Surgery in antiquity: the origin of the Trendelenburg position revisited

INTRODUCTION

The Raised Pelvic Position, also known as Trendelenburg position, consists of the elevation of the pelvis above the horizontal plane in the supine position with the head lowered. The position is named after Friedrich Trendelenburg, a German surgeon, who flourished in Berlin at the end of the nineteenth century. Although modern studies trace the position's principle back to the first century BC, we herein present even earlier descriptions, dating back to the fifth century BC.

MATERIAL AND METHODS

The whole ancient Greek literature was digitally searched. All relevant references were analyzed from the original sources.

RESULTS

We found at least nine references to the Raised Pelvic Position in the ancient Greek literature from the following physicians: Hippocrates (fifth century BC), Soranus of Ephesus (first century AD), Aetius of Amida (fifth century AD) and Paulus Aegineta (seventh century AD).

DISCUSSION AND CONCLUSION

All references presented, describe clearly the Raised Pelvic Position, as part of a strategy to repair uterine pathologies, mainly prolapsed uterus, but also instability, bleeding, tumors and infertility. We conclude that ancient Greek writers were aware of the usefulness of the head-down position, as reflected from the numerous existing descriptions dating back to the fifth century BC.

The history and illustration of anatomy in the Middle Ages

This article reviews the influence of key figures on the pictorial representation of anatomy and the evolution of anatomical illustration during the Middle Ages until the time of the Renaissance, based on medical history books, journals and ancient medical books. During the early period in the Middle Ages, most illustrations were traditional drawings of emblematic nature, oftentimes unrealistic, not only because the precise knowledge of anatomy was lacking but also because the objective was to elucidate certain principles for teaching purposes. Five figure-series that came down to us through ancient manuscripts and textbooks represent the best examples of such traditional illustrations. With the advent of human dissection in the 13th and 14th centuries, a significant transformation in the depiction of anatomy began to project the practice of human dissection, as we see in the works of Mondino de Luzzi, Henri de Mondeville and Guido de Vigevano. After the invention of book printing in the second half of the 15th century, the reproduction of books was commonly practised and the woodcut made multiplication of pictures easier. Peter of Abano, Hieronymous Brunschwig, Johannes de Ketham, Johannes Peyligk, Gregory Reisch, Magnus Hundt, Laurentius Phryesen and many more included several anatomical illustrations in their treatises that demonstrated the development of anatomical illustration during the later Middle Ages.