Surgical Instruments in Greek and Roman Times Part 14

FORCEPS

_Epilation Forceps._

Greek, t?????a??, t????????? (== t?????a?d???); Latin, _vulsella_.

The removal of the hair from the face for cosmetic purposes is a custom which has come down to us from prehistoric times, and seems to have been very prevalent among all primitive races. In the bronze age the method by which this was accomplished seems to have been to fix the hairs with a broad jawed forceps and cut them off close to the skin by means of a knife or 'razor'. Thus did primitive men 'shave', and very often in early bronze age graves in Scandinavia and in the Swiss lake-dwelling excavations these forceps and razors are found together. No doubt also epilation proper was practised occasionally, but the majority of the prehistoric forceps are not for epilation but for fixing the hairs to allow the knife to divide them close to the skin. At a later time, with the more common use of steel, the Greeks and Romans shaved as we do, and epilation proper was practised for removing superfluous hairs from the face and also to remove trichiasis. Aristophanes, a contemporary of Hippocrates (Ran. 516, Lys.

89, 151), Persius (iv. 37) and Juvenal (vii. 114) refer to the depilation of the p.u.b.es as being common among certain cla.s.ses, and the early Christian Fathers deplore the practice. See also the remarks of Suetonius on the conduct of Domitian (xxii). Prosper Alpinus, who visited Egypt in the sixteenth century and wrote an interesting book on the state of medicine in that country, found the custom still prevalent among the Egyptian women, and thus explains the object with which it was practised (_Medicina Aegyptiorum_, cap. III. xv):

A pulveribus, qui Aegyptiis fere toto anno ventorum terraeque siccitatis occasione perpetuo familiares existunt, atque ab a.s.siduis sudoribus quibus coeli calore omnia corpora continue abundant, illuvieque quadam immunda redduntur, atque foetentia, ex quo pleraque ipsorum et foetere et pediculis abundare solent. Balneis omnes hi populi utuntur familiarissime pro corporum abstersione, maximeque mulieres, quibus curae magis est corpora ipsarum pulchriora facere ipsorum, illuviem et foetorem corrigentes, ut cariores sint suis viris. Eae etenim saep.i.s.sime corpora in iis lavant, at mundant ab illuvie, perlotaque variis ornant odoribus ut recte unguentis oleant.

Ac veluti Italae mulieres atque aliarum multarum etiam nationum ad capillorum facieique omne cultum adhibent studium, ita Aegyptiae capillorum cultum negligunt ex consuetudine omnes capillos in bursam serico panno paratam concludentes, ac ad pudendorum abditarumque corporis partium ornatum omnem diligentiam adhibent. Pudendis igitur tota cura in balneis ab iis adhibetur. Ea siquidem in primis lavant, pilisque nudant, locaque pudendorum perpetuo glabra gestant, turpeque ibi est mulierum pilis obsitam v.u.l.v.am habere. Demum lotas eas partes glabrasque effectas variis unguentis etiam exornant.

The custom survived in France and Italy in the sixteenth century.

Epilation as a purely surgical operation was frequently necessary for the trichiasis consequent on the granular ophthalmia which was so common among the Romans. Paul (VI. xiii) says:

'Turn the eyelid outwards and, with an epilation forceps (t?????a??) dragging out the offending hairs, either one, or two, or three or whatever number there are. Then apply a heated olivary probe or an aural probe or some such slender instrument to the place from whence the hair or hairs have been removed.'

The numbers of toilet epilation forceps which have been found are enormous. Moreover, forceps of exactly similar form were in use in every household as accessories of the lamp for raising and snuffing the wick, and artisans used them also for the finer manipulations of their crafts; so that by far the largest number of forceps of this type are not surgical instruments, but household implements. However, we have plenty of specimens from purely surgical finds.

Of the surgical instruments all forms agree in having no teeth. The simplest form consists of a strip of metal bent on itself straight as in Pl. XXVI, fig. 3, or with the jaws turned inwards, as in Pl. XXVI, fig. 5.

These are often pocket forceps. A 'pocket-companion', consisting of a toilet forceps, an ear-pick and a nail-cleaner, such as is seen in Pl.

