Amputation in Ancient Greece

I believe the first person to describe surgical amputation was Hippocrates, in a book called "On Joints". Hippocrates only performed amputation to stop gangrene, and even then only as a last resort. He said to cut into the bone below the boundaries of the blackening when the limb was fairly dead and has lost its sensibility. Also he was happy for the dead flesh to come away naturally, and for some small amount of bone to remain sticking out. He speaks quite calmly of the process taking 60 to 80 days.

The Greeks had no knowledge of how to perform amputation on living flesh. The big problem for the Greek doctors was loss of blood. Hippocrates does mention the use of ligatures elsewhere, but there's no mention of them used in amputation. Where he does mention ligatures he stresses the danger of gangrene. By the first century AD, a doctor called Celsus does write of both cauterizing wounds and ligature of veins.

The other likely cause of amputation was trauma. Guess what? Trauma is a Greek word. Again, the Greeks seem to have been remarkably conservative. It appears they'd rather have carried a mangled limb and risked infection than amputate. This might tell us something about the likely survival rate of amputees. Hippocrates mentions cautery, which means to apply burning heat, about ten times throughout his works, and a few of those are in reference to wounds, but never in reference to amputation. Nevertheless it seems likely to me that in the case of traumatic amputation, the wound would have been cauterized. Incredibly, they didn't use a tourniquet. The tourniquet wasn't invented until 1718!




17 comments:

Carrie said...

The mortality rate must've been high. Well of course it was. Everyones' was. Nice article. Love your tidbits.

Gary Corby said...

Hi Carrie, I was quite astonished when I read Hippocrates in detail. The guy was amazingly non-interventionist. Which might be why so many of his patients lived! Also, a lot of the way he writes could almost come from a modern medical textbook.

Kari Lynn Dell said...

Sorry, but I have to push the grossness to the next level. What did they use for cutting? Saws, chisels? I'm not familiar enough to know what was available at the time.

Also, did they sedate the patients? They seem to have been fairly proficient with pharmaceuticals.

Gary Corby said...

Hi Kari!

No anesthesia. That's a very recent development. Here's a translation from the original:

"Those parts of the body which are below the boundaries of the blackening are to be removed at the joint, as soon as they are fairly dead and have lost their sensibility; care being taken not to wound any living part; for if the part which is cut off give pain, and if it prove not to be quite dead, there is great danger lest the patient may swoon away from the pain, and such swoonings often are immediately fatal."

I guess he means from shock. They did have poppy juice, but don't seem to have thought of using it in surgery. Anyway, Real Men have their extremities cut off while fully conscious.

He doesn't say what he uses to cut the bone, but considering the sophisticated engine he describes elsewhere to fix dislocated hips, I'm guessing a saw or sharp knife.

T. Anne said...

If it weren't for modern medicine I'd be dead a long time ago. Thankfully the good Lord placed me in a time period devoid of 60-80 day amputations. I think I need to read Hippocrates disjointed classic.

You were hilarious on my blog today!

Ricky Bush said...

Wow, you're right, seems like someone would have thought up a tourniquet before the 18th century.

Gary Corby said...

You and me both Anne, and pretty much everyone who's ever needed penicillin or an operation.

Your blog is so much less gross than mine!

Gary Corby said...

Hi Ricky, yeah, weird, isn't it?

If a modern person was flung back in time, they could make a living as a doctor just by applying the most basic common medical knowledge of today.

Sean said...

Two years a go I nearly severed my thumb. Being rather morbid I watched as the doctor cleaned the flap of skin and sewed it back on. All of this was fine until the last stitch when the anesthetic ran out with the needle half way through. First and only time that i experienced the "blood draining from his face" cliche.

Gary Corby said...

Oh dear Sean. Better you than me. I hope the thumb's okay now.

Sean said...

Have a nice jagged scar.

vickileon.com said...

@ Gary. Great gruesome blogpost, Gary! I like your blog. @ Sean; How did you know the 'blood drained from his/your face' cliche...did the doc hold up a mirror? what? That said, I'm sure I would have passed out from observing.

Gary Corby said...

Thanks Vicki. I aim to please.

Sean said...

@vicki,

eyewitness testimony from my wife who was observing and the feeling I had of the blood draining from my face.

Amalia T. said...

I've been thinking lately about how terrible it would have been to be crippled in Athenian society-- I mean, the Spartans just threw crippled people away with the trash, but would it have been much better to live with it a amputation or some kind of impairment of a limb or body in any other Greek city? I mean, later, there is the Byzantine policy that any man or woman who is not WHOLE can't rule as emperor, and that had to have come from somewhere.

Gary Corby said...

I think it's related to the Greek worship of physical perfection. And it's a great point, Amalia. You very rarely read of any Greek carrying war injuries in later age. That might be because of the high death rate from infection though? It's clear too from Hippocrates that such men must have existed, because he mentions long term effects of various crippling injuries.

Amalia T. said...

I wonder if they were kind of marginalized, and that's why we don't hear about it. So someone who was very prominent up to an injury would then be hidden away, or not allowed to participate as fully in society? I read (I can't remember where) infections were really not as large of an issue until guns came on the scene, way later, carrying debris into wounds with the bullets etc. So I have a hard time believing they lost SO many people to infection that no one ever DID anything. I think it's more likely they were closeted away somewhere.