Surgical Instruments in Greek and Roman Times Part 26

_Midwifery Forceps._

Had the Greeks and Romans a forceps for extracting the child alive?

Probably not. We have no mention of any such instrument by Sora.n.u.s or Paul, both accomplished obstetricians, nor can any description of such an instrument be found in the voluminous pseudo-Hippocratic works on women.

Adams, in a note to Paul, III. lxxvi, says that though the Roman and Greek writers do not mention the forceps, Avicenna does so, and he says that a forceps was dug up in the house of an obstetrix at Pompeii bearing a considerable resemblance to the modern forceps. The only pa.s.sage I have met with in the slightest degree supporting the notion that the ancients ever delivered the child alive with instruments is one in the pseudo-Hippocratic treatise _De Superfoetatione_, where we are told that:

'If the woman has a difficult labour, and the child delay long in the pa.s.sage and be born not easily but with difficulty and with the mechanical aids (??a?a??) of the physician, such children are of weak vitality, and the umbilical cord should not be cut till they make water or sneeze or cry' (i. 465).

We are not ent.i.tled to translate ??a?a?? by 'instruments', because it may mean any mechanical aid such as a fillet, or even a.s.sistance with the fingers of the accoucheur; but, even granting that it refers to instruments, it might mean no more than, e. g., the embryo hooks already described. With them, terrible as they were, the child must frequently have been born alive, though mutilated. A child would have had a far better chance of being born alive with them than with the murderously toothed forceps of Albucasis (Pl. XLI, figs. 3, 4), with which probably no child could have been born alive. As regards the statement that Avicenna knew of the forceps, his directions are that the fillet is to be applied, and, if that fail, the forceps is to be put on and the child extracted with it. If that fail, the child is to be extracted by incision, as in the case of a dead foetus. This pa.s.sage, says Adams, puts it beyond doubt that the Arabians were acquainted with the method of extracting the child alive with the forceps.

This is, however, not quite correct. A full consideration of Avicenna's words seems to me to lead to the conclusion that he is describing no more than extraction with a craniotomy forceps. If the forceps fail the child is to be extracted by incision, as in the case of a foetus already dead (and decomposed so that the forceps would not hold).

As regards Adams' statement that a forceps like ours was dug up in Pompeii one may ask, 'Where is that forceps now?' It is certainly not in the Naples Museum, where all the finds from Herculaneum and Pompeii have been stored since the excavations were commenced. Adams has probably been misled by some notice of the 'Pompeian forceps' (Pl. XLIII), which many consider adapted for removing the cranial bones when the child's head is broken up in cephalotripsy. It is, however, a sequestrum forceps.

_Uterine Curette._

Hippocrates (ed. Van der Linden, vol. ii, p. 394) says:

If the menses form thrombi ... we must wind the skin of a vulture or a piece of vellum round a curette and curette the os uteri (?a? pe??

??st?a? pe??e????a? ??p?? d??a ? ???a, d?a??e?? t? st?a t?? ?t????).

??st?a may of course mean the strigil, and some forms of strigil, such as the one shown in Pl. XXV, fig. 1, are not ill adapted for the purpose.

_Instrument for destroying foetus in utero._

Greek, ????sf??t??; Latin, _aeneum spiculum_.

Apart from the destruction of the foetus in criminal abortion, which was so common at Rome in the time of the Empire, we have mention of an instrument for legitimately producing the death of the foetus from humane motives before forced delivery. It is mentioned by Tertullian in his sermon _De Anima_, and the pa.s.sage is so interesting that I give it in full. It is, moreover, an example of the unexpected places in which information regarding the surgery of the ancients crops up. Tertullian is arguing that the foetus is alive in utero, and does not, as others hold, simply take on life in the act of birth, and to support his conclusions he uses the following argument:

Denique et mortui eduntur quomodo, nisi et vivi? qui autem et mortui, nisi qui prius vivi? Atquin et in ipso adhuc utero infans trucidatur necessaria crudelitate, quum in exitu obliquatus denegat partum; matricida, ni moriturus. Itaque et inter arma medicorum et organon est, quo prius patescere secreta coguntur tortili temperamento, c.u.m anulo cultrato, quo intus membra caeduntur anxio arbitrio, c.u.m hebete unco, quo totum facinus extrahitur violento puerperio. Est etiam aeneum spiculum, quo iugulatio ipsa dirigitur caeco latrocinio; ????sf??t?? appellant de infanticidii officio, utique viventis infantis peremptorium. Hoc et Hippocrates habuit et Asclepiades et Erasistratus et maiorum quoque prosector Herophilus et mitior ipse Sora.n.u.s, certi animal esse conceptum, atque ita miserti infelicissimae huiusmodi infantiae, ut prius occidatur ne viva lanietur.

'Finally there are cases of children that are dead when they are born, how so unless they have also lived? For who are dead unless they have previously been alive? And yet, an infant is sometimes by an act of necessary cruelty destroyed when yet in the womb, when owing to an oblique presentation at birth delivery is made impossible and the child would cause the death of the mother unless it were doomed itself to die. And accordingly there is among the appliances of medical men an instrument by which the private parts are dilated with a priapiscus worked by a screw, and also a ring-knife whereby the limbs are cut off in the womb with judicious care, and a blunt hook by which the whole ma.s.s is extracted and a violent form of delivery in this way effected.

There is also a bronze stylet with which a secret death is inflicted; they call it the ????sf??t?? (_foeticide_) from its use in infanticide, as being fatal to a living infant. Hippocrates had this (instrument), Asclepiades and Erasistratus, and of the ancients also Herophilus the anatomist, and Sora.n.u.s, a man of gentler character.

