Surgical Instruments in Greek and Roman Times Part 2

_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:--

??d' ???a?a p??ta e???? p??? t?? ??e?a? ?p???e?? de? t?de e???e?, ?a?

??e?, ?a? ?ept?t?t?.

'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.

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. Ill.u.s.trations 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 circ.u.mstances 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 ma.s.s of oxide bearing some resemblance to the original.

In others only a shapeless ma.s.s of oxide remains.

_Finds of Instruments._

Finds of ancient surgical instruments, though not by any means common, are still sufficiently numerous for specimens to have found their way into most of our larger museums; and private collectors have here and there acquired considerable numbers. The most prolific source has been the excavations at Herculaneum and Pompeii, which have now been systematically pursued for nearly three hundred years, while the objects found have been deposited in the National Museum at Naples. In 1818 a physician's house with a large number of surgical instruments was discovered in the Strada del Consulate of Pompeii, and two chemists' shops have also been found with instruments in them. Besides these there is a large number of instruments from other finds in the two buried cities.

The custom of burying personal effects along with the ashes of a deceased person, which prevailed among the Romans from the second to the fourth century, has preserved to us a number of interesting finds. In 1880 M.

Tolouse, a civil engineer in Paris, in executing some alterations in the neighbourhood of the Avenue Choisy, discovered the grave of a surgeon, containing a bronze pot full of surgical instruments. Among these were numerous forceps and vulsella, ointment tubes, bleeding cup, scalpel handles for blades of steel, probes, and spatulae. Sixty-six coins of the reigns of Tetricus I and II showed that the grave belonged to the end of the second or the beginning of the third century. The find was reported by M. Tolouse in a volume ent.i.tled _Mes fouilles dans le sol du vieux Paris_ (Paris, 1888). In 1892 the find was fully described by Professor Deneffe of Ghent, in the _Revue Archeologique_, under the t.i.tle 'Notice descriptive sur une trousse de medecin au III{me} siecle', and reprinted, with photogravures, in 1893 in a monograph _etude sur la trousse d'un chirurgien Gallo-Romain du III{me} siecle_ (Antwerp, 1893). It is convenient to refer to this find as that of the 'Surgeon of Paris'.

Another grave containing surgical instruments was found at Wancennes in the canton of Beauraing, Namur, in a cemetery of the first or second century. The instruments are now in the Archaeological Museum at Namur (Deneffe, op. cit., p. 35).

In 1854 there were discovered at Rheims the remnants of a wooden chest containing two little iron jars for ointments, several scalpel handles, a small drill, eight handles for needles, five hooks (two blunt and three sharp), two balances, various probes and spatulae, seven forceps, medicament box, a mortar, and a seal showing that the instruments had belonged to an oculist named Gaius Firmius Severus. The instruments are all of the most beautiful pattern and finish, several being finely inlaid with silver. Some coins of the reigns of Antoninus Pius and Marcus Aurelius showed that the interment belonged to the end of the third century.

These instruments, &c., are now in the Museum of St-Germain-en-Laye. The majority of these will be found described and figured later.

Find of s.e.xtus Polleius Sollemnis, oculist of Fonviel, Saint-Privat-d'Allier. In levelling a heap of earth which had fallen from a cliff above as the result of a landslide, there were found at Fonviel in 1864 a number of bronze surgical instruments. The place where they were found is at the intersection of two old Roman roads, and the instruments had been buried in the grave of a Roman surgeon high up above the valley on the edge of a cliff. Eighteen coins of the reigns of Julia Augusta, Trajan, Hadrian, Commodus, Gordian, Philip, Valerian, and Gallus, showed that the interment had been made at the end of the third century. The instruments found included three scalpel handles, fragments of two forceps, and an oculist's seal in stone showing that the grave was that of s.e.xtus Polleius Sollemnis. Many more instruments had probably been buried originally. Those enumerated are now in the Museum of Le Puy-en-Velay. An account of this find, with ill.u.s.trations, is to be found in the _Annales de la Societe d'Agriculture, Sciences, Arts et Commerce du Puy_ (tome xxvi. 1864-5). It is also described, along with the find of Gaius Firmius Severus, in a monograph by Deneffe, under the t.i.tle of _Les Oculistes Gallo-Romaine au III{me} siecle_ (Antwerp, 1896).

One of the most prolific finds of late years has been the discovery of a Roman military hospital at Baden, the ancient Roman station of Aquae, or Vicus Aquensis. From time to time isolated discoveries of instruments had been made, including a catheter, a scalpel, and several varieties of probes, and in March, 1893, MM. Kellersberger and Meyer proceeded to excavate systematically the remains of some Roman buildings on their property. A large chamber 1035 metres by 125, with walls 60 cm. thick, was discovered, and later others were discovered varying from 3 to 27 metres in length. There were in all fourteen rooms. Along the side of the building on which a Roman road ran, there were the remains of an imposing facade, running the whole length of the building. It had consisted of a portico with colonnades, the foundations of which were found at regular intervals. It is possible that some of the larger rooms had been subdivided into others by thin walls or part.i.tions, for fragments of part.i.tions of plaster with wood lathing were found.

A large number of objects--tiles, lamps, vases, pots, knives, spearheads, nails, gla.s.s, fibulae, beads, weavers' weights, three amphorae a metre high--were found near the surface. Then, at a depth of two metres, surgical instruments began to be found. These included probes to the number of 120, unguent spoons in bone and bronze, a fragment of a catheter 13 cm. long, bronze boxes for powder, needles, earscoops, unguentaria, spatulae, a fragment of an etui for instruments, and cauteries. Many coins of the reigns of Claudius, Nero, Domitian, Vespasian, and Hadrian were found, showing that the hospital had been in use between 100 and 200 A. D.

