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What Did the Romans Ever Do For { HISTORY OF UROLOGY } Jonathan Charles Goddard, Curator of the The Museum of Urology, BAUS; Consultant Urological Surgeon, What did the Leicester General Hospital. i Romans ever do Correspondence to: Jonathan Charles Goddard, E: [email protected] for us? n this series of articles I am going to show you some of the exhibits Icontained in the Museum of Urology, hosted on the BAUS website (www.baus. org.uk). Previously in this column, I told you about the Saxons and how they treated some urological diseases (Urology News 2013;17(5):22). Since then I have become aware of even earlier urological activity Figure 1: Highly stylised bronze Roman Phallic amulet. British c.C3rd AD. in Britain. a rank equivalent to a Centurian. A The Romans first came to Britain valetudarium or military hospital has with an expeditionary force under the been identified at Housesteads Fort near command of Julius Caesar in 55 BC; Hadrian’s Wall. There must have been they didn’t stay long. They came again civilian doctors and itinerant healers. The however in AD43 during the reign of few identifiable British medics often have Claudius and Britannia became part of Greek names. Much healing took place the Roman Empire until AD410. in the home, the master or mistress of The Romans brought doctors with the household taking the part of family them, often Greeks, and the medicine healer. of Rome was heavily influenced by the Many herbal remedies were used in doctrines of Ancient Greece. There were Roman times. Pedanius Dioscorides four main medical schools of thought. (c40-90 AD) was a Greek botanist, Figure 2: Roman Bronze Phallic amulet with phimosis. The Dogmatics tried to balance a pharmacologist and physician who Eastern European. c.C3rd AD. patient’s four humours (blood, phlegm, practised in Rome at the time of Nero. yellow bile and black bile); for example, Dioscorides wrote a five-volume if they felt the patient had too much encyclopaedia, De Materia Medica, blood they would bleed them, too much listing over 600 herbal cures. It was used phlegm, they would warm them to try extensively by doctors for 1500 years. and dry them out. The Pneumatists Ancient cesspits are often a useful tried to balance the patient’s pneuma archaeological source and one on the or life spirit using environmental factors Antonine wall (it’s further north than Figure 3: Roman ‘S’ shaped male catheter (Modern reproduction). such as clean water, fresh air and baths. Hadrian’s) in Scotland has revealed The Empiracists used careful clinical faecal material containing both celery Sulis and Brigantia. Votive (small models observation to make a diagnosis and seeds and opium. Celery was a well- of diseased body parts) were given to based management on “whatever described diuretic, used for urinary worked last time in that situation”, hence disorders. One wonders if this poor the gods in the hope the giver would the name. The Methodists followed Roman was suffering from bladder be healed. Often they were thrown into the works of Asclepiades and used a stones and had taken opium for the pain sacred pools or springs. Bronze amulets combination of food, wine, massage, and celery to help him void more easily were also worn often in the shape of exercise and bathing (unsurprisingly, this (complete speculation of course!!). phalluses. It is unclear if these were for was the most popular!). Religion and faith played a major part general good luck or good health or There were different types of in Roman healing. Although Aesclepius specific problems like infertility, sexual or healers in the Roman Empire, with was the major Roman God of healing, penile diseases. The bronze phallus in some being attached to the army. Apollo was also worshipped in Britain Figure 1 was found in Britain, it probably The Medicus Ordinarius probably had as were some older Celtic Gods such as dates from the second or third Century 34 UROLOGY NEWS l V20(4) l May / June 2016 Copyright © Pinpoint Scotland Ltd. All rights reserved. www.urologynews.uk.com UROMJ16.indb 34 28/04/2016 15:22 { HISTORY OF UROLOGY } method of cutting for the stone. Certain Some would have been treated by diet, Roman medical instruments have been fl uids and other conservative measures, Certain Roman