During the third century BCE, the city of Alexandria was home to a remarkable event in the development of ancient medicine as two physicians, named Herophilus and Erasistratus, conducted ground-breaking investigations into internal human anatomy. This research was important not only because it corrected many ancient misconceptions about the body, but because the doctors are believed to have reached their conclusions by dissecting human corpses, a practice outlawed in the Ancient World.
Although both doctors are known to have written several books, no complete work by either author survives. Our knowledge of the two physicians therefore comes from references and quotes by later writers.
Anatomy at Alexandria
‘Let it be your serious concern not only to learn accurately from books the shape of each bone, but also to carry out a keen visual examination of the human bones… This is very easy at Alexandria… [and] for this reason, if for no other, try a visit to the city.’ – Galen, On Anatomical Procedures
Founded in 331 BCE by Alexander the Great, the ancient city of Alexandria was the purpose-built capital of Greek-ruled Ptolemaic Egypt. Designed to act as a link between Greece and the fertile Nile Valley, Alexandria was located on Egypt’s Mediterranean coast and served as both an economic and cultural centre.
The Greek Ptolomies, who ruled Egypt from 323-30 BCE, were enthusiastic patrons of the arts and sciences, and it was under Ptolemy II (pictured) that the Great Library of Alexandria was opened in the third century BCE. This vast depository is believed to have held almost a million books and was part of a larger complex of academies and schools. Due to the Library’s fame and unprecedented royal support, the medical school at Alexandria grew quickly to become the medical centre of the Hellenic Age.
By the time Herophilus and Erasistratus came to Alexandria in c. 290 BCE, Egyptian doctors already had a reputation for their knowledge of human anatomy. The historian Herodotus, who lived and wrote during the fifth century BCE, described Egyptian medicine as highly specialised, with different doctors for each part of the body. In book two of The Histories, he also detailed the traditional process of mummification, a practice that, to his Greek readers, must have seemed both gruesome and bizarre.
Nevertheless, the widespread use of mummification would have afforded physicians in Egypt greater access to the inside of the human body than their Greek counterparts could ever hope to have gained. When Alexander the Great brought Greek rule to Egypt in 332 BCE, the reigning Greek elite carried their customs and traditions with them and exactly why Herophilus and Erasistratus were able to dissect human bodies so freely remains a mystery to this day.
It is possible the drastically different light in which human remains were viewed in Egypt encouraged Greek doctors to shed their traditional inhibitions, or maybe the powerful influence of the Ptolomies was enough to flout convention. Whatever the catalyst for this sudden change in attitude, Herophilus and Erasistratus are believed to have been performing dissections in Alexandria around 280 BCE.
Herophilus and Erasistratus
Herophilus, who was from Chalcedon, a town near modern-day Istanbul, was held in high regard in the Ancient World for his descriptions of the liver, the eye, and the reproductive organs. It is his work on the nervous system however, that is usually considered to have been the most important.
Realising that the network of nerves spread throughout the body could be traced back to the brain, Herophilus concluded that the brain was therefore the controlling organ in Man, through which ‘all bodily actions are accomplished’. This discovery went against Aristotle‘s assertion that the heart was the source of human intellect and reason, which would have been the commonly held belief at the time. Despite this, Herophilus’ remarkable work effectively superseded that of his predecessors’, and later medical writers, such as the Roman doctor Galen of Pergamon, adopted his interpretation over Aristotle’s.
Erasistratus was born on the island of Ceos, and before travelling to Alexandria, is reported to have served as royal physician at the court of Seleucus I in Mesopotamia. One of Erasistratus’ most important works focused on the veins and the arteries and he appears to have been very close to discovering the circulation of the blood, a feat eventually achieved by English physician William Harvey in 1628 CE. In addition, later writers, including Galen, praise Erasistratus for his highly detailed descriptions of the brain which they believed the doctor could only have achieved by dissecting actual human specimens.
These revolutionary discoveries represent an important leap in ancient understanding of the body, yet despite their pioneering research, the two physicians were not without detractors. In the centuries that followed Herophilus and Erasistratus’ work, questions arose over the ethicality of their methods and stories began to circulate that the subjects they dissected were cut up whilst still alive.
The ‘Butchers’ of Alexandria?
‘[Herophilus] that doctor, or rather butcher, who cut up innumerable human beings so that he could investigate nature’ – Tertullian, On the Soul
Following the rise of Christianity in the first century CE, popular opinion once again turned against human dissection, which the early Christian Church labelled a sin. Keen to denounce such unholy behaviour, some ancient scholars seized upon tales that Herophilus and Erasistratus’ dissections were not limited only to the dead, but that they experimented on the living as well, branding the two anatomists the ‘butchers of Alexandria’.
Writing long after the event, the anti-Christian encyclopaedist Aulus Cornelius Celsus (pictured), says that the bodies the doctors dissected came from the royal jail, explaining that they thought it was not cruel ‘that remedies should be sought for innocent people of all future ages in the execution of criminals, and only a few of them’.
Vivisection, on the other hand, was a different matter. In On Medicine, Celsus states that ‘to cut open the bodies of men whilst still alive is both brutal and unnecessary’. One hundred years later, Tertullian, an early Christian scholar from Roman Carthage, went even further, labelling Herophilus a ‘butcher, who cut up innumerable human beings’ and accusing him of hating ‘mankind for the sake of knowledge’.
Whether or not Herophilus and Erasistratus ever actually vivisected human subjects, the gruesome charges made against them helped ensure the practice of dissection was prohibited in the West until the Renaissance, when social and scientific changes allowed anatomists to practice on human corpses once again. The remarkable research that took place in Alexandria during the third century BCE was therefore a unique event in the history of medicine and the Ancient World, and the discoveries made by Herophilus and Erasistratus remained the pinnacle of anatomical knowledge for one and a half thousand years.
Liam is the author of Ancient Medicine: Sickness and Health in Greece and Rome.