CHAPTER V

Hieme saepius fascia circumire debet: aestate quoties necesse est. Tum extrema pars eius inferioribus acu assuenda est; nam nodus vulnus laedit, nisi tamen longe est (V. xxvi).

The round sewing needle was therefore part of the recognized outfit of the surgeon, and numbers have been found associated with surgical instruments. Apart from this association with other instruments it is quite impossible to distinguish them from domestic needles. The same may be said of bodkins, as these too occur in surgical finds, and are also quite indistinguishable from the domestic articles for embroidering.Pl. XVII, fig. 2shows a bronze needle from Roman London. A similar one from Pompeii, now in the Naples Museum, is given by Vulpes as a surgical needle, owing to the fact that it was found along with surgical instruments; but it is evident that it is only a needle for sewing bandages, &c.

Other types of needles and bodkins are found in bronze, but many also are of bone and ivory. Even the latter are quite serviceable, and in spite of their being comparatively thick will stitch compact cloth easily. An ivory needle from Roman London is shown inPl. XVII, fig. 5.

Eyed Probes.

We have frequent references to eyed probes, and we also possess a considerable number of different types. In dealing with the dipyrene I quoted a passage to show that it sometimes carried an eye in one of its olives. Hippocrates refers to an eyed probe of tin. In treating of fistula he directs us to take a rod of tin having one end pierced with an eye (μήλην κασσιτερίνην ἐπ' ἄκρου τετρημένην), and having put one end of a twisted piece of lint through the eye put the probe into the fistula, get the end of the specillum, bend it and hold the thread with the finger and withdraw the ends. Paul quotes this passage (VI. lxxvii), but alters the wording slightly:

‘Hippocrates directs us to pass a thread consisting of five pieces through the fistula by means of an eyed probe or a dipyrene’ (διὰ τετρημένου κοπαρίου ἢ διπυρήνου).

Again in polypus naris (ii. 243) Hippocrates directs us to cut a sponge to the shape of a ball and tie the ball round with thread, and make it hard and of such a size as to fill the nose. To the sponge tie a thread of four pieces, each a cubit long, and make one thread of them. Put the end through a fine tin rod having an eye at the end. Push the rod bent at an acute angle into the mouth, and catch the end of the thread under the palate and pull it through, propping it with another hoof-like probe, and extract the polypus.Pl. XVII, fig. 1shows an eyed probe from the Baden Hospital. Its shape is exactly the same as a lead probe figured by Paré for the insertion of the apolinose.

An example of a scoop at one end and an eyed probe at the other was found at Augst, and is now in the Museum at Basle (Brunner, loc. cit., Taf. I, fig. 14). It is 16 cm. long, of which the spoon, slightly defective at its tip, occupies 3 cm. About 2 cm. from its tip, which is fine, there is an elongated eye, 5 mm. in length.

Various other combinations are met with.

Ligula type of Specillum.

Greek, κυαθίσκος; Latin,ligula.

Ligulae are found in enormous numbers and in very great variety. They are toilet articles for extracting from tubes and boxes ointment, the various salves, balsams, and powders which entered into the mysteries of the Roman lady’s toilet. The ligula is therefore not strictly speaking a surgical instrument, but as it was used by the laity, and no doubt also by physicians, for making applications to affected as well as to unaffected parts, and as it is often found associated with surgical instruments, it is advisable to bring it within the scope of this investigation. It is also convenient to do so, because some varieties approach so closely in form to the true surgical specilla that it is often difficult to decide which class to place a particular specimen in. In doubtful cases it is well to remember that the specillum is most usually a combination of two instrumentson one shaft. Brunner (loc. cit.) figures a number of ligulae from the Swiss museums. These he names specilla oricularia, although admitting that they are only domestic articles. I have shown, however, that the specillum oricularium is a well-defined combination of scoop and probe.

