Classics 250 - Week 3 Lecture & Reading Material

Surgery

The branch of health science that treats diseases, injuries, and deformities by manual or operative methods

Surgery word origin

• Greek CHEIR- = hand

• + ERGON- = work

So the original word for surgeon was “Cheirergon,” but this word went through Latin and French, and thus the modern day word is now surgeon

Earliest known type of surgery

Trepanation

Trepanation

The process of scraping, cutting, or drilling small holes in bone, usually in the skull - of a living person

What type of surgery was trepanation?

A type of craniotomy (“cutting in the skull”); NOT a brain surgery - avoids penetrating the dura mater (membrane protecting the brain)

What happened if the dura mater was cut during a trepanation?

risk of infection from non-sterile instruments and environment was much higher

When are the earliest known examples of trepanation from?

~five thousand years ago

Where was evidence of trepanation found?

Worldwide

Reasons for trepanation

unknown

Potential reasons for trepanation

• treat head wounds, especially to relieve pressure from swelling

• Egyptians practiced trephining to cure migraines

• Possibly to attempt to cure mental disorders

What on a skull indicates that a person survived a trepanation?

The ingrowth of new bony tissue (the rounded edges) indicate that a patient survived the operation

How do you know if a hole in the head is a trepanation or something else?

• Cranial defects such as those caused by trepanation, especially after bone repair, can be hard for archaeologists/forensic anthropologists to diagnose

• With identifying (ancient) trepanation, the easier cases are those with little to no bone healing, because the surgical tool marks are more visible.

• If bone remodeling has occurred, it’s more difficult to asses what caused the hole

• Normal cranial anatomy can include skull depressions; so can some cranial birth defects

• Healed depressed fractures and wounds from certain weapons can be mistaken for trepanations

Terebra

Ancient Greek instrument used for trepanning. This instrument may have been used to drill single small holes, but it is more likely to have been used to make multiple holes arranged in a circle, so that the piece of bone within the circle as made easier to remove

What early Greek medical treatise had information about trepanation (and other head surgeries) and when to use it?

The Hippocratic corpus, medical essays dating from 460 to 377 BCE

Hippocrates

• Physician, born c. 460 BCE (5th BCE)

• Nearly nothing is know about him

• Focus: rational (not superstitious) explanation for illness

  • Taught anyone wishing to learn

Hippocratic medicine

• Based on observation and study of the human body

• First known person/school of thought to record experiences for future physicians to reference

  • Principles reflected in Hippocratic oath

Hippocratic corpus

• 60 separate works (treatises)

• covered many aspects of medicine

• Example: On the Sacred disease

  • about epilepsy

  • rational approach: excess phlegm from brain flowing into veins (i.e. not divine/supernatural origin)

What part of the Hippocratic corpus describes trepanation?

On Wounds in the Head (late 5th c. BCE), part 9

According to the Hippocratic corpus, what kinds of injuries required trepanation?

Of these modes of fracture, the following require trepanation: contusions and fissures

In trepanning you must frequently remove the trepan and plunge it into cold water. Why?

This is because the trepan, being heated by running round, and heating and drying the bone, burns the bone and causes a larger piece of it around the sawing to drop off, than would otherwise happen

Didn’t trepanation result in brain injury?

It sometimes did. The three main potential injuries from trepanation are:

1. hemorrhage

2. brain injury

3. infection

Wasn’t trepanation incredibly painful?

Unlike the skull, which has very few nerves, and unlike the brain itself, which has no pain receptors, your scalp, periosteum (membrane covering the bone) and meninges (the membranes covering the brain and spinal cord; cf. meningitis) have many pain receptors

What is meant by granulation in a wound?

In the Hippocratic corpus’s context, granulation refers to the stage of healing in which lumps of new tissue (containing new connective tissue and capillaries) form around the edges/surface of a wound. The lumpy appearance of this new tissue is “granular”- hence “granulation”

What is a contrecoup injury?

An injury that occurs at a site opposite from the point of impact

“toxic” information

• Greeks used to smear poison their arrowheads called toxicon pharmakon (toxon, bow, archery; pharmoakon, drug), thus providing the modern word toxic.

• Toxicologist, toxicity = something to do with “poison”

• Toxophilite = lover of archery (not of poison)

-osis information

• -osis indicates an abnormal condition

• When affixed to a combining form indicating an organ or a part of the body, it usually indicates a noninflammatory diseased condition

• Following the combining form cyt- (cell) it means an abnormal increase in number of the type of cell indicated

• Following the combining form for an adjective, it indicates the abnormality characterized by the meaning of the adjective

• A few words ending in -osis have special meanings

Anatomosis

A surgical or pathological connection between two passages

Exostosis

a bony growth arising from the surface of a bone

aponeurosis

a sheet of tissue connecting muscles to bones

symbiosis

the living together in close association of two organisms of different species

antibiosis

the association between two organisms in which one is harmful to the other

Adjectival word ending to -osis

-otic

-ist meaning

-itis meaning

indicating an inflamed condition; inflammation (noun-forming)

-osis meaning

*abnormal or diseased condition (noun-forming)

• special cases

-oid meaning

indicating a particular shape, form, or resemblance: like, resembling (both noun- and adjective-forming suffix)

-oma meaning

usually tumor; occasionally disease. (noun-forming)

Arachne story summary

• Arachne was a young girl who was extremely skilled in the art of weaving, and she decided to challenge Athena to a weaving contest (to which Athena actually responded and agreed).

• Athena and Arachne wove, and Athena was impressed by Arachne’s work/couldn’t find any flaws in her work.

• There are different versions of the story from this part on:

  1. Athena punishes Arachne for challenging a god (either by striking her multiple times and/or having her hang herself, etc.), and then Athena…

  2. Athena is impressed and rewards Arachne by…

• Turning her into a spider