Scalpel, Forceps, Bone Drill: Modern Medicine in Ancient Rome

Doctors are generally held in high regard today, but Romans of the first century were skeptical, even scornful, of medical practitioners, many of whom ministered to ailments they did not understand. Poets especially ridiculed surgeons for being greedy, for taking sexual advantage of patients and, above all, for incompetence.

In his “Natural History,” Pliny the Elder, the admiral and scholar who died in 79 A.D. while trying to rescue desperate villagers fleeing the debris of Mt. Vesuvius, endeavored to speak out against the medical profession “on behalf of the senate and Roman people and 600 years of Rome.” Their fees were excessive, their remedies dubious, their squabbling insufferable. “Physicians gain experience at our peril and conduct their experiments by means of our deaths,” he wrote. The epitaph on more than one Roman tombstone read: “A gang of doctors killed me.”

Medical remedies have improved since those times — no more smashed snails, salt-cured weasel flesh or ashes of cremated dogs’ heads — but surgical instruments have changed surprisingly little. Scalpels, needles, tweezers, probes, hooks, chisels and drills are as much part of today’s standard medical tool kit as they were during Rome’s imperial era.

Archaeologists in Hungary recently unearthed a rare and perplexing set of such appliances. The items were found in a necropolis near Jászberény, some 35 miles from Budapest, in two wooden chests and included a forceps, for pulling teeth; a curet, for mixing, measuring and applying medicaments, and three copper-alloy scalpels fitted with detachable steel blades and inlaid with silver in a Roman style. Alongside were the remains of a man presumed to have been a Roman citizen.

The site, seemingly undisturbed for 2,000 years, also yielded a pestle that, judging by the abrasion marks and drug 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 trepanning the skull and extracting impacted weaponry from bone.

The instrumentarium, suitable for performing complex operations, provides a glimpse into the advanced medical practices of first-century Romans and how far afield doctors may have journeyed to offer care. “In ancient times, these were comparatively sophisticated tools made of the finest materials,” said Tivadar Vida, director of the Institute of Archaeology at Eötvös Loránd University, or ELTE, in Budapest and leader of the excavation.

Two millenniums ago Jászberény and the county around it were part of the Barbaricum, a vast region that lay beyond the frontiers of the Empire and served as a buffer against possible outside threats. “How could such a well-equipped individual die so far from Rome, in the middle of the Barbaricum,” mused Leventu Samu, a research fellow at ELTE and a member of the team on the dig. “Was he there to heal a prestigious local figure, or was he perhaps accompanying a military movement of the Roman legions?”

Similar kits have been found across most of the Empire; the largest and most varied was discovered in 1989 in the ruins of a third-century physician’s home in Rimini, Italy. But the new find is described as one of the most extensive collections of first-century Roman medical instruments known. Until now, the oldest was thought to be a trove of objects dug up in 1997 at a burial site in Colchester, England, that date to around 70 A.D., very early in the Roman occupation of Britain. The most renowned set turned up in the 1770s at 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 classics professor at the University of California, Davis, and president of the Society for Ancient Medicine and Pharmacology, said the discovery illustrated the porousness of cultural boundaries in the ancient world. “Medicine has long been one of the most active vectors for intercultural exchange,” he said. “And this finding certainly helps show the physical evidence of these dynamics.”

No license needed

The Romans had high hopes for their medical experts. In his treatise “De Medicina,” or “On Medicine,” the first-century Roman encyclopedist Aulus Cornelius Celsus mused that “a surgeon should be youthful or at any rate nearer youth than age; with a strong and steady hand that never trembles, and ready to use the left hand as well as the right; with vision sharp and clear.” The surgeon should be undaunted and empathetic but unmoved by a patient’s screams of pain; his greatest desire should be to make the patient well.

A majority of these undaunted Roman physicians were Greek, or at least speakers of the Greek language. Many were freedmen or even slaves, which may account for their low social standing. The man buried in the Hungarian necropolis was 50 or 60 when he died; whether he actually was a medical practitioner is unclear, researchers said, but he probably was not a local.

“Studying medicine was only possible, at the time, in a large urban center of the empire,” Dr. Samu said. Doctors were peripatetic and medical traditions varied by territory. “Ancient medical writers, such as Galen, advised that physicians should travel to learn about diseases that were common to certain areas,” said Patty Baker, former head of archaeology and classics at the University of Kent in England.

Would-be surgeons were encouraged to apprentice with recognized doctors, study at large libraries and listen to lectures in such far-flung places as Athens and Alexandria, a hub of anatomical learning. For firsthand experience in treating combat wounds, medics frequently interned in the army and gladiatorial schools, which might explain the presence of medical tools in the Barbaricum.

“There were no licensing boards and no formal requirements for entrance to the profession,” said Lawrence Bliquez, emeritus archaeologist at the University of Washington. “Anyone could call himself a doctor.” If his methods were successful, he attracted more patients; if not, he found another career.

Surgeries included many performed in the body’s orifices to treat polyps, inflamed tonsils, hemorrhoids and fistulas. Beside trepanning, the more radical surgeries included mastectomy, amputation, hernia reduction and cataract couching. “Surgery was a male domain,” Dr. Bliquez said. “But there were certainly many female midwives, so who can say they knew nothing about surgery, especially as it pertains to gynecology.”

Contrary to myth, cesarean sections did not enter medicine until long after Julius Caesar’s birth in 100 B.C. The Romans did, however, practice embryotomy, a surgery by which a knife was used to cut the limbs from an infant while it was stuck in the birth canal. “A hook was used to withdraw the limbs, torso and head from the birth canal once they had been cut,” Dr. Baker said. “It was a gruesome procedure used to save the life of a mother.”

Surgery was often the last resort of all medical treatments. “Any of the tools found in the Barbaricum grave could have caused death,” Dr. Baker said. “There was no knowledge of sterilization or germ theory. Patients were likely to die of sepsis and shock.”

Second opinions welcome

The tool-laden grave was discovered last year at a site where relics from the Copper Age (4500 B.C. to 3500 B.C.) and the Avar period (560 to 790 A.D.) had been found on the surface. A subsequent survey with a magnetometer identified a necropolis of the Avars, a nomadic peoples who succeeded Attila’s Huns. Among the rows of tombs, the researchers uncovered the man’s grave, revealing a skull, leg bones and, at the foot of the body, the chests of metal instruments. “The fact that the deceased was buried with his equipment is perhaps a sign of respect,” Dr. Samu said.

That is not the only possibility. Dr. Baker said that she often cautioned her students about interpreting ancient artifacts, and asked them to consider alternative explanations. What if, she proposed, the medical tools were interred with the so-called physician because he was so bad at his practice that his family and friends wanted to get rid of everything associated with his poor medical skills? “This was a joke,” Dr. Baker said. “But it was intended to make students think about how we jump to quick conclusions about objects we find in burials.”