Plate XVIIIshows a variety of ligulae from various sources, some simple, some combined instruments. Figs. 4, 5, 8 are most typical forms. Some of this simple type are two feet in length. They are often overlaid with gold. Fig. 7 shows a ligula which has so been treated. It carries a small fork on which to poise a pellet of semi-solid medicament.

Spoons for measuring, preparing, and pouring medicaments.

A type of spoon not uncommonly met with has a round bowl about 2 cm. in diameter, and a handle of about 10 cm. long. Usually they are of bronze; but occasionally they are of silver, and a considerable number in bone were found in the Roman Hospital at Baden. They are for measuring medicaments, heating them, and removing them from unguentaria, &c. They are often found alongside the glass unguentaria which contained the salves. They were also used for religious purposes.

Similar spoons with pointed handles are common in finds of domestic articles. The sharp end is for extracting shellfish, &c. A larger variety of the unguent spoon has a spout to assist in pouring the contents. This variety is rather rare.

Pl. XIX, fig. 4is from the British Museum. The bowl is 2.5 cm. in diameter and the handle is 15 cm. long. The handle is round, and it has a small ringed ornamentation at its end and one close to the bowl. The bottom has been thinned out with heat, and there is a small perforation visible in it. A similar spoon was found in the grave of the Paris surgeon. Traces of medicament remain on it. This type is probably intended for warming salves and pouring them into the eye and other affected parts. Another varietyis seen inPl. XIX, fig. 1. This specimen is in the Naples Museum, and was found along with the spatula shown inPl. XIX, fig. 2. The handles of each are of bronze, the scoop and spatula parts are of silver. Vulpes describes these as a lancet for drawing blood and a spoon for collecting and examining the same. It is impossible to regard an instrument of silver as a cutting instrument. These are for mixing and spreading medicaments. A large spoon of a peculiar shape from the Naples Museum is seen inPl. XIX, fig. 3. It is of silver. The handle, which is of ivory, is ornamented with spiral carving, and the end bears a ram’s head. Another interesting little shovel from the same museum is of bronze, and carries the head of Minerva Medica on the end of the handle (Pl. XX, fig. 5). We may here include the large double spatulae of the type shown inPl. XX, fig. 1, which represents a specimen from Naples. A similar one was found in the outfit of the Paris surgeon, and Scultetus shows precisely similar instruments in use in his time for applying the stiffening to the bandages, &c. for setting fractures. The Romans probably used theirs for a similar purpose.

Tongue Depressor.

Greek, γλωσσοκάτοχος.

To open a quinsy Aetius says (II. iv. 45):

‘If the patient is adult, seat him and make him open his mouth, and depress the tongue with a spathomele, or a tongue depressor, and open the abscess with a probe or a needle knife.’

In excision of the tonsil Paul (VI. xxx) bids us seat the patient in the sun and depress the tongue with a tongue depressor (γλωσσοκατόχῳ).

Pl. XX, fig. 6shows one of six bronze tongue depressors, burnished like small mirrors, from the Lépine collection (Védrènes,Celse).

Uterine Sound.

The uterine sound is frequently mentioned by Hippocratesfor correcting malpositions of the uterus, and dilating and applying medicaments to the interior of the cervix. After falling into disuse in the middle ages it was reintroduced by Sir J. Y. Simpson, only to disappear once more almost entirely from sight.

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.

Καὶ ὑπάλειπτρον καθιέναι καὶ ἀναστομοῦν καὶ τῷ γε δακτύλῳ ὡσαύτως λειοῦν.

Soranus (II. x) describes plugging for uterine haemorrhage by means of the sound:

Καὶ τρυφερὸν ἔριον ἑνί τινι τῶν εἰρημένων χυλῶν διάβροχον διὰ δακτύλου ἢ μήλης παρεντιθέσθω τῷ στόματι τῆς ὑστέρας. καὶ πολὺ μᾶλλον ἐντεῦθεν τῆς αἱμορραγίας ὑπαρχούσης.

