Sunday, 25 August 2013

Supplying the Ancient Roman Sawbones

Sunday Selection- Roman dentistry...or what might have passed for the dental surgeon. 


Last week I had a scheduled visit to the dentist. Going to visit doesn’t bother me as it might do some people. I can’t say I love someone poking around at my teeth, but my dental surgeon is excellent and does quality work. 

ww.123rf.com
On my last visit, I knew I was in for some repair work since my teeth - two of them - had broken off around previous fillings (probably that age thing). I wasn’t worried about any pain –except that of the huge bill that lands in my lap nowadays!

Why was I not worried about the dentist drilling out a previous filling and on into my cavity to ensure it was decay free? 

Well, there is that wonderful administering during such visits of effective anaesthesia. Decades ago, I had to ‘steel’ myself not to flinch when a huge syringe came my way, but that isn’t how it is today. The needle is tiny and almost not felt at all, the freezing almost immediate - unlike years ago when it took some 10 minutes or more for the numbing effect to take place. (I now seriously rap my knuckles for neglecting my teeth back then.)

www.123rf.com
My visit was short and painless. I now sport one excellent reconstructed filling and the second filling is a ‘hope that it will work' or the future alternatives will be extraction, or a horrendously expensive programme of root canal work and the insertion of a ‘crown’.

It made me think of what might have happened to the characters in my recently completed historical Celtic/Roman Britain novels. Were there any documented dental practices in Celtic times that I could find? 

I haven’t yet come across specific Celtic references, but Roman and Greek documentation for general surgical practice is more available. Were the Ancient Roman and Greek tools for work on teeth nice and shiny like this set on the right?

Maybe originally they had a nice shiny patina but the likelihood was they were made from a more crude iron or steel and looked a bit like this:

wikimedia commons

Amongst this amazing array of surgical tools found in Pompeii there must be a few which were used for teeth extraction. Or for repair work to damaged teeth, perhaps to set a loose tooth back into place? Archaeological evidence exists that indicates some early civilisations used drilling techniques in teeth, and I recently saw a mention that someone had had a tooth 'rammed/hammered' back into place after it had fallen out. I dread to think what that was like, but if it ultimately helped the patient- then no more requires to be said! 

Dioscorides - wikimedia commons
I wondered what my new 'friend' Dioscorides - the Greek physician who was practising around the same era as my novels- would have prescribed, or have done to patients who had teeth issues. He travelled extensively around the Roman Empire with the Emperor Nero's Army some years before the time I'm writing about.  He collected a wealth of information about medical practice, herbs and the use of herbal remedies which he recorded and shared. 

Would he have used some of the pliers you see above to extract teeth long past any palliative remedies? There are a few that I think look pretty suitable. Would he have used herbal pain killers to dull the agony during any procedure that was undertaken? What might he have used? Poppy juice? Something else?

Perhaps if extraction wasn't necessary he would have prescribed the use of clove oil to ease the pain of toothache. Or maybe he would have used a clove of garlic or a piece of onion, both with known antiseptic properties to help with pain control and reduction of inflammation?
http://en.wikipedia.org/wiki/File:1554Arnoullet.jpg

In his writings, Dioscorides detailed over 600 herbs for varying uses. Many copies of his works were made over the almost 2000 years since his initial writing of them, his practise used as standards of medical care for many centuries by physicians.
 
In my own writing would Gaius Livanus Valerius, my Roman tribune, have gone to the camp surgeon if he had dental issues? I rather think he would – if he trusted the man.

What have I discovered about Roman Army medical practice from written evidence?  

It seems there is a good deal of it and investigative research made me take a lot of diversions. What was established practice in the fortresses of southern Britannia during my time period may have varied a little with that in northern Britannia- the area covered in my published novels and new manuscripts. Yet, I'm sure it did not take the Roman Empire very long to get the usual standards 'up and running' in those northern forts. My tribune, Gaius Livanus Valerius, has specific duties which include ensuring the safe passage of 'metal' supplies to the new forts and fortresses set up by Agricola on his Northern Britannia campaign. I'm convinced the wherewithal to replace damaged medical instruments would have come under his remit.

