Surgical Instruments in Greek and Roman Times Part 21

Greek, ?p???p??, a butcher's block.

The ancients frequently amputated parts by placing them on a block and striking them with a chisel. The mediaeval surgeons amputated parts as large as the forearm in this way, but the Greeks all describe amputation by knife and saw. We have reference to the 'block' in Greek literature, however. In describing the plastic removal of a portion of the s.c.r.o.t.u.m Paul (VI. lxvii) says:

'Leonidas, laying the patient on his back, cuts off the redundant portion upon a chopping block of any kind of wood or stiff leather'

(?at' ?p???p?? sa??d??? t???? ? s?????? d??at??).

Galen uses the same word in the eighth book of his work on Practical Anatomy--apologizing somewhat for calling the article used by anatomists and surgeons by the undignified term of butcher's block:

???e??? ?p???p?, ?a??sa? ??? ??t?? ??d?? ?e???? ?st?? ????? t???

??at?????? te ?a? ?e????????? t? st????a t?? ?p?e?????? t? t??

t?? s??t?? (ii. 685).

_Meningophylax._

Greek, ??????f??a?; Latin, _membranae custos_.

The meningophylax was a small plate, which was inserted under a bone which was being cut in order to protect underlying structures. 'In cutting or sawing the bone,' says Paul (VI. lxxvii), 'when any vital parts are situated below, such as the pleura, spinal marrow, or the like, we must use the instrument called the meningophylax for protecting them (??????f??a?a).'

Celsus thus describes it (VIII. iii):

Factis foraminibus eodem modo media septa, sed multo circ.u.mspectius, excidenda sunt, ne forte angulus scalpri eandem membranam violet; donec fiat aditus, per quem membranae custos immittatur; ??????f??a?a Graeci vocant. Lamina aenea est, firma paulum resima, ab exteriore parte laevis; quae demissa sic ut exterior pars eius cerebro proprior sit, subinde ei subiicitur quod scalpro discutiendum est; ac si excipit eius angulum, ultra transire non pat.i.tur; eoque et audacius, et tutius, scalprum malleolo medicus subinde ferit, donec undique excisum os eadem lamina levetur, tollique sine ulla noxa cerebri possit.

Pl. XL, fig. 3 shows a figure of the meningophylax from Vidius.

_Drill._

Greek, t??pa???; Latin, _terebra_, _terebella_.

There are, says Celsus, two kinds of drills. The first like those used by artisans and driven by a thong, the second with a guard to prevent the instrument from sinking too deeply into the bone. The drill was used in excising a piece of the skull where the diseased portion was larger than could be comprehended by the modiolus of a trephine. The part to be removed was surrounded by perforations with the drill and the intervening s.p.a.ces were divided with chisels or raspatories. Celsus says:

At si latius vitium est quam ut illo comprehendatur, terebra res agenda est. Ea foramen fit in ipso fine vitiosi ossis atque integri; deinde alterum non ita longe, tertiumque, donec totus is locus qui excidendus est his cavis cinctus sit. Atque ibi quoque, quatenus terebra agenda sit, scobis significat. Tum excisorius scalper ab altero foramine ad alterum malleolo adactus id quod inter utrumque medium est excidit; ac sic ambitus similis ei fit qui in angustiorem orbem modiolo imprimitur (VIII. iii).

Paul says:

'If a weapon be lodged deep in bone of considerable thickness it may be bored out with drills' (t??p?????) (VI. lx.x.xviii).

Aretaeus (ed. Adams, p. 467) says that exposed bones are to be surrounded with perforations by means of the drill and thus reduced (te??t?? ???

pe????pte?? t? ????).

The boring parts of drills are not unfrequently found. The most ancient ill.u.s.trations known to me of drills driven by thongs are in the work by Vidus Vidius (_Chirurgia e Graeco in Lat. Conversa_, V. Vidio. Florent.

interprete c. nonn. eiusd. commentariis. Lutec. Paris., 1544).

Vidius shows three arrangements for driving these drills with thongs: the first method consists simply of a thong attached to the shaft of the drill (Pl. XLII, fig. 4); the second consists of a bow with the string of the bow wound once round the shaft (Pl. XLII, fig. 5); and the third consists of a crosspiece with a hole in the centre of it through which the shaft pa.s.ses, and having strings from the end of the crosspiece to the top of the shaft (Pl. XLII, fig. 3). Primitive arrangements truly, yet all three methods of producing rotary motion are to be seen in use at the present day, and be it known that some of the most delicate boring performed by the hand of man at the present day is done with drills turned by the thong stretched across a bow. The latest developments in mechanical devices for drilling have failed to displace thong-driven drills for boring the holes in which the wheel spindles of the best hand-made chronometers move, and the spindles themselves are turned in chucks rotated not by belts in continuous rotary motion, but in alternating motion by means of a thong stretched across a bow. A bow of cane with a strong but fine thread, one turn of which is taken round the drill, is drawn backwards and forwards and rotates the drill with marvellous rapidity and accuracy. The bows used by watchmakers average about a foot along the string. Similar drills are used by engineers in turning out small work. The form with the crosspiece may be seen in use by travelling crockery menders, who drill holes in broken pottery and clamp the pieces with rivets. A turn or two of the string is made round the shaft, and the point of the drill being adjusted on the spot to be bored the crosspiece is gently pressed down by the first and third fingers, causing the shaft to rotate. When the thong has nearly uncoiled itself the pressure is slightly removed, the momentum causes the shaft to overrun and coil the thong in the opposite direction to which it originally was. The crosspiece is again depressed and the alternating rotation goes on without intermission, and the drill bores through the pottery. The travelling crockery mender is, in the northern towns of England, not an unusual sight squatting at work on the kerb. On the continent the 'Rastelbinder' is a regular domestic inst.i.tution. Not only crockery but gla.s.s is readily drilled by these means, and one who has seen the rapidity with which these drills rotate can readily understand the necessity for the advice given both by Hippocrates and Celsus to frequently remove the drill and dip it in cold water, in case sufficient heat be generated by the friction to cause subsequent exfoliation of the neighbouring bone.