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 (περὶ μήλην) 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 pass a sound (μήλην ὑπαλειπτρίδα) 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 (μήλας διαπύρους ἐμβάλλοντα).

Again we find the sound applied to correct malposition of the uterus (iii. 140):

‘When the semen 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 (ὑπάλειπτρον) and the olivary probe named. With both of these we have met before. However, I have thought it of historical interest to cast these passages 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, διαστομωτρίς, μήλην τὴν διαστέλλουσαν—τὸν διαστολέα (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 μήλη 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 patientis to have fumigations for five or six days till the cervix is softened. After these fumigations, dilators (προσθέτων) 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 (4·2 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 pushing it simultaneously till it entered for a distance of four finger breadths (2·8 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. 2shows a specimen from Pompeii, which Védrènes 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 (τῇ μήλῃ τῇ κασσιτερίνῃ ἢ μολυβδαίνῃ), 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, μήλη δικροῦς, χηλή.

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 pass 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: ἔπειτα χηλὴν ὑποθεὶς ὑπὸ τὸν γαργαρεῶνα ἀντερείδων ἕλκειν ἔστ' ἂν ἐξειρύσῃς τὸν πώλυπον). In Galen’sLexiconwe find χηλή explained as meaning a notched probe, split like a hoof at the point (μήλην δικροῦν, κατὰ τὸ ἀκρὸν ἐκτετμημένην ἐμφερῶς χηλῇ). And again under the heading δικροῦν he gives τὸ οἷον δίκρανον, ὅπερ καὶ δισχιδὲς ὀνομάζουσι τὸ δὲ αὐτὸ καὶ δηλοῖ, ‘what they call cloven and also cleft.’ The same word also means the notch of an arrow. InDe Morbis(ii. 245), Hippocrates describes another method of extracting polypus with the same instrument. Taking a piece of stringy gut (χορδήν) and making a loop on it pass the end through the loop, thus making a second larger one, i. e. a noose. Pass 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 (μήλῃ τῇ ἐντετμημένῃ), 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 Λ. The Aldine edition has ψ. 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-pronged 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 inPl. XXI, fig. 6. The specimen shown inPl. XXI, fig. 3is 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 assistant, and make a superficial incision along the vessel. Then cutting down and retracting with hooks and exposing the vessel with dissectors (δι' ἐξυμενιστήρων) 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, ὑδροκηλικὸν κοπάριον.

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

‘When the fluid is in the tunica vaginalis 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 (ἐξυμενίσαντες τῷ τε ὑδροκηλικῷ κοπάριω καὶ τῷ σμιλίῳ), we divide it through the middle with a lancet.’

Treating of the excision of varices (VI. lxxxii) 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’ (ὑδροκηλικοῖς ἐπικαμπέσι κοπαρίοις).

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, ἄγκιστρον, ἀγκυρομήλη; Latin,hamus,hamulus acutus.

Hooks blunt and sharp are frequently mentioned in bothGreek 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:

Tum idem medicus hamulum acutum, paulum mucrone intus recurvato, subiicere extremo ungui debet eumque infigere; atque eam quoque palpebram tradere alteri; ipse, hamulo apprehenso, levare unguem eumque acu traiicere linum trahente (VII. vii).

Aetius also mentions this use of the sharp hook:

‘And, transfixing the pterygium with a hook (καὶ ἀγκίστρῳ καταπείροντες περὶ τὰ μέσα τὸ πτερύγιον), we gently make traction on it’ (Tet.II. iii. 60).

Paul also says:

‘Seizing the pterygium with a hook with a small curve, (ἀγκίστρῳ μικροκαμπεῖ ἀναδειξάμενοι) we stretch it’ (VI. xviii).

The method of excision of the tonsil described by Celsus, Aetius, and Paul is to bring the tonsil into view by dragging on it with a sharp hook and then amputating it. Thus Paul says:

‘Wherefore seating the person in the light of the sun, and, directing him to open his mouth, while one assistant holds his head and another presses down the tongue to the lower jaw with a tongue depressor we take a hook (ἄγκιστρον) and transfix the tonsil with it and draw it outwards as much as we can without drawing the capsule along with it, and then we cut it out by the root with the tonsil knife suited to that hand’ (VI. xxx).