medical excavated that appear to be urological. some medically with herbs and some instruments have been Bronze catheters for males were S surgically; sound familiar? excavated“ that appear to shaped (Figure 3) whilst female catheters Next time, I will explore the history of something we fi nd diffi cult to treat in be urological were shorter. Hooks and scoops with roughened surfaces have been modern urology clinics to see how our identifi ed; these are typical of lithotomy forebears tackled it; chronic bladder scoops, to pull out bladder stones. Some pain. have a groove on the other end, which may have contained a blade to make the * I am very grateful to Dr Ralph initial lithotomy incision (like a modern Jackson FSA, Senior Curator at The AD. The one in” Figure 2 appears to have disposable scalpel blade). British Museum for putting me straight a phimosis, perhaps the wearer was Some surgical instruments have on this point. hoping for a divine cure to avoid the been excavated in Britain at the forts at surgeon’s knife? Housesteads and Corbridge. Although Surgery was certainly carried out in there are hooks, scoops and one artefact has been named a bladder sound, no Roman Britain. Lithotomy was of course Previous Urology News historical articles known to Greco-Roman doctors; the urological instruments have convincingly can now be read online in The Museum of procedure was carefully described by been found (as yet!) in the UK.* Urology, BAUS. Aulus Cornelius Celsus (c25 – c50 BC). It is not clear if lithotomy was carried Celsus was a Roman encyclopaedist out in Roman Britain by specialised rather than a doctor but he is famous ‘lithotomists” or stone cutters or by for his well-known medical book, De doctors who specialised in surgery, or Medicina. This was a primary source on if doctors were expected to be both diet, pharmacy and surgery for centuries physician and surgeon. Remember and is one of the best sources of Hippocrates warned his colleagues to medical knowledge in the Roman world. leave stone cutting to specialists! It is His description of ancient lithotomy certain that urological conditions would has led to it being called the Celsian have presented to healers in Britannia. Radical Cystectomy or Bladder Preservation? Now your high-intermediate risk NMIBC patient has a real choice. Sequential BCG / Electromotive drug administration of Mitomycin-C is now the best-proven option by far. “EMDA from Physion Italy – Make your patients an offer they can’t refuse” • Consistently better outcomes The results of clinical studies have shown BCG/EMDA+MMC – proven in numerous clinical trials to have the following clinical benefi ts: • Lowest cost of any mechanically assisted drug delivery modality • Excellent oncological effi cacy • Shortest treatment times than any mechanically • Signifi cantly increased disease free interval assisted chemotherapy • Lower rates of progression • Improved patient tolerability • Lower rates of recurrence • More cost effective than radical cystectomy EMDA is now being adopted in more hospitals throughout the UK and Internationally than any other drug delivery system. Call Jump Start Medical on 01234 888955 to discuss how we can help you to adopt the EMDA protocol for your intermediate-high risk NMIBC patients as the standard of care in your hospital. Clinical trial enquiries welcome. Other applications and treatment protocols for EMDA, making it the only and most versatile drug Robin D. Luper delivery system available today, include: Managing Director • Interstitial Cystitis, OAB, Peyronie’s Disease, UTIs, GAG Layer Repair, Prostatitis The Granary, High Street, Turvey, Bedfordshire MK43 8DB, Great Britain References: 1. Gan C, et.al – The Journal of Urology, 2016 2. DiStasi S M et.al – EAU, 2015 T: +44 (0)1234 888955 F: +44 (0)1234 252121 3. DiStasi S Met.al – Lancet Oncology, 2006 M: +44 (0)7774 930316 4. Black P et.al – American Cancer Society, 2014 5. DiStasi S M et.al – Lancet Oncology, 2011 E: [email protected] 6. DiStasi S M et.al – AUA, 2012 W: www.jump-start-consulting.co.uk 7. EAU and BAUS Guidelines, 2015 – BCG Shortage www.urologynews.uk.com Copyright © Pinpoint Scotland Ltd. All rights reserved. UROLOGY NEWS l V20(4) l May / June 2016 35 UROMJ16.indb 35 28/04/2016 15:23.
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