Surgical Instruments in Greek and Roman Times Part 11

I give a figure of a stylus in silver, beautifully oxidized, which was found at York while making excavations there in constructing the railway (Pl. XVII, fig. 3).

Pl. XVII, fig. 6 shows an instrument which is figured by Vulpes (op. cit.) as a specillum. Personally, I think its highly ornamented form shows that it is rather a domestic article, but, as no information is available as to the surroundings among which it was found, we can only say that its shape fits it equally well either for writing or minor surgical manipulations.

_Grooved Director._

Although we have no actual description of a grooved director, we have many manipulations described in which such an instrument would be used nowadays. For example, in describing the treatment of fistulae Celsus says:

In has demisso specillo ad ultimum eius caput incidi cutis debet (VII.

iv).

'A director being inserted into them down to their termination the skin ought to be incised.'

It is interesting to find that we have at least one grooved director extant to prove that this instrument was known to the Romans. It is in the Section of Surgical Antiquities of the Musee de Cinquantenaire, Brussels, and it was discovered, along with several other surgical instruments, in a surgeon's case of the usual cylindrical form.

It is 15 cm. long, 2 mm. in diameter. A deep groove runs for 6 cm. from one end. The other end terminates in a small b.u.t.ton. It is of silver, as also were the other contents of the case. It is possible that grooved specilla may have been in quite common use, but may have been made of wood or tin, and have therefore not survived; because we learn from Galen's Manual of Dissection that probes which were used as directors in dissecting work were generally of wood, such as boxwood, so that they might not chip the scalpel (ii. 711).

_Surgical Needle (three cornered)._

Before discussing the eyed probes it will be well to clear the way by disposing of the needles, and of these, as the most easily defined cla.s.s, it will be best to take the surgical needles first. We have innumerable references to the surgical needle though we have no actual description of it. There must have been many different sizes of it, for the manipulations vary greatly in magnitude. I shall content myself with giving two quotations describing respectively one of the largest and one of the smallest of these. Both pa.s.sages are from Celsus. He thus describes the operation of suturing the abdominal parietes:

Sutura autem neque summae cutis neque interioris membranae per se satis proficit; sed utriusque: et quidem duobus linis iniicienda est, sp.i.s.sior quam alibi; quia et rumpi facilius motu ventris potest, et non aeque magnis inflammationibus pars ea exposita est. Igitur in duas acus fila coniicienda, eaeque duabus manibus tenendae; et prius interiori membranae sutura, iniicienda est sic ut sinistra ma.n.u.s in dexteriore ora, dextra in sinisteriore a principio vulneris orsa, ab interiore parte in exteriorem ac.u.m immittat: quo fit ut ab intestinis ea pars semper acuum sit quae retusa est. Semel utraque parte traiecta, permutandae acus inter ma.n.u.s sunt, ut ea sit in dextra quae fuit in sinistra, ea veniat in sinistram quam dextra continuit: iterumque eodem modo per oras immittendae sunt: atque ita tertio et quarto, deincepsque permutatis inter ma.n.u.s acubus plaga includenda.

Post haec, eadem fila eaedemque acus ad cutem transferendae similique ratione ei quoque parti sutura iniicienda; semper ab interiore parte acubus venientibus, semper inter ma.n.u.s traiectis: dein glutinantia iniicienda (VII. xvi).

In the next case, where Celsus describes the treatment of staphyloma of the cornea, a very small needle must have been used:

Haec fere circa oculum in angulis palpebrisque incidere consuerunt. In ipso autem oculo nonnunquam summa attolitur tunica, sive ruptis intus membranis aliquibus sive laxatis; et similis figura acino fit: unde id staf???a Graeci vocant. Curatio duplex est: altera, ad ipsas radices per mediam transsuere acu duo lina ducente; deinde alterius lini duo capita ex superiore parte, alterius ex inferiore adstringere inter se; quae paulatim secando id excidunt: altera in summa parte eius ad lenticulae magnitudinem excidere (VII. vii).