The remaining method of producing rotation by means of a string fixed to the shaft can be seen in use by boatmen when clearing water out of a boat with a mop, The mop is laid over the side of the boat. A few turns of a rope fixed to the shaft are made round it and the rope being pulled the shaft rotates. The momentum generated causes the shaft to overrun and the rope to coil itself in the reverse way to the original. This is repeated till the speed generated causes the water to fly off the mop by centrifugal motion.

The fire drill of the ancient Egyptians was turned by a bow, and it is interesting in connexion with the advice of Hippocrates to avoid generating too much heat in drilling the skull, and also because it helps to explain the construction of the instruments of Vidius. A sketch of an ancient fire drill found by Flinders Petrie (_Ten Years Digging in Egypt_) shows that the head of the drill was separate and the points were also removable.

_Drill with Guard._

Greek, t??pa??? ??pt?st??; Latin, _terebra abaptista_.

This is the second variety of drills described by Celsus. It had a collar which prevented it from sinking beyond a certain depth, so that in excising a piece of bone from the skull, which was the object for which it was used, there was little danger of its doing injury to the brain or its membranes:

Terebrarum autem duo genera sunt; alterum simile ei quo fabri utuntur; alterum capituli longioris, quod ab acuto mucrone incipit, deinde subito latius fit; atque iterum ab alio principio paulo minus quam aequaliter sursum procedit (VIII. iii).

Further on in the same pa.s.sage Celsus states that they were to be frequently removed and dipped in water lest too great heat should be generated, so that they were evidently driven at a rapid rate with a thong like the other drills. They are not mentioned by Hippocrates, but Galen (x. 445) describes them:

'In order to make less chance of error they have invented drills called abaptista (??pt?sta t??pa?a), which have a circular border a little above the sharp point of the drill. It is best to have several for every thickness of the calvarium; for thicker bone longer are required, for thinner bone shorter.'

Paul (VI. xc) says:

'But if the bone is strong it is first to be perforated with that kind of perforators called abaptista (pe??t??p?sa?te? ?apt?st??? t???

?e???????), which have certain eminences to prevent them sinking down to the membrane, and then with chisels we remove the bone not whole, but in pieces.'

The ill.u.s.trations of drills given from Vidius (Pl. XLII) are really abaptista.

_Saw._

Greek, p????, a?a???t?? p???? (as if from a?a????); Latin, _serrula_.

The saw is very frequently mentioned in the description of operation on bone. Celsus (VII. x.x.xiii), in describing the amputation of a gangrenous limb, says:

Dein id serrula praecidendum est, quam proxime sanae carni etiam inhaerenti: ac tum frons ossis, quam serrula exasperavit, laevanda est.

And Paul says that in amputating a gangrenous limb the flesh ought to be retracted with a band lest it be torn by the saw. Saws were also used in cranial surgery. Hippocrates frequently mentions a saw (p????) in this connexion, but it is evident that he means the trephine, as he describes its circular motion. Paul, however, makes it quite clear that he means flat cranial saws, for he mentions both saws and trephines in one paragraph:

?d? ?a? t?? p?????? te ?a? ???????d?? ?e???????a?, ?t?.

'The method of operating with saws and trephines is condemned by the moderns as a bad one' (VI. xc).

Pl. XLI, fig. 3 shows a surgical saw from the British Museum (No. 2,328).

It is of bronze, and measures 112 mm. long, 3 cm. broad at one end, narrowing to 23 mm. at the other. There are surgical saws of steel in the Naples Museum. Many of the saws extant are for use as 'frame' saws. Others have the saw portion continuous with the handle, like a knife. Galen (xviii. 331) mentions these 'knife-shaped' saws: 'For in this way each does not become so exactly smooth as with sword-shaped saws (a?a???t??

p??????).' There is an example of this form of saw in the Guildhall Museum, London.

_Trephine._

Greek, t??pa???, p????, p???? ?a?a?t??, ????????, ????p????; Latin, _modiolus_.

The ancient trephine is referred to by Hippocrates, who mentions a saw (p???? and p???? ?a?a?t??) having a circular motion (iii. 374):

'In trephining you must frequently remove the trephine, on account of the heat in the bone, and plunge it in cold water. For the trephine (p????), being heated by the circular motion (pe???d??) and heating and drying the bone, burns it and makes a larger piece of bone exfoliate than would otherwise be necessary.'