Surgical Instruments in Greek and Roman Times Part 27

Greek, ???t??; Latin, _fibula_.

Celsus (V. xxvi) in describing the closing of wounds says:

Nam si plaga in molli parto est, sui debet, maximeque si discissa auris ima est, vel imus nasus, vel frons, vel bucca, vel palpebra, vel labrum, vel circa guttur cutis, vel venter. Si vero in carne vulnus est hiatque, neque in unum orae facile attrahuntur, sutura quidem aliena est; imponendae vero fibulae sunt; ???t??a? Graeci nominant; quae oras paulum tamen contrahant, quo minus lata postea cicatrix sit.

'Suture is indicated if the lesion is in a soft part, especially in the lobule of the ear, or the ala nasi, or the forehead, or cheek, the edge of the eyelid, or the skin over the throat, or the abdominal wall. But if the wound is in a muscular part and gape, and the edges cannot easily be opposed, suture is contraindicated, and fibulae (Graece ???t??a?) are to be used in order that the cicatrix afterwards may not be wide.'

We have here contrasted two methods of closing a wound, and the conclusion is readily arrived at that sutures in the first case and some metal contrivance in the second are intended. Celsus goes on to say, however:

Utraque optima est ex acia molli, non nimis torta, quo mitius corpori insidat. Utraque neque nimis rara, neque nimis crebra iniicienda.

'Both are best made of soft thread, not too hard twisted that it may sit easier on the tissues, nor are too few nor too many of either of them to be put in.'

A consideration of various pa.s.sages in which the Greek authors use the term leaves a distinct impression on one's mind that a metal clasp is intended. Thus Paul (VI. cvii), in treating of compound fractures, says that if a large portion of the bone is laid bare we use fibulae and sutures (???t??s? ?a? ?afa??). It must be confessed, however, that the words of Celsus render it difficult for us to a.s.sert with certainty that fibulae were metal clasps, and we find ancient commentators in equal difficulty. Fallopius and Fabricius d' Aquapendente think fibulae mean interrupted sutures. Guido de Cauliac thinks they mean metal clasps. There is just the possibility that a contrivance like our harelip pin with a figure of eight thread may be indicated. This would satisfy both sides of the question. If fibulae were metal clasps, however, we have several varieties of ancient fibulae that might have been used for closing wounds.

That most suited for the purpose in hand seems to me to be one consisting of a small bar terminating in two hooks. Several of these from Roman London are in the Guildhall Museum (Pl. LII, figs. 5, 6, 7). They represent a useful form of 'clip' still in use by cyclists, and they could be applied to wounds to act on the principle of Malgaigne's hooks for the patella. A modic.u.m of support for this view may be derived from the fact that whereas Galen, from whom the above pa.s.sage on compound fractures is quoted by Paul, uses the word ???t??s?, the codices of Paul almost unanimously have ????st????. Fourteen out of fifteen give the latter rendering.

_Band of Antyllus._

In the interesting dissertation which Oribasius gives on the subject of phlebotomy (_Med. Collect._ vii) he states that Antyllus directs us to apply a ligature of two fingers' breadth round the arm when going to let blood at the elbow. He says that they are mistaken who affirm that the same effect may be produced by applying the band below, for the veins will not then swell even if the arm be fomented. When going to bleed at the ankle the ligature is to be applied at the knee. When the blood does not flow well he advises us to slacken the bandage if too tight. This is the famous 'band of Antyllus'.

It is mentioned also in the pseudo-Hippocratic treatise on Ulcers (iii.

328):

'When you have opened the vein and after you have let blood and have loosened the fillet (ta???a?) and yet the blood does not stop.'

Paul also mentions the band, including one round the neck when the veins of the forehead are to be opened for ophthalmia. So far as we know the fillet was nothing more than a plain strip of linen or some such material, but Deneffe, commenting on two bronze fibulae which were found in the grave of the surgeon of Paris, conjectures that they may have been used to fix the fillet in venesection. I give figures of these after Deneffe, but it seems to me that these buckles are more likely to have belonged to the straps of a portable instrument-case of canvas or leather which had disappeared. One is a neat little heptagonal fibula, 28 cm. in its widest part, with a tongue 27 mm. long (Pl. LII, fig. 2). The other fibula is in the form of a penannular ring, formed by a two-headed serpent curved on itself so that the two heads look at each other, separated from each other by a s.p.a.ce of a few millimetres (Pl. LII, fig. 8). Opposite the heads there is a small rectangular opening to receive the end of the strap.

