Dear Editor:

In ancient Greece, transplantation was a common practice performed mainly in the field of agriculture. When people discussed transplanting, they mainly referred to grafting techniques used by farmers. Leaves from trees and vegetables were considered as grafts. Transposition of plant seedlings was consi­dered the essence of transplantation. Both trans­plantation and grafting comprised techniques applied in agriculture with no clear connection to medicine.¹

Organ harvesting and grafting, terms presently used to denote organ transplant, were never referred to in the works of acclaimed ancient Greek physicians for a number of reasons. In addition to the primitive and crude viewpoints of ancient physicians, ancient philosophy had not yet grasped or even concep­tualized the idea of transferring organs from one body to another.

Another issue was that ancient physicians lacked basic surgical knowledge and skills. This is apparent in the rudimentary progress shown in the field of anatomy. Advanced surgical knowledge and skills were particularly limited at the time. Furthermore, there was no accurate information on human body physiology and its functions. Ancient physicians had not yet recognized the basic principles on how organs, such as the liver and the kidneys, functioned. The inadequate knowledge and skill in the fields of anatomy and human physiology would have made it almost impossible for physicians to perform complicated organ transplant procedures.²

In addition to lack of surgical knowledge and skills, the mentality and ideology of the time played a significant role in hindering organ transplant. Vital energy, a concept that was recognized as indispensable for the existence of life, was perpetually created by superior natural forces: seed and semen. The cycles of life and death were viewed as triggered by the substantiating power of these 2 dynamic factors. Seed and semen regulated this cycle and determined a balance between destructive and revitalizing impact. This basic doctrine was widely accepted by ancient physicians.³

Ancient Greeks also considered the psyche (the soul) to be sacred and closely related to the functions of the body. Most organ functions were concep­tualized as outlets for the expression of the soul. More specifically, human organs were considered, more in a philosophical manner, as vehicles for the flow of vitality throughout the body. Thus, intervening and disrupting the normal form and function of a person’s body could irrevocably harm a person’s soul. These ideas pertaining to the mindset of ancient physicians would have substantially blocked the practice of surgical interventions and radical operations.⁴

Mythology may provide additional evidence. Mythological heroes, such as the Sirens, Gorgons, Harpies, the Minotaur, Centaurs, Chimaera, Hippalectryon, Silens, and the Sphinx, were considered products of the human imagination and were worshipped as such. Of importance, there has been no actual link between mythological figures and reality. What is more, myths were not considered evidence of and had no practical application in ancient scientific advancements. The myth of Prometheus, a Greek Titan who was condemned by Zeus to eternal torment for defyingly providing humanity with fire, is no exception. In this myth, the regeneration of the titan’s liver comprises a central theme. Nevertheless, the myth should not be considered as evidence of an advanced understanding of the liver’s anatomy and physiology. Although mythology contained bits and pieces of medical knowledge, it was never used or even considered as contemporary knowledge.⁵

Respect and praise of human bodies was another important reason why the practice of transplantation was never established during the ancient times. Religious and moral principles of the times dictated that a dead body should be deeply revered, worshiped, and honored. As a result, the retrieval of organs and tissues from a human corpse was generally prohibited. It would have been considered as insulting. It is for the same reason that anatomic dissections were also limited.⁶

Ancient physicians acknowledged that all organs were necessary for the general well-being and health of an individual. This was basically inferred from the weakened condition of physically debilitated people. Physicians concluded that a lack of organs caused people to become cachectic, that is, weak and decrepit. Hence, the retrieval and reimplantation of foreign anatomic structures in humans would also cause severe damage to the organ donor.⁷

Finally, definitions of diseased and their patho­physiologies were not solid and objective. Only 2 predominant approaches for explanations of diseases existed in ancient Greece. First, sickness was attributed to a substantial imbalance among the 4 basic elements (blood, phlegm, yellow bile, and black bile).⁸ The “methodologists” established a different basis and the second explanation of disease. Methodologists created a school of thought named “stereopathology” (from the Greek word stereos [στερεóς] and pathologia [παθολογíα]). According to this explanation, sickness resulted from imbalanced contractions and relaxations of ducts within the human body. The main focus of attention was directed toward explaining the causes of a disease, regardless of its effect on human organs and structures.⁹ In addition, damage to organs was only attributed to trauma and the natural aging processes. Organ damage was collateral damage to the course and natural history of each and every disease. Treatment of the underlying condition was believed to relieve and cure the damage caused to individual organs.¹⁰

In conclusion, the absence of organ and tissue transplantation in ancient Greece was predominantly caused by a lack of knowledge and the viewpoints during that period of time. Scientific, moral, and religious imperatives hampered the establishment of this surgical practice.

References:

1. Isager S, Skydsgaard JE. Ancient Greek Agriculture. London, UK: Routledge; 1993.
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2. Nutton V. Ancient Medicine. London, UK: Routledge; 2014.
   
3. Longrigg J. Greek Rational Medicine: Philosophy and Medicine From Alcmaeon to the Alexandrians. New York, NY: Routledge; 1993.
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4. Kirke GS, Raven JE. The Presocratic Philosophers. A Critical History with a Selection of Texts. Cambridge, UK: Cambridge University Press; 1957.
   
5. Graf F. Greek Mythology. An Introduction; Marier T (translator). Baltimore, MD: Johns Hopkins University Press; 1993.
   
6. Gundert B. Soma and psyche in Hippocratic medicine. In: Wright JP, Potter P (Eds.). Psyche and Soma: Physicians and Metaphysicians on the Mind-Body Problem From Antiquity to Enlightenment. Oxford, UK: Oxford University Press; 2000:13-36.
   
7. Longrigg J. Greek Medicine: From the Heroic to the Hellenistic Age. A Source Book. New York, NY: Routledge; 1998.
   
8. Schöner E. Das Viererschema in der Antiken Humoralpathologie. Wiesbaden, Germany: Franz Steiner Verlag; 1964.
   
9. Tecusan M. The Fragments of the Methodists: Methodism Outside Soranus. Leiden: Brill; 2004.
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10. Leven K-H. Antike Medizin: Ein Lexikon. München, Germany: Beck; 2005.