Surgical Instruments in Greek and Roman Times Part 8

Here Briau reads p????a (an olivary point), but the balance of the evidence of the codices is in favour of d?ap??????, and the parallel to the pa.s.sage quoted from Galen is so complete that I have no hesitation in adopting the reading given above.

I give an example of the dipyrene from my own collection. It is 112 cm.

long. The shaft is unequally divided by a ringed fluting into two portions; 45 cm. and 67 cm. long respectively. The shorter portion of the shaft is plain, the longer is grooved longitudinally by eight grooves (Pl. XI, fig. 1). In many instances the dipyrene carried an eye in one of its olives. This variety is frequently mentioned. Thus Paul (VI. xxv) says, under treatment of nasal polypus:

'Taking then a thread moderately thick like a cord, and having tied knots on it at the distance of two or three finger-breadths, we introduce it into the eye of a dipyrene (d?p?????? t??at?), and we push the other end of the probe (t? ?te??? p??a? t?? d?p??????) upwards to the ethmoid openings, withdrawing it by the palate and the mouth, and then pulling with both hands we, as it were, saw the fleshy bodies away by means of the knots.'

Pl. XI, figs. 5 and 3 show single olive probes for the application of semi-solid medicaments. The former is from the outfit of the oculist of Rheims, in the Museum at St-Germain-en-Laye; the latter, more highly ornamented by spirally twisting the stem, is from my own collection.

_Spathomele or Spatula probe._

Greek, ?p??e?pt???, spa?????; Latin, _spathomele_ (Theodorus Priscia.n.u.s), _spathomela_ (Marcellus); German, _Spatelsonde_.

Almost every medical writer mentions the spathomele. It consists of a long shaft with an olivary point at one end and a spatula at the other. Galen (_Lex._) calls the one st???????? ????, the other ??? p?ate?a. It was a pharmaceutical rather than a strictly surgical instrument. The olive end was used for stirring medicaments, the spatula for spreading them on the affected part or on lint. Galen (xiii. 466) says that certain applications are to be softened in the hand with rosaceum by means of the spathomele (a???a? ?p? t?? ?e???? d?? spa??????).

Marcellus frequently refers to it as used for stirring liquids in a vessel:

Immo manu vel digitis moderantibus paulatim insperges et adsidue spathomela commovebis et permiscebis, post haec omnia mittes oleum chamaemelinum, et iterum igni non nimio adposita olla lente et paulatim decoques medicamen, ita ut illud manu non contingas, sed spathomela agites (vii. 19).

In xiv. 44 he mentions a spathomele of copper:

Oportet autem moveri aquam ipsam rudicula vel spathomela aeris rubri.

The following pa.s.sage from Theodorus Priscia.n.u.s refers to its use for applying ointment to an affected part:

Si veluti carbunculus innatus fuerit, lycium c.u.m melle contritum suppono frequenter per diem et spathomela temptante (_Euporiston_, xxvii).

Aetius (II. iv. 16) directs a particular medicament to be rubbed in and to be sc.r.a.ped off after a moderate s.p.a.ce of time with a spathomele (t?

spa?????).

The spathomele was used by painters for preparing and mixing their colours. The very large numbers in which they are found would indicate that their use was not confined to medical men.

Although the nucleus of the spathomele was too large to admit of its use as a probe for small lesions, it is evident that in exploring large cavities it must have been a valuable instrument. Galen (ii. 712) says:

'In small bodies the opening into the torcular Herophili may not be large enough to admit a spathomele nucleus, and therefore we must try some of the other olivary probes or even an ear probe, and cut alongside it.'

Priscia.n.u.s alludes to plugging the nares with it:

Prius spathomeles extremo in baca molli lana obvoluto glebas sanguinis e naribus frequentius purgare nos convenit, post lana identidem obturando perclaudere (xiv).

'First of all we must frequently wipe away the clots of blood from the nose with the end of a spathomele wrapped on the 'berry' with soft wool, and then occlude it by plugging with wool in the same way.'

From Leonidas (Aetius, VI) we learn that it was used as a tongue depressor. He says:

'In inflammation of the throat in adults seat the patient, open his mouth and depress the tongue with a tongue depressor or a spathomele, and open the abscess with a scalpel or a needle-knife.'

The following pa.s.sage from Galen shows that it was used as a subst.i.tute for the meningophylax (_q. v._):

'Having separated the pleura from the rib and placed a thin meningophylax or a flat spathomele (spa?????? p?ate?a?) between the ribs, and taking care that you neither tear nor perforate the membrane, which being properly accomplished, cut the bone of the rib with two chisels placed opposed to each other' (ii. 686).

Sora.n.u.s (xxvii) refers to its use as a cautery:

'After cutting off the umbilical cord, cauterize the umbilicus with a heated reed, or the flat of a probe' (t?? p??te?? t?? ????).

An interesting pa.s.sage in Aetius shows that it was used as a dissector in opening up an occluded v.a.g.i.n.a:

'Pa.s.s a sound into the cervix, and dissect with the spathomele below the spot marked out by the sound' (Aet. IV. iv. 96).

This probably means blunt dissection only, as none of the spathomeles found have edges sharp enough to be actually cutting. Large numbers of this instrument have been found. It is the commonest surgical instrument in museums. It must be remembered, however, that not every spathomele is a surgical instrument strictly speaking, as pharmacopolists and even artists used exactly similar instruments.