Now for suturing tissues, and more especially tissues of such toughness and thickness as the abdominal parietes, a round needle is absolutely of no use. A surgical needle not only requires to have cutting edges, as our three-cornered needles have, but these edges need to be in good condition to work well. Three-cornered surgical needles were in use from very early times. They are fully described in the Vedas of the Hindoos (Wise, _Hindoo System of Medicine_, p. 171). A few three-cornered needles of Roman origin have been found, although they are rare. Those which exist are of bronze.

Probably the majority were of steel, and of these none have survived. I give a photograph of a three-cornered needle from my collection (Pl. XVII, fig. 4). It is imperfect at the point. It measures 72 cm. in length, and the sides are each 2 mm. in breadth. It is important to emphasize the fact that only needles with cutting edges are to be looked on as surgical, because it is not unusual to find needles, which are round and of large calibre, described as surgical, although they are quite unfitted for surgical work. Such is the one figured by Vulpes (op. cit.).

Needles of this kind are sometimes found, as this one was, among surgical instruments. But they are not surgical needles in the sense that they are intended for suturing tissues. They are for fixing bandages. I shall describe them in the next section.

_Round Needles and Bodkins._

Hippocrates tells us that bandages for fixing dressings and splints on a fractured limb ought to be finished off by st.i.tching with a thread (iii.

55), and Celsus repeats the advice:

Hieme saepius fascia circ.u.mire debet: aestate quoties necesse est.

Tum extrema pars eius inferioribus acu a.s.suenda est; nam nodus vulnus laedit, nisi tamen longe est (V. xxvi).

The round sewing needle was therefore part of the recognized outfit of the surgeon, and numbers have been found a.s.sociated with surgical instruments.

Apart from this a.s.sociation with other instruments it is quite impossible to distinguish them from domestic needles. The same may be said of bodkins, as these too occur in surgical finds, and are also quite indistinguishable from the domestic articles for embroidering. Pl. XVII, fig. 2 shows a bronze needle from Roman London. A similar one from Pompeii, now in the Naples Museum, is given by Vulpes as a surgical needle, owing to the fact that it was found along with surgical instruments; but it is evident that it is only a needle for sewing bandages, &c.

Other types of needles and bodkins are found in bronze, but many also are of bone and ivory. Even the latter are quite serviceable, and in spite of their being comparatively thick will st.i.tch compact cloth easily. An ivory needle from Roman London is shown in Pl. XVII, fig. 5.

_Eyed Probes._

We have frequent references to eyed probes, and we also possess a considerable number of different types. In dealing with the dipyrene I quoted a pa.s.sage to show that it sometimes carried an eye in one of its olives. Hippocrates refers to an eyed probe of tin. In treating of fistula he directs us to take a rod of tin having one end pierced with an eye (???? ?a.s.s?te????? ?p' ????? tet??????), and having put one end of a twisted piece of lint through the eye put the probe into the fistula, get the end of the specillum, bend it and hold the thread with the finger and withdraw the ends. Paul quotes this pa.s.sage (VI. lxxvii), but alters the wording slightly:

'Hippocrates directs us to pa.s.s a thread consisting of five pieces through the fistula by means of an eyed probe or a dipyrene' (d??

tet?????? ??pa???? ? d?p??????).

Again in polypus naris (ii. 243) Hippocrates directs us to cut a sponge to the shape of a ball and tie the ball round with thread, and make it hard and of such a size as to fill the nose. To the sponge tie a thread of four pieces, each a cubit long, and make one thread of them. Put the end through a fine tin rod having an eye at the end. Push the rod bent at an acute angle into the mouth, and catch the end of the thread under the palate and pull it through, propping it with another hoof-like probe, and extract the polypus. Pl. XVII, fig. 1 shows an eyed probe from the Baden Hospital. Its shape is exactly the same as a lead probe figured by Pare for the insertion of the apolinose.

An example of a scoop at one end and an eyed probe at the other was found at Augst, and is now in the Museum at Basle (Brunner, loc. cit., Taf. I, fig. 14). It is 16 cm. long, of which the spoon, slightly defective at its tip, occupies 3 cm. About 2 cm. from its tip, which is fine, there is an elongated eye, 5 mm. in length.

Various other combinations are met with.

_Ligula type of Specillum._

Greek, ??a??s???; Latin, _ligula_.

