CHAPTER X

‘The best places for the insertion of the hooks are in head presentations, the eyes, the occiput, and the mouth, the clavicles, and the parts about the ribs. In footling cases the pubes, ribs, and clavicles, are the best. Warm oil having been applied as a lubricant the hook is to be held in the right hand; the curvature concealed in the left hand is to be carefully introduced into the uterus, and plunged into some of the places mentioned till it pierce right through to the hollow part beneath. Then a second one is to be put in opposite to it (καταπείρειν δὲ καὶ ἀντίθετον τούτῳ δεύτερον), in order that the pulling may be straight and not one-sided’ (II. xix).

Aetius (IV. iv. 23) and Paul (VI. lxxiv) copy this.

Hippocrates (ii. 701) bids us break up the head with a cephalotribe in such a way as not to splinter the bones, and remove the bones with bone forceps; or, a traction hook (τῷ ἑλκυστῆρι) being inserted near the clavicle so as to hold, make traction but not much at once, but little by little, withdrawing and again inserting it.

There are three traction hooks from Pompeii in the Naples Museum. One of these is given inPl. L, fig. 1. They are of steel, with handles of bronze. Hooks on the same principle, and differing in appearance very littlefrom the Pompeian hooks, are still used by veterinary surgeons.

Decapitator.

Of transverse presentations, Celsus says:

Remedio est cervix praecisa; ut separatim utraque pars auferatur. Id unco fit, qui, priori similis, in interiore tantum parte per totam aciem exacuitur. Tum id agendum est ut ante caput deinde reliqua pars auferatur.‘The treatment is to divide the neck so that each part may be extracted separately. This is done with a hook which, though similar to the last, is sharpened on its inside only, along its whole border. Then we must endeavour to bring away the head first, and then the rest of the body.’

‘The treatment is to divide the neck so that each part may be extracted separately. This is done with a hook which, though similar to the last, is sharpened on its inside only, along its whole border. Then we must endeavour to bring away the head first, and then the rest of the body.’

Decapitation has now given way before Caesarean section; but the decapitator, little altered since the days of Celsus, still finds a place in surgical instrument catalogues.

Paul and Aetius both mention division at the neck, but do not describe a special instrument. A ring knife for dismembering the foetus has already been discussed among the cutting instruments; but this seems to be a different variety with a handle, which it is convenient to discuss in proximity to the embryo hook.Pl. L, fig. 2shows a knife on this principle in the Bibliothèque Nationale.

Cranioclast.

Greek, πίεστρον, ἐμβρυοθλάστης, θλάστης;

The cranioclast is mentioned by Hippocrates (ii. 701).

Σχίσαντα τὴν κεφαλὴν μαχαιρίῳ ξυμπλάσαι ἵνα μὴ θραύσῃ τῷ πιέστρῳ καὶ τὰ ὀστέα ἕλκειν τῷ ὀστεουλκῷ.‘Opening the head with a scalpel, break it up with the cranioclast in such a way as not to splinter it into fragments, and remove the bones with a bone forceps.’

Σχίσαντα τὴν κεφαλὴν μαχαιρίῳ ξυμπλάσαι ἵνα μὴ θραύσῃ τῷ πιέστρῳ καὶ τὰ ὀστέα ἕλκειν τῷ ὀστεουλκῷ.

‘Opening the head with a scalpel, break it up with the cranioclast in such a way as not to splinter it into fragments, and remove the bones with a bone forceps.’

The nature of the cranioclast is pretty well indicated by this passage, and in Galen’s Lexicon we find πιέστρῳ defined as τῷ ἐμβρυοθλάστῃ καλουμένῳ. I give drawings from Albucasis of a ‘forceps to crush the child’s head’ (Pl. LI, fig. 3).

Cephalotribe.

Whether or not the instrument last described was used also for the operation of cephalotripsy, or whether there was a special instrument, we cannot say, but it is certain that the operation of crushing the head and delivering the child without removing the bones was practised. In Aetius (IV. iv. 23) cephalotripsy is thus described:

‘But if the foetus be doubled on itself and cannot be straightened, if the head is presenting, break up the bones of it without cutting the skin. Then to some part of it fix on a traction hook and make traction, and the legs becoming straightened out we get it away.’

Though there is an essential difference between the operations of cephalotripsy and cranioclasie there is no essential difference between the instruments necessary for carrying out the same, and it is possible that the instrument used may be the same as the last. The cephalotribe figured by Albucasis is not essentially different from his cranioclast (seePl. LI, fig. 4).

Midwifery Forceps.

Had the Greeks and Romans a forceps for extracting the child alive? Probably not. We have no mention of any such instrument by Soranus or Paul, both accomplished obstetricians, nor can any description of such an instrument be found in the voluminous pseudo-Hippocratic works on women. Adams, in a note to Paul, III. lxxvi, says that though the Roman and Greek writers do not mention the forceps, Avicenna does so, and he says that a forceps was dug up in the house of an obstetrix at Pompeii bearing a considerable resemblance to the modern forceps. The only passage I have met with in the slightest degree supporting the notion that the ancients ever delivered the child alive with instruments is one in the pseudo-Hippocratic treatiseDe Superfoetatione, where we are told that:

‘If the woman has a difficult labour, and the child delay long in the passage and be born not easily but with difficulty and with the mechanical aids (μηχαναῖς) of the physician, such children are of weak vitality, and the umbilical cord should not be cut till they make water or sneeze or cry’ (i. 465).

