The Project Gutenberg EBook of Surgical Instruments in Greek and Roman Times, by John Stewart Milne This eBook is for the use of anyone anywhere at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.org Title: Surgical Instruments in Greek and Roman Times Author: John Stewart Milne Release Date: August 6, 2012 [EBook #40424] Language: English Character set encoding: UTF-8 *** START OF THIS PROJECT GUTENBERG EBOOK SURGICAL INSTRUMENTS, GREEK/ROMAN TIMES *** Produced by Bryan Ness and the Online Distributed Proofreading Team at http://www.pgdp.net (This file was produced from images generously made available by The Internet Archive/American Libraries.) SURGICAL INSTRUMENTS IN GREEK AND ROMAN TIMES BY JOHN STEWART MILNE, M.A., M.D. Aberd. KEITH GOLD MEDALLIST IN CLINICAL SURGERY WITH ILLUSTRATIONS OXFORD AT THE CLARENDON PRESS 1907 HENRY FROWDE, M.A. PUBLISHER TO THE UNIVERSITY OF OXFORD LONDON, EDINBURGH NEW YORK AND TORONTO PREFACE [Pg iii] The object of this book is to lay before the student of medical history an account of the various instruments with which the ancient Greek and Roman surgeons prosecuted their craft. It is self-evident that no clear conception of a surgical operation, ancient or modern, can be formed from a written description without some previous knowledge of the instruments intended to be used. Many interesting operations described in detail in the classical authors are rendered obscure or quite unintelligible from lack of this knowledge. The learned Adams gives an accurate translation of a long and involved chapter by Paulus Aegineta on the use of the vaginal speculum, but remarks that owing to our want of knowledge of the specula possessed by the ancients the chapter is unintelligible. Daremberg says it is impossible to say what was the shape of any of the cutting instruments mentioned by Hippocrates. The steady progress of archaeological discovery has gradually added find after find of surgical instruments, till now there is scarcely a museum with any considerable number of antique petits bronzes which does not number among its contents a few surgical instruments, and in the Naples Museum alone there are hundreds. In several cases we know even the name of the original possessor of these and the special branch of surgery which he practised. There are thus open to us materials which were not available to the men of learning to whom I have referred above, and the time seems opportune to undertake a systematic review of all the materials at our disposal, and attempt to reconstruct the surgical armamentarium of the ancients. Considering the importance of the subject, it is surprising that no such systematic attempt has previously been made. Indeed, comparatively little attention has been given to this department of archaeology. Literature bearing on it is comparatively scarce. What we have is entirely continental, and consists of a series of reports of different finds with attempts to indicate the uses of the instruments described. In addition to these reports and the actual instruments scattered over various museums, we have at our disposal the writings of the ancient authors themselves. In these a fair number of instruments are minutely described, while many others are named, and here and there points about their shape are mentioned in different places; and by piecing these particulars together and deducing other facts from the nature of the manipulations the instruments are employed in, we can describe in detail, with a tolerable amount of certainty, a surprisingly large number of instruments. It must be confessed that these ancient classics are rather difficult of access, surprisingly so considering that until a few decades ago they were reverenced as works of authority for medical practice; but the fact seems to be that our predecessors were largely content to draw their knowledge of these authors from mediaeval Latin translations. Part of one of the most interesting authors has never been published in the original Greek, and for our knowledge of it we are dependent on a sixteenth-century Latin translation, supplemented, it may be, by fugitive consultations of codices in libraries and museums. Others of the Greek texts have not been reprinted since the sixteenth century, and bristle with the ingenious but at first perplexing shorthand contractions with which the Renaissance typographer imitated the Compendia of the manuscripts. These difficulties can be got over with patience, however, and the waste of gray matter necessary as a preliminary is not out of proportion to