Surgical Instruments in Greek and Roman Times

CHAPTER II

MATERIAL, EXECUTION, AND ORNAMENTATION 10-23

Steel and Iron--Bronze--Copper--Brass--Tin--Lead--Gold-- Silver--Horn--Wood--Bone--Ivory--Stone--Execution and Ornamentation--Ringed Ornamentation--Inlaying--Plating-- Patina--Finds of Instruments--Herculaneum and Pompeii--Find of Surgeon of Paris--Oculist Severus of Rheims--Oculist Sollemnis of Fonviel--Military Hospital at Baden--Surgeon of Cologne.

CHAPTER III

KNIVES 24-50

Cutting instruments--The scalpel handle--Typical form rectangular, with blunt dissector--Round--Octagonal--Mounting the blade--Varieties of blade--Classification--Straight blades with one cutting edge--Scalpel--Bistoury--Scarificator single or multiple--Razor type--Blunt-pointed bistoury--Ring knife for dismembering the foetus--Straight two-edged knives--Galen's long dissecting knife--Phlebotome--Fleams-- Katias--Spathion--Hemispathion--Polypus knife--Lithotomy knife--Knife for lithotomy invented by Meges--Perforator for foetal cranium--Probe-pointed bistoury with two edges--Curved bistoury--Crow-bill--Pterygium knife--Knife for plastic operation for entropion--Uvula knife--Tonsil knife--Fistula knife--Curved two-edged blades--Galen's cartilage knife-- Curved myrtle-leaf-shaped blade--Shears.

CHAPTER IV

PROBES 51-89

Specilla or probe-like instruments--Definition of specillum-- κοπάριον--μήλη--ὑπάλειπτρον--Materials--Bronze--Silver--Gold--Tin-- Wood--Bristle--Flower-stalk--Specillum as sound--Combination of instruments on one shaft--Plain rods--Double olive-- Spathomele or spatula-probe--Cyathiscomele or spoon-probe-- Ear specillum--Probe with screw thread--Specillum vulnerarium--Handled needle--Ophthalmic probe--Rasping specillum--Trachoma curette (Blepharoxyston)--Styli and styloid specilla--Grooved director--Surgical needle--Dressing needle--Bodkin--Eyed probes--Ligula--Spoons for warming and pouring salves--Tongue depressor--Uterine sounds--Uterine dilators--Bifurcated probe--Y probe--Blunt dissector--Curved dissectors--Sharp hooks--Blunt hooks--Aneurism needle-- Strigil--Spoon for applying liquid to uvula.

CHAPTER V

FORCEPS 90-100

Epilation--Polypus--Tumour vulsellum--Eyelid fixation forceps--Uvula (Staphylagra)--Forceps for applying caustic to uvula--Pharyngeal.

CHAPTER VI

BLEEDING CUPS, CLYSTERS, ETC. 101-115

Bleeding cups--Materials--Glass--Silver-Bronze--Shapes-- Syringes--Principles--Rectal--Vaginal and uterine--Bladder-- Nose--Sinus--Ear--Insufflator--Cannula for ascites and empyema--Leaden tubes to prevent contraction and adhesion-- Calamus scriptorius--Quill.

CHAPTER VII. Cauteries 116-120

CAUTERIES 116-120

Cautery knife--Trident--Olivary--Gamma-shaped--Obol-- Lunated--Nail--Tile--Button--Wedge--Needle--Cautery with tube--Wood--Moxa.

CHAPTER VIII

BONE AND TOOTH INSTRUMENTS 121-142

Raspatory--Chisel--Gouge--Lenticular--Hammer--Block-- Meningophylax--Drill--Drill with guard (Abaptista)--Saw-- Trephine--Perforator for fistula lachrymalis--Bone elevator-- Sequestrum forceps--Varix extractor--Blacksmith's tongs-- Tooth forceps--stump forceps--Tooth elevator--Tooth scalers-- File--Forceps for extracting weapons--Periosteal elevator for the pericranium--Impellent--Arrow scoop.

CHAPTER IX

BLADDER AND GYNAECOLOGICAL INSTRUMENTS 143-160

Catheter--Male--Female--Child--Bladder sounds--Lithotomy scoop--Forceps--Lithotrite--Speculum--Rectal--Vaginal-- Trivalve--Quadrivalve--Traction hook--Decapitator-- Cranioclast--Cephalotribe--Midwifery forceps--Uterine curette--Instrument for destroying foetus in utero-- Apparatus for fumigating uterus and vagina--Vaginal pessaries.