Ligulae are found in enormous numbers and in very great variety. They are toilet articles for extracting from tubes and boxes ointment, the various salves, balsams, and powders which entered into the mysteries of the Roman lady's toilet. The ligula is therefore not strictly speaking a surgical instrument, but as it was used by the laity, and no doubt also by physicians, for making applications to affected as well as to unaffected parts, and as it is often found a.s.sociated with surgical instruments, it is advisable to bring it within the scope of this investigation. It is also convenient to do so, because some varieties approach so closely in form to the true surgical specilla that it is often difficult to decide which cla.s.s to place a particular specimen in. In doubtful cases it is well to remember that the specillum is most usually a combination of two instruments on one shaft. Brunner (loc. cit.) figures a number of ligulae from the Swiss museums. These he names specilla oricularia, although admitting that they are only domestic articles. I have shown, however, that the specillum oricularium is a well-defined combination of scoop and probe.

Plate XVIII shows a variety of ligulae from various sources, some simple, some combined instruments. Figs. 4, 5, 8 are most typical forms. Some of this simple type are two feet in length. They are often overlaid with gold. Fig. 7 shows a ligula which has so been treated. It carries a small fork on which to poise a pellet of semi-solid medicament.

_Spoons for measuring, preparing, and pouring medicaments._

A type of spoon not uncommonly met with has a round bowl about 2 cm. in diameter, and a handle of about 10 cm. long. Usually they are of bronze; but occasionally they are of silver, and a considerable number in bone were found in the Roman Hospital at Baden. They are for measuring medicaments, heating them, and removing them from unguentaria, &c. They are often found alongside the gla.s.s unguentaria which contained the salves. They were also used for religious purposes.

Similar spoons with pointed handles are common in finds of domestic articles. The sharp end is for extracting sh.e.l.lfish, &c. A larger variety of the unguent spoon has a spout to a.s.sist in pouring the contents. This variety is rather rare.

Pl. XIX, fig. 4 is from the British Museum. The bowl is 2.5 cm. in diameter and the handle is 15 cm. long. The handle is round, and it has a small ringed ornamentation at its end and one close to the bowl. The bottom has been thinned out with heat, and there is a small perforation visible in it. A similar spoon was found in the grave of the Paris surgeon. Traces of medicament remain on it. This type is probably intended for warming salves and pouring them into the eye and other affected parts.

Another variety is seen in Pl. XIX, fig. 1. This specimen is in the Naples Museum, and was found along with the spatula shown in Pl. XIX, fig.

2. The handles of each are of bronze, the scoop and spatula parts are of silver. Vulpes describes these as a lancet for drawing blood and a spoon for collecting and examining the same. It is impossible to regard an instrument of silver as a cutting instrument. These are for mixing and spreading medicaments. A large spoon of a peculiar shape from the Naples Museum is seen in Pl. XIX, fig. 3. It is of silver. The handle, which is of ivory, is ornamented with spiral carving, and the end bears a ram's head. Another interesting little shovel from the same museum is of bronze, and carries the head of Minerva Medica on the end of the handle (Pl. XX, fig. 5). We may here include the large double spatulae of the type shown in Pl. XX, fig. 1, which represents a specimen from Naples. A similar one was found in the outfit of the Paris surgeon, and Scultetus shows precisely similar instruments in use in his time for applying the stiffening to the bandages, &c. for setting fractures. The Romans probably used theirs for a similar purpose.

_Tongue Depressor._

Greek, ???ss???t????.

To open a quinsy Aetius says (II. iv. 45):

'If the patient is adult, seat him and make him open his mouth, and depress the tongue with a spathomele, or a tongue depressor, and open the abscess with a probe or a needle knife.'

In excision of the tonsil Paul (VI. x.x.x) bids us seat the patient in the sun and depress the tongue with a tongue depressor (???ss??at???).

Pl. XX, fig. 6 shows one of six bronze tongue depressors, burnished like small mirrors, from the Lepine collection (Vedrenes, _Celse_).

_Uterine Sound._

The uterine sound is frequently mentioned by Hippocrates for correcting malpositions of the uterus, and dilating and applying medicaments to the interior of the cervix. After falling into disuse in the middle ages it was reintroduced by Sir J. Y. Simpson, only to disappear once more almost entirely from sight.