the results to be obtained. Even as a quarry for philological materials the medical classics are far from being worked out, and it is surprising how many words one meets with which are not to be found in the best Greek-English dictionaries. The method pursued in the present investigation was to make a complete examination of the classical medical, surgical, anatomical, and pharmaceutical writings which have been preserved to us, copying out the portions in which an instrument was mentioned. These extracts were then rearranged in ledger form, each extract being classified under the heading of the instrument it referred to. Out of the enormous number of references thus obtained, those passages were selected which seemed to throw any light on the shape and size of the instrument to which they referred. Next, an examination was made of the reports of finds in various localities; as many specimens in various museums were examined as possible; and annotations of classical texts were searched for any further information they might give. The total information thus gained is so arranged that under the heading of each instrument will be found a series of selected extracts from different authors, with the deductions from them which it is possible to make regarding the appearance of the instrument, and an illustration is given of it from some ancient specimen where such is in existence. Failing actual ancient specimens, I have fallen back on mediaeval or ancient Arabian authors for illustration. I have omitted a discussion of the many interesting mechanical contrivances for the reduction of deformities due to fracture and dislocation, and also of the splints, pads, and bandages for maintaining these injuries in position. These form such a well-defined group that they might fitly form the subject of a special monograph, and the illustrations required are of a different nature from those in the present volume. The majority of these contrivances will be found described in a chapter by Heliodorus preserved in Oribasius. I have omitted also all reference to the numerous forms of vessels in which the ancients prepared and stored their medicaments, with the exception of those which are intended for carrying on the person. Some of these merge into forms which are common to both drug and instrument cases, and it is impossible to separate them. It has been necessary also to include as far as possible the instruments involved in the preparation and application of medicaments, as most of these are either actually or potentially implements of minor surgery. The volume opens with a short account of the ancient authors whose writings have any bearing on the subject in hand. At the end of the book will be found a bibliography of reports on finds, and a list of the most interesting instruments to be found in various museums. The latter makes no pretence of being a complete inventory, although it might serve as a skeleton for the construction of a more comprehensive list at some future date. The bibliography, on the other hand, is believed to be fairly complete. The bulk of the book consists of an attempt to [Pg iv] [Pg v] [Pg vi] reconstruct, in the manner described above, the different instruments used in classical times. The books from which I have drawn most information are Brunner’s Die Spuren der römischen Ärzte auf dem Boden der Schweiz, Deneffe’s Étude sur la Trousse d’un Chirurgien Gallo-Romain du IIIe Siècle, Adams’ translation of Paulus Aegineta, and the papers of Vulpes in the volume for 1851 of the Memorie della Regale Accademia Ercolanese di Archeologia. During the five or six years which I have spent on this investigation I have unsparingly laid all my friends under contribution whenever opportunity occurred; but among those to whom I am particularly indebted I may mention Mr. M. G. Swallow of Baden, who has given me much assistance in working up the Swiss finds, Professor Alexander Ogston, under whom I spent many happy days as house-surgeon, and who has all along kept a fatherly eye on the progress of the work and encouraged me to proceed to the end with a task which at times seemed inclined to swamp me, Mr. R. C. Bosanquet, late director of the British Archaeological School at Athens, who procured for me photographs of the instruments in the Athens museum, and Mr. H. R. Nielsen of Hartlepool, who has been the companion of my wanderings among the continental museums. I have also to thank my father, John Milne, LL.D., for much help at many different points. The expense of visiting the museums in the North of France and of obtaining photographs of the instruments in them has been borne by a grant from the Carnegie University Research Fund. This monograph was presented as the thesis which forms part of the examination for the degree of M.D. of the University of Aberdeen, and it was successful in gaining ‘Highest Honours.’ Hartlepool, April 19, 1907. CONTENTS PAGES CHAPTER I Introductory 1-9 Hippocrates—Celsus—Rufus of Ephesus—Aretaeus of Cappadocia—Galen— Oribasius—Soranus of Ephesus—Moschion—Caelius Aurelianus—Aetius—Pliny the Younger—Scribonius Largus—Marcellus Empiricus—Theodorus Priscianus— Alexander Trallianus—Paulus Aegineta—Hero of Alexandria—Christian Fathers—The Arabs—Paré—Scultetus—Heister. 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. [Pg vii] [Pg viii] [Pg ix] [Pg x] 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 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 [Pg xi] 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 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). [Pg 1] [Pg 2] 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 [Pg 3] [Pg 4] [Pg 5] 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. Pliny the Younger. Plinius Secundus (Rose, Leipzig, 1875). The writings of Pliny contain little information of any kind and are absolutely of no use for our purpose. Scribonius Largus (45 a. d.). The edition I have examined is named ‘Scribonii Largi Compositiones’ and is edited by Helmreich, Leipzig, 1887. The work of Scribonius Largus is entirely pharmaceutical, but he gives many references to appliances by which medicaments were prepared in the surgery. Marcellus Empiricus (300 a. d.) wrote a work on pharmacy, of large size but little value, and in a poor style. There are a few passages bearing on implements of minor surgery. A good deal is copied from Largus. Aldus published the text by Cornarius at Venice in his collection of Medici Antiqui (1547), republished by Stephanus (Medicae Artis Principes), 1567. The edition I have used is that of Helmreich (Leipzig, 1889). Theodorus Priscianus, alias Octavius Horatianus, lived in the fourth century and has left a work, in three books, called Euporiston. It is a compilation in African Latin of extracts from Galen, Oribasius, &c. The style of the Latin is so barbarous that it really must be seen to be believed. There is a little information to be gathered about minor instruments. The edition I have used is that of Rose, Leipzig, 1894. To this edition are tacked on the medical remains of Vindicianus Afer, mere fragments without anything to interest us. The works of Alexander Trallianus (526-605 a. d.) contain practically no surgery at all, although I have managed to extract a few references of minor interest. The last of the eminent Greek writers is Paulus Aegineta, a writer who probably lived in the sixth and seventh centuries. This is getting rather late in the day, it is true, but to omit the works of Paulus, or Paul, as he is affectionately called by his admirers, would be to omit some of the most valuable knowledge of ancient medicine we possess. Paul, like most of his time, was a compiler, but he was a skilful one, and while he entirely depends on Galen, Archigenes, Soranus, &c. for his information, he has gathered up the best of the medical knowledge of his time in a little encyclopaedia whose artistic completeness and orderly arrangement are not surpassed by any work of a corresponding nature at the present day. The work is divided into seven books, the sixth of which deals with surgery and teems with information about instruments. Aldus published the entire Greek text at Venice in 1527. A fine English translation, with a most valuable commentary, was published by Adams of Banchory for the Sydenham Society in 1846. No one who reads it can wonder that Adams had a worldwide reputation for his knowledge of medical history. The important sixth book was published along with a translation in French by Briau at Paris in 1855. I have obtained a description of two very important instruments from the works of Hero of Alexandria (285-222 b. c., ed. 1575). There are a few interesting references to instruments in the works of the early Christian fathers. Tertullian is the only one of these I can claim to have systematically searched, but in one of his sermons he refers to no less than four surgical instruments, one of which is not described by any other author. It were a work of supererogation to recount the names of the other Greek and Roman writers whose works I have run through in a profitless search for references