Surgical Instruments in Greek and Roman Times Part 7

Shears are very common objects in museums. Some are of bronze and some are of steel. Judging from the relative numbers in which they have been preserved it would seem that the steel shears far outnumbered the bronze.

In Pl. X, fig. 5 is shown a bronze pair from the Naples Museum, found in Pompeii.

CHAPTER IV

PROBES

Greek, ???, ??p?????, ?p??e?pt???, ?pa?e?pt???; Latin, _specillum_.

This is a very comprehensive cla.s.s. The original specillum was no doubt a simple sound. Varro thus defines the specillum: 'Quo oculos inunguimus quibus specimus specillum est. Graecis ??? dicitur.' Thus it meant a probe or sound.

??? is probably derived from ????, an apple or fruit, from the olivary enlargement at the end of a sound.

The term ?p??e?pt???, which is frequently used by Hippocrates, originally meant an ointment spatula, being derived from ?pa?e?f?, to spread ointment. But the custom of combining two instruments on one shaft gradually led to the application of these terms, especially the term specillum, to denote a large variety of instruments.

The name ??p????? is evidently derived from the resemblance of the probe to the pestle, which was such a frequent utensil in Greek homes. It is connected with ??pa???, 'pestle,' ??pa??st?????, 'mortar,' and ??pa????, 'bray,' and ??pt?????, a medicament pounded in a mortar (Dioscorides, iv.

190). The exact significance of the term ??p????? is sometimes difficult to determine. It is easy to prove that in general it is merely a sound.

Thus Paul (VI. lxxviii), in quoting a pa.s.sage from Hippocrates, subst.i.tutes ??p????? for the word ???, which Hippocrates uses to denote the sound used for exploring a fistula. Throughout this chapter, in which the word occurs ten times in all, Briau translates it by 'manche du scalpel', although the whole context shows that a probe is meant. Even where it is spoken of as an eyed probe (d?? tet?????? ??pa????) Briau translates it by 'au moyen du manche perce d'un scalpel', an expression which is meaningless to a surgeon. Briau evidently thinks it is derived from ??pt?, and at times it seems as if it might denote a cutting instrument. Thus Adams, in a note to Paul, VI. lxxvii, says, 'if the ??p?????, however, was the same as the ??? or specillum it was evidently used for cutting with, as well as for cutting upon', and on one occasion (Paul, VI. lx.x.x) he translates ??p????? by 'knife'. Liddell and Scott translate it as 'a small knife'. A careful examination of those pa.s.sages where it seems to indicate a cutting instrument will show, however, that only blunt dissection, which was frequently performed with the spatula end of a probe, is meant. I am quite convinced that the word ??p????? is only a late Greek term for the earlier ???, and means essentially a sound, and not a knife. While on this subject we may note that throughout the codices and texts there is great confusion between words meaning probe and words meaning scalpel. The proper forms s???, 'scalpel,' and ???, 'probe,' are distinct, but the inferior reading s??? is frequent in both codices and texts as a b.a.s.t.a.r.d, for s??? is often written s??? incorrectly, and ???

often becomes s???, just as ????? is written s?????. Thus in Paul (VI.

viii), where the author is describing the eversion of the eyelid by means of the olivary point of a probe (t? p????? t?? ????), four codices and the Aldine and Basle texts read s????, two codices read s????, one reads ????, four ????, and Briau reads s????. In a case like this only a knowledge of surgery can tell us whether a probe or scalpel is meant.

_The Specillum as a Sound._

The ancients were fully aware of the value of the information to be gained by searching the recesses of a lesion with a rod of metal. Celsus (v. 28) says regarding fistulae:

Ante omnia autem demitti specillum in fistulam convenit, ut quo tendat et quam alte perveniat scire possimus; simul etiam protinus humida an siccior sit: quod extracto specillo patet. Si vero os in vicino est id quoque disci potest si iam necne eo fistula penetraverit et quatenus nocuerit; nam si molle est quod ultimo specillo contingitur, intra carnem adhuc vitium est, si magis id renit.i.tur, ad os ventum est. Ibi deinde si labitur specillum, nondum caries est: si non labitur sed aequali innit.i.tur, caries quidem, verum adhuc levis est: si inaequale quoque et asperum subest, vehementius os exesum est. At cartilago ubi subsit, ipsa sedes docet; perventumque esse ad eam ex renisu patet.

