Surgical Instruments in Greek and Roman Times Part 10

In fistula in ano Paul says it may be used as a director to cut upon.

'Having introduced a sound or an ear probe (?p??????te? ??p????? ?

???t?da) through its orifice, we cut the skin over it at one incision' (VII. lxxviii).

Ill.u.s.trations of two ear probes are given. What I regard as the type is seen in Pl. XV, fig. 5, which shows an instrument from the Roman Hospital at Baden. Typical specimens are not by any means common. Pl. XV, fig. 2 shows another variety from my own collection.

_Screw Probes._

On probes for wrapping round with wool we frequently raise a screw thread to enable the wool to adhere better. This useful contrivance was also known to the ancients. I give a figure of one in my possession. It was found in the Roman Camp at Sandy (Pl. XXI, fig. 5). It measures 97 cm. in length and is 15 mm. thick. The screwed portion occupies 7 mm. of one end. The other end is plain. The little instrument is well adapted for treating small cavities, such as an ear or a carious tooth by wrapping round the screw portion with wool and dipping in medicaments.

_Ear specillum for wounds._

Greek, t?a?at??? ???; Latin, _specillum vulnerarium_.

There was a special variety of ear specillum which was adapted for wounds.

Paul (VI. lx.x.xviii) says:

'Stones and other missiles from slings may be removed by levers or the scoop of an ear probe adapted for wounds' (??a??s??? t?a?at????

???t?d??).

This was probably an instrument on the same principle as the ear probe, i.

e. a combined probe and scoop, but on a larger scale. Possibly it may have had a slight olivary enlargement. That it was large we learn from Galen's Lexicon, where ???? ?s????? is stated to mean t?? t?a?at???? ????. It will easily be seen that the _specillum vulnerarium_ has considerable affinity with the other cla.s.s of spoon probes which I const.i.tuted, viz.

the cla.s.s of cyathiscomeles--for these had a scoop at one end--and this being specially intended for wounds most likely had a certain amount of olivary enlargement at its tip, but smaller than the olive of a cyathiscomele, which was too large for ordinary wounds. The typical ear specilla and the typical cyathiscomeles both form well defined groups, but between these innumerable gradations occur among the specimens extant. For practical purposes it is convenient to cla.s.s all these intermediate forms as _specilla vulneraria_.

_Handled Needles._

In the find of the oculist Severus were no less than nine handles for needles. Of these, six were merely cylinders of bronze, expanded slightly at one end and perforated at the other with a small hole for a needle.

They were from 72 to 40 mm. long and 7 to 5 mm. in diameter. Two were hexagonal, four were round (Pl. XXI, figs. 2, 4, Pl. XVI, figs. 3, 4, 5, 6). Two others had the same holes for needles at one end, but at the other they were pierced with a slot, 10 mm. deep, for the insertion of a knife blade. One was 60 x 7 mm., the other 53 x 5 mm. (Pl. II, figs. 1, 2).

Another, perforated at one end as before, carried at the other an olive-pointed probe. It was 8 cm. in length, and of this 35 cm. consisted of a hexagonal handle 35 cm. in diameter. The remainder was cylindrical, and it terminated in a probe point with a slight olivary enlargement (Pl.

XVI, fig. 2). In all cases the needles had evidently been made of steel and had entirely disappeared.

We have many allusions to the use of handled needles in ophthalmic work.

In describing the couching of cataract Celsus says:

Tum acus admovenda est, acuta ut foret sed non nimium tenuis (VII.

vii).

'Then a needle is to be applied, sharp so as to penetrate, but not too fine.'

s.e.xtus Platonicus (_Med. ex Animalibus_) says that cataract is depressed with a specillum.

A full description of the operation is given by Paul:

'We measure off a nucleus' breadth (?s?? p?????????) from the part called the iris and in the direction of the outer canthus, then mark with the olivary end of the couching needle (p????? pa?a?e?t?????) the place to be perforated. If it is in the left eye, we work with the right hand, and vice versa. Bringing round the pointed end of the perforator, which is round at the tip (?a? ??ast???a?te? t?? ????

st???????? ?at? t? p??a? ?p?????sa? t?? ?e?t?????), we push it firmly through at the part which was marked out until we come to an empty s.p.a.ce. The depth of the perforation should be as great as the distance of the cornea from the iris. Then raising the needle to the apex of the cataract (the bronze of it is plainly visible through the transparent part of the cornea) we depress the cataract to the underlying parts. After the couching of the cataract we gently extract the needle with a rotatory movement' (VI. xxi).