to instruments. Some of these, such as Dioscorides, are of great importance in themselves though valueless for our purpose. Others, such as many of the minor Greek writers contained in the collection by Ideler entitled Physici et Medici Graeci Minores (Berlin, 1841), and the minor Latin writers contained in the collection of Medici Antiqui Omnes (Aldus, 1547), are of little value of any kind. Before the capture of Alexandria by Omar in 651, many Greek medical writings had been translated into Syrian. At a later date such of these as had escaped destruction were turned into Arabic by the scholars of Bagdad (Honain and his School), in the ninth century. These, introduced into Spain in the Middle Ages by the Moors, were again translated into Latin and supplied for many a day the greater part of the medical knowledge of Europe, until the study of the few Greek texts which had escaped destruction showed the true origin of Arabian medicine. It will thus be seen that there is some information, in fact a great deal, to be had from the study of the works of the Arabs, but the barbarous style of the Latin and the roundabout way in which the works have been preserved, having passed through translations of three different languages, preclude any very exact deductions being drawn from them. Some of these works are profusely illustrated with figures of instruments, but I have been careful not to fall back on any of the Arabs except to support deductions drawn from more direct sources. The chief Arab writers of interest to us are:—Serapion (800), Rhases (882), and Ali Abbas (after 950), all of Honain’s School at Bagdad. The huge work of Avicenna (born 980), The Canon, was much used by the Arabs. It was published at Cordova, which became the Bagdad of the West after the Arabs crossed to Spain in 811. [Pg 6] [Pg 7] [Pg 8] The work of Albucasis (ob. 1106) was also published at Cordova, and contains much surgical information and has many illustrations of surgical instruments, but these must be used with due caution. I have used the edition published at Strasburg in 1532. A word must be said of the later writers such as Paré (1509-90), Scultetus (1650), and Heister (1739). The works of these are profusely illustrated with instruments, some of which can plainly be seen to tally exactly with the descriptions of the classical authors. In other cases, although the names given to the instruments are those of classical times, it is, to say the least, doubtful whether they are of the same form as the ancient instruments whose names they bear. That was an age of great activity in the manufacture of new forms of surgical instruments, and we must accept with caution illustrations professing to indicate ancient forms of instruments. At the same time it is very interesting to note the large number of primitive arrangements which remained in use till nearly 1800. The enema syringe figured by Heister is exactly the same as we find described in the Hippocratic works—the bladder of an animal affixed to a tube—and many practitioners alive at the present day have seen the same simple arrangement in actual use. CHAPTER II MATERIAL, EXECUTION, AND ORNAMENTATION Steel and Iron. The surgical instruments we meet with are, as a rule, of bronze. Not that the Greeks and Romans did not make many of their instruments of iron and steel, but the iron has mainly perished while more of the bronze has persisted. Long before the date of the earliest medical writings, Greece had passed into the iron age. The Homeric poems picture a civilization in the state of transition from a bronze to an iron period, and weapons such as sword, axe, and spear, are frequently described as made of iron. In the Iliad we even read of implements of agriculture made of iron, but it is ‘hard to work’ (πολύκμητος, Iliad vi. 48, Od. xxi. 10). However, by the time that Hippocrates wrote, it was in common use, and, if we had only the evidence of the Hippocratic writings to go by, we could see that it was in common use in the time of Hippocrates. Certain instruments, such as the cautery, are always spoken of as made of iron, in fact, the term for cautery is, as a rule, ‘the iron,’ and σίδηρος ὁ ὀξύς is a general term for ‘the knife’. The smelting of iron is even used as a simile by Hippocrates: ‘In the same way iron comes from stones and earth burnt together. In the first exposure to the fire stones and earth mix together with scoria, but at the second and third burning the scoria separate themselves from the iron, and this phenomenon meets the eye, that the iron remains