Battlefield Surgery

The Romans are known to have had some knowledge of the internal workings of human bodies, particularly through the work of Galen. However, historians question whether they performed internal surgical operations. Through their work with gladiators and wounded soldiers, Roman doctors became experts at practical first aid and external surgery.

THE first evidence that doctors in ancient Rome were able to carry out successful amputations has been uncovered by anthropologists.

A 2nd Century thigh bone found in a cemetery near Rome clearly shows the serrated marks of a surgeon's saw. The amputee was a tall man who must have survived for months or even years after his operation, because the bone had started to heal. This suggests that the surgeons were skilled enough to fashion a flap of tissue to sew over the amputated end, protecting it from the air.

Roberto Macchiarelli, of the Museo Preistorico e Etnografico L Pigorini in Rome, whose team uncovered the bone, said that the man was probably from the middle or upper middle classes to be able to afford the cost of an operation. The bone was found mixed with a number of skeletal remains in a large monumental tomb at the Isola Sacra cemetery.

David Weaver, an expert in ancient bones who analysed the femur at Wake Forest University, North Carolina, thinks that the man possibly wore a wooden leg, because of the way the cut end had worn. The 1st Century Roman writer Celsus refers to the practice of surgical amputations and there are instruments in museum collections capable of carrying out such operations.

Mr Weaver said: "But we have never seen an amputation before. This confirms what we suspected, that Roman doctors were able to do this." He believes that ancient Roman doctors were at least as skilful as those during the American civil war who carried out battlefield amputations with a similar level of expertise.

The femur also shows signs of a painful infection, pyogenic osteomyelitis, which either led to the amputation in the first place or set in afterwards. Important families would have a large ornate grave constructed, in which the bodies of relatives and freed slaves would be laid to rest alongside their masters. Unfortunately, the quantity of bones mixed together have defeated efforts to reunite the femur with the rest of its skeleton, to get a better idea of the person it belonged to.
By coincidence, the tomb lies close to another imposing monument to Ulpius Amerimnus, who was a famous doctor of medicine, and to his Greek wife, Scribonia Attice. The couple's tomb bears two bas-reliefs, one showing surgical cutting tools and another showing Scribonia acting as a midwife. Mr Macchiarelli said: "We can't say for sure that this man was contemporaneous with Ulpius or that there was a link between the two, but symbolically it seems important."
Isola Sacra lies in the city of Portus, the main port of Rome, which was built by the emperor Trajan to accommodate the huge number of ships plying to and fro from the imperial capital. Analysis of the oxygen composition of the bone remains show that its population was extremely diverse. Hundreds of thousands lived there, slaves from Nubia jostling with immigrants from England.
Mr Macchiarelli said: "It was a New York-like city where you could find very rich and very poor people living side by side. Little is known about the physical remains of ancient Romans because the main imperial graveyards were excavated in the 19th century before science had developed sufficiently to analyse the bones.
Now they have been concreted over and lie inaccessible, several metres below the modern city. The graves of Isola Sacra have survived because the cemetery lies outside Rome, along a narrow road between Portus and Ostia, the original Roman port.