'But first it is well to put a probe into the fistula to learn where it goes and how deeply it reaches, also whether it is moist or rather dry as is evident when the probe is withdrawn. Further, if there be bone adjacent, it is possible to learn whether the fistula has entered it or not and how deeply it has caused disease. For if the part is soft which is reached by the end of the probe the disease is still intermuscular; if the resistance be greater it has reached the bone: if there the probe slip there is as yet no caries. If it does not slip but meets with a uniform resistance there is indeed caries, but it is as yet slight. If what is below is uneven and rough the bone is seriously eroded, and whether there is cartilage below will be known by the situation, and if the disease has reached it will be evident from the resistance.'

These remarks show that with the probe the ancients had cultivated the tactus eruditus to a high degree, and the remarks of Aetius and Paul are equally to the point.

The tips of the probes which have survived vary considerably in size and shape. Some have a point which is almost sharp like a stylet; in others the natural thickness of the shaft is kept right to the tip, which is simply rounded off or there is an oval enlargement like that on our olivary probes and sounds. In rare cases the enlargement is globular. The oval enlargement was named by the Greeks p????, which means 'olive-kernel'. The sixteenth-century translators uniformly render this by 'nucleus', which is a convenient term to use, but it has no cla.s.sical Latin authority. Indeed, there is no cla.s.sical Latin equivalent used by medical authors. Theodorus Priscia.n.u.s uses _baca_ (_sic_), a berry, and _bacula_, little berry, and in the _Additamenta_ (I. viii. 21, ed. Rose) he uses the transliteration _pyrena meles_. But this is African Latin.

A probe without enlargement at the tip was called ?p???????? or ?p??????. The ear probe is frequently referred to as belonging to this cla.s.s. These probes without nuclei were specially adapted for wrapping round with wool to apply medicaments, or wipe away discharge.

The size of the nucleus varied in different varieties of probe, but was pretty constant in each particular. It was largest in the probe known as the spathomele--a combination of spatula and probe which was in extremely common use for pharmaceutical purposes. The nucleus of this probe was such a well-known object that it is frequently referred to as a standard of size and shape. Galen (ii. 898) says:

'In the cervix uteri is the foramen by which the woman both pa.s.ses the monthly flux and receives the s.e.m.e.n of the husband. By it also the foetus leaves the womb. It is marvellous how it varies in size according to circ.u.mstances. When the woman is not pregnant it admits the nucleus of a probe or something slightly larger' (p????a ?? ????

?p?d??eta? ? ?a?? t? t??t?? pa??te???).

Here Kuhn translates p????a by 'ac.u.minatum capitulum specilli', which is incorrect. It is an olivary enlargement, not sharp point. In Paul (VI.

xc), we have the nucleus given at the measure of distance between the perforations by which a bone was surrounded preparatory to its excision by means of chisels: 'the s.p.a.ce between the perforations made by the drills should be the breadth of the nucleus of a probe' (t? ???? p??????).

Aetius (III. i. 16) says in volvulus the sphincter ani is so contracted that the nucleus of a probe cannot be got in.

Paul (VI. xxi) says that in couching a cataract we must enter the couching needle a nucleus breadth from the iris.

Besides its use as a sound the nucleus was frequently used as a means of applying medicaments, either in the form of ointments or dry powder, to affected parts.

Paul (VI. ix) says that in the cases of entropion, where the ordinary plastic operation is objected to, an elliptical piece may be burnt out of the eyelid with caustic applied on the nucleus of a probe (p?????s????), and similarly after removal of sebaceous cysts from the lid, levigated salts may be applied on the nucleus (t?? p????a t?? ????).

Aetius (II. iv. 23), quoting from Galen, says that in caries of the teeth some wax may be warmed on the nucleus of a probe (p?????? ????), and again (II. iv. 14) he directs us to use it for application of pomade to the face (p????? ????). It would seem that this, and not the exploration of wounds, was the original use to which the olivary-pointed probe was put, for in early Egyptian tombs small pestle-like probes are, as a rule, found accompanying the toilet pigment boxes which are so common. They are mostly made of wood (Pl. X, fig. 2). The kohl-stick was not unknown to Greek ladies. (See Eustathius, _Comment. in Iliad_.)