In contraction of the vulva, Paul says:

‘Having transfixed the connecting body, whether flesh or membrane, with hooks, we stretch it and divide it with the fistula knife’ (VI. lxxii).

Similarly Celsus (VII. xxviii) says:

At si caro increvit, necessaria est recta linea patefacere; tum ab ora, vel vulsella vel hamo apprehensa, tamquam habenulam excidere.

In dissection, many of the manipulations which we perform with the dissecting forceps were performed by the ancients with sharp hooks.Pl. XXIV, figs. 1-5represent specimens from various sources; some simple, others combined with another implement.

Blunt Hooks.

Greek, τυφλάγκιστρον; Latin,hamus retusus.

Aetius (Tet.III. i. 13) says:

‘Whatever adhesions there are of the lower border of the lids to the tunics of the eye, we must put them on the stretch with a blunt hook (τυφλαγκίστρῳ) and with a pterygotome free the adhesion.’

In Aetius (Tet.II. iii) we see the blunt hook used in the same way as we use an aneurism needle, except that the ligature is not introduced with it, but with another needle. He says we transfix the lips of the incisions with two hooks and gradually dissecting with the scalpel we free the vessel from the underlying fascia. Then with a blunt hook (τυφλάγκιστρον) placed under the vessel we raise it up from the depth, and beneath it when raised we place a two ply thread by means of a needle, and doubly tie and cut between.

Paul says:

‘Exposing the vessel with dissectors we must raise it up when it is separated all round. If it be small, having stretched and twisted it with a blunt hook, we may divide it through in such a way as to remove part of it. But if it be large we must apply a double ligature under it with a needle, either a piece of raw flax or some other strong thing’ (VI. v).

The ‘eyed hook’ is mentioned by Galen in describing the dissection of the spinal cord:

Ἐνδέχεται δὲ καὶ χωρὶς βελόνης ἀγκίστρῳ διατρήτῳ γενέσθαι τὴν ἐγχείρησιν, ὡς ἐπὶ τῶν περὶ τὰς καρωτίδας ἀρτηρίας νεύρων εἴωθε ποιεῖσθαι (ii. 669).‘It is advisable that the manipulation be performed not with a needle but with an eyed hook, as is usually done in the case of the tendons in the neighbourhood of the carotid arteries.’

Ἐνδέχεται δὲ καὶ χωρὶς βελόνης ἀγκίστρῳ διατρήτῳ γενέσθαι τὴν ἐγχείρησιν, ὡς ἐπὶ τῶν περὶ τὰς καρωτίδας ἀρτηρίας νεύρων εἴωθε ποιεῖσθαι (ii. 669).

‘It is advisable that the manipulation be performed not with a needle but with an eyed hook, as is usually done in the case of the tendons in the neighbourhood of the carotid arteries.’

A small variety of the blunt hook is mentioned by Celsus, Galen, and Paul.

Of the extraction of foreign bodies from the ear Celsus says:

Sin aliquid exanime est, specillo oriculario protrahendum est, aut hamulo retuso paulum recurvato (VI. vii).

Paul says that if stones of fruits, &c. fall into the ear they must be extracted with an ear scoop, a hook, or a forceps.

Both types of blunt hook are represented by extant specimens; seePl. XXIII, figs. 3, 4. These remind us of our aneurism needles, and it is interesting to note that Galen (ut supra) speaks of an ‘eyed hook’. The instruments shown inPl. XXIII, figs. 2, 4we might look on either as curved retractors or dissectors as they are half sharp.Pl. XXV, fig. 2shows a hook of crotchet-hook type combined with a scoop. It is from Herculaneum.

The Strigil.

Greek, ξύστρα. Latin,strigil.