There is no tongue. It may have been fixed by a metal bar attached to the other end of the strap.

_Sieves and Strainers._

Greek, ????, ???t??; Latin, _cribrum_.

Scribonius Largus mentions sieves of different sizes. In ch. xc a small one is mentioned:

Contunditur hic cortex per se et cribratur tenui cribro.

In other places larger sizes are mentioned:

In his macerantur res quae infra scriptae sunt, contusae et percribratae grandioribus foraminibus cribri (cclxix).

Marcellus (_De Medicamentis_, x.x.xiii. 9) says:

Pulverem facito, et cribello medicinali omnem pulverem cerne et permisce, et c.u.m vino vetere calefacto loc.u.m inline.

There are large numbers of sieves and strainers in bronze and earthenware in the Naples Museum.

Paul (VII. xx) says oil of sesame is to be prepared from sesame pounded, softened, and pressed in a strainer with screws (d?? ???t?d?? t??

???????). The word ???t?? literally means a basket or wicker eel-trap.

Here it must mean a strainer.

_Mortar and Pestle._

Greek, ??d???, mortar: d??d??, pestle; Latin, _mortarium_, _pilum_.

In the find of the oculist Severus is a bronze dish which Deneffe regards as a mortar. It is 8 cm. in diameter and 35 deep, and rests on a base of 3 cm. diameter, so that it sits firmly. Marcellus (_De Medic._ i) mentions a mortar of marble:

Haec universa conteres in mortario marmoreo, et aceto admixto fronti inlines.

He also mentions one of wood:

Huius radicem colliges et findes in partes duas, quarum unam siccabis ac minutatim concides et mittes in pilam ligneam atque illic diligenter tundes (xxiii).

Scrib. Larg. speaks of pestles of wood:

Hoc medicamentum c.u.m componitur pilum ligneum sit (clii).

In Paul we have a mortar of lead and a leaden pestle mentioned several times:

?? ???d??? ??d?? ?a? ???d??? d??d??? ?e??sa?.

'Triturate ceruse with wine and rose oil in a leaden mortar with a leaden pestle and anoint with it' (III. lix).

Galen (_De Simpl._ x) speaks of bronze mortars:

'Wherefore, some call only the natural mineral by this name, but some also the substance which is prepared in a bronze mortar with a copper pestle by means of the urine of a boy, which some value according to the differences of the verdigris. But it is better to prepare it in summer, or at least in hot weather, rubbing up the urine in the mortar, and it answers the more excellently if the bronze of which you make the mortar is red and the pestle too, for more is thus rubbed off by the turning of the pestle when the bronze is of a softer nature.'

Paul mentions a mortar of marble. A small mortar of bronze was found amongst the instruments of the surgeon of Paris. Another small one from my own collection is shown in Pl. LII, fig. 3. The excavation of the temple of Aesculapius in the forum has brought to light a large number of mortars of marble. They are mostly about six or seven inches in diameter, but are much deeper in proportion than our modern mortars are. The spathomele and other olivary probes were no doubt often used as small pestles.

_Whetstone._

Greek, ?????; Latin, _cos_.

We saw that several of the slabs on which ointments were prepared had evidently been used for sharpening knives, and whetstones are often found of varying degrees of roughness from sandstone to fine argillaceous smooth stones. Paul (VII. iii) says:

?? ?e ?? t?? ?a??a? ?????? ?p?t??a ???t???? e??a? fas?? ?ste ?a?

t?t???? pa?????? ?a? pa?d?? ???e?? p??st???e??. t?? ??a?a????? d? t?

?p?t??a ??pt???? ?p????? ???pe??a?? ???tte?.

'The filings of the Naxian whetstone are said to be refrigerant, repressing the b.r.e.a.s.t.s of maidens and the t.e.s.t.i.c.l.es of boys. The filings of the oilstone being detergent suit with alopecia.'

It is uncertain what the Naxian whetstone was, but it was considered the best variety of whetstone. It is mentioned in Pindar. From the fact that emery is found in Naxos one might conclude that the Naxian whetstone was of emery, but a few lines before the pa.s.sage quoted from Paul he has already mentioned the emery:

? d? s???? ??pt???? ????sa d??a?? ?d??ta? s??e?.