Who, being a.s.sured that a living thing had been conceived, mercifully judged that an unfortunate infant of this sort should be destroyed before birth to save it from being mangled alive.'

We have here apparently a different instrument from the embryotome, which we saw was a form of knife. This is a pointed spike-shaped instrument. It must have had much the shape of one of the huge bodkins in the Naples Museum (Pl. LI, fig. 1).

_Apparatus for fumigating the Uterus and v.a.g.i.n.a._

Fumigation formed an important part of the treatment of all varieties of disease of the uterus and v.a.g.i.n.a. The notion that the uterus was an animal within the body which could wander about on its own initiative and which was attracted by pleasant smells and repelled by disagreeable smells, was responsible for much of the treatment of gynaecological diseases by the ancients. To make a fumigation, Hippocrates directs us to take a vessel which holds about four gallons (d?? ??t?a?), and fit a lid to it so that no vapour can escape from it. Pierce a hole in the lid, and into this aperture force a reed about a cubit in length so that the vapour cannot escape along the outside of the reed. The cover is then fixed on the vessel with clay. Dig a hole about two feet deep and sufficiently large to receive the vessel, and burn wood until the sides of the hole become very hot. After this remove the wood and larger pieces of charcoal which have most flame, but leave the ashes and cinders. When the vessel is placed in position, and the vapour begins to issue out, if it is too hot wait for some time; if, however, it be of the proper temperature the reed should be introduced into the uterine orifice and the fumigation made. Oribasius, quoting Antyllus (_Coll._ X. xix) varies the treatment somewhat by placing a vessel similarly prepared underneath an obstetrical chair, which had an opening in the seat, allowing a leaden pipe connected with the tube of the fumigating vessel to be pa.s.sed into the v.a.g.i.n.a.

A fumigating apparatus of a more portable nature is mentioned by Sora.n.u.s (xxiii) who tells us that Strato, a pupil of Erasistratus, used to place in a small vessel of silver or bronze, closed by a cover of tin, herbs of various kinds, and, having adjusted a small tube to the vessel, the mouth of the tube was placed in the v.a.g.i.n.a, and the vessel was then gently heated. Sora.n.u.s admits that severe burning might follow this practice if unskilfully used.

_Pessaries._

Greek, ??a???, pess??, pess??; Latin, _pessum_, _pessus_, _pessulum_.

Pessaries are frequently mentioned. They are usually bags filled with medicaments and not mechanical supports. However, in ii. 824, Hippocrates says that prolapse of the womb is to be reduced and the half of a pomegranate is to be introduced into the v.a.g.i.n.a. Sora.n.u.s says that in prolapse Diocles was accustomed to introduce into the v.a.g.i.n.a a pomegranate soaked in vinegar. He also says that a large ball of wool may be introduced after reduction, and Aetius, Oribasius, and Paul copy him.

Hippocrates (iii. 331) says that in cases of fistula in ano, after the introduction of a medicated plug of lint, a pessary of horn is to be inserted (??a??? ???e?? ?e?at????). This would appear to be partly to distend the r.e.c.t.u.m, but partly also most likely to carry medicament, like the leaden tubes full of medicaments which were inserted into the uterus.

A pessary of bronze was found in Pompeii (Pl. LI, fig. 2), and is described by Ceci. It is hollow and has a plate perforated with holes (evidently for st.i.tching it on a band, to fix it round the body). Heister figures a similar instrument. It is impossible to say whether this specimen was intended for rectal or v.a.g.i.n.al use.

CHAPTER X

SUTURES, ETC.

_Sponge._

Greek, sp?????; Latin, _spongia_.

Sponges were used for many purposes. Paul (VII. iii) says they should be fresh and still preserve the smell of the sea. They were applied with water, wine, or oxycrate to agglutinate wounds, and also soaked in asphalt and set fire to and applied to wounds to stop haemorrhage.

Galen (_De Simp._ xi) says he has seen haemorrhage stopped by applying a sponge dipped in asphalt to a bleeding wound and setting fire to it, and leaving the unburnt part to cover the wound. Celsus says a sponge dipped in oil and vinegar or cold water relieves gouty swellings. He also recommends a sponge dipped in vinegar or cold water for stopping haemorrhage.

Dioscorides says that fistulae may be dilated with sponge tents.

Scribonius Largus says that in epistaxis the nose may be plugged with sponge:

Proderit et spongeae particulam praesectam apte forfice ad amplitudinem et patorem narium figuratam inicere paulo pressius ex aceto per se (xlvi).

Sora.n.u.s (xli) says haemorrhage from the uterus may be stopped with a sponge tent:

?p?te t??fe??? ?a? ?a?a??? sp???????? ?p???e? ?sa?t?? d??????? ??

?s?t?t? pa?e?t????a? p??s??e?.

_Sutures._

Celsus (V. xxvi) says sutures should be of soft thread not overtwisted that they may be the more easy on the part: 'Ex acia molli non nimis torta quo mitius corpori insidat'. They were made of flax. The apolinose described by Hippocrates (iii. 132) is directed to be made of crude flax (???????), the strands of which were stronger than those of dressed lint.

This also is what Paul used for the deligation of arteries.

Galen alludes to sutures of wool, and Paulus Aegineta in the operation for ectropion says:

'Afterwards we unite the divided parts with a needle carrying a woollen thread, being satisfied with two sutures.'

We have no mention of catgut being used for this purpose, though that substance was early known to the Greeks. The Homeric harp was strung with catgut. In fact ???d?, the term for harp-string, simply means intestines.

Paul used a woman's hair in a needle to transplant hairs in trichiasis (VI. xiii). Horsehair was used to raise a pterygium in Paul VI. xviii, but it is not mentioned as being used for suturing wounds.

_Serres Fines._