Hitherto I have spoken of the probe as if it were a single instrument; but, as a matter of fact, the ends of the shaft are usually fashioned to serve different purposes. Thus at one end there will be a probe, at the other a spatula, a spoon, or a hook. Some of these combinations have names of their own, and others are so frequently met with that they too seem to have been constant types.

It may simplify matters if we antic.i.p.ate a little and remark that while the uses of the probes in actual surgery were the same as at the present day, in the minor surgery, consisting of the application of medicaments and toilet preparations, they were used in a slightly different manner.

Semi-solids, like eyebrow pigment and eye ointments, were applied on olivary-pointed probes. Liquids, like ear and eye drops, were usually instilled by squeezing a ball of wool dipped in the liquid and placed round the middle of a probe, and letting it run off the point. Thus a common form of toilet instruments consists of a probe-like instrument with an olive at one end and a sharp stylet at the other. Ligulae with scoops were used to withdraw drops of fluid essences, &c. from unguentaria. Some of these ligulae run up to a foot and a half in length.

The specilla which remain to us are mostly made of bronze. A few are overlaid with gold and silver, and a few are solid gold or solid silver.

We read, however, of specilla of lead, tin, copper, and wood, and of the use of a boar's bristle or a stalk of garlic for searching fistulae.

I shall now proceed to cla.s.sify and discuss these different varieties, premising, however, that no hard and fast line can be drawn between different types. They shade off into each other by imperceptible gradations, so that whatever system of cla.s.sification we adopt b.a.s.t.a.r.d forms are sure to occur.

_Double Simple Probe._

Greek, ?p????????, ?p??????; Latin, _specillum_.

The simplest form of specillum is a plain rod of metal rounded off at either end. These are not infrequently met with. I figure one from my collection. Its length is 14.5 cm., its diameter 2 mm. At either end it tapers rapidly off to a blunt point. At a distance of 3 cm. from one end is a raised ring (Pl. X, fig. 4). A similar probe in silver may be seen in the Musee de Cinquantenaire, Brussels. It was found with other probes in an etui. Pl. X, Fig. 3 shows a rather longer specimen from the Naples Museum. A variety with non-tapered ends is seen in Pl. X, fig. 1. It is also from the Naples Museum. Pl. XI, fig. 4 shows a probe, from my own collection, which carries the snake of Aesculapius at one end. One with a double snake (caduceus form) was found in the Roman Hospital at Baden (Pl.

XI, fig. 2).

_Specilla with two olivary ends._

Greek, d?p?????? ???, ?f?s????.

A slender sound with slight olivary enlargement at either end is very frequently mentioned under the name d?p?????? ??? by Galen. He also calls it ?f?s????. Thus he says:

?a? s?? d????e? ?st? d?e???e?? a?t?? t? t?? pa?as?e?as???? ?ept??

e?te ?f?s????, e?te d?p?????? ?????e?? ????e??, e? d? t? ?ept?te???

d?? ?a? ???t?da (ii. 581).

'And in the double pa.s.sage you must insert some one of the slender instruments you have at hand, either a double-ended probe (a 'double olive' if you prefer to call it so), or if something finer be necessary, even an ear probe.'

In dealing with fistulae Paul (VI. lxxvii) says:

'We must first examine them with a sound if they be straight, or with a very flexible 'double olive' (d?p????? e??ape?), such as those made of tin or the smallest of those made of bronze, if they be crooked.'

Paul refers to its use as a cautery to destroy the roots of hairs after epilation (VI. xiv):

'Some, preferring cauterizing to the operation of transplantation, evert the eyelid, and with a cilia forceps dragging out the offending hair, or two or even three hairs, apply a heated double-olive probe or an ear probe, or some such slender instrument, to the place from which the hair or hairs were removed' (??ap?????? ? ???t?da ? t? t????t??

?ept?? ???a??? pep??????? e????s? t? t?p? ??e? ? ???? ? a? t???e?

????s??sa?).