Surgical Instruments in Greek and Roman Times Part 3

The ordinary scalpel had apparently a straight, sharp-pointed blade. The word which Galen, Aetius, and Paulus Aegineta use to denote scalpel is s???. Latin authors use _scalpellus_, the diminutive of _scalper_. From the etymology of these terms we can learn nothing as to the shape of the blade; they are merely general terms denoting a cutting blade of any kind--chisel, graving tool, knife, &c. The word Hippocrates uses, ??a??a or a?a?????, has a more definite meaning. It is from ??a??a, the old Lacedaemonian sword, a broad blade cutting on one edge, sharp-pointed, and straight or with the tip turned slightly backwards. Thus, even in Hippocratic times the scalpel was apparently much of the same shape as it is now. Good examples of the ordinary scalpel may be seen in Pl. V, figs.

1 and 2 from the British Museum. They are all of steel. A variety with the point turned back at the tip is seen in one of the scalpels in the scalpel box from the Acropolis (Pl. IV).

A more bellied form is seen in Pl. V, fig. 5, which is from the Naples Museum, and is all of bronze, handle and blade. At the Scientific Congress held at Naples in 1845 Vulpes showed this specimen, and described it as the lithotomy knife invented by Meges and mentioned by Celsus (VII. xxvi).

Later I shall discuss in detail the instrument of Meges, but I believe the instrument shown by Vulpes is only an ordinary scalpel with a somewhat bellied shape.

Hippocrates refers to a bellied scalpel in a well-known pa.s.sage on empyema (ii. 258):

???? s?? ? ???d?? t?? p???? e???? ? t??e?? de? eta?? t?? p?e????

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

'Incise the outer integument between the ribs with a bellied scalpel.'

St???e?d?? means rounded like the breast of a woman. Galen translates it in his lexicon t? s???? ?at???? ?ast??de?, 'the bellied surgical knife.'

It is quite a serviceable instrument for several kinds of work, and it seems to have been a common form. Three out of the six scalpels depicted in the votive tablet from the Acropolis are of this form, and there are now in the Naples Museum four others of the same shape as the one described by Vulpes. These have blades of steel and handles of bronze. The figures of three of these (Pl. V, figs. 3-6), show the gradual evolution from a common scalpel into the bellied form. I have seen a scalpel with a blade similar to Pl. V, fig. 3 in use in Scotland for castrating piglings and calves.

_Scarificator for wet cupping._

Paul (VI. xli) says that some have conceived for the purpose of scarifying before wet cupping an instrument compounded of three blades joined together in such a way that at one stroke three scarifications are made:

????? ??? ?pe???sa? ???a??? p??? t??t?, t??a s???a ?sa ?e??a?te?

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

Paul says he prefers a single scalpel.

What the precise shape of scalpel used was we cannot say, but it would most likely be one of the bellied forms. Hippocrates, in his treatise _De Medico_, says that the lancets used in wet cupping should be rounded and not too narrow at the tip (?ap????? ?? ????? ? ???? ste????). Even if ?ap???? meant curved and not bellied it would not be certain that it was meant to cut on the convex side of the blade. The words of Hippocrates imply at any rate a blade with a rounded, not sharp point (i. 62).

_Straight sharp-pointed bistoury._

Greek, s????p?a?a?????, s????p???; Latin, _scalpellus_.

The etymology of the term s????p?a?a????? as applied to a cutting instrument sufficiently indicates its shape. It takes its name from its similarity to the beak of a snipe, which is long and slender[1]. We find it used by Galen (xi. 1011) for dissecting out warts, excising caruncles from the inner canthus, puncturing the foetal cranium in obstructed labour, &c.

[1] So says Briau (_Paul D'Egine_, p. 97), but it seems more likely to be derived from s????? 'a spike'.

In Aetius (IV. iv. 23) and Paulus Aegineta (VI. lxxiv) it is used for opening not only the foetal cranium but also the thorax and abdomen of the foetus in transverse presentations. Paul refers to it for opening the thorax in empyema (VI. xliv) and the abdomen in ascites (VI. l). In both cases the outer integument was incised with a scalpel and the deeper layer punctured with the bistoury. In opening the abdomen for ascites, by sliding the outer skin upwards before the peritoneal cut was made, a valvular opening was secured. Although many other interesting applications of this instrument are to be found, these instances will suffice to show that the uses to which the instrument was put agree with the supposition that it was of the shape indicated by the etymology of its name. A variant form of the same name is s????p??? which also occurs pretty often.

A large variety of this instrument is mentioned by Galen as devised by him for the dissection of the spinal cord. He says he uses a knife of the same shape as the scolopomachaerion, but larger and stouter and made of the best Norican steel, so as to neither blunt, bend, nor break easily (ii.

682).

I. A (_b_) _Straight blade cutting on one side, blunt-pointed._

(a) Novacula or razor (Greek ?????, diminutive ??????).