I've mentioned the immunesof the Roman Army quite regularly in my two follow-on manuscripts to The Beltane Choice which have been submitted to my publisher for consideration. The immune class of soldiers were soldiers who had specific training, specific jobs to conduct, and were generally exempt from combat unless they found themselves needed for defence.

In my second manuscript, I have some scenes which include the Roman Army surgeon at the Roman Garrison Fortress of Deva. It’s likely that he would have had a reasonable selection of tools as seen in the Pompeii collection, since my surgeon was a contemporary: the eruption at Pompeii being AD 79 and my manuscripts spanning the years between AD 71 and AD 84.

Where might the surgeon be found at the Fortress of Deva? I expect at the valetudinarium - the hospital.

It’s known that established forts and fortresses in Britannia had a specific hospital site, according to layout plans for Roman forts- the options for those plans being few in number and with minimum variations to those found elsewhere in the Roman Empire.  The typical plan was for barrack-like wards to surround a central courtyard. Rooms could be isolated, the patient kept as infection free as possible. Fresh water was piped in from as clean a source as could be found nearby and running water was laid to carry the waste away - the plumbing and drains laid in typical Roman fashion.

The surgeon worked in an operating room with that amazing array of tools. They may seem rudimentary, in comparison to modern surgical techniques, but they must have been highly sophisticated for the time. If you look at the two larger tools central in the 'Pompeii' range, the methods for clamping and hinging were finely wrought and must have taken excellent smithing to create. The picks, tweezers, and hooks must have been very effective and searingly sharp when new.

The instruments, it appears, were boiled before use. After the necessary treatment, cleaning wounds with vinegar was customary, before stitching.  Within the hospital, there were kitchens, baths, and latrines. A mortuary would have been used till funeral arrangements were made, the body generally being cremated. Within the hospital complex, there would have been herb gardens- the doctors using herbal concoctions as anaesthetics- like poppy juice (morphine), and henbane (scopolamine).
Depending on local supplies, it’s known that a starch mix pasted over bandages was used to immobilise broken bones and sometimes traction was effected by the use of heavy weights to pull on the damaged limb to keep the realigned bones in place.  

A medicus legionis or medicus cohortis would have been the chief medical officer in a legion or auxiliary unit, respectively. Those chief medical officers would have reported to the Camp Prefect- the Praefectus Castrorum. The medicus would likely have been assisted by a team of immunes of differing ability and experience- those men paid according to rank and experience.

When the garrison fortress of Deva was fully established my surgeon might have been assisted by an optio valetudinarii – a hospital administrator. During the Augustan era, and perhaps later on at the time of my novels, there may have been a grade of doctors named the medicus duplicarius. These were doctors who earned double pay while milites sesquiplicarii earned one and a half times the normal pay. The term medici vulnerarii seems to indicate the main type of surgeons: the medici ordinarii being the lowest ranking physicians. There’s scant written evidence for medical orderlies but there had to have been many of those who did the general caring after the surgical work was over.

When my tribune, Gaius, was out on campaign, it would have been a different situation. During a battle, near the field headquarters and close to the standards would likely have been a ‘medical’ area. Initial first aid would have been administered by soldiers, or corpsmen, in the field. Capsarii were soldiers who carried bandages (fascia) in their bag (capsae) and they would tend to minor wounds at the scene. If the patient needed more complex treatment, there might have been mounted soldiers who ‘picked up’ the wounded and rode them back to the ‘medical aid station’. Depending on the nature of the wounds the patient might have been transferred to the permanent base camp by horse drawn transport/wagon.

As with other areas of the Roman Military machine, the hospitals and medical force were well structured and effectively supplied by soldiers like my Gaius.

I've found this research quite fascinating and would love to have it added to- or even corrected - if my interpretation is for some reason inaccurate. Please feel free to comment!

Slainthe! 

Added extra! - facebook friend has given this update on the tools found at Pompeii-  
"the big one in the middle is a retractor used in abdominal surgery to hold everything open. The one to the right is similar but I have also seen it described as a vaginal speculum...at any rate it allows the surgeon to see better. The other instruments are skin hooks, bone rongeurs and forceps for removing bone fragments and missles like arrow heads or other foiegn bodies, a urinary catheter and a lot of skin probes, currettes and spoons for scraping and exploring wounds ..all very similar to what we still use today. They are NOT devining rods."
 My thanks to Thomas!





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