Editorial: How Cranial Surgery was Performed in Italy During the Centuries After the Roman Empire but Before the Rise of the Medieval Universities: Integrating Paleopathology and Medical History (original) (raw)
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International Journal of Osteoarchaeology
The Longobard necropolis of Castel Trosino dates from the 6th to the 8th century CE. Among the tombs excavated, the skull of an older female shows the first evidence of a cross-shaped bone modification on a living subject. Macroscopic, microscopic, and CT scan analyses revealed signs of at least two sets of scraping marks. Specifically, SEM analysis shows that perimortem bone-scraping traces are present on the skull. Both healed and non-healed defects suggest that the woman has received at least twice intentional bone modifications to address her condition. This is the first evidence of a cross-shaped therapeutic intervention on a living subject.
New light on cranial surgery in ancient Rome
In exceptional cases, archaeology can shed new light on patients, diseases, and therapeutic interventions of the remote past. Cranial trepanation, an operation probably developed towards the end of the palaeolithic period and rooted in a mixture of empiricism and magical belief, has been widely documented from both the Old World and the New World since late neolithic times, showing the antiquity of the surgical approach to disease treatment. 1-7 This type of surgery was mainly associated with traumatic lesions, but in most cases the underlying diseases, if any, remain unknown. Evidence of cranial trepanations on children is extremely rare, 1-8 which may reflect a lower childhood frequency of the disorders that were treated by cranial surgery, an uneven preservation of fragile skeletal remains, or a reluctance of physicians in ancient times to subject children to potentially life-threatening surgical procedures. Cranial trepanation is recorded in Greco-Roman medicine, first by Hippocrates (460-355 BC). The Hippocratic corpus, Celsus (first half of the first century AD), Heliodorus (second half of the first century AD), and Galen (end of the second century AD), recommended trepanation for splintered fractures of the cranial vault and for closed head traumas, 9,13 but, at present, there is no decisive evidence that the Greco-Roman medical authors understood the role of craniotomy in the relief of endogenous "disease of the head", considered by Pliny the Elder as the third most painful illness of mankind. 14 Despite the rich literary record, the skeletal evidence documenting cranial trepanation in Greco-Roman medicine is scarce. Few trepanned Roman skulls are known from regions that were within the confines of the Empire, 1,3,6-8,15,16 and just two examples have been reported from Italy. 7,17,18 In these cases, all concerning adults, there is no trace of lesions, other than violent trauma, 16 that might have prompted cranial surgery. In 1995, the skeleton of a hydrocephalic child was excavated from a cemetery that was probably part of a villa in suburban Rome, on the site of the ancient town of Fidenae. 19 The child was 5-6 years old, on the basis of the teeth, and was dated to about the end of the first or the start of the second century AD on archaeological context. The remarkably well-preserved cranium of this child (figure 1) is a fine example of trepanation, which may have
Surgery in the early middle ages: Evidence of cauterization from Pisa
Archeological excavations carried out in the famous Cathedral Square of Pisa brought to light a multiple ground grave dating to the early Middle Ages (8th–10th Centuries AD). The well preserved skull of an adult female aged about 30 years revealed some form of ‘‘surgical’’ intervention. In the central part of the frontal bone, 4 cm from the bregma, a 20 x 17 mm elliptical lesion limited by a shallow 1-mm thick groove is easily visible. The central position on the sagittal axis and the size and regular shape of the lesion excludes some disease as the cause, suggesting that this lesion is an artifact, in particular the result of cauterization.
An Archaeological Exploration of Surgery
This article explores how, through the use of Archaeological science, one may envision how surgery has evolved into the techniques and procedures that are utilized in operating suites today.
Anatomy and Surgery from Antiquity to the Renaissance, 2016
My aim here is to consider the evidence for both anatomical and surgical knowledge in the Middle East and Europe during the medieval period. A large body of excellent re-search exists that explores medicine at that time. However, some areas are understood much better than others, and some theories from the nineteenth and twentieth centuries are still included in modern texts even though they have been disproved or significant-ly revised. The Middle East and Europe were distinct geographically, linguistically, and theologically, but the theory that underpinned the understanding of medieval med-icine was the same since both regions followed the humoural theory of the ancient Greeks. Despite the known differences between medieval Europe and the Middle East, there was considerable movement of people, translation of medical texts, and practical interaction between medical practitioners from both regions, especially at the time of the crusades. This complex interaction allows us to consider the flow of ideas between cultures, and to compare and contrast how these differing cultures led to variation in the practice of anatomical dissection and surgery.