The objects mentioned are still the private property of MM. Kellersberger and Meyer. In 1905, by the kindness of these gentlemen, I was allowed to make a complete examination of the collection.

A case containing a surgeon's outfit was found in the Luxemburgerstra.s.se, Cologne. It contained a phlebotome, a chisel, and some fragments of other instruments of steel, two forceps and two sharp hooks in bronze, and a small ivory pestle-like instrument. These are now in the Cologne Museum.

This is a most interesting and important little find. The phlebotome is by far the best preserved and best authenticated example which we possess of this instrument. Probably the same may be said of the chisel as a purely surgical instrument.

CHAPTER III

KNIVES

The surgical knife had, as a rule, the blade of steel and the handle of bronze. We find specimens all of steel or all of bronze but these are exceptional forms; and hence it happens that many more handles than blades have been preserved to us, as usually the blade has oxidized away leaving no trace of its shape. It will be well, therefore, to commence with the study of the handle.

The scalpel handle consists, as a rule, of a bar of bronze, which may be round, square, hexagonal, or trapezoidal in section. At one end there is a slot to receive the steel blade, varying in depth from 2 cm. in the larger, to 1 cm. in the smaller, instruments. The other end of the handle carried a leaf-shaped spatula to act as a blunt dissector. A groove is often formed near the end of the handle, or the end is raised into a cylindrical roll on each side, and this roll again is sometimes perforated with a hole.

It is generally believed that the blades were fixed in the handle by a binding thread or wire, and that the rolls and perforations were to give security to the mounting used. This detachable arrangement would allow of removal for cleaning, and also permit one handle to be used with several varieties of blade. A consideration of the slots in a large number of handles leads me to believe, however, that this was, to say the least, not the usual arrangement. The proportion of the depth of the slot to the size of the blade to be supported is in most cases not large enough to allow of a temporary mounting to fix the blade firmly, and I believe that most blades were either luted or brazed in permanently. These processes were well known to the ancients, and in fact we have them in evidence in other surgical instruments. Those bleeding-cups from Pompeii which carry rings on their summits have the top part brazed or soldered on. Galen (ii. 717) alludes to the blowpipe which goldsmiths used, and Paulus Aegineta has a chapter on the fluxes used by these artists. We frequently meet with ornaments fixed on boxes by means of solder.

On the other hand, the slot in some handles expands at its termination into a wider portion which would carry a cylindrical expansion on the other end of the blade. This form of blade could not be pulled outwards, and might well be fixed with a temporary mounting.

Different varieties of handles are shown in Plates I-III. Some are beautifully damascened with silver. These are mostly of the third century, but Sambon reports some damascened handles of the first century. A rare form is seen in a specimen in the Museum at Le Puy-en-Velay, where the handle is round and decorated with a spiral band of silver inlaid round it. It is from the find of the oculist Sollemnis (Pl. II, fig. 6).

A few variations from the characteristic combination of handle and spatula-shaped dissector occur. Thus we have a handle ending in a conical point (Pl. II, fig. 7), which Deneffe regards as a drill for perforating the nasal septum in cases of fistula lachrymalis. Archigenes describes this operation, and the handle was found in the grave of the oculist Severus. Along with it were found two other handles, which, instead of a spatula, had carried a steel needle (Pl. II, figs. 1, 2). The needles have disappeared of course, but there are the holes to receive them. In other cases the handle was round, and either quite plain or ornamented with raised rings. Some of these ended in a small round k.n.o.b (Pl. V, fig. 2).

Others carry the head of Minerva Medica like the spoon in Pl. XX, fig. 5.

There are three of these handles in the Naples Museum. Rufus of Ephesus describes a lithotomy knife which had a scoop at the end of the handle with which to extract the stone. An example of this is seen in the box of scalpels from Athens (Pl. IV).

_The Blade._

For the study of the different varieties of blade we have at our disposal first of all the specimens that have actually survived. Of these the largest number are to be seen in the Naples Museum, but a considerable number are to be found scattered over various museums. An _ex voto_ tablet found on the site of the temple of Aesculapius on the Acropolis at Athens shows a box of scalpels, among which are some interesting forms (Pl. IV).

The scalpels, it will be noted, are arranged head and tail alternately. A few varieties are actually described in detail in the cla.s.sical authors, and, by piecing together other references to particular instruments and drawing inferences from the various uses to which we find them put, we are able to describe a surprisingly large number of forms. The sixteenth-century writers, such as Pare, and seventeenth-century writers, such as Scultetus, ill.u.s.trate with great confidence many of the cutting instruments mentioned by ancient writers, but it is easy to show that in several instances they are wrong, and, therefore, I have drawn on them as little as possible.

As a basis of cla.s.sification we may select the following points about the blade. The form may be straight or curved. There may be only one cutting edge or there may be two, and the point may be sharp or blunt. We shall examine combinations of these in the following order:

I. Blade straight-- (A) Cutting on one side only (_a_) sharp-pointed, (_b_) blunt-pointed.

(B) Cutting on two edges (_a_) sharp-pointed, (_b_) blunt-pointed.

II. Blade curved-- (A) Cutting on one edge (_a_) sharp-pointed, (_b_) blunt-pointed.

(B) Cutting on two edges, sharp-pointed.

I. A (_a_) _Straight blade cutting on one edge, sharp-pointed._

1. Ordinary scalpel.

2. Scalpel with tip turned back.

3. Bellied scalpel.

4. Scolopomachaerion.

_Ordinary Scalpel._