It will be seen from Paul's vivid description that the couching instrument consisted of a handle with a nucleus at one end, to measure off the spot at which to perforate, and a needle at the other. We saw that the outfit of the oculist Severus contained one such instrument (Pl. XVI, fig. 2).

The same combination is not infrequently met with. In the Museum at Aarau there are four from the station at Vindonissa. I have one in my collection which is interesting as showing a screw thread for fitting on a cover to protect the needle (Pl. XVI, fig. 7). It was found in Bedfordshire. It reminds one very strongly of the couching needle figured by Pare. Other handled needles were used in eye work as cauteries. Of trichiasis Celsus says (VII. vii):

Si pili nati sunt qui non debuerunt, tenuis acus ferrea ad similitudinem spathae lata in ignem coniicienda est: deinde candens, sublata palpebra sic ut eius perniciosi pili in conspectum curantis veniant, sub ipsis pilorum radicibus ab angulo immittenda est ut ea tertiam partem palpebrae transsuat; deinde iterum, tertioque usque ad alterum angulum; quo fit ut omnes pilorum radices adustae emoriantur.

_Ophthalmic Probe._

Greek, ?f?a???? ???.

In Hippocrates (ii. 100) we find an ophthalmic probe mentioned.

?ep?d?? ??a? t?e?? t? p?ate? ?a? ???t?? s?ta???? ??????, p??ta ta?ta ?e?a t???a?, ?atap?t?a p???sa? d?d??.

'Of squama aeris three times the full of a specillum and [as much] of the gluten of wheat. Levigate all up fine, form into pills and administer.'

Galen in his Lexicon explains that ??a? t?e?? t? p?ate? means t? ??a??s??

?f?a????? ????. This is the only mention which we have of a special ophthalmic probe with scoop. In applying medicaments to the eye with a probe whenever any variety of probe is mentioned it is always the ear specillum which is named. It seems most likely that either the ear specillum or some variety of it is referred to here. It may have had a nucleus for applying medicaments at one end and a scoop at the other.

_Rasping Specillum._

Greek, ?efa????st??; Latin, _specillum asperatum_ (Celsus).

A special burred specillum, for curetting the granular lids so common as a result of the ophthalmia which is endemic in most Eastern countries, and which was rampant in ancient Greece and Rome, is described by Celsus and also by Paul. Celsus says:

In hoc genere valetudinis quidam cra.s.sas durasque palpebras et ficulneo folio, et asperato specillo, et interdum scalpello eradunt, versasque quotidie medicamentis suffricant (VI. vi).

Paul says:

'But if the granulation be hard and yield to none of these things we must evert the eyelid, and rub it down with pumice stone, or the sh.e.l.l of the cuttlefish, or fig-leaves, or the surgical instrument called blepharoxyston' (d?? t?? ?efa????st?? ?a???????, III. xxii).

Heister (vol. i. tab. xvi. p. 591) figures the blepharoxyston as a spoon-shaped instrument burred on the convex side. There is in the Orfila Museum, Paris, an instrument of similar form. It consists of a handle with an olivary point at one end, and at the other a plate with transverse ridges. This agrees well enough with what we know of the cla.s.sical instrument. It was found in Herculaneum. (Pl. XVI, fig. 1).

_Styli and Styloid Specilla._

Greek, ???f???, ??afe???, ??af??; Latin, _stylus_ or _stilus_.

The difficulty of deciding as to whether any particular instrument is a surgical or a domestic article is often well ill.u.s.trated by styloid instruments. In the British Museum several types of instrument will be found cla.s.sed among surgical instruments, and a series of exactly similar articles will be found repeated among the styli used for inscribing and erasing characters on wax tablets. As even the writing stylus was occasionally used for surgical manipulations we are justified in looking on all styloid instruments as potentially implements of minor surgery. The claims of any doubtful instrument to be considered as once having been one of a surgeon's tools must be decided on such grounds as the circ.u.mstances of its discovery.

Galen (xii. 865) says teeth may be extracted with the stylus (??afe??

????ae) or with the finger.

Hippocrates (i. 46) thus describes the method of extraction of the secundines:

'Place the patient on the obstetric chair and, leaving the cord uncut, place the child on two bladders filled with water and puncture each of the bladders with a stylus (??af??) so that the water may slowly flow away.'

The writing stylus, then, from the fact of its being at hand and of suitable shape was occasionally, perhaps often, used as a surgical instrument.