It seems to have been a common method of applying remedies to the auditory canal to warm them in a strigil and pour them in with it. Galen frequently mentions this. InMed. Sec. Loc.(xii. 622) he says:

Having warmed the fat of a squirrel in a strigil, instil it.

Celsus (VI. vii. l) says:

In aurem vero infundere aliquod alimentum oportet quod semper ante tepefieri convenit; commodissimeque per strigilem instillatur.

Marcellus (IX. l) says:

Conteres et in strigili calefacies, et infundes, et lana occludes aurem.

Scribonius Largus (xxxix) says:

Ad auriculae dolorem et tumorem sine ulcere prodest herbae urceolaris aut cucurbitae ramentorum sucus tepens per strigilem in foramen auris dolentis infusus.

The strigil varied much in size and shape. A common form was a sickle-shaped instrument, the circular part being hollow and semicircular on section, and admirably adapted for warming and pouring oil and other medicaments into the ear as above described.Pl. XXV, fig. 1shows a small strigil from my collection.

Spoon for applying astringent liquids to the uvula.

Greek, σταφυλεπάρτης.

In his description of the medical treatment of diseases of the mouth Paul (III. xxvi) says:

‘When the uvula is inflamed we must use the gargles recommended for inflammation of the tonsils, and those of a moderately astringent nature, such as the juice of pomegranate, applied by means of a spoon or the instrument called the “uvula medicator”’ (σταφυλεπάρτου).

It is evident that it is quite a different instrument from the staphylocaustus (q. v.), which we are specially told had more than one hollow and was a grasping instrument like a forceps. The present instrument is for applying liquids, and was apparently of the form of a spoon. Fabricius describes and figures such an instrument. It is a small round spoon with a long handle.

FORCEPS

Epilation Forceps.

Greek, τριχολαβίς, τριχολάβιον (== τριχολαβίδιον); Latin,vulsella.

The removal of the hair from the face for cosmetic purposes is a custom which has come down to us from prehistoric times, and seems to have been very prevalent among all primitive races. In the bronze age the method by which this was accomplished seems to have been to fix the hairs with a broad jawed forceps and cut them off close to the skin by means of a knife or ‘razor’. Thus did primitive men ‘shave’, and very often in early bronze age graves in Scandinavia and in the Swiss lake-dwelling excavations these forceps and razors are found together. No doubt also epilation proper was practised occasionally, but the majority of the prehistoric forceps are not for epilation but for fixing the hairs to allow the knife to divide them close to the skin. At a later time, with the more common use of steel, the Greeks and Romans shaved as we do, and epilation proper was practised for removing superfluous hairs from the face and also to remove trichiasis. Aristophanes, a contemporary of Hippocrates (Ran. 516, Lys. 89, 151), Persius (iv. 37) and Juvenal (vii. 114) refer to the depilation of the pubes as being common among certain classes, and the early Christian Fathers deplore the practice. See also the remarks of Suetonius on the conduct of Domitian (xxii). Prosper Alpinus, who visited Egypt in the sixteenth century and wrote an interesting book on the state of medicine in that country,found the custom still prevalent among the Egyptian women, and thus explains the object with which it was practised (Medicina Aegyptiorum, cap. III. xv):

A pulveribus, qui Aegyptiis fere toto anno ventorum terraeque siccitatis occasione perpetuo familiares existunt, atque ab assiduis sudoribus quibus coeli calore omnia corpora continue abundant, illuvieque quadam immunda redduntur, atque foetentia, ex quo pleraque ipsorum et foetere et pediculis abundare solent. Balneis omnes hi populi utuntur familiarissime pro corporum abstersione, maximeque mulieres, quibus curae magis est corpora ipsarum pulchriora facere ipsorum, illuviem et foetorem corrigentes, ut cariores sint suis viris. Eae etenim saepissime corpora in iis lavant, at mundant ab illuvie, perlotaque variis ornant odoribus ut recte unguentis oleant. Ac veluti Italae mulieres atque aliarum multarum etiam nationum ad capillorum facieique omne cultum adhibent studium, ita Aegyptiae capillorum cultum negligunt ex consuetudine omnes capillos in bursam serico panno paratam concludentes, ac ad pudendorum abditarumque corporis partium ornatum omnem diligentiam adhibent. Pudendis igitur tota cura in balneis ab iis adhibetur. Ea siquidem in primis lavant, pilisque nudant, locaque pudendorum perpetuo glabra gestant, turpeque ibi est mulierum pilis obsitam vulvam habere. Demum lotas eas partes glabrasque effectas variis unguentis etiam exornant.