We are not entitled to translate μηχαναῖς by ‘instruments’, because it may mean any mechanical aid such as a fillet, or even assistance with the fingers of the accoucheur; but, even granting that it refers to instruments, it might mean no more than, e. g., the embryo hooks already described. With them, terrible as they were, the child must frequently have been born alive, though mutilated. A child would have had a far better chance of being born alive with them than with the murderously toothed forceps of Albucasis (Pl. XLI, figs. 3, 4), with which probably no child could have been born alive. As regards the statement that Avicenna knew of the forceps, his directions are that the fillet is to be applied, and, if that fail, the forceps is to be put on and the child extracted with it. If that fail, the child is to be extracted by incision, as in the case of a dead foetus. This passage, says Adams, puts it beyond doubt that the Arabians were acquainted with the method of extracting the child alive with the forceps.

This is, however, not quite correct. A full consideration of Avicenna’s words seems to me to lead to the conclusion that he is describing no more than extraction with a craniotomy forceps. If the forceps fail the child is to be extracted by incision, as in the case of a foetus already dead (and decomposed so that the forceps would not hold).

As regards Adams’ statement that a forceps like ours was dug up in Pompeii one may ask, ‘Where is that forceps now?’ It is certainly not in the Naples Museum, where all the finds from Herculaneum and Pompeii have been stored since the excavations were commenced. Adams has probably been misled by some notice of the ‘Pompeian forceps’ (Pl. XLIII), which many consider adapted for removingthe cranial bones when the child’s head is broken up in cephalotripsy. It is, however, a sequestrum forceps.

Uterine Curette.

Hippocrates (ed. Van der Linden, vol. ii, p. 394) says:

If the menses form thrombi ... we must wind the skin of a vulture or a piece of vellum round a curette and curette the os uteri (καὶ περὶ ξύστραν περιειλίξας γυπὸς δέρμα ἢ ὑμένα, διαξύειν τὸ στόμα τῶν μητρέων).

ξύστρα may of course mean the strigil, and some forms of strigil, such as the one shown inPl. XXV, fig. 1, are not ill adapted for the purpose.

Instrument for destroying foetus in utero.

Greek, ἐμβρυοσφάκτης; Latin,aeneum spiculum.

Apart from the destruction of the foetus in criminal abortion, which was so common at Rome in the time of the Empire, we have mention of an instrument for legitimately producing the death of the foetus from humane motives before forced delivery. It is mentioned by Tertullian in his sermonDe Anima, and the passage is so interesting that I give it in full. It is, moreover, an example of the unexpected places in which information regarding the surgery of the ancients crops up. Tertullian is arguing that the foetus is alive in utero, and does not, as others hold, simply take on life in the act of birth, and to support his conclusions he uses the following argument:

Denique et mortui eduntur quomodo, nisi et vivi? qui autem et mortui, nisi qui prius vivi? Atquin et in ipso adhuc utero infans trucidatur necessaria crudelitate, quum in exitu obliquatus denegat partum; matricida, ni moriturus. Itaque et inter arma medicorum et organon est, quo prius patescere secreta coguntur tortili temperamento, cum anulo cultrato, quo intus membra caeduntur anxio arbitrio, cum hebete unco, quo totum facinus extrahitur violento puerperio. Est etiam aeneum spiculum, quo iugulatio ipsa dirigitur caeco latrocinio; ἐμβρυοσφάκτην appellant de infanticidii officio, utique viventis infantis peremptorium. Hoc et Hippocrates habuit et Asclepiades et Erasistratus etmaiorum quoque prosector Herophilus et mitior ipse Soranus, certi animal esse conceptum, atque ita miserti infelicissimae huiusmodi infantiae, ut prius occidatur ne viva lanietur.‘Finally there are cases of children that are dead when they are born, how so unless they have also lived? For who are dead unless they have previously been alive? And yet, an infant is sometimes by an act of necessary cruelty destroyed when yet in the womb, when owing to an oblique presentation at birth delivery is made impossible and the child would cause the death of the mother unless it were doomed itself to die. And accordingly there is among the appliances of medical men an instrument by which the private parts are dilated with a priapiscus worked by a screw, and also a ring-knife whereby the limbs are cut off in the womb with judicious care, and a blunt hook by which the whole mass is extracted and a violent form of delivery in this way effected. There is also a bronze stylet with which a secret death is inflicted; they call it the ἐμβρυοσφάκτης (foeticide) from its use in infanticide, as being fatal to a living infant. Hippocrates had this (instrument), Asclepiades and Erasistratus, and of the ancients also Herophilus the anatomist, and Soranus, a man of gentler character. Who, being assured that a living thing had been conceived, mercifully judged that an unfortunate infant of this sort should be destroyed before birth to save it from being mangled alive.’

