Roman Surgical Extraction Of Projectiles In Ancient Combat

The most comprehensive treatise on Roman medicine that has survived is Celsus’s De Medicina (On Medicine), a work that fills eight carefully composed books written in a simple and elegant style.  His full name was Aulus Cornelius Celsus, and appears to have flourished during the emperorship of Tiberius (A.D. 14—37).  But beyond these bare bones we know almost nothing about the man or his background.  Scholars have established that his manual was originally part of a larger, Pliny-esque encyclopedia that included books on military science, agriculture, law, and rhetoric, among other topics; in this respect he is very much like the biographer Cornelius Nepos, whose surviving work is but a fraction of a larger corpus.

Whether Celsus actually practiced medicine himself has been the subject of considerable debate.  Some commentators believe that he synthesized and summarized the work of eminent Greek physicians who preceded him, and that his book bears scant evidence of practical surgical experience.  Others take a different view.  They point out that in Celsus’s day, the gap between professional and amateur was far from distinct.  A wealthy Roman landowner in the countryside, they point out, charged with the well-being and health of a large household of family, servants, and slaves, would of necessity have had to perform all kinds of medical procedures.  My own impression, derived from reading him carefully, is that Celsus did indeed have actual surgical experience, and that he combined this knowledge with extensive study of the works of Greek physicians.  It is difficult to see, in fact, how anyone could write with the kind of immediacy and authority we find in Celsus if he did not have such experience.

An interesting fact about De Medicina is that it contains (VII.5) the only surviving description of the treatment of Roman projectile combat wounds.  Combat surgery in Roman times was far more sophisticated and advanced than is generally believed.  As Dr. J.S. Milne makes clear in his fascinating Surgical Instruments in Greek and Roman Times,[1] ancient surgeons had a large number of refined tools and techniques at their disposal.  We will summarize Celsus’s guidance on the treatment of projectile wounds in Roman combat; that is, wounds incurred from the penetration of arrows, spears, and small lead projectiles.

Missiles (arrows, javelins, spears, and small projectiles) that have penetrated the body can be very difficult to extract, he says; this is due to both the barbed shape of the missile, as well as the deep position in which it may have become lodged.  Missiles can be removed in two ways:  either by pulling them out from the original entry hole, or by making an incision in another part of the body and pushing the projectile through.  This latter method is preferred in situations where the projectile head might damage arteries, nerves, or ligaments if it were to be pulled out from the point of entry.  If the projectile is to be pulled out from the point of entry, the wound must be enlarged with a scalpel; this causes less inflammation and reduces the risk of tissue damage.  These are Celsus’s general rules for projectile extraction.  They sound simple enough, but like so much else in medical practice, everything comes down to technique.  Readers may recall from Cornelius Nepos’s biographical sketch (Epaminondas 9) that the Theban general Epaminondas bled to death from the improper extraction of a spear-head that had embedded itself in his side.

Arrow wounds are distinguished by their deep penetration.  Owing to this, says Celsus, it is usually better to make a counter-opening in the body and pass the arrow through, rather than try to pull it out from the point of entry.  When a new “pass-through” opening has been made, it should be enlarged and held open by an instrument designed for this purpose (Celsus does not name the instrument, but tells us only that its shape resembles a certain Greek letter which has been lost in the original text).  If the arrow’s shaft has detached from the arrowhead, the arrowhead should be removed by the surgeon’s fingers or forceps.  If it is necessary to withdraw the arrow from the point of entry, great care must be taken.  The entry wound must be enlarged; as the arrowhead becomes visible, it must be determined whether the barbs pose a threat.  If they do, the barbs should be cut off by a scissor-like forceps.  If the barbs are too large to be snipped away, they should be covered by “split reed pens” (fissis scriptoris calamis contegenda), which protect the body’s viscera from the barbs.