in the fire fallen apart from the scoria, and becomes solid and compact’ (ii. 371). Again, he uses as a simile a speculative theory as to the way in which heating iron softens it and dipping it in water hardens it. He believes that this comes about by the fire depriving the iron of its nourishing substance, while the addition of water restores it. Σιδήρου ὄργανα τέχνης· τὸν σίδηρον περιτήκουσι, πνεύματι ἀναγκάζοντες τὸ πῦρ, τὴν ὑπάρχουσαν τροφὴν ἀφαιρέοντες, ἀραιὸν δὲ ποιήσαντες, παίουσι καὶ συνελαύνουσιν. ὕδατος δὲ ἄλλου τροφῇ ἰσχυρὸν γίνεται (ii. 641). ‘The instruments of ironworking soften iron by driving the fire with wind and taking away the supporting substance, and when they have rarefied it they strike and beat it. By the nourishment of water it is again strengthened.’ This is the earliest reference to tempering steel by the Greeks with which I am acquainted. It is a curious commentary on the relative destruction of iron instruments compared with those of bronze, that cauteries, which are always described as made of iron and which must have existed in enormous numbers, are among the rarest surgical instruments found. We have a few cauteries of iron, however, and some knives and knife-blades and other instruments remain. Pots for ointments of certain kinds were made of iron, and we have actually two of these which had been the property of a Roman oculist whose full name is known. I have entered into this discussion because there seems to be a general tendency to underestimate the extent to which iron was employed by the Greeks and Romans. The quantity of scoria left by the primitive founders should alone be sufficient to teach us to how great an extent iron was in use. Wherever there was good iron in any of the Roman provinces, veritable mountains of scoria are found. The heaps of scoria left in the Forest of Dean by the Roman founders contained such a large percentage of iron still remaining that they were smelted over again in later times, and to do this [Pg 9] [Pg 10] [Pg 11] occupied over twenty furnaces for a couple of centuries. Tolouse calculated that similar heaps in Gaul contained over 120,000 tons of scoria. If, however, we tend to underestimate the extent to which iron was in use among the Greeks and Romans, still more, I believe, do we tend to underrate the quantity and the quality of the steel available in those times. This comes about from the fact that in our day we require such enormous quantities of iron and steel that we have to employ iron ores of a very low quality. The greater part of the so-called steel of which battleships are made is got from a ferruginous mud with only 30 per cent. of iron, less than there was left in the scoria after the Roman founder had done with it. To the impurities already existing in this we add others, because the coal we use contains sulphur. It is getting rid of these impurities that makes the production of steel such a roundabout process with us. We forget that, with primitive methods but fine ores and a fuel devoid of sulphur, the production of steel of fine quality is as easy a process as the manufacture of iron, in fact the only difference between the method of procuring iron and steel under these circumstances is the length of time the process is allowed to go on. The ancient founders used the finest ores, often containing 75 per cent. of iron, and, working with charcoal fuel, which was nearly pure carbon, they could produce steel as easily as iron. The difference between steel and iron is that steel contains carbon, and, by allowing the ore to remain longer in contact with the charcoal, steel is formed, so that a founder setting out to make iron with a pure ore and a pure fuel like charcoal, may, if he is not careful, turn out steel of fine quality. This primitive method of making steel is still in vogue in India, Burma, Borneo, China, &c., and very fine qualities of steel are produced. The majority of the tools found in the earliest Greek colonies on the Nile—Naukratis and Daphnae—are of steel or iron, although those of the Egyptians among whom they were living (circa 600 b. c.) were of bronze. The classical medical writings themselves are sufficient evidence of the quality of the steel available in those times. Galen (ii. 683) says that the best quality of steel (which came from Norica) yielded a knife which neither blunted easily nor bent or chipped. Ἐκ σιδήρου δὲ ἔστω τοῦτο τοῦ καλλίστου, οἷόν περ τὸ Νωρικόν ἐστιν, ἵνα μήτ' ἀμβλύνηται ταχέως, μήτ' ἀνακάμπτηται ἢ θραύηται. This shows that the Greek surgeon appreciated good steel, and what I have said will show that there was plenty of it to be had. Yet modern writers almost invariably speak of or describe even the cutting instruments of the ancients as made of iron. Greek and Latin have each only one word to indicate both steel and iron, but that is because, as I have shown, they prepared both in the same way. The ancient Hindoo Vedas say that cutting instruments were to be made of steel, well polished and sufficiently keen to divide a hair. For sharpening, a stone was to be used, and they were to be kept clean and wrapt in flannel and laid by in a box of sandalwood. Albucasis in mentioning steel always specifies Indian steel. Many of the Roman shears of steel retain their spring perfectly. As an illustration of the keenness of edge which can be put by simple methods upon steel of primitive manufacture, take the following account of the operations of an African barber of the Hausa tribe, as reported in an account by Professor R. W. Reid, Aberdeen, of a Hausa barber-doctor’s outfit presented to the Anthropological Museum of the University by Sir William MacGregor, Governor of Lagos. The description of the outfit is quoted from Sir William MacGregor, who says: ‘The knife, made by an African bush blacksmith, he uses for shaving. He employs no soap to soften the skin or roughen the hair, only a little water. He sharpens his razor on a black leather strap, turning the knife on the back so deftly that the eye cannot follow the movement; the few last touches he gives to it by turning it with splendid dexterity on the front of the left arm, where the skin is worn and bare by this manipulation. He shaves the whole face, except the nose. He leaves a fine line of eyebrow. The hair is cut short. The outline of the hairy part of the scalp in front is very clearly demarcated by shaving back about a half to an inch and a half. Then he turns the front edge by a marvellous stroke. He holds the knife horizontally, and, with a downward stroke cuts off all the projecting ends of the hair round the forehead. No European barber could do it without burying his razor in the skin. He never draws blood’ (Proc. Anat. and Anthrop. Soc. Univ. Abdn., 1900-2). Bronze. Although, as I have shown, iron and steel were largely used in the manufacture of instruments, fortunately for us bronze was the metal usually selected, for thus many instruments have withstood the lapse of time which would otherwise have been oxidized out of existence. Copper is much more easily got from ore than iron, and consequently it was the first to be used by man, and very early the advantage of combining it with tin to form bronze was found out. Bronze was used by the Egyptians 6,000 years ago, and the Phoenicians, who got it from them, passed it on to the whole of Europe. The quantity of tin in the bronze is very constantly about 7½ per cent. The majority of the instruments which have been preserved to us are of bronze. Hippocrates (i. 58) says: Χαλκώματι δὲ πλὴν τῶν ὀργάνων, μηδενὶ χρήσθω. καλλωπισμὸς γάρ τις εἶναί μοι δοκεῖ φορτικὸς σκεύεσι τοιουτέοισι χρῆσθαι. ‘Use bronze only for instruments, for it seems laboured ornamentation to use vessels of it.’ [Pg 12] [Pg 13] [Pg 14] We have, however, a good many specimens of vessels which prove that physicians did not adhere to this advice. We know too that certain medicaments were intentionally stored in copper vessels. Scribonius says: Deinde in patella aeris Cyprii super carbones posita infervescit, donec mellis habeat non nimium liquidi spissitudinem atque ita reponitur puxide aeris Cyprii (Compositiones, xxxvii). Pure copper was occasionally used for instruments, and of these we have a few remaining, and vessels and instruments of it are frequently mentioned: ‘Oportet autem moveri aquam ipsam rudicula vel spathomela aeris rubri’ (Marcellus, De Medicamentis, xiv. 44). Coins were frequently made of brass (ὀρείχαλκος, orichalcum, aurichalcum), a mixture of copper, tin, and zinc, and in Pompeii there have been found two scalpel handles of brass composed of 25 per cent. of zinc and 75 per cent. of copper. The copper was got mainly from Cyprus and Spain. A small amount, however, came from Africa and Asia. Tin. Tin came mainly from Britain. We have no instruments of tin preserved to us, but they are frequently referred to. Hippocrates mentions, over and over again, uterine sounds of tin, and he also speaks of sounds and eyed probes for rectal work, which were made of tin so that they might be flexible. Vessels of tin for storing medicaments in are spoken of by Largus: ‘Reponitur