‘Finally there are cases of children that are dead when they are born, how so unless they have also lived? For who are dead unless they have previously been alive? And yet, an infant is sometimes by an act of necessary cruelty destroyed when yet in the womb, when owing to an oblique presentation at birth delivery is made impossible and the child would cause the death of the mother unless it were doomed itself to die. And accordingly there is among the appliances of medical men an instrument by which the private parts are dilated with a priapiscus worked by a screw, and also a ring-knife whereby the limbs are cut off in the womb with judicious care, and a blunt hook by which the whole mass is extracted and a violent form of delivery in this way effected. There is also a bronze stylet with which a secret death is inflicted; they call it the ἐμβρυοσφάκτης (foeticide) from its use in infanticide, as being fatal to a living infant. Hippocrates had this (instrument), Asclepiades and Erasistratus, and of the ancients also Herophilus the anatomist, and Soranus, a man of gentler character. Who, being assured that a living thing had been conceived, mercifully judged that an unfortunate infant of this sort should be destroyed before birth to save it from being mangled alive.’

We have here apparently a different instrument from the embryotome, which we saw was a form of knife. This is a pointed spike-shaped instrument. It must have had much the shape of one of the huge bodkins in the Naples Museum (Pl. LI, fig. 1).

Apparatus for fumigating the Uterus and Vagina.

Fumigation formed an important part of the treatment of all varieties of disease of the uterus and vagina. The notion that the uterus was an animal within the body which could wander about on its own initiative and which was attracted by pleasant smells and repelled by disagreeable smells, was responsible for much of the treatment of gynaecological diseases by the ancients. To make afumigation, Hippocrates directs us to take a vessel which holds about four gallons (δύο ἑκτέας), and fit a lid to it so that no vapour can escape from it. Pierce a hole in the lid, and into this aperture force a reed about a cubit in length so that the vapour cannot escape along the outside of the reed. The cover is then fixed on the vessel with clay. Dig a hole about two feet deep and sufficiently large to receive the vessel, and burn wood until the sides of the hole become very hot. After this remove the wood and larger pieces of charcoal which have most flame, but leave the ashes and cinders. When the vessel is placed in position, and the vapour begins to issue out, if it is too hot wait for some time; if, however, it be of the proper temperature the reed should be introduced into the uterine orifice and the fumigation made. Oribasius, quoting Antyllus (Coll.X. xix) varies the treatment somewhat by placing a vessel similarly prepared underneath an obstetrical chair, which had an opening in the seat, allowing a leaden pipe connected with the tube of the fumigating vessel to be passed into the vagina.

A fumigating apparatus of a more portable nature is mentioned by Soranus (xxiii) who tells us that Strato, a pupil of Erasistratus, used to place in a small vessel of silver or bronze, closed by a cover of tin, herbs of various kinds, and, having adjusted a small tube to the vessel, the mouth of the tube was placed in the vagina, and the vessel was then gently heated. Soranus admits that severe burning might follow this practice if unskilfully used.

Pessaries.

Greek, βάλανος, πεσσόν, πεσσός; Latin,pessum,pessus,pessulum.

Pessaries are frequently mentioned. They are usually bags filled with medicaments and not mechanical supports. However, in ii. 824, Hippocrates says that prolapse of the womb is to be reduced and the half of a pomegranate is to be introduced into the vagina. Soranus says that inprolapse Diocles was accustomed to introduce into the vagina a pomegranate soaked in vinegar. He also says that a large ball of wool may be introduced after reduction, and Aetius, Oribasius, and Paul copy him.

Hippocrates (iii. 331) says that in cases of fistula in ano, after the introduction of a medicated plug of lint, a pessary of horn is to be inserted (βάλανον ἐνθεὶς κερατίνην). This would appear to be partly to distend the rectum, but partly also most likely to carry medicament, like the leaden tubes full of medicaments which were inserted into the uterus.

A pessary of bronze was found in Pompeii (Pl. LI, fig. 2), and is described by Ceci. It is hollow and has a plate perforated with holes (evidently for stitching it on a band, to fix it round the body). Heister figures a similar instrument. It is impossible to say whether this specimen was intended for rectal or vaginal use.

SUTURES, ETC.

Sponge.

Greek, σπόγγος; Latin,spongia.

Sponges were used for many purposes. Paul (VII. iii) says they should be fresh and still preserve the smell of the sea. They were applied with water, wine, or oxycrate to agglutinate wounds, and also soaked in asphalt and set fire to and applied to wounds to stop haemorrhage.

Galen (De Simp.xi) says he has seen haemorrhage stopped by applying a sponge dipped in asphalt to a bleeding wound and setting fire to it, and leaving the unburnt part to cover the wound. Celsus says a sponge dipped in oil and vinegar or cold water relieves gouty swellings. He also recommends a sponge dipped in vinegar or cold water for stopping haemorrhage.

Dioscorides says that fistulae may be dilated with sponge tents.

