The Romans and the Dark Ages

Much of what the Greeks knew, the Romans adopted. But they added their own knowledge through Celsus and Galen. Celsus was an encyclopedist, and likely not a practicing physician. He compiled the known Materia Medica, as well as the surgical knowledge of that era in one compilation, De Medicina, where he describes the techniques of fixing an umbilical hernia, draining an abscess, and removing foreign bodies. Celsus also recommended putting honey in the abscess cavity. He admonished surgeons to cut away the dead skin to allow adequate drainage to continue. Galen was a practicing surgeon who started his career in the gladiatorial colosseum of Pergamum. As in the Greek era, the dissection of humans was still not allowed. He learned from dissecting monkeys that he regarded as very similar to human anatomy. Also, when he treated injured gladiators, he gleaned  the essence of human anatomy. He had very advanced instruments, and used them to great advantage  in his job  as a  surgeon  to  the  gladiators. The mortality of gladiators dramatically decreased after he started caring for them.

Because he had imperfect knowledge, based on animal anatomy, he got some things wrong. He never understood the function of the heart and thought it was like a tidal wave organ that created a “to and fro” motion of blood, just like waves.

Galen thought that the left and right side of the heart was connected by openings in the heart’s septa, an idea that was eventually refuted, and disproved by Andreas Vesalius some 1500 years later.

The second Dark Ages, from the 5th to the 15th century AD, were indeed dark for surgery. Disease was again thought to be God’s punishment for man’s wickedness, reversing the teachings of Hippocrates. Treating illness, therefore, was thwarting God’s will, and thwarting God’s will is not the right thing to do. Little progress was made in the middle ages. Bloodletting was the standard treatment for whatever ailed you, from headache, sore throat, and just as a prophylactic measure to “keep you healthy.” During the plague epidemics, doctors refused to visit patients for fear of becoming infected themselves. Nevertheless, healthy nutrition was advised to have a higher resistance to disease, and compulsory baths, at least four times a year, were mandated, whether you needed it or not. Bladder stones were crushed with curved forceps inserted transurethrally, or by manual methods, transrectally. The barber-surgeon needed to be ready to leave town quickly, if his ministrations went awry.

Although darkness descended on all of the former Roman Empire, the Middle East enjoyed the unfolding of the Golden Era of Islam from 700 AD to 1400 AD. Science, culture, art, and medicine flourished, as the descendants of Mohammad did not discard the wisdom of the Greeks. Socrates, Aristotle, and Plato were preserved. The Islamic culture maintained the knowledge that had been so ardently developed by Aristarchus, Archimedes, Pythagoras, and Hero, as well as the Hippocratic philosophy in dealing with the sick.

Islam was much more open to accepting other cultures than it is now. As Islam spread through northern Africa into the Iberian Peninsula, great centers of learning sprang up in Cordova, Segovia, Toledo, and Barcelona, in what the Muslims called Al-Andalus. The intellectuals of the Court of Charlemagne stole over the Pyrenees into Al-Andalus to study at the madrassas (schools) to learn algebra, trigonometry, and medicine. The great Arab physicians were Avicenna (Ibn Sina) and Abulcasis (Al- Zahwarwi). We owe the use of ligature with catgut and the control of bleeding to those doctors of medicine and surgery. Abulcasis was the first to do a tracheostomy, and he invented some 200 surgical instruments, including obstetric forceps. He introduced temporal artery ligation for the treatment of migraine headaches, brought back the Hippocratic method of reducing the dislocated shoulder (euphemistically called the dirty sock method because the doctor put his heel into the armpit of the patient, grabbed his hand, and pulled). Abulcasis even realized that teeth needed to be cleaned to keep them from getting caries. Lipstick and perfume were also among his ideas. In The Canon of Medicine,  Avicenna outlined his tenants of caring for the sick, and recognized that we must wash our hands between patients a millennium before Ignaz Semmelweis reintroduced that concept, an idea that was not accepted by Ignaz’s contemporaries, and eventually drove him to an insane asylum where he died.

Abulcasis had a variety of instruments which he invented for his use.