() Blunt-pointed bistoury.

(?) Ring knife for dismembering foetus.

_Razor._

Shaving and cutting the hair were looked upon as important means of treatment in several diseases. Oribasius (_Med. Coll._ xxv) has a chapter on this ent.i.tled pe?? ?????? ?a? ????se??. 'These things,' he says, 'have been introduced into medicine as a means of evacuation and as remedies in chronic diseases.'

Celsus makes frequent mention of shaving as a means of treatment. Of alopecia he says:

Sed nihil melius est quam novacula quotidie radere--quia, c.u.m paulatim summa pellicula excisa est, adaperiuntur piloram radiculae. Neque ante oportet desistere quam frequentem pilum nasci apparuerit (VI. iv).

A large scalpel of this form from the Naples Museum is shown in Pl. VI, fig. 1. The handle is of the usual shape and is made of bronze. The blade is of steel. It measures 15 cm. all over, the blade being 2 cm. broad at the heel. The cutting border slopes backward to the back of the blade, which is in a straight line with the border of the handle. At the point the blade is 15 cm. broad. It may be noted that this instrument had much the same shape as the _culter_, but _culter_ is not a term applied by any Latin author to a surgical instrument, nor is _cultellus_, although the sixteenth-century translators of Aetius and Paulus Aegineta very frequently use the latter term. Scultetus figures a scalpel of this form and sums up its uses well:

La fig. est un rasoir ou scalpel droit ne tranchant que d'un coste et de l'autre mousse, dont les chirurgiens se servent lorsqu'il ne faut avoir aucun egard aux parties sujettes, scavoir lorsqu'il s'agit de faire des incisions au cuir de la teste jusqu'au crane, &c.

Another specimen also of this cla.s.s, but with the blade so long in proportion to its width as to deserve the name of a blunt-pointed bistoury was excavated in a third-century graveyard at Stree, and is now in the Charleroi Museum. It is 14 cm. long by 1 cm. broad at the heel, widening gradually towards the point where it is 2 mm. broader than at the heel.

The end of the blade is square (Pl. VI, fig. 2). An example of the domestic _culter_ or _cultellus_ is shown in Pl. VII, fig. 4. It is from a Roman camp at Sandy in Bedfordshire.

In the curious pseudo-Hippocratic treatise (i. 463) a knife to fix on the thumb and dismember a foetus in utero is mentioned:

??e?? d? ??? p??? t? t??a?ta ?a? ????a ?p? t? da?t??? t? e????. ?a?

d?e???ta ??e?e??e?? t?? ?e??a? ?t?.

'If, however, the foetus be dead and remain, and cannot either spontaneously or with the aid of drugs come away in the natural manner, having liberally anointed the hand with cerate and inserted it in the uterus endeavour to separate the shoulders from the neck with the thumb. It is necessary to have for this a 'claw' upon the thumb and, the amputation having been performed, to extract the arms and, again inserting the hand, to open the abdomen and, having done so to remove the intestines, &c.'

An instrument answering to this description is still in use by veterinary surgeons (Pl. VII, fig. 1), but the forefinger, and not the thumb, is used. A scalpel blade is mounted on a ring and the forefinger is pa.s.sed through the ring. Foals and calves are in this way easily dismembered in exactly the same way as is described by Hippocrates. The name of the instrument of Hippocrates would rather indicate that its blade was curved, but as the modern instrument has a probe point I have included it in this cla.s.s. It is called by Tertullian the 'ring knife'--'c.u.m annulo cultrato (var. lect. anulocultro) quo intus membra caeduntur anxio arbitrio' (_De Anima_, 26).

I. B (_a_) _Straight blade cutting on two edges, sharp-pointed._

(1) Galen's 'long' dissecting knife.

(2) Phlebotome.

(3) Lithotome.

(4) Polypus knife.

_Galen's knife for opening the vertebral ca.n.a.l._

In his description of the dissection of the spine Galen describes a large straight two-edged knife (ii. 682):

?a???? t? p????e? a?a?????, ??t? ??? a?t? ?a?? d?? p?e???? ??e?a?

???? ?p? t?? p??at?? e?? ?a? ????f?? ??????sa?.

'I push in the 'long scalpel', for thus I describe the one with two cutting edges meeting in one at the tip.'

What Galen means by p????e? when applied to an instrument he has himself explained in a note on the chapter by Hippocrates on the treatment of dislocation of the shoulder. He applies it to instruments long in proportion to their breadth (see p. 118). The knife referred to here is a large strong instrument, for it is intended for cutting through the lateral processes of the vertebrae.

_Phlebotome._

Greek, f?e?t???, t? (sc. s?????), also f?e?t???, ? (Galen). ???e???

(sc. ???a???); Latin, _phlebotomum_ (late), _scalpellus_.