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Plastic surgery and

Achil leas Thoma MD FRCSC FACS Di vi sion of Plas tic and Re con struc tive Sur gery, De part ment of Sur gery, St Jo se ph’s Hos pi tal, McMas ter Uni ver sity, Ham il ton, On tario

“Noth ing good and beau ti ful can be achieved with out sacri fice” – Prome theus

reek mythol ogy is a collec tio n of the leg ends of the an - Gcient which starts with the creation of the uni- verse from and cov ers the five ages of man. The ancient Greeks believed that the gods created the human race not only once, but five . They were the golden, sil ver, , he roic and iron gen era tions (1). It was during the heroic genera tion that most of the fa- mous he roes of the an cient Greeks such as cles (Her cu - les), (of the nauts) and came to the world. It is this particu lar period with which Greek mythol ogy is most in volved. These sto ries came from vari ous sources such as ancient art works, ru ins of tem ples un earthed by ar che olo gists and the pottery and sculpture that fills the national muse ums of many coun tries. Al though there are variations on the Greek , the gen er ally ac cepted ver sions are those found in Hom er’s ‘’ and ‘Ody ssey’. Scholars believe that Homer lived some where be tween 750 BC and 1000 BC. These two epics Fig ure 1) Achilles bandag ing the injured arm of his best friend Patro - are widely consid ered to be the begin ning of the European lit- clus era ture (1). Other sources in clude He siod, a writer of leg ends and myths who lived some where be tween 800 and 700 BC, Greek mythol ogy tells us about the inter ac tion between and nius of Rhodes who followed by 400 gods and hu mans, he roes and mon sters. In con trast to the years. Un for tu nately, the works of Apol lo nius were lost in myths of other cul tures, Greek my thol ogy sur vived for over the fires of the fa mous li brar ies at Per ga mon and Al ex an dria. three mil len nia be cause the Greek gods had hu man traits with His works were referred to by the Roman poets Virgil and which mor tals could iden tify. The Greeks imagined their . gods to be flawed just like them selves. An other im por tant source of Greek my thol ogy is the When one reads the Greek my thol ogy, one is in trigued by Greek thea tre, in par ticu lar the sur viv ing works of the fa mous the similari ties between it and the Christian mythol ogy born play wrights Aeschy lus (525 BC to 456 BC), Sophocles 1000 years later. For ex am ple, the of Prome theus (496 BC to 406 BC) and Eurip ides (485 BC to 406 BC) (2). chained on the rocks and tortured by an eagle eating his liver which contin ued to regen er ate and prolong his pain for steal- This paper was presented in part at the 48th Annual Meeting of the ing the fire from Mount Olym pus to save man kind is remi nis - Canadian Society of Plastic and Reconstructive Surgeons, Ottawa, May cent of Je sus’ cru ci fix ion. This should not be sur pris ing, 28, 1994. however, as the advent of Christi an ity occurred in the Helle - Correspondence and reprints: Dr A Thoma, Division of Plastic and Reconstructive Surgery, Department of Surgery, St Joseph’s Hospital, nis tic world where the Greek lan guage, cul ture and myths 208-220 James Street South, Hamilton, Ontario L8P 3A9. Telephone (905) were para mount. 523-0019, Fax (905) 523-0229

