Surgical Instruments in Greek and Roman Times Part 12

I have already referred to Galen's statement that the non-pregnant os is of such a size that it will just admit an olive-pointed probe (p. 54).

Hippocrates (ii. 836) directs us to treat hysteria by dilating the cervix, first with an ointment probe and then with the finger.

?a? ?p??e?pt??? ?a????a? ?a? ??ast???? ?a? t? ?e da?t??? ?sa?t??

?e????.

Sora.n.u.s (II. x) describes plugging for uterine haemorrhage by means of the sound:

?a? t??fe??? ????? ??? t??? t?? e??????? ????? d??????? d?? da?t????

? ???? pa?e?t???s?? t? st?at? t?? ?st??a?. ?a? p??? ????? ??te??e?

t?? a????a??a? ?pa????s??.

Hippocrates (iii. 34) alludes to applying medicament to the internal os with the sound:

'Grind the pulp of colocynth, &c., and rub it up with honey and smear it on the sound (pe?? ????) making the consistence such that it can enter the os and always be pushed beyond until it has penetrated to the interior of the uterus. When the medicament has liquefied extract the sound, and again in the same way apply elaterium.'

If pus collect in the uterus post partum, or after abortion or from any other cause, it is good practice to pa.s.s a sound (???? ?pa?e?pt??da) into the cervix (i. 471). In another place we are directed to draw off gas in the uterus by fomenting the whole body and the uterus with vinegar and water, warmed specilla being afterwards inserted (??a? d?ap?????

??????ta).

Again we find the sound applied to correct malposition of the uterus (iii.

140):

'When the s.e.m.e.n is extruded on the third day and the woman consequently fails to conceive, take small soft feathers and tie them together, and foment the uterus as we do the eyes. Make the feathers even at the tips and tie the ends with a very fine thread, and anoint with much rosaceum. Also place the patient on her back on a couch, and place a pillow under the loins, and, the woman's thighs being extended and separated, insert a sound and turn it to this side and that till it project.'

In all these cases there is no special instrument designated as being used for a uterine sound, only the spathomele (?p??e?pt???) and the olivary probe named. With both of these we have met before. However, I have thought it of historical interest to cast these pa.s.sages together. It will also clear the way for the discussion of other instruments, whose use is entirely reserved for the purpose of dilation of the cervix.

A more questionable use of the sound is referred to by many authors.

During the Empire the death of the foetus was frequently procured both by abortifacients and instruments. Frequent references to the use of drugs for this purpose may be found in the lay writers such as Juvenal and Suetonius (_Domitian_), and the later medical authors do not hesitate to describe the composition of abortifacient pessaries. It will be remembered that the Hippocratic oath specially forbids this practice.

_Uterine Dilators--Solid, graduated wooden._

Greek, d?ast??t???, ???? t?? d?ast?????sa?--t?? d?ast???a (Galen, _Lexicon_).

Besides the ordinary probes, which we have just seen that Hippocrates used occasionally for dilating the os, we have frequent mention made of a special variety of dilators which, although they are called ??? by Hippocrates, are not, strictly speaking, probes or sounds, but a graduated set of dilators of wood, tin, or lead. They correspond, in fact, to our Hegar's dilators.

Hippocrates describes these dilators (ii. 799). The patient is to have fumigations for five or six days till the cervix is softened. After these fumigations, dilators (p??s??t??) made of pieces of very smooth slipping pinewood are to be introduced into the cervix. There were six of these.

Each was six finger breadths (42 in.) in length. They ended in a point, and each succeeding rod was larger than the preceding one; the largest being of the diameter and shape of the index finger, being smaller at one extremity than the other. They should be as round as possible and with no splinters. Before being introduced they were smeared with oil. First the point was gradually introduced by rotating the dilator and pus.h.i.+ng it simultaneously till it entered for a distance of four finger breadths (28 in.). After the first rod was introduced it was withdrawn and replaced by a larger one. During the after treatment a leaden tube filled with mutton fat was left in the uterus at night, while through the day one of the pine dilators was used. Pl. XX, fig. 2 shows a specimen from Pompeii, which Vedrenes regards as a uterine dilator. It is hollow, and is ornamented to resemble the head and body of a snake.

_Metal Dilators mounted on handles of wood._

Hippocrates (i. 473) mentions a variety of dilator made of tin or lead, and hollow behind for mounting on a wooden handle:

'After douching and fumigation, dilate, and, if necessary, straighten the cervix with a dilator of tin or lead (t? ??? t? ?a.s.s?te???? ?

???da???), beginning with a fine one, and then a thicker if it be admitted, until it seems to be in proper position. Dip the dilators in some emollient. The dilators are to be made hollow behind, and fitted round rather long pieces of wood and thus used.'

This evidently refers to a portable set of dilators, each capable of fitting on a common handle, like Fritsch's, Peaslee's, or Lawson Tait's of modern times.

_Bifurcated Probe._

Greek, ??? d??????, ????.

In treating of polypus naris Hippocrates directs us to take a sponge and tie it into a hard ball, and attach a four ply thread to it. Next to pa.s.s the end of this thread by means of an eyed probe of tin till it is caught at the back of the mouth, and drawing it out of the mouth to place a bifurcated probe under the palate, and using this as a fulcrum pull until the polypus is extracted (_De Morbis_, ii. 243: ?pe?ta ????? ?p??e?? ?p?

t?? ?a??a?e??a ??te?e?d?? ???e?? ?st' ?? ??e???s?? t?? p???p??). In Galen's _Lexicon_ we find ???? explained as meaning a notched probe, split like a hoof at the point (???? d??????, ?at? t? ????? ??tet?????