medicamentum fictili vel stagneo vase’ (cclxviii). In the Museum at Chesters (Chollerford) there is a tin weight for medicines. Lead. Leaden sounds and tubes for intra-uterine medication are frequently mentioned in the Hippocratic writings, and Celsus and Paul refer to leaden tubes for insertion in the rectum and vagina to prevent cicatricial contractions and adhesions after operations on these parts. The therapists also mention medicament jars of lead. There is one in the Capitoline Museum from the temple of Aesculapius in the forum. Gold. There is in the Museum at Stockholm a forceps of gold, but it is more than probable that this is a toilet article. I have a spatula-probe which had been overlaid with gold, and I have met with several others similarly treated. Theodorus Priscianus recommends a cautery of gold for stopping haemorrhage from the throat (Logicus, xxii). Avenzoar speaks of a golden probe for applying salve to the eye and for separating adhesion of the eye to the lid. Avicenna lets out the pustules of small-pox with a golden probe. Albucasis recommends burning the roots of hairs in trichiasis with a probe of gold. Mesue recommends a heated scalpel of gold to excise the tonsil. Hippocrates binds the teeth together in fracture of the jaw with a gold wire (iii. 174): cf. Paul, VI. xcii. In one of his dialogues Lucian satirizes a medical man who sought to conceal his ignorance by a display of a fine library, bleeding-cups of silver, and scalpel handles inlaid with gold—the devices of quacks, Lucian says, who did not know how to use the instruments when necessity arose. Silver. There is a forceps of silver in the Athens Museum, and another in the Museum at Kiel. Both are, however, possibly toilet articles. Paul condemns bleeding-cups of silver, as he says they burn, so it is evident that Lucian had grounds for his statement. In the Musée de Cinquantenaire, Brussels, there is in the section of ancient surgery a bronze instrument case from Pompeii which contained a silver spoon and probe combined, a plain probe, and a grooved director, all in silver. I have frequently met with ligulae of silver and also of copper overlaid with silver, and styli, which we shall see were used as implements of minor surgery, were frequently made of silver. Medicament boxes of silver are mentioned by Marcellus. Hippocrates describes a uterine syringe with a tube of silver. Albucasis mentions silver catheters. A mixture of gold and silver, which was called electrum, was much used for coinage, and I have met with one or two ligulae of this metal. It was found mixed naturally in the mountain districts of Tmolus and Sipylus in Lydia, and it was also artificially produced by alloying the two metals. Horn. Hippocrates (iii. 331) speaks of a pessary of horn inserted into the rectum. It would seem that the tube of various syringes was often made of horn, as both Greek and Latin writers speak of the ‘horn’ of the syringe. Scribonius Largus (Compositiones, vii) says: [Pg 15] [Pg 16] Per nares ergo purgatur caput his rebus infusis per cornu, quod rhinenchytes vocatur (cf. Galen, xi. 125). Wood. Galen speaks of sounds or directors of wood, and ointment spatulae of wood are very frequently mentioned in the therapeutic works, as are also boxes for storing ointments in. Bone and Ivory. Numbers of bone ligulae were found in a Roman hospital lately excavated at Baden. In the Naples Museum there are two ointment spoons with carved bone handles. Needles such as Hippocrates and Celsus speak of for stitching bandages to fix them were very frequently made of bone and ivory. Knife handles of bone and ivory are common. A carved ivory medicament box with sliding lid will be fully described later. Scribonius Largus describes knives of bone and ivory for preparing plants for pharmaceutical purposes (Compositiones, lxxxiii). An ivory pestle was found with a surgeon’s outfit in Cologne. Stone. Medicaments were prepared on stone slabs, and the great majority of oculists’ seals were of stone. Execution and Ornamentation. The execution of the instruments is, as a rule, all that could be desired, and the weight and thickness are no more than is consistent with the requisite strength. Hippocrates points out the necessity for this:— Τάδ' ὄργανα πάντα εὐήρη πρὸς τὴν χρείαν ὑπάρχειν δεῖ τῷδε μεγέθει, καὶ βάρει, καὶ λεπτότητι. ‘All instruments ought to be well suited for the purpose in hand as regards their size, weight, and delicacy’ (i. 58). The ornamentation is simple and effective. In the round instruments like the probes it consists usually