The antiquity of cranial surgery in Europe and in the Mediterranean basin
Comptes Rendus De L Academie Des Sciences Serie Ii Fascicule a-Sciences De La Terre Et Des Planetes, 2001
Through personal observations and a literature study we have made a synthesis of the most ancient healed trephinations in Europe and in the Mediterranean basin. Cases of small dimensions that were carried out with simple techniques are found in the Mesolithic populations from North Africa, Ukraine and Portugal. The first Neolithic examples of trephinations are extensive and have been realised with more sophisticated techniques. This suggests that the development of agriculture was accompanied by the command of new procedures in the field of surgery. 2001 Académie des sciences / Éditions scientifiques et médicales Elsevier SAS trephination / Neolithic / Mesolithic / North Africa / Ukraine / Portugal / Europa Résumé -Ancienneté de la chirurgie crânienne en Europe et dans le Bassin méditerranéen. À partir d'observations et de la littérature, nous avons effectué une synthèse des plus anciennes trépanations cicatrisées en Europe et dans le Bassin méditerranéen. Des cas de trépanations de petites dimensions et réalisées avec des techniques simples sont retrouvés dans les populations mésolithiques de l'Afrique du Nord, de l'Ukraine et du Portugal. Les premiers exemples néolithiques sont de vastes dimensions, réalisés avec des techniques plus complexes. Cela suggère que le développement de l'agriculture s'est accompagné très tôt d'une maîtrise de gestes nouveaux dans le domaine chirurgical. 2001 Académie des sciences / Éditions scientifiques et médicales Elsevier SAS trépanations / Néolithique / Mésolithique / Afrique du Nord / Ukraine / Portugal / Europe
The Women of Salerno: Contribution to the Origins of Surgery From Medieval Italy
Annals of Thoracic Surgery, 1997
Medicine in medieval Europe benefited from Greek, Arabic, Hebrew, and Latin influences. Because of geographic and other favorable conditions, many of these cultural contributions synergized to form the Medical School at Salerno around 900 AD. Somewhat uncharacteristically, women physicians played a part in the advances that came from this school. Among the contributions associated with the School of Salerno were (1) textbooks of anatomy, obtained mainly from porcine dissections, (2) insistence on certification and training for physicians, (3) application of investigative thinking and deduction that led to important advances such as the use of healing by secondary intention, (4) the first textbook about women's medicine, and (5) the first recorded female medical school faculty member named Trotula de Ruggiero or Trocta Salernitana. The women physicians of Salerno contributed to a textbook that gained wide acceptance and distribution throughout Europe. The textbook, called De Passionibus Mulierium, was first published about 1100 AD and was a prominent text until a significant revision by Ambrose Paré's assistant in the early 1600s. Paré was the preeminent anatomist of his time, and many of his important anatomic and surgical considerations were directly and indirectly derived from the work of the women of Salerno. The advances first recorded, taught, and implemented by the women of Salerno are an interesting and important part of our surgical heritage.
Reading Graeco-Roman Medicine in the Light of its Medical-Surgical Instruments
HISTÓRIA DA CIÊNCIA NO ENSINO: Revisitando Abordagens, Inovando Saberes, 2021
Abstract: Viewing the history of science through its objects provides a practical and direct comprehension of its technical-scientific level and social-historical context. This approach is particularly useful in the study of Greek-Roman surgery and tools, highlighting its unrivalled advances over previous proto-medicines. A survey of the instruments asserts the complementarity of medicine and surgery as well as their devising and preparation of medicines by physicians. The tools, the sources for their study and their context illustrate textbooks, provide data on similar medical thought and practice in the whole Roman Empire and on physician’s social status. They testify the existence of funerary medical honours such as heroization, following the example of Asclepius, the patron of Greek-Roman medicine. The discovery of surgical instruments in female tombs also discloses the existence of female medical practitioners. The study of Greek-Roman surgical tools provides an accurate and global view on founding procedures that established Western surgery.