The custom survived in France and Italy in the sixteenth century.

Epilation as a purely surgical operation was frequently necessary for the trichiasis consequent on the granular ophthalmia which was so common among the Romans. Paul (VI. xiii) says:

‘Turn the eyelid outwards and, with an epilation forceps (τριχολαβίῳ) dragging out the offending hairs, either one, or two, or three or whatever number there are. Then apply a heated olivary probe or an aural probe or some such slender instrument to the place from whence the hair or hairs have been removed.’

The numbers of toilet epilation forceps which have been found are enormous. Moreover, forceps of exactly similarform were in use in every household as accessories of the lamp for raising and snuffing the wick, and artisans used them also for the finer manipulations of their crafts; so that by far the largest number of forceps of this type are not surgical instruments, but household implements. However, we have plenty of specimens from purely surgical finds.

Of the surgical instruments all forms agree in having no teeth. The simplest form consists of a strip of metal bent on itself straight as inPl. XXVI, fig. 3, or with the jaws turned inwards, as inPl. XXVI, fig. 5. These are often pocket forceps. A ‘pocket-companion’, consisting of a toilet forceps, an ear-pick and a nail-cleaner, such as is seen inPl. XXVI, fig. 4, is a common object in museums, such as the Guildhall Museum, where this object is. A variety of epilation forceps with rounded legs is seen inPl. XXVI, fig. 2. Several of these have been obtained from purely surgical finds. Others are formed by sawing a bar of bronze up its centre, as in the specimen shown inPl. XXVI, fig. 1, which is 13 cm. 4 mm. long, and with jaws 10 mm. broad. It is from the Naples Museum.

This is the form most typical of the surgical epilation forceps. Several of this type were found in the grave of the oculist Gaius F. Severus at Rheims (Pl. XXVI, fig. 6). They are very large powerful instruments, from 15 to 16 cm. long, and with jaws 7 to 8 mm. in breadth (Deneffe,Oc. du 3esiècle, ii. 1-8). This form was no doubt used as a dissecting forceps or tumour vulsellum as well as for epilation, but the typical tumour forceps was toothed, and it is convenient to classify all those of the untoothed type as epilation forceps.

Other epilation forceps, which are however more likely to be toilet articles, have the jaws of extreme breadth, as inPl. XXVII, fig. 3from the Mainz Museum. It has a sliding catch. They are evidently intended to remove a considerable number of hairs at once, or to fix them while they were cut with razor or shears.

It is certain, however, that in addition to these broaderforceps a variety with quite narrow blades was used, as Paul (VI. xxiv) tells us that stones, &c. may be removed from the ear with epilation forceps (τριχολαβίῳ), and again in fracture of the nose Paul (VI. xxiv) says that splinters of detached bone are to be removed with these forceps. We have several forceps of this type. There are in the Naples Museum three, one from Pompeii, two from Herculaneum (Deneffe). One from my own collection is shown inPl. XXVI, fig. 2. The points are narrow and rounded.

A very interesting form is seen inPl. XXVII, fig. 4, which shows a forceps in the Thorwaldsen Museum, Copenhagen. It is 12 cm. long, of which 6 cm. of the upper end are solid and round. The remainder of the length is occupied by the blades of the forceps, each 5 mm. broad, except for 12 mm. at the extremity, where it expands into a leaf-shaped portion, 10 mm. broad in its broader part. These leaf-shaped expansions oppose each other accurately, and on the narrow part of the blade above them there slides a rectangular catch which serves to clamp the blades and fix them like the jaws of a vice.