Scribonius Largus says that in epistaxis the nose may be plugged with sponge:

Proderit et spongeae particulam praesectam apte forfice ad amplitudinem et patorem narium figuratam inicere paulo pressius ex aceto per se (xlvi).

Soranus (xli) says haemorrhage from the uterus may be stopped with a sponge tent:

Ὁπότε τρυφερὸν καὶ καθαρὸν σπογγάριον ἐπιμήκες ὡσαύτως διάβροχον ὡς ἐσωτάτω παρεντιθέναι προσήκει.

Sutures.

Celsus (V. xxvi) says sutures should be of soft thread not overtwisted that they may be the more easy on the part:‘Ex acia molli non nimis torta quo mitius corpori insidat’. They were made of flax. The apolinose described by Hippocrates (iii. 132) is directed to be made of crude flax (ὠμολίνου), the strands of which were stronger than those of dressed lint. This also is what Paul used for the deligation of arteries.

Galen alludes to sutures of wool, and Paulus Aegineta in the operation for ectropion says:

‘Afterwards we unite the divided parts with a needle carrying a woollen thread, being satisfied with two sutures.’

We have no mention of catgut being used for this purpose, though that substance was early known to the Greeks. The Homeric harp was strung with catgut. In fact χορδή, the term for harp-string, simply means intestines. Paul used a woman’s hair in a needle to transplant hairs in trichiasis (VI. xiii). Horsehair was used to raise a pterygium in Paul VI. xviii, but it is not mentioned as being used for suturing wounds.

Serres Fines.

Greek, ἀγκτήρ; Latin,fibula.

Celsus (V. xxvi) in describing the closing of wounds says:

Nam si plaga in molli parto est, sui debet, maximeque si discissa auris ima est, vel imus nasus, vel frons, vel bucca, vel palpebra, vel labrum, vel circa guttur cutis, vel venter. Si vero in carne vulnus est hiatque, neque in unum orae facile attrahuntur, sutura quidem aliena est; imponendae vero fibulae sunt; ἀγκτῆρας Graeci nominant; quae oras paulum tamen contrahant, quo minus lata postea cicatrix sit.‘Suture is indicated if the lesion is in a soft part, especially in the lobule of the ear, or the ala nasi, or the forehead, or cheek, the edge of the eyelid, or the skin over the throat, or the abdominal wall. But if the wound is in a muscular part and gape, and the edges cannot easily be opposed, suture is contraindicated, and fibulae (Graece ἀγκτῆρας) are to be used in order that the cicatrix afterwards may not be wide.’

‘Suture is indicated if the lesion is in a soft part, especially in the lobule of the ear, or the ala nasi, or the forehead, or cheek, the edge of the eyelid, or the skin over the throat, or the abdominal wall. But if the wound is in a muscular part and gape, and the edges cannot easily be opposed, suture is contraindicated, and fibulae (Graece ἀγκτῆρας) are to be used in order that the cicatrix afterwards may not be wide.’

We have here contrasted two methods of closing a wound, and the conclusion is readily arrived at that sutures in the first case and some metal contrivance in the second are intended. Celsus goes on to say, however:

Utraque optima est ex acia molli, non nimis torta, quo mitius corpori insidat. Utraque neque nimis rara, neque nimis crebra iniicienda.‘Both are best made of soft thread, not too hard twisted that it may sit easier on the tissues, nor are too few nor too many of either of them to be put in.’

Utraque optima est ex acia molli, non nimis torta, quo mitius corpori insidat. Utraque neque nimis rara, neque nimis crebra iniicienda.

‘Both are best made of soft thread, not too hard twisted that it may sit easier on the tissues, nor are too few nor too many of either of them to be put in.’

A consideration of various passages in which the Greek authors use the term leaves a distinct impression on one’s mind that a metal clasp is intended. Thus Paul (VI. cvii), in treating of compound fractures, says that if a large portion of the bone is laid bare we use fibulae and sutures (ἀγκτῆρσι καὶ ῥαφαῖς). It must be confessed, however, that the words of Celsus render it difficult for us to assert with certainty that fibulae were metal clasps, and we find ancient commentators in equal difficulty. Fallopius and Fabricius d’ Aquapendente think fibulae mean interrupted sutures. Guido de Cauliac thinks they mean metal clasps. There is just the possibility that a contrivance like our harelip pin with a figure of eight thread may be indicated. This would satisfy both sides of the question. If fibulae were metal clasps, however, we have several varieties of ancient fibulae that might have been used for closing wounds. That most suited for the purpose in hand seems to me to be one consisting of a small bar terminating in two hooks. Several of these from Roman London are in the Guildhall Museum (Pl. LII, figs. 5, 6, 7). They represent a useful form of ‘clip’ still in use by cyclists, and they could be applied to wounds to act on the principle of Malgaigne’s hooks for the patella. A modicum of support for this view may be derived from the fact that whereas Galen, from whom the above passage on compound fractures is quoted by Paul, uses the word ἀγκτῆρσι, the codices of Paul almost unanimously have ἀγκίστροις. Fourteen out of fifteen give the latter rendering.

Band of Antyllus.

In the interesting dissertation which Oribasius gives on the subject of phlebotomy (Med. Collect.vii) he states that Antyllus directs us to apply a ligature of two fingers’ breadth round the arm when going to let blood at the elbow. He says that they are mistaken who affirm that the same effect may be produced by applying the band below, for the veins will not then swell even if the arm be fomented. When going to bleed at the ankle the ligature is to be applied at the knee. When the blood does not flow well he advises us to slacken the bandage if too tight. This is the famous ‘band of Antyllus’.

It is mentioned also in the pseudo-Hippocratic treatise on Ulcers (iii. 328):

‘When you have opened the vein and after you have let blood and have loosened the fillet (ταινίαν) and yet the blood does not stop.’

Paul also mentions the band, including one round the neck when the veins of the forehead are to be opened for ophthalmia. So far as we know the fillet was nothing more than a plain strip of linen or some such material, but Deneffe, commenting on two bronze fibulae which were found in the grave of the surgeon of Paris, conjectures that they may have been used to fix the fillet in venesection. I give figures of these after Deneffe, but it seems to me that these buckles are more likely to have belonged to the straps of a portable instrument-case of canvas or leather which had disappeared. One is a neat little heptagonal fibula, 2·8 cm. in its widest part, with a tongue 27 mm. long (Pl. LII, fig. 2). The other fibula is in the form of a penannular ring, formed by a two-headed serpent curved on itself so that the two heads look at each other, separated from each other by a space of a few millimetres (Pl. LII, fig. 8). Opposite the heads there is a small rectangular opening to receive the end of the strap. There is no tongue.It may have been fixed by a metal bar attached to the other end of the strap.

Sieves and Strainers.

Greek, ἠθμός, κυρτίς; Latin,cribrum.

Scribonius Largus mentions sieves of different sizes. In ch. xc a small one is mentioned:

Contunditur hic cortex per se et cribratur tenui cribro.

In other places larger sizes are mentioned:

In his macerantur res quae infra scriptae sunt, contusae et percribratae grandioribus foraminibus cribri (cclxix).

Marcellus (De Medicamentis, xxxiii. 9) says:

Pulverem facito, et cribello medicinali omnem pulverem cerne et permisce, et cum vino vetere calefacto locum inline.

There are large numbers of sieves and strainers in bronze and earthenware in the Naples Museum.

Paul (VII. xx) says oil of sesame is to be prepared from sesame pounded, softened, and pressed in a strainer with screws (διὰ κυρτίδων τῶν κοχλιῶν). The word κυρτίς literally means a basket or wicker eel-trap. Here it must mean a strainer.

Mortar and Pestle.

Greek, ἰγδίον, mortar: δοῖδυξ, pestle; Latin,mortarium,pilum.

In the find of the oculist Severus is a bronze dish which Deneffe regards as a mortar. It is 8 cm. in diameter and 3·5 deep, and rests on a base of 3 cm. diameter, so that it sits firmly. Marcellus (De Medic.i) mentions a mortar of marble:

Haec universa conteres in mortario marmoreo, et aceto admixto fronti inlines.

He also mentions one of wood:

Huius radicem colliges et findes in partes duas, quarum unam siccabis ac minutatim concides et mittes in pilam ligneam atque illic diligenter tundes (xxiii).

Scrib. Larg. speaks of pestles of wood:

Hoc medicamentum cum componitur pilum ligneum sit (clii).

In Paul we have a mortar of lead and a leaden pestle mentioned several times:

Ἐν μολυβδίνῳ ἰγδίῳ καὶ μολυβδίνῳ δοίδυκι λειώσας.‘Triturate ceruse with wine and rose oil in a leaden mortar with a leaden pestle and anoint with it’ (III. lix).

Ἐν μολυβδίνῳ ἰγδίῳ καὶ μολυβδίνῳ δοίδυκι λειώσας.

‘Triturate ceruse with wine and rose oil in a leaden mortar with a leaden pestle and anoint with it’ (III. lix).

Galen (De Simpl.x) speaks of bronze mortars:

‘Wherefore, some call only the natural mineral by this name, but some also the substance which is prepared in a bronze mortar with a copper pestle by means of the urine of a boy, which some value according to the differences of the verdigris. But it is better to prepare it in summer, or at least in hot weather, rubbing up the urine in the mortar, and it answers the more excellently if the bronze of which you make the mortar is red and the pestle too, for more is thus rubbed off by the turning of the pestle when the bronze is of a softer nature.’

Paul mentions a mortar of marble. A small mortar of bronze was found amongst the instruments of the surgeon of Paris. Another small one from my own collection is shown inPl. LII, fig. 3. The excavation of the temple of Aesculapius in the forum has brought to light a large number of mortars of marble. They are mostly about six or seven inches in diameter, but are much deeper in proportion than our modern mortars are. The spathomele and other olivary probes were no doubt often used as small pestles.

Whetstone.

Greek, ἀκόνη; Latin,cos.

