements. In many cases, they had completely healed, indicating that the holes had been made for therapeutic purposes. This is a technique that is still used in the same way. In fact, surgical instruments (drills) have been found that were used in these operations in the 4th century BC and which are almost identical to those used today,» he said. According to Geroulanos, the first openings of abscesses in bones appear in ancient Egypt and mummies have been found with signs that drills had been used to relieve abscesses in teeth. «There are references to the lancing of abscesses in the time of Hippocrates,» said Geroulanos. «Hippocrates was brave enough to open up an abscess within the chest wall, to remove parts of one or two ribs, to wash the chest out with wine and then to place a cloth soaked in oil within the chest. Wine contains polyphenols that have antiseptic qualities. Until recently, we thought that alcohol was only a small component of wine, not enough to kill bacteria. Oil coats surfaces, preventing oxygen reaching the cells and also kills anaerobic bacteria.» Even in Hippocrates’ time, bandages were carefully sterilized; in all images dating from antiquity they are always white. They were washed with soap and hot water and hung out in the sun to dry. Surgical stitches were sterilized in hot oil. Modern medicine has also inherited many diagnostic methods from antiquity. «The parts of an abscess were first described in the 1st century BC by Celsus, a Roman encyclopedist who collected all the medical knowledge available at the time in a single volume on medicine,» he said. One of the most typical descriptions of the treatment of injuries is found in Virgil’s «Aeneid.» When Aeneas was wounded in the leg by an arrow, the doctor Iapyx had to use an instrument to remove the arrowhead and then wash the injury. As the wound would not heal, however, the goddess Aphrodite brought some of the Cretan herb dittany (Origanum dictamnus, dictamos in Greek) which she placed on the wound as an antiseptic and to staunch the bleeding. Today we know that if the foreign body is not removed from the wound and if the site is not properly cleaned and disinfected, the wound will not heal. Homer hinted at the use of mud baths in «The Iliad.» Apparently, during Philoctetes’ campaign against Troy, he was bitten by a snake on the island of Tenedos. Because of the stench from his wound and his cries of pain, his fellow soldiers left him on the island of Lemnos. «One wonders if that was mere coincidence,» said Geroulanos, adding that the island was famous for a type of mud that was used for chronic diseases and infected wounds. «In fact, it was so well-known in antiquity that it bore a special stamp to indicate its origin, even as far away as Rome.» The centaur, dittany and the strawberry tree The first medicine referred to in a European text (in Linear B) is dittany, a herb exported from Crete to Egypt. Even today, it is used to relieve stomach problems and sore throats and to clean wounds. According to Professor Stefanos Geroulanos, dozens of medicines used today have their roots in knowledge acquired by the ancients. «A pioneer in the knowledge of pharmaceuticals was the centaur Chiron, half-human and half-horse, who wandered around Mt Pelion collecting herbs and distilling their therapeutic properties. He taught some of the great healers of antiquity including Asclepius,» he said. Typical examples of «ancient medicines» that are used as much today are the fruit of the strawberry tree (Arbutus unedo, koumaria), used by Hippocrates to treat thrombophlebitis. Sixty years ago the first substances were extracted from this plant to make modern anticoagulants subscribed to sufferers of thrombosis. It is also known that the active agent in common aspirin was extracted from the bark of the Holm oak (Quercus ilex, itia), which was used as an analgesic. Alcohol, the great antiseptic One aspect of lost or forgotten ancient lore that has been «rediscovered» is the antiseptic properties of wine. Geroulanos says the Modern Greek word for wine, krasi, comes from kekramenos oinos (wine diluted with water) used in antiquity. «Until recently, we believed that the ancient Greeks added water to their wine so as not to get drunk,» said Geroulanos. «Today we know after studies by Canadian scientists that if one part wine is mixed with nine parts water, the polyphenols in the wine kill dangerous microorganisms such as E. coli and salmonella in the water within four hours. In ancient Greece, water was mixed with wine a few hours before a symposium began.»