XXVI, fig. 4, is a common object in museums, such as the Guildhall Museum, where this object is. A variety of epilation forceps with rounded legs is seen in Pl. XXVI, fig. 2. Several of these have been obtained from purely surgical finds. Others are formed by sawing a bar of bronze up its centre, as in the specimen shown in Pl. XXVI, fig. 1, which is 13 cm. 4 mm. long, and with jaws 10 mm. broad. It is from the Naples Museum.

This is the form most typical of the surgical epilation forceps. Several of this type were found in the grave of the oculist Gaius F. Severus at Rheims (Pl. XXVI, fig. 6). They are very large powerful instruments, from 15 to 16 cm. long, and with jaws 7 to 8 mm. in breadth (Deneffe, _Oc. du 3{e} siecle_, ii. 1-8). This form was no doubt used as a dissecting forceps or tumour vulsellum as well as for epilation, but the typical tumour forceps was toothed, and it is convenient to cla.s.sify all those of the untoothed type as epilation forceps.

Other epilation forceps, which are however more likely to be toilet articles, have the jaws of extreme breadth, as in Pl. XXVII, fig. 3 from the Mainz Museum. It has a sliding catch. They are evidently intended to remove a considerable number of hairs at once, or to fix them while they were cut with razor or shears.

It is certain, however, that in addition to these broader forceps a variety with quite narrow blades was used, as Paul (VI. xxiv) tells us that stones, &c. may be removed from the ear with epilation forceps (t?????a??), and again in fracture of the nose Paul (VI. xxiv) says that splinters of detached bone are to be removed with these forceps. We have several forceps of this type. There are in the Naples Museum three, one from Pompeii, two from Herculaneum (Deneffe). One from my own collection is shown in Pl. XXVI, fig. 2. The points are narrow and rounded.

A very interesting form is seen in Pl. XXVII, fig. 4, which shows a forceps in the Thorwaldsen Museum, Copenhagen. It is 12 cm. long, of which 6 cm. of the upper end are solid and round. The remainder of the length is occupied by the blades of the forceps, each 5 mm. broad, except for 12 mm.

at the extremity, where it expands into a leaf-shaped portion, 10 mm.

broad in its broader part. These leaf-shaped expansions oppose each other accurately, and on the narrow part of the blade above them there slides a rectangular catch which serves to clamp the blades and fix them like the jaws of a vice.

The surgical epilation forceps is, as we have seen, usually a simple instrument. Occasionally we meet with a forceps combined with some other instrument. These are, as a rule, toilet articles. A pocket ear-scoop and epilation forceps combined was found in Paris. Precisely similar articles of steel may be bought in chemists' shops to-day. Another has a small unguent spatula combined with a forceps, while others carry olivary probes. There are several of these in the St-Germain-en-Laye Museum (Pl.

XXVII, figs. 5, 2). One from Melos, in the Athens Museum, has a porte-caustique.

_Polypus Forceps._

Greek, p???p???st??.

Galen (_Med. Sec. Loc._ xii. 685) alludes to the method of extraction of polypus from the nose by means of a forceps (?pe?ta ?a?d?? ??a??e?), and from what Paul says it would seem that there was a special polypus instrument, consisting of a forceps at one end and a rugine at the other.

After describing extraction by means of a knife and scoop he says:

'If, however, any part of the tumour be left behind, we take another polypus eradicator (?te??? p???p???st??), and with the end of it (?p???? a?t?? ??st?????) bring away what remains, by stretching, twisting, and sc.r.a.ping it strongly.'

??st????? means a small rugine, but stretching and twisting can only be done with a forceps. Rare as the combination of an antique forceps with another instrument is, we have one example of the combination of a rugine and a forceps, and, as it is admirably adapted for the extraction of nasal polypus, I think we are quite justified in considering it to be the instrument indicated by Paul. This instrument was found in the grave of the Paris surgeon. It is elegantly formed and is of one piece of bronze sawn down the middle. The upper part is surmounted by a rugine strongly curved, pointed at the tip and cutting on one edge. The rugine measures 3 cm. in length, and 5 mm. in breadth (Deneffe, _Tr. d'un Chir._, pl. v, fig. 1) (Pl. XXVII, fig. 1).