102 CAN J PLAST SURG VOL 3 NO 2 SUM MER 1995 Plas tic sur gery and Greek my thol ogy

Although most scholars accep t the Homeric version of the Chei ron, he re fused to treat his enemy. The cunning Odys- Greek myths as of fi cial, many peo ple in the Medi ter ra nean seus (Ulys ses) took Achil les’ spear which had wounded Te - ba sin have their own ver sions. An ex am ple of this was found lephus and scraped some rust into the wound which caused it at the Olympic games of Barce lona in Spain in 1992. Dur ing to heal imme di atel y! Out of grati tude, Te le phus led the Greek the open ing cere mo nies there was a huge ef figy of Hera cles army the cor rect way to this . Thus, Te le phus, mar - (Her cu les) en ter ing the Olym pic sta dium. The peo ple of Bar - ried to Priam’s daugh ter (Priam was king of Troy), be trayed ce lona be lieve that it was who built their city. In the his father- in- law in or der to save his leg. Homeric version, there is no such mention of this event. It is An other fa mous wound in Greek my thol ogy was a snake prob able that Bar ce lona was built dur ing Hera cles’ ex pe di - bite suffered by Philoc te tes, another hero of the Greek army tion to ac com plish his tenth la bour which took him be yond which con quered Troy. This par ticu lar event oc curred on the Gi bral tar (pil lars of Hera cles) onto the Atlan tic ocean to fetch is land of Lem nos just off shore from Troy. The Greeks left Geryon’s cattle (3). him be hind on the is land since in his con di tion he was of no The an cient Greeks be lieved in the 12 Olympian gods. use to them in the war. This intro duced the concept of speciali za tion. They did not The war was not go ing well for the Greeks, and the believe that one god could be omnipo tent and therefore they told them that Troy could not be taken without Heracles’ ar- iden ti fied their gods with par ticu lar tasks, ie, Po sei don, god rows which were safe guarded by Phi loc te tes. Odys seus of the seas, , god of war, , goddess of wisdom, brought Philoc te tes to Troy and there in the Greek camp he Aphro dite, goddess of love, etc. In review ing the Greek my- was success fully treated by Machaon, the son of Ascle pius, thol ogy, one can find ref er ences relevant to the specialty of and pro ceeded to fight in the war (5,7). plastic surgery. A fa mous scar in Greek my thol ogy was the one on the leg of . After the fall of Troy, Odysseus spent 10 years WOUND HEAL ING AND SCARS roaming the seas before manag ing to reach Ith aca. He dis - The scene depicted in Figure 1 is taken from a guised himself as a beggar to en ter his pal ace in an at tempt to (drinking vessel) dated around 490 BC and housed in the An- get rid of the suit ors who had in ten tions on his wife, Pe - tiq uity Mu seum of Ber lin (4,5,6). It shows Achil les, one of nelope. His old wet nurse Eurycleia recog nized her old mas- the he roes of the Tro jan war, ban dag ing the arm of his close ter by the scar on the leg while washing his feet. Odysseus friend Patro clus with a two-tailed ban dage. This is per haps begged her not to re veal his iden tity un til he got rid of his the oldest picto rial repre sen ta tion of bandag ing and wound ene mies (8). manage ment, since the event it de picts took place about 1000 BC. HAND SUR GERY At one stage of the Tro jan war, Achil les had a feud with The first refer ence to hand surgery is also found in Greek Agamem non, the commander-in- chief, over a beauti ful girl mythol ogy. During the battle of the , Mother Earth was named Chry seis who had been given to Achil les as a prize of so enraged at for being harsh on her children after his the war. Aga mem non took her for him self, pull ing rank as the victory over , that she gave birth to a monster Ty- commander-in- chief. Achilles, the bravest warrior in the phoon and sent him against Zeus. This mon ster had 100 Greek camp, re fused to fight and as a result the Trojans man- heads and fire flashed from his eyes. With its snaky coils, Ty - aged to take the up per hand. Achil les’ friend Pa tro clus, in de - phoon avulsed the ten dons from Zeus’ hands and feet. Un - spair to push back the Tro jans, picked up Achil les’ ar mour able to fight, Zeus was cap tured and impris oned in a cave by and fought val iantly but was killed by Hec tor in bat tle. the monster. While there is no mention of an arm injury suffered by Pa- Her mes (Mer cury), the God of Com merce and mes sen ger tro clus in the Il iad (4), we learn from an other source (7) that it to the Olym pian gods, came to the res cue of Zeus. He stole took place in Mysia, where the Greeks mis tak enly landed ini - back Zeus’ ten dons from Ty phoon and su tured them back tially on their way to Troy. Achil les was leader of the first ex - into his feet and hands. With his tendons back, Zeus was able pe di tion, but his mother, The tis, knew that her son would die to fight again and defeated the monster (9). in the war with Troy be cause of his vul ner able heel and fal si - Various hand inju ries were described in the Iliad and their fied the naviga tion plans such that the Greeks landed in initial manage ment included cleansing with warm water. In Mysia instead. It was here that Patro clus was involved in a one par ticu lar epi sode, Hec tor hit Teucer with a ragged stone skir mish with Te le phus (son of Hera cles). The wound de - frac tur ing his clavi cle and paralyz ing his hand, de scrib ing the picted on the Kylix most likely rep re sents the in jury that oc - first brachial plexus injury (10). curred in this lo ca tion. Te le phus was also in jured on the leg in the same skir mish RECON STRUC TIVE SURGERY by Achilles. His wound would not heal, most likely due to os- In terms of re con struc tion, there is the story of Tan ta lus, teomye li tis. The oracle had told him that “only he who who was King of Phrygia and was also son of Zeus. He was wounded you can cure you”. Tele phus went to Myce nae one of the few mor tals in vited to Mount Olym pus, home of where the Greek force had reas sem bled. He met Achilles and the gods. Af ter a while, he started think ing of him self as a god begged him to cure his leg. While Achil les had knowl edge of and his exces sive pride led to his downfall. He thought he medicine and surgery, taught to him by the famous was im mune from any pun ish ment af ter he got away with