of raised circular ornamentation, with or without a secondary ornamentation on the raised ringing. In others there are longitudinal or spiral grooves running along the instrument. In some cases the bronze is decorated with an inlay of silver damascening. This is rare in the instruments from Pompeii, though there are two probes with a spiral inlay in the Naples Museum. The majority of the instruments treated in this way have been found in the western provinces, and they are of later date than the Pompeian. The handles of some scalpels belonging to the third century are beautifully inlaid with silver. Lucian, as I have mentioned, speaks of scalpels inlaid with gold. In the Mainz Museum there is a medicament box on the lid of which is inlaid a snake coiled round a tree, the tree and the snake’s body being outlined in copper and the snake’s head in silver. So far no damascened instruments are reported from Greece. Damascening began in Europe apparently in the first century, and reached its height in the time of the Merovingian kings. Examples of plated instruments are not uncommon. I have a spatula dissector thinly plated with gold, and I have met with several ligulae plated with silver. One of these was so thickly plated that on cutting into it the silver, which was deeply oxidized on the outside and was, therefore, quite black, showed also a layer of metallic silver still bright on section. All the surgical instruments found in the provinces have an air de famille which would lead one to suppose that they had been manufactured in Italy, but this is not certain. The ointment slabs, however, are rarely of the stone of the country in which they are found. On the other hand, the orthographical faults on the oculists’ seals would indicate that they were cut in the provinces. Wherever possible two instruments are combined into one. Thus very few of the probes are simple instruments but carry a spatula, a scoop or spoon, an eye, or a hook, at the opposite end. Vulsella are more difficult to combine with other instruments, but here again we meet with combinations such as vulsella at one end and scoop, raspatory, or probe, at the other. The typical scalpel handle carries at the end opposite the blade a spatula for blunt dissection. We have needles at one end and probes, scalpel blades, &c., at the other end of a handle. This combination of two instruments in one is still in use in our day. We must notice the fact that the majority of instruments we know were all of metal, not folding into hollow handles of wood, bone, &c., as the instruments of a decade ago did, so that they were easily cleaned. In fact we shall see that where the scalpel and handle were not forged in one piece they were united by something very like our aseptic joint. Hippocrates insists on the importance of keeping everything in the surgery absolutely clean. [Pg 17] [Pg 18] [Pg 19] A few instruments bear the image of deities connected with medicine, or attributes of these. The figures of Aesculapius and his daughter Hygeia are found on medicament boxes, the former with the serpent entwining his staff, the latter feeding a serpent from a bowl. The serpent is sometimes found on a probe. A uterine dilator from Pompeii also carries it. A probe surmounted by a double serpent (caduceus form) was found in the Roman Hospital at Baden. Two scalpels in the Naples Museum carry on their ends the head of Minerva Medica. The quadrivalve speculum in the Naples Museum has each end of the crossbar tipped with a fine image of a ram’s head. There is also a medicine shovel with the same symbol. Illustrations of these instruments will be found later. Preservation. Some of the instruments of silver retain their brightness as when they were made, but under certain circumstances a considerable amount of oxidation takes place, and then they have a thick black coating. Very few bronze articles are found to have retained their colour. In volcanic districts the various sulphur compounds formed give rise to a beautiful patina of varying shades of green and blue, sometimes so evenly distributed as to resemble enamel. This, when fine, much enhances the value of the article. Articles of iron are sometimes but little destroyed. It is surprising in how good condition the iron or steel may be. The bow of a shears is sometimes quite springy. In some cases a steel or iron article is often represented by a mass of oxide bearing some resemblance to the original. In others only a shapeless mass of oxide remains. Finds of Instruments. Finds of ancient surgical instruments, t...