CHAPTER X

SUTURES, ETC. 161-167

Sponge--Sutures--Serres fines--Band of Antyllus--Sieves and strainers--Mortar--Pestle--Whetstone.

CHAPTER XI

ÉTUI, ETC. 168-173

Portable outfit--Probe cases--Scalpel box--Ointment box-- Boxes for collyrium sticks--Ointment slabs--Boxes for drugs.

APPENDIX

I. INVENTORY OF CHIEF INSTRUMENTS IN VARIOUS MUSEUMS 174-177

II. BIBLIOGRAPHY 177-178

CHAPTER I. Introductory

INTRODUCTORY

The earliest classical writer on medical subjects is Hippocrates, who was born in 460 B. C. and who practised in Athens and other parts of Greece. The 'Hippocratic Collection' is well known to consist of works which are not all by Hippocrates himself; but as the pseudo-Hippocratic works all belong to the classical period they are all admissible as evidence for our purpose, and for the sake of brevity I shall throughout refer to them as if all were by Hippocrates. Many interesting instruments are named in the comparatively small collection of treatises which make up the admittedly genuine list of Hippocratic works, but, taking these along with the pseudo-Hippocratic works, the number of instruments named in the whole collection is surprisingly large, comprising as it does trephines, bone drills, probes, needles, tooth forceps, uvula forceps, bone elevators, uterine sounds, graduated dilators, cranioclasts, and others. After Hippocrates there is a break in the continuity of the literature, and for some hundreds of years Greek medicine is represented almost entirely by the Alexandrian Schools. The first printed edition of the Hippocratic works was a Latin translation printed at Rome in 1525, followed by the Aldine edition of the Greek text printed at Venice in the following year. Other editions are the edition of Föes (1595), Van der Linden (1665), Kühn (Leipzig, 1821). Later editions are the text with a French translation by Littré (10 vols., 1849-61), a scholarly edition by Ermerins with a Latin rendering (1859-64), and an excellent translation of the genuine works of Hippocrates by the world-famous Dr. Adams of Banchory (Sydenham Soc. Trans., 1849). The best edition, however, is the edition of Kuehlewein, begun in 1894 and at present in course of publication by Teubner, Leipzig. The later volumes have not yet appeared. For the portion of the text which is not contained in the first two volumes of Kuehlewein I have relied on the edition of Kühn for most of the readings, although occasionally those of Van der Linden or Föes are to be preferred. The references given are to the volumes and pages of Kühn's edition, but in this edition indications are given of the corresponding localities in the other editions so that cross-references to these can easily be made. There seems to be a different arrangement in different editions of Föes, for Liddell and Scott say the references in their Lexicon are to the pages in Föes but they do not correspond in any way to the pagination of the edition before me (Frankfort, 1595).

Aulus Cornelius Celsus is the next writer we have. His system of medicine in eight books is a marvel of lucid arrangement, and his beautiful style makes it a pleasure to read any of his works. The seventh book gives a most interesting review of the surgery of the Alexandrian School. He describes many instruments in detail, although he names fewer special instruments than some of the Greek writers as the Latin language lends itself less well to the formation of compound words than the Greek does. To take one example only, Celsus has practically one word for all varieties of forceps--vulsella, while the Greeks use many compounds like hair forceps (τριχο-λαβίς), flesh forceps (σαρκο-λάβος), tooth forceps (ὀδοντάγρα), stump forceps (ῥιζάγρα). Indeed, in the case of the two latter words Celsus falls back on Greek to express himself. Celsus was first published in 1478. Another edition is that of Targa, 1769. The editions before me are those of Daremberg, published at Leipzig in 1859, and Védrènes (Paris, 1876). The latter contains illustrations of a considerable number of specimens from Italian and French museums.

Rufus of Ephesus (98-117 A. D.) has left little to interest us for our particular purpose, as he merely mentions, without describing, a few instruments, all of which are already known to us from other sources. The best edition is that of Daremberg, Paris, 1879. A Latin translation of his works will be found in Medicae Artis Principes (Stephanus).