_Tumour Vulsellum (Myzon)._

Greek, ?d???, ??d???, sa????a??, sa???????; Latin, _myzon_, _sarcolabon_, _vulsella_.

The form vulsellum has got so well established by usage in modern medical writings that it would seem pedantic to write 'vulsella forceps', but so far as I am aware it is not a form which has any cla.s.sical authority. The cla.s.sical usage is _vulsella_, _-ae_, feminine. I shall follow custom and use the modern term when using it as an English word.

The myzon, or tumour forceps, was a toothed instrument of the dissecting forceps type. Ducange says it takes its name from the sh.e.l.ls which are called ?t????, vulgo ?d?a (mussels). It was used whenever it was desired to make traction on any object--such as a tumour--to excise it, or to raise and fix a piece of skin. Aetius (xvi. 106) says:

??d?? p?at?st?? s???a?? t?? ??f?? d?? t?? e?????? ?e????

?p?te???t? t? d? de??? ?p?te??t? pa?? t??? ?d??ta? t?? ?d???.

'Seizing the c.l.i.toris with a broad jawed vulsellum in the left hand, put it on the stretch, and with the right cut it off close to the teeth of the instrument.'

Paul gives pretty much the same instructions (VI. lxx):

??d?? ?atas???te? t? pe??tt?? t?? ??f?? ??t???e? s???.

'Seizing the hypertrophied portion of the c.l.i.toris with a vulsellum, excise it with a scalpel.'

Aetius (xvi. 107) also says:

?spe? ??? ?p? t?? ??f?? p??e???ta? s??at??e?? ??? t?? ???a??a ?a?

?d?? ?p?te??e?? t?? ?pe????? ?a? t? p???p??? spa??? ???se?? ???? t?

pe??tt?? ?fa??e??.

Cf. also Paul, VI. lxxi and again Aetius (iv. ii. 3).

Again Aetius says:

'If there is a large and malignant excrescence in the angle of the orbit, the enlarged part must be seized with vulsella (?d??) and cut off' (vi. 74).

In the corresponding pa.s.sage in Paul (VI. xvii) another name for the vulsellum is used, viz. sa???????:--'granuloma of the inner canthus we seize with vulsella and excise' (sa??????). In treating of epulis he again uses the same term: 'Epulis we seize with vulsella and excise'

(sa??????).

In Moschion (II. x.x.x), in the chapter 'De Haemorrhoidibus quae in matrice nasc.u.n.tur', we find a Latin transliteration of the two terms ?d??? and sa??????? side by side:

Myzo vel sarcolabo haemorrhoides teneantur ita ut in aliquantum extensas scalpello prius radices earum scarifes, et in aliquantum artifex sarcolabo convertat.

Here, in all probability, Sora.n.u.s, from whom Moschion is copying, has simply used ?d???, and the added 'vel sarcolabo' is simply a gloss, for the terms ?d??? and sa??????? are synonymous. However this part of Sora.n.u.s is lost. Extant specimens of the vulsellum are common. A simple variety is formed by folding a plate of bronze on itself, as in Pl.

XXVIII, fig. 1, which shows a specimen in the British Museum. The jaws are finely toothed.

More usually the myzon is formed by sawing a plate of bronze partly along its midline as in Pl. XXIX, fig. 2, which is taken from the find of the oculist Severus.

An interesting variation is seen in the specimen shown in Pl. XXVIII, fig.

3 which is from my own collection. The line of junction of the jaws instead of being in the median plane is sloping. The object of this arrangement is not quite clear. A small variety of the vulsellum is referred to by Aetius:

'Epulis we seize with a small vulsellum and excise with a small scalpel' (? ?p????? ?d??s????? ?p?ta?e?sa ??te??s?? s??a??? ste??, vii. 24, 25).

We have one or two of these instruments. They remind one of fixation forceps. I ill.u.s.trate one in Pl. XXIX, fig. 3. It is from the Mainz Museum. There are four similar ones in the Frankfort Historical Museum.