We saw that several of the slabs on which ointments were prepared had evidently been used for sharpening knives, and whetstones are often found of varying degrees of roughness from sandstone to fine argillaceous smooth stones. Paul (VII. iii) says:

Τό γε μὴν τῆς Ναξίας ἀκόνης ἀπότριμμα ψυκτικὸν εἶναι φασὶν ὥστε καὶ τιτθοὺς παρθένων καὶ παίδων ὄρχεις προστέλλειν. τῆς ἐλαιακόνης δὲ τὸ ἀπότριμμα ῥυπτικὸν ὑπάρχον ἀλωπεκίαις ἁρμόττει.‘The filings of the Naxian whetstone are said to be refrigerant, repressing the breasts of maidens and the testicles of boys. The filings of the oilstone being detergent suit with alopecia.’

‘The filings of the Naxian whetstone are said to be refrigerant, repressing the breasts of maidens and the testicles of boys. The filings of the oilstone being detergent suit with alopecia.’

It is uncertain what the Naxian whetstone was, but it was considered the best variety of whetstone. It is mentioned in Pindar. From the fact that emery is found in Naxos one might conclude that the Naxian whetstone was of emery, but a few lines before the passage quoted from Paul he has already mentioned the emery:

Ἡ δὲ σμύρις ῥυπτικὴν ἔχουσα δύναμιν ὀδόντας σμήχει.‘The emery having detergent powers cleanses teeth.’

Ἡ δὲ σμύρις ῥυπτικὴν ἔχουσα δύναμιν ὀδόντας σμήχει.

‘The emery having detergent powers cleanses teeth.’

Galen makes the Naxian stone a variety of ostracites which was apparently marble formed of shells. One of the marble ointment tablets had, we saw, been used as a whetstone, but the whetstones for which Naxos was famous must, if not emery, have been some variety of shale or slate. It seems contrasted to some extent with the ‘oilstone’, i. e. whetstone which required oil. This was a clay slate (see Pliny,H. N.xxxvi. 47).

There are several whetstones from Stabiae in the Naples Museum which are classed among surgical implements. Whetstones are common objects in the finds from any Roman settlement, but they are not ground to regular shapes as our whetstones are. They usually consist of fine sandy schistaceous shale.

ÉTUI, ETC.

Portable Outfit.

After describing the larger apparatus necessary for the equipment of the surgery, Hippocrates mentions a portable equipment for use on journeys:

‘Have also another apparatus ready to hand for journeys, simply prepared, and handy too by method of arrangement, for one cannot overhaul everything’ (i. 72).

The component parts of this portable outfit so far known to us are as follows:

The scalpels of different shapes seem to have been carried in boxes, probably wooden, which opened in two halves like a modern mathematical instrument box. In these the scalpels lay head and tail, separated from each other by small fixed partitions. A box of scalpels of this kind is represented in a marble votive tablet which was found on the Acropolis on the site of the Temple of Aesculapius. A similar box with different instruments is seen in a donarium in the Capitoline Museum. The probes and forceps were carried in cylindrical cases like those in which the scribes carried their pens. A good many of these have come down to us. From the fact that in the grave of the surgeon of Paris there were found two buckles, it is probable that there had been buried along with the instruments a case of leather or some such perishable material, which had been used to contain instruments, but which had disappeared when the grave was opened. There have also been found boxes of various shapes for containing medicaments, cylindrical boxes for drugs in sticks, boxes divided into little partitions for drugs in semi-solid form, and other boxes for powders.

Portable Probe Cases.

The spatulae, sounds, hooks, and forceps were carried about in a cylindrical case of bronze. Several of these étui have been found containing instruments. They average 18 cm. in length and 1·5 cm. in diameter. The lid lifts off. One in the museum at Lausanne was found in a Roman conduit at Bosséaz and contained a cyathiscomele of the usual type (Bonstetten,Recueil des Antiqq. Suisses, pl. xii, figs. 11 and 12). A case exactly similar to the above containing a cyathiscomele and a toothed vulsellum was found in the Rhine Valley. Another case of the same kind was found at Bregenz. It contained a long ligula, a spathomele, a cyathiscomele, and a double olivary probe.

In the Naples Museum are four of these cases, three of which were found in Pompeii and one in Herculaneum. One of these is a plain cylindrical case 18 cm. long and 1·5 in diameter. It contained instruments (Pl. LIII, fig. 1). Another case is ornamented with raised rings. It was found in the House of the Physician, and contained six specilla of different kinds and a vulsellum. A third is of similar size and shape, but it is considerably destroyed by oxidation, and it is adherent to a rectangular slab of black stone which had been used for mixing medicaments. Through the cracks in the case there may be seen the probes which it contains. The case from Herculaneum is a plain cylindrical case 19 cm. long and 2 cm. in diameter.

Lately, several other cases have been found in Italy which are placed in the Naples Museum. One in a fragmentary condition showing its contents is seen inPl. LIII, fig. 2.

In the Musée de Cinquantenaire, Brussels, there is one of these cases which was brought by M. Ravenstein from Italy. It contained three instruments all of silver, a cyathiscomele, a grooved director, and a plain double-ended stylet. It is 18 cm. long and 1·5 in diameter.

