Developments in surgical abortion are alluded to by Soranos and Galen (as well as Ptolemy and Vettius Valens) and later texts. Surgical abortion is mentioned in no prior extant text, although Tertullian, in a typical spasm of sarcasm and excess, attributes its instruments to Herophilos and even Hippocrates. The references in Soranos, Ptolemy, Galen, and Vettius suggest that surgeons had recently begun to explore the difficult and risky intervention of surgical abortion.
Earlier, abortions had been provided in various ways. For example, the Hippocratic Diseases of Women prescribes an herbal vaginal suppository as abortifacient, the very pesos prohibited in the Hippocratic Oath. Secondly, by numerous oral-route drugs, often thinly disguised as emmenagogues, as in Dioscorides, Scribonius Largus, or Pliny. Pliny refers only to pharmacological abortus (but he rarely mentions surgery at all). Juvenal, Satires, attacking women who abort, mentions only drugs.
The Hippocratic Excision of the Fetus and Celsus both describe surgery to remove a dead near full-term fetus, which is in effect an “inverse caesarean” operation, performed to save the woman's life, not an abortion. This intervention was adopted by veterinarians to treat cases of transverse birth presentation in livestock (described by Columella), which might have influenced the development of surgical abortion.
Ovid, Amores, is sometimes cited as the earliest extant reference to surgical abortion. However, the text hardly allows a strictly literal or medical reading, and given uenena (2.14.28) plus Ovid's pervasive militia amoris discourse, the “surgical” telis (2.14.27) may simply be a trope. Many drugs had violent effects.
Several surgeons, contemporary with Galen or his teachers, made significant advances in surgical procedure: LeÅnidas of Alexandria (ca 100 CE) and HÄ“liodÅros of Alexandria (ca 90 CE), plus Antullos (ca 100–260 CE). LeÅnidas is credited, e.g., with successful interventions on infected and cancerous breasts by Aetios of Amida. Likewise, HÄ“liodÅros and Antullos successfully excised blockages in the urethra; and the latter even managed the surgical care of aneurysms, which Galen rightly classes as among the most risky of procedures.
Whether achieved by some of these named surgeons, or some of the many others operating in the same period, whose names are now lost, we seem to have reason to believe that there were significant developments in surgical abortion. The practice of surgical abortion rendered it a topic of debate and reflection among doctors, provided more opportunities to learn fetal anatomy, and opened up a debate about the status of the fetus, visible in works by Galen, Porphyry, and a third-century anonymous.