CAN J PLAST SURG VOL 3 NO 2 SUM MER 1995 103 Thoma some mi nor in frac tions. He felt he was as pow er ful as Zeus FETAL SURGERY and decided to commit a most heinous crime, killing his own From the Bacchae by Eurypides we learn that Zeus per - son and serv ing him at a ban quet to the Olym pian gods. formed the first fetal surgery (11). The goddess Hera, wife of Zeus hurled Tan ta lus to Ha des to suf fer eter nal tor ture. He Zeus, was bitterly jealous of the lovely Semele with whom con demned him to stand in a pool of crystal clear water. Zeus had had an af fair. She dis guised her self as an old lady When he was afflicted by thirst and bent down to drink, the and told Se mele that Zeus was an im poster claim ing to be a wa ter dis ap peared. Above his head were branches bearing god, whereas in fact he was just a mor tal. Se mele started fruit, but when he reached to take one, the branches lifted doubt ing Zeus and made him give his oath that he would do higher. His punish ment was eternal hunger and thirst. Zeus whatever she asked him do. Her wish was for Zeus to appear or dered Her mes to col lect all the pieces of Tanta lus’ son from in front of her in all his glory as a god. Zeus had no choice but the dinner table and recon stru ct them to gether. The shoul der to com ply since he gave his oath to the holy river . The part was miss ing, how ever. Ab sent minded god dess De me ter, tremen dous heat which radi ated from this metamor pho sis who was preoc cu pied with her daughter Perse phone’s disap - burned poor Se mele into cinders. Just before her death, pear ance, had eaten that part. Hephaes tus (the black smith god) Zeus re trieved the fe tus from Se me le’s uterus and trans - re con structed the shoul der with ivory and then Zeus breathed planted it into his own thigh. Seven months later, god life into Tan ta lus’ son, . Leg end has it that any one who Apollo was born. has a birth mark on the shoul der is a de scen dent of Pelops. OUT RA GEOUS FEES CRANIO FA CIAL DE FORMI TIES AND SUR GERY The subject of fees that physi cians should or should not The first ref er ence to cranio fa cial ab nor mali ties comes to charge can be found in the story of , who was con - us from the Od ys sey. The Cy clopes were huge mon sters with sid ered to be a wise seer and healer (12). He ac quired his single eyes in the middle of their fore heads. Al though this se - healing powers in a strange way. One day he saw an eagle vere deform ity is incom pati ble with life, the Greek mythol - swoop down on a snake nest and ran to the res cue. Un able to ogy por trayed the mon sters with immense strength. One such save the par ent snakes, Melam pus saved the lit tle ones from Cyclops was Polyphe mus who captured Odysseus in his at- the ea gle’s tal ons. In grati tude, the lit tle snakes came to him tempt to sail back to his homeland, Ithaca. The cunning in his sleep and licked his ears clean, bestow ing on Melam - Odys seus gave Poly phe mus wine to drink and then blinded pus the abil ity to com pre hend the speech of wild ani mals and the intoxi cated Cyclops by driv ing a hot red stake through his birds and giv ing him an in credi ble heal ing power. His fame sin gu lar eye, fa cili tat ing his es cape (8). grew in the ancient world, but along with his fame so did his A more in trigu ing ref er ence to cranio fa cial sur gery is the fees. When he was asked to cure King ’ daughter who birth of goddess Athena. Zeus had been afflicted by terri ble went mad, he asked for one third of the kingdom. When his headaches, and in a desper ate attempt to relieve his headache, other daughter suffered a similar illness, his fee was two ordered his son to split his head open from which thirds of the kingdom. Normally such greed would have been sprang the god dess of wis dom Athena (1). punished by the Olympian gods; however there is no evidence that this occurred. It seems that Melampus got away with it.

REFER ENCES 1. Graves R. Greek Myths. London: Cassell & Co Ltd, 1955. 7. Stephanides M. The Iliad - The . Athens: Sigma 2. Morford MPO, Lenardon RJ. Classical Mythology, 4th edn. New York: Publications, 1989. Longman, 1991. 8. Homer. The . Rieu EV (trans). Penguin Books, 1946. 3. Stephanides M. Heracles: Greek Mythology. Athens: Sigma 9. Stephanides M. The Battle of the Titans. Athens: Sigma Publications, Publications, 1989. 1989. 4. Mueller B. Achilles bandaging Patroclus. Surgery 1989;106:589. 10. Homer. The Iliad. Rieu EV (trans). Penguin Books, 1950. 5. Balas P. Ancient Hellenic surgery. Bull Am Coll Surg 1994;79(6):22-9. 11. Sandys JE. The Bacchae of Euripides, 4th edn. Cambridge: University 6. Singer C. Greek Biology and Greek Medicine. London: Oxford Press, 1900. University Press, 1922. 12. Stephanides M. -. Athens: Sigma Publications, 1989.

104 CAN J PLAST SURG VOL 3 NO 2 SUM MER 1995