Aretaeus of Cappadocia has left us a work on Acute and Chronic Diseases. He has few references to instruments, but such as they are they are interesting, as he names some which are given by no other author. He has a tantalizing allusion to a work by himself on surgery which has not been preserved. There is a fine edition of the text, with an English translation by Adams of Banchory, in the Transactions of the Sydenham Society.

Galen (130-200 A. D.) was a most voluminous writer, much of whose work remains and teems with matter of interest to us. Much information about instruments is to be gained from even his purely anatomical writings. The most accessible edition is that of Kühn (20 vols., Leipzig, 1821), but it is slipshod in the text, and even more so in the translation, which is in Latin.

Oribasius (325 A. D.) wrote an encyclopaedia of medicine, which is called Συναγωγαὶ Ἰατρικαί--Collecta Medicinalia, in seventy books, only about one third of which remain. This is the most interesting of his works from our point of view, but he has left also a synopsis of the encyclopaedia called Σύνοψις, and a sort of first aid manual called Εὐπόριστα. I have used the edition of Daremberg and Bussemaker (1851-76).

Soranus of Ephesus has left us a most valuable treatise on obstetrics and gynaecology, which, though written only for midwives, contains many interesting references to instruments such as the speculum, uterine sound, cephalotribe, decapitator, and embryo hook. He lived in the reign of Trajan. Some of the chapters, of which the Greek is lost, have been preserved to us by his abbreviator Moschion. I have used the edition of Rose published at Leipzig in 1882.

Moschion (fifth century) translated into Latin the gynaecological and obstetrical part of the works of Soranus for the benefit of midwives who could not speak Greek. This version is now lost, but we have a translation of it into Greek, made after the fall of the Western Empire and the development of the Greek-speaking Empire at Constantinople in the sixth century. There is an Edition of this by Gesner (Basle, 1566). Finally, this Greek version of Moschion was translated back into barbarous Latin at some early date, Barbour thinks by some member of the Schola Salernitana. This was published at Venice by Aldus in the sixteenth century, and Rose has prefaced his edition of Soranus with it. This work of Moschion is only of interest to us from the fact that he preserves to us the substance of some chapters of which the original in Soranus is wanting.

Caelius Aurelianus Siccensis, an African of the fourth or fifth century, translated the works of Soranus, both those on gynaecology and those on general diseases, and he preserves some of Soranus which we would not otherwise possess; but he writes in a barbarous Latin which, like the Latin of some other African writers on medical subjects, is calculated to cause great pain to any one not familiar with this particular style.

Aetius lived in the first half of the sixth century, and compiled a voluminous treatise on medicine in sixteen books. He worked entirely with scissors and paste, but the result is the preservation to us of a large number of extracts from writers whose works would otherwise have entirely disappeared, and his work is of great value for the study of instruments. In 1534 an Aldine Edition of the first eight books was published, and, though a translation of the whole work was published by Cornarius in 1533-42 in Latin, six of the last eight books were never published in the original Greek. This is unfortunate for us, as for our purpose the original is the only thing of any great value, Greek being, as I have already pointed out, a language richer in compounds than Latin is, and lending itself better to the coining of special names for special instruments. Not that the sixteenth-century translator is ever at a loss for a turn by which to express himself in Latin, but the turn, as often as not, is by periphrasis just at the very point when we would have liked a very exact equivalent for the Greek. The translation of the part of the work of which we have the Greek shows that we cannot entirely depend on some of these periphrases even where they appear definite, as in some cases an unwarrantable assumption is made about the form of an instrument. Thus λιθουλκῷ is translated 'forcipe ad id facta' because in Cornarius's time the instrument used for extracting stone from the bladder was a forceps, whereas it is doubtful whether there was in the Roman period anything more than a scoop, and, therefore, we are not entitled to translate λιθουλκός by anything more definite than 'stone extractor', its etymological equivalent. Although, therefore, I have examined the latter eight books of Aetius in the Latin translation, and although they contain some of the most interesting information to be found in the whole work, I have been very chary about laying stress on any deductions drawn from the Latin translation only. It may be noted that there are two ways of referring to the different books in Aetius, according to whether the Greek text or the translation of Cornarius is meant. Cornarius arranged his version in four tetrabibli of four books each, whereas the Greek text is simply numbered from i-viii. 'No vii.' of the Greek text is, therefore, called by Cornarius 'Tetr. ii. lib. iii.' The eleventh book was published by Daremberg in his edition of Rufus (1879), and the twelfth book was published by Costomeris at Paris in 1892.

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