Surgical Instruments in Greek and Roman Times Part 17

Greek, f?sa.

In cases of volvulus, Hippocrates bids us insert a purgative suppository and administer an enema. If these means are not successful:

'Insert a blacksmith's bellows (f?sa? ?a??e?t????) and inflate the intestine in order that you may dilate the contraction both of the colon and the intestine. Then remove it and give an enema' (ii. 305).

_Nasal Syringe._

Greek, ???e???t??; Latin, _rhinenchytes_.

A special nasal syringe with a double tube is mentioned by Aretaeus (ed.

Adams, vol. ii. 459). The medicament is made into liquid form and is injected by means of a nasal pipe. The instrument consists of two pipes united together by one outlet so that we can inject by both at one time, for to inject each nostril separately is a thing which could not be borne.

Galen also mentions a nasal syringe (???e???t??), though he does not describe it (xi. 125).

Scribonius Largus also mentions it:

Per nares ergo purgatur caput his rebus infusis per cornu quod rhinenchytes vocatur (_Compositiones_, vii).

_Aspiration Syringe and Sinus Irrigator._

Greek, p???????.

Galen (xi. 125) says:

'In cases of sinus he uses a tube of bronze or horn with a straight bore, or otherwise the instrument called the pus extractor (p???????), which has a wide bore. But if you inject rosaceum into the former (i.

e. tube of bronze, &c.) it will not pa.s.s through the syringe (p??????), so that in that case a pipe of wide bore is to be fixed to a sow's bladder.'

This pa.s.sage shows that the pyulcus differed in principle from the syringe formed by fixing a bladder on a tube. Hero (_De Spiritalibus_, c. 57) shows that it was a syringe formed of a cylinder of metal with a well-fitting plunger.

Hero says:

'And the instrument called pyulcus works on the same principle.

'For a long tube AB is made, to which let there be fitted another CD, and let C, the end of it, be closed by a plate. At D let it have a handle EF, and let the mouth of the tube AB at A be blocked by a plate furnished with a slender syringe GH, perforated.

'When therefore we wish to draw out pus, applying the extreme mouth H of the little syringe to the place in which the pus is, by the handle we draw the tube CD outward, and the s.p.a.ce which is in the tube being emptied something else is of necessity drawn in, and since there is no other s.p.a.ce than the mouth of the tube the liquid at and near it must of necessity be drawn into it.

'Again when we wish to inject some liquid we put it into the tube AB and taking hold of EF and pressing in the tube CD we press out as much as we think necessary.'

Note that Hero's description does not tally with the drawings which accompany the edition of his works which we possess (Pl. x.x.xVIII, figs. 3, 4, 5). These show an instrument with a piston formed by a plug at the end of a rod, whereas Hero says the piston is to be formed of a second tube fitting inside the first. This is interesting, because it is much easier to get a well-fitting piston in this way than in the other; and this principle has been reverted to in many of our best hypodermic syringes and in some of the best air pumps, such as Edwards's.

_Ear Syringe._

Greek, ?te???t??, ?t???? ???st??; Latin, _oricularius clyster_.

The ear syringe is very frequently referred to by both Greek and Latin writers; in fact, Celsus uses the term so often to denote a syringe for a large variety of uses that it is evident that it is almost a general term for any small syringe.

In addition to its use in washing out the ear in cases of foreign bodies, impacted cerumen, &c. he uses it to wash out the foreskin in balanitis, to syringe fistulae, to wash out the bladder through a lithotomy wound, &c.

In cases of foreign bodies in the ear he says:

Sternutamenta quoque admota id commode elidunt, aut oriculario clystere aqua vehementer intus compulsa (VI. vii).

Aetius and Paul tell us it was used to wash out the v.a.g.i.n.a, and Paul says it might be used to make injections into the bladder. Oribasius says:

'We use flushing with an ear syringe in abscess of the intercostal s.p.a.ce, and in fistulas to expel first the pus with warm water, then to cleanse the cavity with melicrate' (_Collect._ viii. 24).

From a consideration of the various uses to which this instrument was put, and from the fact that it is contrasted at times (e. g. in Paul, VI. lix) with syringes formed by adding a bladder to a tube, I am of the opinion that this instrument, like the pyulcus, was a syringe of the form of a metal cylinder with a plunger like the ear syringe of to-day, and used, as the ear syringe was a few years ago, for flushing sinuses and irrigating wounds, and as a handy instrument for all general purposes of the kind.