The average length of twenty specimens measured by me was 16 cm. Of this the nucleus occupies 15 cm., the spatula 6 cm. The average diameter of the nucleus is 75 mm. The width of the spatula averages 15 mm., but the size and shape of the spatula both vary considerably.

The different varieties of shape will be better understood by a reference to the accompanying figures of actual specimens than from a written description. Pl. XII shows neatly formed specimens from various sources; the specimen shown in fig. 3 having ornamental grooves along the length of the shaft. Figs. 3 and 4, Pl. XIII show coa.r.s.e, thick specimens, which are most likely to have been used for non-medical purposes. All have the characteristic oar-blade shape, though the outline varies greatly. In some the blade widens out at the end, so that the tip is broad and rounded. In others the blade slopes to a rounded point, or the point is quite acute.

The edges of the blade are usually thick and blunt. In some specimens, however, the edges are thin, sharp, and almost suitable for use for cutting with. These are well adapted for use as blunt dissectors.

The shaft, as a rule, is plain, occasionally it is ornamented with longitudinal or spiral fluting. More rare is a silver band, inlaid in a spiral round the shaft. I have seen a few specimens which have been entirely plated with gold.

Hitherto I have taken no notice of spathomeles in which the spatulae are not flat. In many specimens, however, the blades are hollowed. For these it seems advisable to const.i.tute a special cla.s.s, which may be called the cyathiscomele cla.s.s.

_Cyathiscomele._

German, _Loffelsonde_.

Although this variety of the spathomele is not one which is specially mentioned by any cla.s.sical writer, it is convenient to have a name by which we can denote that variety of the spathomele in which the blade is not flat.

It has the same large oval nucleus as the flat spathomele, and the same shaft, plain, or fluted, or overlaid with silver, but the spatula is replaced by a spoon, the outline of which shows the same variety of form as we met with in the spatula. The depth of the spoon varies greatly. Pl.

XIV, fig. 3 shows an instrument in which the two lateral halves of the blade, instead of lying exactly in the same plane, meet in the midline at a slight angle so as to form a cavity obtusely angular on cross section, and gently rounded on longitudinal section:

Cross sec. [Ill.u.s.tration]

Long. sec. [Ill.u.s.tration]

Pl. XV, fig. 1 shows a similar arrangement, except that the cavity is more marked, and the tip instead of being sharp is rounded. In Pl. XIV, fig. 1 the cavity is so marked that a typical spoon is formed. This specimen is interesting as showing the ornamentation of the shaft by overlaying a spiral silver wire. It is from the Naples Museum, and it is figured by Vulpes. Other varieties are seen in Plates XIV, XV. Pl. XV, fig. 4 shows a very coa.r.s.e, thick specimen. The scope of the cyathiscomele in medical art is evidently like the flat spathomele to act occasionally as a sound, but mainly to mix, measure, and apply medicaments. Some are adapted for use as curettes. But the large number in which this instrument occurs would of itself indicate that it was used for lay as well as medical purposes. Many are toilet articles. An interesting discovery of two typical specimens in the grave of a lady artist was made in Vendee in 1847. Among a number of colour pots and alabaster mortars for rubbing down and mixing colours was an etui similar to the typical cylindrical instrument case of the ancient surgeon, and in this were two spoon probes like the one shown in Pl. XIV, fig. 1. Evidently they were favourite instruments of the painter, and had been used by her for mixing and preparing her colours.[2]

[2] Blumner, _Technologie und Terminologie der Gewerbe und Kunste bei Griechen und Romern_, vol. iii. p. 458.

The form of cyathiscomele, in which the two lateral halves of the scoop meet at an angle (Pl. XIV, fig. 1), has a tendency to split along the ridge in the middle of the scoop if roughly handled. One of these, to which this accident has happened, is in the Naples Museum (Pl. XV, fig. 3) and has an interesting history. In 1847 Vulpes described it as a guard for dividing the fraenum linguae, and successive writers have copied this ever since, and it is so described in the catalogue. As the photograph shows, it is only a spoon probe which had been trod on or otherwise damaged, and which had split down the centre, or rather near the centre, for the crack has deviated at its termination from the midline. The termination of the notch thus formed has quite a different appearance from the figure by Vulpes. The accident is not an uncommon one. There is in the Capitoline Museum an instrument to which precisely the same has happened, and I have a probe in my own possession which has split, and which with a little manipulation would make a beautiful duplicate of the one in the Naples Museum (Pl. XV, fig. 1). It is almost certain that the guard is quite a modern invention.

Many ancient writers point out the danger of wounding the vein, but none mention the guard. Thus Celsus says:

Horum extrema lingua vulsella prehendenda est, sub eaque membrana incidenda: magna cura habita ne venae quae iuxta sunt violentur et profusione sanguinis noceant (VII. xii).

Paul says:

'The patient is to be placed in a proper seat, the tongue is to be raised to the roof of the mouth and the membranous fraenum cut transversely. But if the curvature is occasioned by a cicatrix we transfix the callus by a hook and draw it upwards, and making a cross incision free the bent parts, taking care not to make deep incisions of the parts, for haemorrhages, which have been found difficult to stop, have thereby been occasioned' (VI. xxix).

Aetius gives a similar account.