A fragment of a similar case was found in the Roman Hospital at Baden.

Box for Scalpels.

Among the ruins of the Temple of Aesculapius on the top of the Acropolis at Athens there was found a marble donarium or votive tablet, which represents a box of scalpels flanked by a pair of bleeding-cups.

The box reminds one of a modern box for mathematical instruments, being divided into a top and bottom half, each of which contains instruments separated from each other by small blocks. There are three instruments in each half and they are arranged head and tail. Five are scalpels of different shapes; the sixth has a curved cutting instrument at one end and at the other a lithotomy scoop. The size of each half of the box is 9 × 18 cm. outside measurement, and 7 × 16·5 cm. inside. SeePl. IV.

A similar box is seen in a marble tablet in the Capitoline Museum at Rome. Here the instruments are different.

Ointment Boxes.

Among the instruments of the surgeon of Paris was a box which Deneffe regards as a portable unguentarium. Unlike the medicament boxes it is not divided into compartments and the lid lifts off instead of sliding in grooves. It is 83 mm. long, 45 wide, and 35 deep. A line running round the middle of the box divides it into two equal parts and shows the division between cover and box. On the top is a little ring attached by a little pyramidal eminence 1·5 cm. high by which the cover was lifted off. Several circular ointment boxes, some containing medicaments, are to be seen in the Naples Museum.

Collyrium Boxes.

A large number of cylindrical boxes containing sticks of medicament have been found in Pompeii. In the find of the oculist of Rheims there were five cylindrical boxes, all of the same size and shape. They were 14 cm. long and 12 mm. in diameter. The covers are 35 mm. high. Inthem were the remains of sticks of collyria which they had contained. The term collyrium includes in classical writings not only liquid but also solid applications. Collyria were often moulded into sticks for portability, and liquefied with water, wine, white of egg, &c., as required. These boxes which have come down to us are exactly similar to the case shown inPl. LIII, but they are on a smaller scale.

Slabs for preparation of Ointment.

In the Roman provinces small rectangular slabs are occasionally found which have evidently been used for rubbing medicaments upon. Some have also their edges worn by the sharpening of scalpels. As they are rarely of the stone of the country in which they are found they have evidently been manufactured in Italy and carried by their owners on their travels. They are rather rare. There are two in the museum at Naples. One was discovered in Herculaneum which is 13 cm. long and 8 cm. broad. A cylindrical instrument case is adherent to it. The edges are bevelled on its upper surface. One of similar size and shape, but made of white marble, was found in the grave of the surgeon of Paris. It shows by the hollowing out of one of its edges that it has been used for sharpening scalpels.

There are two in the Archaeological Museum at Namur. They are of black marble. They measure 11 cm. by 7·5, but a bevelling of ·75 cm. all round reduced the top surface to 9·5 cm. by 6. One of these was found along with surgical instruments in a second-century cemetery at Wancennes near Namur.

There is one of a dark-coloured stone in the museum at Chesters, Northumberland. A small specimen of my own is shown inPl. LII, fig. 4. Similar small slabs, engraved with oculists’ names and the names of drugs to serve as seals, have been found in considerable numbers, but these oculists’ seals have already an extensive literature of their own.

Boxes for Drugs.

A considerable number of medicament boxes have been found. They are usually of bronze, rectangular and of a convenient size and weight for carrying in the pocket. In size they average 12 cm. in length by 7·5 in breadth and 2 in height. As a rule they are divided into four or more small divisions by partitions. Those reported are as follows:

There are two in the Royal Antiquarian Museum at Berlin. Of these, one was found in the Rhenish country between Neuss and Xanten. It is of bronze. Inlaid with silver on its sliding cover is the figure of Aesculapius standing in a small temple.

The second, of similar construction and appearance, was brought by Friedlander from Naples and presented by him to the museum.

A third, in the museum at Mainz, was found in the Rhine while dredging near the town. It is of bronze, 10 cm. long, 8 wide, 2 in height. It weighs 123 grammes. The sliding lid is decorated with the snake of Aesculapius, twisted round the stem of a laurel tree. The tree and the body of the snake are formed by inlaying copper in the bronze. The outline of the head of the snake and the scales of the body are of silver. On withdrawing the lid the interior is seen to be divided into four compartments each shut by a little hinged lid, which may be lifted by means of a little ring. Two of these compartments are 6 cm. by 3, the two others are 4 cm. by 3.

In the Naples Museum there are three of these boxes. They are all of bronze and divided into compartments. One is divided into five compartments. It is 18 cm. long by 8 wide and 2 deep. Of the compartments three are 8 cm. by 2 and two are 5 cm. by 3. There is at the upper end of the box a small handle by which to carry it. Another box is 13 cm. by 7·5. On removing the lid it is seen to be divided into six compartments, two of which have hinged lids of theirown, like the Mainz box. These compartments still contain medicaments (Pl. LIV).