?fe??? ????). And again under the heading d?????? he gives t? ????

d???a???, ?pe? ?a? d?s??d?? ???????s? t? d? a?t? ?a? d????, 'what they call cloven and also cleft.' The same word also means the notch of an arrow. In _De Morbis_ (ii. 245), Hippocrates describes another method of extracting polypus with the same instrument. Taking a piece of stringy gut (???d??) and making a loop on it pa.s.s the end through the loop, thus making a second larger one, i. e. a noose. Pa.s.s the end of the gut through the nose into the mouth with a tin probe. Pull the loop into the nose and adjust it round the polypus with a notched probe (??? t? ??tet????), and when this is done pull on the gut, using the notched probe as a fulcrum.

There must have been one form of bifurcated probe with a rounded end bearing a notch like an arrow. This is the only form of cleft probe which it would be safe to use in the back of the throat in the manner described by Hippocrates. We know, however, of other forms of bifurcated probes.

Celsus describes a bifurcated retractor used for the extraction of weapons buried in the flesh:

Saepius itaque ab altera parte quam ex qua venit recipienda est; praecipueque quia fere spiculis cingitur; quae magis laniant si retrorsus quam si contra eximatur. Sed inde aperta via caro diduci debet ferramento facto ad similitudinem Graecae litterae Y; deinde, ubi apparuit mucro, si arundo inhaeret propellenda est donec ab altera parte apprehendi et extrahi possit (VII. v).

Variant readings are V and ?. The Aldine edition has ?. The reading I have adopted is Daremberg's; but whichever is correct matters little, as all indicate a bifurcated instrument, except the Aldine, which would indicate a three-p.r.o.nged one. There are several bifurcated specilla in the British Museum (Pl. XXII). One in the Orfila Museum, Paris, of slender construction, carries a hook at the other end. It is from Herculaneum (Pl.

XXI, fig. 1). A plain variety is shown in Pl. XXI, fig. 6. The specimen shown in Pl. XXI, fig. 3 is interesting as showing a possible fallacy. It has considerable affinity to the Roman netting-needle, and may not be a probe at all. The typical netting-needle has, however, blunt points, and the planes in which the forks lie are at right angles to each other.

_Blunt Dissectors._

In his chapter on Angiology (or Division of the Temporal Blood Vessels) for headache and ophthalmia (VI. v), Paul mentions the use of dissectors:

'Having therefore first shaven the hairs of the temples we make an examination by palpation, applying warm fomentations or even a fillet round the neck, and mapping out the vessels with ink as they become apparent, we stretch the skin to either side with the fingers of our own left hand and those of an a.s.sistant, and make a superficial incision along the vessel. Then cutting down and retracting with hooks and exposing the vessel with dissectors (d?' ???e??st????) we must raise it up completely isolated. If it be small, having stretched it and applied torsion we may divide it through in such a way as to remove a piece of it at one stroke.'

The typical scalpel handle ends in a leaf-shaped dissector, and Celsus always describes blunt dissection as being performed with the manubriolus of the scalpel. We have, however, a few dissecting manubrioli as separate instruments not designed to carry scalpel blades. Three were found together in the grave of the surgeon of Paris. There are also two in the museum of St-Germain-en-Laye, and one in the Museum at Mainz. We may take as types two from the find of the oculist Severus in the St-Germain-en-Laye Museum (Pl. XX, figs. 3, 4). They consist of elongated leaf-shaped blades carried on hexagonal handles, and are exactly similar in appearance to a scalpel handle, except that they do not carry a slot for the insertion of a blade.

_Curved Dissectors._

Greek, ?d????????? ??p?????.

On the cure of hydrocele Paul (VI. lxii) says:

'When the fluid is in the tunica v.a.g.i.n.alis we make the incision where the apex of the tunica makes its appearance, and, separating the lips of the incision with a hook, and having dissected off the fascia with the hydrocele specillum and the scalpel (???e??sa?te? t? te ?d???????? ??p???? ?a? t? s????), we divide it through the middle with a lancet.'

Treating of the excision of varices (VI. lx.x.xii) he says:

'Having separated the lips of the wound with hooks, and dissected away the fascia with curved hydrocele specilla, and laid bare the vein and freed it all round' (?d?????????? ?p??ap?s? ??pa?????).

A curved dissector from the find of the oculist Severus, now in the Museum of St-Germain-en-Laye, has a neatly ornamented handle with a small hook at one end, and at the other it curves first backward and then forward to join a small leaf-shaped dissector 3 cm. long and 1 cm. in its greatest breadth (Pl. XXIII, fig. 2).

_Sharp Hooks._

Greek, ????st???, ?????????; Latin, _hamus_, _hamulus acutus_.

Hooks blunt and sharp are frequently mentioned in both Greek and Latin literature, and served the same purposes as we use them for; the blunt for dissecting and raising blood-vessels like the modern aneurism needle, the sharp for seizing and raising small pieces of tissue for excision, and for fixing and retracting the edges of wounds. We are fortunate also in possessing many fine specimens of both sharp and blunt hooks in museums, &c. In the Naples Museum alone there are upwards of forty examples of hooks. Of pterygium Celsus says: