Surgical Instruments in Greek and Roman Times Part 23

Greek, ?d??t???a, ??????a.

The ancients regarded tooth extraction as an operation to be avoided wherever possible. Caelius Aurelia.n.u.s says death had followed in some cases, and that in the temple of Apollo at Delos there hung a tooth forceps of lead as a reminder for operators to exert little force in tooth extraction (_Pa.s.s. Tard._ II. iv). Scribonius Largus (_Comp._ liii) is equally pessimistic:

Ad dentium dolorem quamvis plurimi dicant forcipes remedium esse, multa tamen citra hanc necessitatem scio profuisse.

Celsus (VII. xii) says extraction may result in injury to the temples and eyes, and fracture or dislocation of the jaw may occur. He recommends therefore to free the tooth all round down to the socket, then to shake it repeatedly till it has been thoroughly loosened, and remove it with fingers or forceps. If the tooth be hollow, it should be plugged with lint or lead to prevent it breaking under the forceps. The tooth should be pulled out straight, lest the alveolus be broken. Stumps are to be removed with the forceps which the Greeks call ??????a. Paulus Aegineta (VI.

xxvii) bids us scarify down to the socket and loosen the tooth gradually by shaking with a tooth extractor (?d??t???a) and extract it.

Supernumerary teeth are, if fast, to be rasped down with a graving tool; if loose, to be extracted with tooth forceps (d?? t?? ?d??t???a?). There is no ancient forceps which can with certainty be set down as a tooth forceps, although some have looked upon the Pompeian forceps (see p. 135) as a tooth extractor. Although its shape is not otherwise unsuitable for this purpose its jaws are not particularly well adapted for seizing a tooth, as they are not hollowed inside. It may be noted that the tooth forceps was evidently a 'universal', as no special variety is ever mentioned beyond the two I have given--'tooth' and 'stump'. Whatever the shape of the Graeco-Roman forceps was it seems to have been a handy instrument for many different manipulations. Sora.n.u.s (ii. 63) says that in impaction of the foetal cranium we may open the head and remove the bones with a bone forceps or a tooth forceps (?st???a? ? ?d??t???a?). Paul (VI.

xc) says that in fracture of the skull the fragment is to be surrounded with perforations by the drill and finally separated with chisels, the chips being removed with the fingers or with tooth forceps, bone forceps, &c. (?d??t???a ? ?st???a). Again in ch. lx.x.xviii he says that if the shaft of a weapon imbedded in the flesh be broken off, the weapon may be extracted with a tooth forceps or a stump forceps (?d??t???a? ? ??????a?).

_Tooth Elevator._

In a note on a pa.s.sage in Hippocrates describing the lever for replacing the protruding end of a fractured bone, Galen mentions an instrument for levering teeth. He says the instruments for levering the bone are of the same size as the instrument for levering teeth (xviii. 593). As we know from Paul (VI. cvi) that these bone levers were seven or eight finger breadths in length, we may take this as the length of the tooth elevator.

_Tooth Scalers._

Greek, ??st?????, s?????, s????t?? (sc. ???a???); Latin, _scalper medicinalis_.

Paul (VI. xxviii) mentions a small raspatory used for removing tartar from teeth:

'The scaly concretions which adhere to teeth we may remove with the scoop of a specillum, or with a scaler (??st????) or a file.'

Scribonius Largus (_Comp._ liii) mentions an excavator:

Itaque c.u.m etiam exesus est aliqua ex parte, tum non suadeo protinus tollendum, sed excidendum scalpro medicinali, qua cavatus est, quod sine ullo fit dolore, reliqua enim solida pars eius et speciem et usum dentis praestabit.

Marcellus conveys this pa.s.sage entire (_De Med._ xii).

Paul (VI. xii) says supernumerary teeth may be cut down with excavators (t?? s????t??).

_File._

Greek, ????????, ????, ??????; Latin, _lima_, _limula_.

In compound fracture with protrusion of bone Celsus says:

'Should any small piece of bone protrude, if it is blunt it should be reduced to its place. If it is sharp its point should first be cut off if it is long, and if short it should be filed. "In either case it should be smoothed with the raspatory."' (Si longius est, praecidendum; si brevius, limandum, et utrumque scalpro laevandum.)

The application of the raspatory to smooth the bone after the use of the file shows that it must have been more of the nature of a rasp than a file which was used for bones. Scribonius Largus speaks of a wood file or rasp used in reducing a hart's horn to powder (_Comp._ cxli):

Ad lumbricos satis commode facit et santonica herba, quae non viget, et cornum cervinum limatum lima lignaria.

Files were largely used in dental work. All the surgeons state that where a tooth projects above its fellows it should be filed down; Galen says that for this purpose he has invented an olivary pointed file of steel: s?d????? ?p???sa ?????? p?????e?d?? (xiv. 871).

Aetius copies Galen's chapter word for word (II. iv. 30). Paul (VI.

xxviii) says the file (????????) may be used to remove tartar from teeth.

There are several files of steel in the Naples Museum which are cla.s.sed among the surgical instruments. Many Roman files of steel which have been found in London are now in the Guildhall Museum. Some of these have transverse edges like our own files. Other extant specimens have coa.r.s.e frets on them, like our wood rasps. Pl. XLII. fig. 1 shows one in the Guildhall collection, which is of the rasp variety.

_Forceps for extracting Weapons._

Greek, e??????? (sc. ???a???).

Paul has a most interesting chapter on the extraction of weapons, and in it he mentions a special instrument for extracting weapons, evidently a forceps:

'If the head of the weapon has fixed in the flesh, it is to be drawn out with the hands, or by laying hold of the appendage which is called the shaft, if it has not fallen off. This part is commonly made of wood. When it has fallen off we make the extraction by means of a tooth forceps, or a stump forceps, or a forceps for extracting weapons (e???????), or any other convenient instrument. And sometimes we make an incision in the flesh around it in the first place, if the wound do not admit the instrument' (VI. lx.x.xvii).

It is true that etymologically we are only ent.i.tled to translate e???????

by 'weapon-extractor', but its a.s.sociation with the other two forceps shows pretty conclusively that a forceps is meant, and Celsus says weapons are to be extracted with the forceps under similar conditions. In the picture of Aeneas wounded, found in a house at Stabiae and now in the Naples Museum, the surgeon, Iapix, is engaged in extracting a weapon from the wound in the thigh of the hero. The instrument he is using is a long forceps with crossed legs (Pl. XLIV).

_Periosteal Elevator for the Pericranium._

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

The hypospathister was an elevator for separating the pericranium from the calvarium. It gave the name to a formidable operation in which it was used, viz. hypospathismus. This operation is described by Galen, Aetius, and Paul, by the latter (VI. vi) best of all. Paul is the only one who mentions the instrument by name. The operation consisted in making three vertical incisions, one down each side of the forehead and one down the centre. Next the skin was raised along with the pericranium from the whole of the front of the forehead with the hypospathister (?p?spa??st??), and the vessels lying in the raised flaps were subcutaneously divided by a knife pa.s.sed under them, with its back to the skull. The elevator by which the pericranium was separated is called by Paul ?p?spa??st??. The operation is mentioned by Epiphanius, a bishop of Alexandria in the fourth century, by whom the instrument is referred to as spa??st??.

_Impellent._

Greek, d??st??.

In his chapter on the extraction of weapons, one of the most remarkable chapters in the whole of his works, Paul mentions an impellent for forcing an arrow head through a part so as to extract it at the side opposite to that by which it went in.

'If the head of the weapon has pa.s.sed to the other side and it is found impossible to extract it by the way it entered, having divided the parts opposite we extract it through the middle of them, either extracting it in the manner spoken of (i. e. with forceps), or we make an opening by means of the weapon itself, pushing it by the shaft, or, if that has come away, by an impellent instrument (d??st????), taking care not to divide a nerve, artery, vein, or any important part; for it would be malpractice if, in extracting the weapon, we should do more mischief than the weapon itself had done. If the weapon has a tang, which is ascertained by examination with the probe, having introduced the female part of the impellent instrument and engaged it, we push the weapon forwards, or, if it has a socket, the male part'

(t?? ???e?a? t?? d??st???? ?a???te? ?a? ??a??sa?te? ???s?e? t? ????

e? d? a???? t?? ???e?a).

Impellents formed an important part of the armamentarium of the surgeon, at least down to the time of Scultetus, and in his works and in those of Albucasis and Pare there are numerous figures of these instruments. None of these quite agree with the idea of the instrument which one gathers from Paul's description. It would seem to have been a very simple affair, probably a plain rod of metal pointed at one end and hollowed at the other, the pointed end being introduced into the socket of an arrow where it possessed one, the hollow end being fitted over the tip of the tang in cases where the arrow was tanged.

_Arrow Scoop._

Greek, ??a??s??? ?????e???.

A scoop for extracting arrow heads is thus described by Celsus (VII. v):

Latum vero telum, si conditum est, ab altera parte educi non expedit, ne ingenti vulneri ipsi quoque ingens vulnus adiiciamus. Evellendum est ergo genere quodam ferramenti quod ?????e??? ??a??s??? Graeci vocant, quoniam auctorem Dioclem habet: quem inter priscos maximosque medicos fuisse iam posui. Lamina, vel ferrea vel etiam aenea, ab altero capite duos utrimque deorsum conversos uncos habet; ab altero duplicata lateribus, leviterque extrema in eam partem inclinata quae sinuata est, insuper ibi etiam perforata est. Haec iuxta telum transversa demitt.i.tur; deinde ubi ad imum mucronem ventum est paulum torquetur, ut telum foramine suo excipiat; quum in cavo mucro est, duo digiti subiecti partis alterius uncis simul et ferramentum id extrahunt et telum.

'But a broad weapon if buried should not be extracted from a counter opening, lest to one large wound we add another; therefore it is to be extracted with a special variety of instrument which the Greeks call the Scoop of Diocles, since Diocles invented it. I have already stated that he was one of the most eminent of the old pract.i.tioners. Its blade of iron, or even of bronze, has at one end two hooks, one at each side turned backwards. At the other end it is folded over at the sides, and the end is slightly curved up towards that part which is bent. Moreover in it there is a perforation. This is introduced crosswise near the weapon, then when it comes near the point it is twisted a little so that it receives the point in the hole. When the weapon is in the cavity two fingers placed under the hooks at the other end simultaneously extract both the instrument and the weapon.'

This description seems very definite until we attempt to reconstruct the instrument, when it becomes evident that more than one construction may be put on some parts of it. Pl. XLV, fig. 4, shows the instrument as conceived by me.