Medicine at Sea Page

MEDICINE AT SEA: UNDERWATER DISCOVERY OF ROMAN SURGICAL EQUIPMENT

by David Gibbins

One of the most exciting finds I have ever made was a Roman surgeon’s instrument kit, excavated from the ancient shipwreck of Plemmirio B off Sicily. The picture below shows me holding one of the instruments at the moment of discovery. It was an incredibly lucky find – you can see how small and delicate the instrument is, and the gully below was heavily encrusted and fissured. In the end we found three bronze instruments, all closely similar. When we first reported them, these finds attracted a great deal of interest – they were discussed in the London Times, as well as in the media worldwide. Not only were they exquisite artefacts in their own right, but they also represent the first time ancient surgical instruments had ever been found in a wreck. Most other instrument finds have come from doctors’ graves, but here we had uncovered a kit actually in use, carried by a doctor who was probably a passenger – a surgeon, perhaps an eye specialist, who perished when the ship smashed into a cliff almost two thousand years ago on its way from Africa to Rome.

The article that follows first appeared in the British Medical Journal and was co-authored with Dr Chris Edge, who had been present at the discovery and took that picture of me. He was the perfect person to help research these finds – not only was he medical officer on my expedition and a highly experienced archaeological diver, but he was also one of the leading lights in diving medicine, a role he maintains today as Chair of the Medical Committee of the British Sub-Aqua Club. In the years that followed we were able to carry out more comparative research, for example on a surgeon’s kit found at Pompeii, but the conclusions we reached remain substantially unaltered – the Plemmirio find remains unique in the annals of underwater archaeology.

Ancient shipwrecks can yield much information about contemporary culture, such as the food eaten, clothes worn and domestic equipment used. Off the south east coast of Sicily, 3 km from the ancient city of Syracuse, lie the remains of a Roman shipwreck known simply as ‘Plemmirio B.’ Pottery amphoras, the ‘jerrycans’ of antiquity, are scattered on the seabed at a depth of 30 m. These and objects from the kitchen stores – terracotta lamps, glass vessels and cooking pots – have been dated and show that the ship foundered around AD 200. She was carrying a cargo of fish paste, olive oil, and iron bars when she sank, probably in one of the fierce storms that are common off the Sicilian coast.

Investigations of the site of the wreck in 1983-7 led to a unique find. Careful sifting of the black sediment at the bottom of a gully uncovered a small bronze object 8.5 cm long. At first we thought it was part of the ship’s equipment, though we were uncertain of its purpose. Further research, however, showed that it was a bronze scalpel handle, the first recorded specimen found from an ancient shipwreck. The long slender point was a blunt dissector, but the crescent shaped iron scalpel blade that would have been attached to the other end had corroded away; iron rarely survives in archaeological sites, and few extant examples of such blades are known.

Subsequent excavation uncovered two more scalpel handles of identical manufacture to the first (although one was without the blunt dissector) and a long wooden shaft, which may have been a ‘bandaging stick’ for winding tourniquets. The scalpel without the blunt dissector had been combined with a second instrument made of iron, the remains of which were preserved in a hole at the end of the handle. This was probably a solid cataract needle – a rare combination with a scalpel. All three handles showed metallic residue from the iron scalpel blades as well as the remains of solder or iron wire used to bind them securely in place.

Functional or decorative?

The carefully designed rolls and perforations at the end of such handles originally were thought not only to hold the blade, but also to be a feature designed to help the interchanging of blades, so that a surgeon’s kit, in Latin an instrumentarium, might comprise several handles with a range of blades and other attachments. The arrangement of slots at the end of the handle would allow a broken blade to be replaced without the handle having to be discarded, but there is now some dispute over whether blades would have been changed regularly. The principle evidence against this theory is the large number of handles found in complete instrumentaria – for instance, one from a surgeon’s grave in Bingen, Germany, contained 134 such handles. Possibly the rolls at the end of the handles were largely decorative.

The manufacture of handles and mending of broken blades were probably carried out by a smith or cutler or perhaps a specialist instrument maker. These objects display both elegance of form and a refined understanding of the practical requirements of their use. They represent the peak of Roman bronze work, and the manufacturer of such precision equipment probably had the status of a modern jeweler or clock maker. In Ostia, the port of Rome, a terracotta relief from the second century shows a specialist smith with a small boxed set of scalpels by his side.

Scrotums, cysts and cataracts

We are fortunate in having contemporary written accounts of the use to which specific medical instruments were put. In De Medicina, a compendium of medical practice, the Roman encyclopaedist Celsus describes procedures in which scalpels and blunt dissectors were used, such as in surgery of the scrotum: ‘Now wherever the disease is found to be, the assistant should press the scrotum gently upwards; the surgeon either with his finger, or with the handle of the scalpel, separates the middle tunic from its connection with the scrotal wall and brings it forwards.’ There is a similarly vivid description for the removal of dermoid cysts: ‘Then as soon as the white and tight coat is seen, it is to be separated from the skin and flesh by the handle of the scalpel and turned out together with its contents.’ His account of cataract removal, for which a handle with a needle was used, is a graphic illustration of the extraordinary refinements of Roman eye surgery:

Thereupon a needle is to be taken pointed enough to penetrate, yet not too fine; and this is to be inserted straight through the two outer tunics at a spot intermediate between the pupil of the eye and the angle adjacent to the temple, away from the middle of the cataract, in such a way that no vein is wounded.

Travelling doctor

Perhaps the finds from the Plemmirio site are part of a comprehensive instrumentarium, and other items from the kit, which could range from bone mallets to metal urinary catheters, remain at the site. Whether or not this is the case, the finds are probably the belongings of a surgeon, perhaps a specialist oculist – an eye surgeon – rather than equipment from the ship’s first aid box. We suggest that the doctor was traveling on board as a passenger. This theory is supported by the unique nature of these finds among more than 1500 ancient shipwrecks that have been found in the Mediterranean, and the consequent lack of evidence for surgeons in ship’s crews. These finds are not only of huge archaeological interest, but also provide an exciting contact with someone who, although dead for almost two millennia, had skills and concerns with which we can identify intimately today.

This is an updated version of Edge, C. and Gibbins, D., 1988, Underwater finds of Roman surgical equipment. British Medical Journal 6664: 1645-6.

For more detailed discussion of these finds, including archaeological comparisons and full scholarly references, you can download the following articles from the leading journal Antiquity by going to www.antiquity.ac.uk to access their website archive:

Gibbins, D.J.L. 1988. Surgical instruments from a Roman shipwreck off Sicily. Antiquity 62: 294-7.

Gibbins, D.J.L. 1997. More underwater finds of Roman medical equipment. Antiquity 71: 457-8.

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