The surgical epilation forceps is, as we have seen, usually a simple instrument. Occasionally we meet with a forceps combined with some other instrument. These are, as a rule, toilet articles. A pocket ear-scoop and epilation forceps combined was found in Paris. Precisely similar articles of steel may be bought in chemists’ shops to-day. Another has a small unguent spatula combined with a forceps, while others carry olivary probes. There are several of these in the St-Germain-en-Laye Museum (Pl. XXVII, figs. 5, 2). One from Melos, in the Athens Museum, has a porte-caustique.

Polypus Forceps.

Greek, πολυποξύστης.

Galen (Med. Sec. Loc.xii. 685) alludes to the method of extraction of polypus from the nose by means of a forceps (ἔπειτα λαβιδίῳ ἐξαίρει), and from what Paul says it wouldseem that there was a special polypus instrument, consisting of a forceps at one end and a rugine at the other. After describing extraction by means of a knife and scoop he says:

‘If, however, any part of the tumour be left behind, we take another polypus eradicator (ἕτερον πολυποξύστην), and with the end of it (ἐπάκμου αὐτοῦ ξυστηρίου) bring away what remains, by stretching, twisting, and scraping it strongly.’

Ξυστήριον means a small rugine, but stretching and twisting can only be done with a forceps. Rare as the combination of an antique forceps with another instrument is, we have one example of the combination of a rugine and a forceps, and, as it is admirably adapted for the extraction of nasal polypus, I think we are quite justified in considering it to be the instrument indicated by Paul. This instrument was found in the grave of the Paris surgeon. It is elegantly formed and is of one piece of bronze sawn down the middle. The upper part is surmounted by a rugine strongly curved, pointed at the tip and cutting on one edge. The rugine measures 3 cm. in length, and 5 mm. in breadth (Deneffe,Tr. d’un Chir., pl. v, fig. 1) (Pl. XXVII, fig. 1).

Tumour Vulsellum (Myzon).

Greek, μύδιον, μύγδιον, σαρκολαβίς, σαρκολάβος; Latin,myzon,sarcolabon,vulsella.

The form vulsellum has got so well established by usage in modern medical writings that it would seem pedantic to write ‘vulsella forceps’, but so far as I am aware it is not a form which has any classical authority. The classical usage isvulsella,-ae, feminine. I shall follow custom and use the modern term when using it as an English word.

The myzon, or tumour forceps, was a toothed instrument of the dissecting forceps type. Ducange says it takes its name from the shells which are called μυτίλοι, vulgo μύδια (mussels). It was used whenever it was desired to maketraction on any object—such as a tumour—to excise it, or to raise and fix a piece of skin. Aetius (xvi. 106) says:

Μυδίῳ πλατυστόμῳ συλλαβὼν τὴν νύμφην διὰ τῆς εὐωνύμου χειρὸς ἀποτεινέτω τῇ δὲ δεξιᾷ ἀποτεμνέτω παρὰ τοὺς ὀδόντας τοῦ μυδίου.‘Seizing the clitoris with a broad jawed vulsellum in the left hand, put it on the stretch, and with the right cut it off close to the teeth of the instrument.’

Μυδίῳ πλατυστόμῳ συλλαβὼν τὴν νύμφην διὰ τῆς εὐωνύμου χειρὸς ἀποτεινέτω τῇ δὲ δεξιᾷ ἀποτεμνέτω παρὰ τοὺς ὀδόντας τοῦ μυδίου.

‘Seizing the clitoris with a broad jawed vulsellum in the left hand, put it on the stretch, and with the right cut it off close to the teeth of the instrument.’

Paul gives pretty much the same instructions (VI. lxx):

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