This is borne out by the fact that the ear syringe, described in detail by Albucasis (p. 157), is a cylinder of bronze or silver, wide above and narrowed to a point with a small opening in it and with a well-fitting plunger wrapped with a little cotton at one end. His figure, though quite intelligible, is too conventionalised to give any additional information.

_Insufflator for Powder._

Insufflation in powder form was a common method of applying medicaments to the throat and nose. All writers mention this, but the fullest description of the tube used is given by Oribasius, who says (_Collect._ xii):

'Those things which evacuate the head we use in the following manner.

A reed slender and with a straight bore, six inches in length, and of such a size that it can be placed in the nares, is taken and its cavity entirely filled with medicament. The reed may be either natural or of bronze. This being placed in the nares, we propel the medicament by blowing into the other end.'

Alexander Trallia.n.u.s (IV. viii) describes the insufflation of the woolly hairs of the plata.n.u.s to stop epistaxis, and Aretaeus mentions the insufflation of sternutatories (459, vol. ii), and again (408, vol. ii) he says medicines may be blown into the pharynx by a reed, or quill, or wide long tube (?a??? ? pt??? ? ?a??? pa?e? ?a? ?p???e?).

A fine example of a bronze insufflator was discovered among the instruments of the surgeon of Paris. It is 15-1/2 cm. in length, and 5 mm.

in diameter. It is formed by a plate of bronze bent round and soldered. It terminates in a little elliptical shovel slightly cup-shaped, of which the transverse diameter is 3 cm. and the longitudinal 3 mm.; it had originally been overlaid with gold (Pl. XL, fig. 4).

_Cannulae for draining Ascites and Empyema._

Celsus describes the cannula for draining ascites (VII. xv):

Ferramentum autem demitt.i.tur magna cura habita ne qua vena incidatur.

Id tale esse debet ut fere tertiam digiti partem lat.i.tudo mucronis impleat; demittendumque ita est ut membranam quoque transeat qua caro ab interiore parte finitur; eo tum plumbea aut aenea fistula coniicienda est vel recurvatis in exteriorem partem labris vel in media circ.u.msurgente quadam mora, ne tota intus delabi possit. Huius ea pars quae intra paulo longior esse debet quam quae extra, ut ultra interiorem membranam procedat. Per hanc effundendus humor est; atque ubi maior pars eius evocata est claudenda demisso linteolo fistula est; et in vulnere si id ustum non est relinquenda. Deinde per insequentes dies circa singulas heminas emittendum, donec nullum aquae vestigium appareat.

The following pa.s.sage from Paul shows that the tip was bevelled off like a writing pen:

?a????? ?a?a?s??? ... ?a??s?e? ????ta t?? ??t??? pa?ap??s?a? t???

??af????? ?a?????.

'We introduce through the incision in the abdomen and peritoneum, a bronze cannula having a tip like that of a writing pen' (VL. l).

Two instruments answering to the above description are to be seen in the museum on the Capitol at Rome.

Another, answering more closely to the description of Celsus, is to be seen at Naples (Pl. x.x.xIX, fig. 2). It consists of a bronze tube, 9 cm. in length, 7 mm. wide at one end, narrowing to 4 mm. at the other end, which is bevelled off as described by Paul. Surrounding the tube and 25 cm.

from the bevelled tip is a ring 25 cm. in diameter.

A more elaborate form of the cannula for ascites is seen in another specimen, also in the Naples Museum (Pl. x.x.xIX, fig. 3). A tube 65 mm. in diameter and 392 cm. long, has one end rounded and closed, except for a small hole in its tip and another in the side near the first. The other end carries a circular plate 25 cm. in diameter. Near the middle of the tube there is a slightly raised projection as if to carry a circular disc.

Inside the cannula is fixed by oxidation an obturator, which carries on its end a small handle fixed on in T-fashion. Scoutetten described this to the Royal Academy of Medicine of Paris as a trocar and cannula, but the formation of the end is not such that the instrument could have pierced its own way through. It is rather an instrument which could be inserted in an incision made by a scalpel, and which could be closed after the abstraction of a certain amount of fluid--the obturator acting as an improvement on the pledget of wool described by Celsus--but otherwise inserted like the previous example. A tube on similar principles to the ascites cannula was employed in empyema (Hippocrates, ii. 259):