Images of surgical instruments from Milne’s “Surgical Instruments in Greek and Roman Times”

However, removing a larger weapon (such as a javelin or spear) by making a counter-opening is normally not desirable.  The body may not be able to tolerate a large incision.  In these cases, it is preferable to withdraw the projectile from the point of entry using a special instrument Celsus calls the cyathiscus of Diocles, or the “Spoon of Diocles,” which was named after its inventor, the Greek physician Diocles.  The exact appearance of this instrument is not entirely clear. In fact, we may use this example as a way to highlight the difficulties translators can face when trying to reconstruct the precise appearances of objects for which archaeological evidence is inconclusive.  This is Celsus’s original description of the Spoon of Diocles:

Lammina vel ferrea vel aenea etiam ab altero capite duo utrimque deorsum conversos uncos habet; ab altero duplicata lateribus, leviterque extrema in eam partem inclinata, qua sinuata est, insuper ibi etiam perforata est.  Haec iuxta telum transversa demittitur; deinde ubi ad imum mucronem ventum est, paulum torquetur, ut telum foramine suo excipiat.  Cum in cavo mucro est ilico digiti subiecti partis alterius uncis simul et ferramentum id extrahunt et telum.

Dr. Milne, in his Surgical Instruments in Greek and Roman Times, provides the following translation of this passage:

Its blade of iron, or even of bronze, has at one end two hooks, one at each side turned backwards. At the other end it is folded over at the sides, and the end is slightly curved up towards that part which is bent. Moreover in it there is a perforation. This is introduced crosswise near the weapon, then when it comes near the point it is twisted a little so that it receives the point in the hole. When the weapon is in the cavity two fingers placed under the hooks at the other end simultaneously extract both the instrument and the weapon.

It must be said that this rendering leaves something to be desired, as it omits some of Celsus’s nuances.  But Milne is right in calling attention to the ambiguity of Celsus’s description.  He notes, “this description seems very definite until we attempt to reconstruct the instrument, when it becomes evident that more than one construction may be put on some parts of it.”  Milne’s suggestion for the appearance of the Spoon of Diocles is given below in the image marked as figure 4:

 

However, W.G. Spencer’s 1938 translation of Celsus takes a somewhat different position.  He claims the instrument resembled a “present-day midwifery forceps,” and provides the following much improved translation of the passage quoted above:

The instrument [the Spoon of Diocles] consists of two iron or even copper blades; one blade has at each angle of its end a hook, turned downwards; the other blade has its sides turned up so that it forms a groove, also its end is turned up somewhat, and perforated by a hole.  The latter blade is first passed up to the weapon, and then underneath it, until the point is reached, the blade is then rotated somewhat until the point becomes engaged in the perforation.  After the point has entered the perforation, the hooks of the first mentioned blade are fitted by the aid of the fingers over the upturned end of the blade already passed, after which simultaneously the cyathiscus and the weapon are withdrawn.

It is in situations like this one where we realize that a picture can be worth a thousand words.  The final type of missile that may require withdrawal is the lead ball, called in Latin blumbea glans.  This was a pointed lead projectile hurled from slings that was about the size of a marble.  It could penetrate the body and cause fearsome wounds.  Celsus advises that such wounds should be enlarged, and the ball withdrawn with the aid of forceps.  Complications can arise when the missile is fixed to bone, or within a joint.  If affixed to bone, the glans should be nudged back and forth until it releases itself, and then it may be drawn out.  If the projectile cannot be removed, then the bone should be “bored into” at a place close to the projectile, and a “V” shape cut into the bone around the missile; the piece of bone is then removed along with the projectile.  The bone is left to regenerate itself during the healing process.  If the projectile has entered a joint, then the best way to remove it is to wrap the limbs around the joint with straps, and pull in opposite directions, to open up the joint; the projectile may then be more easily dislodged, but care must be taken to avoid damaging the ligaments.  These, then, are Celsus’s comments on the removal of projectile weapons from the body.

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[1] Oxford:  Clarendon Press (1907).

 

 

Read more in Digest:

4 thoughts on “Roman Surgical Extraction Of Projectiles In Ancient Combat

  1. Interesting read, is there any mention of anesthesia or pain relief? (by the way I don’t see this essay in the index for Digest, did I overlook it? ) Good refresher to see just how much is packed into your Digest book. Please keep up your excellent work!

    Liked by 1 person

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