The third of the Naples boxes is of an unusual type. It is 12·5 cm. by 7·5, but it is 3 cm. high and is divided into an upper and a lower division each 1·5 cm. deep. Each division has a sliding lid of its own. The upper division is separated into four compartments, two of which are 7 cm. by 2 and two are 4 cm. by 2. The lower stage occupies the whole area of the box.

A medicament box of a unique character was in use in a chapel as a reliquary till its original use was pointed out. It is of ivory, and carved on its sliding lid is a representation of Aesculapius and his daughter Hygeia. Aesculapius carries in his left hand a staff, round which is coiled a snake, and in his right a pine cone. Hygeia carries a snake in her right hand, and in her left a bowl from which she feeds the snake. The execution of the design shows the box to belong to the third century. The box is divided into eleven compartments. It is now in the Castle Valeria at Sitten.

I. INVENTORY OF CHIEF INSTRUMENTS IN VARIOUS MUSEUMS

English Museums.

TheBritish Museumcontains the following (Case ii. B):

Bleeding cup (No. 2313); collyrium spoon with spout (two, Nos. 2314-5); staphylagra (two, Nos. 2316-7); hook, sharp (No. 2318); ditto blunt, i. e. retractor (No. 2319); forceps (No. 2320); two-pronged retractors (Nos. 2322-6); scarifier (No. 2327); knife, steel (No. 2321); scalpel handles (Nos. 2331-9); spathomeles; cyathiscomeles; spatulae; ligulae; ear specilla; aneurism needle (No. 2372); epilation forceps (narrow), ditto (broad), ditto ditto with catch.

The Guildhall Museum contains a good few instruments found in London, amongst others a considerable number of ear specilla, vulsella, lancets, and numberless instruments common to both domestic and surgical use, such as strigils, ligulae, styli, and needles. The Celtic cutting instruments are of interest for comparison. This collection is in many ways one of the most interesting we have in England.

The museum at Shrewsbury contains several surgical instruments from the ancient Roman city of Uriconium on which Wroxeter now stands. The most interesting is a bleeding lancet. There are also styli and an ointment slab and the seal of an oculist.

The museum at Chesters, Northumberland, containing finds from the Roman camps at Cilurnum, Procolitia, Borcovicus, and other sites on the Roman Wall, contains amongst other things hooks, spatulae, bougie, a triangular medicine weight of tin, forceps, needles of bone and bronze, borers, knife blades, ear specilla, steelyard, counterpoises, many in the form of snakes and therefore, perhaps, for pharmaceutical purposes, the serpent being the symbol of Aesculapius.

Museums in France.

Saint-Germain-en-Laye.Outfit of Severus, viz. two iron pitchers, four bowls, mortar, two balances, seven forceps, one spathomele, scalpel handle, ditto damascened, spatulae (two), two knife-and-needle handles, four needle handles, olive-and-needle, scalpel-handle-and-borer, three sharp hooks, blunt and sharp hook, small blunt hook, seal. Alsofour scalpel handles, forty forceps, four pocket companions with forceps, fifty bodkins and needles, thirty-three ligulae, fourteen spathomeles, thirty cyathiscomeles, twelve olivary probes.

Le Puy-en-Velay.Outfit of Sollemnis, viz. two knife-handles, ditto damascened, amulet, fragments of two forceps, seal, spathomele.

Paris.Private museum of M. Tolouse. Instruments from the grave of the Surgeon of Paris—Large bronze bowl which contained:

1, Marble slab for preparing ointments; 2, amulet of black obsidian; 3, bronze ointment box with silver damascening; 4, 5, 6, 7, 8, five cylindrical boxes for collyrium sticks; 9, 10, two buckles; 11, pharyngeal insufflator; 12, collyrium spoon; 13, 14, 15, three spathomeles; 16, 17, probes; 18, polypus forceps and scoop; 19, 20, epilation forceps; 21, 22, vulsella (toothed); 23, staphylagra; 24, 25, coudé vulsella; 26, spathomele of elegant form; 27, bleeding cup; 28, three-pronged fork.

Louvre Museum.Double curette, cyathiscomele, ear probe, stylet with large olivary point, forceps with olivary point.

Cluniac Museum.Scoop probe, scalpel.

Orfila Museum.All from Herculaneum. Ligula, ear scoop, two raspatories, hook and scoop, scalpel, fork and hook, curette and hook, bodkin.

Montauban Museum.(Tarn-et-Garonne.) Large surgical needle, cyathiscomeles (four), spathomele (one), scoop and spatula (steel), epilation forceps (one), four ear specilla, round spatula, bistoury handle, all from Cosa.

Rouen.Four epilation forceps, one small forceps with locking arrangement, one forceps with narrow rounded legs, one fine-toothed forceps, twelve cyathiscomeles, three needles and bodkins, twenty styloid instruments, three ligulae.

Amiens.Round scalpel handle with spiral lines, one large epilation forceps, one spud and probe, one blunt hook, one styloid probe, two spathomeles, six cyathiscomeles.

Museums in Belgium.

Namur.Find of Surgeon of Wancennes, including ointment slab (Deneffe).

Brussels.Mus. de RavensteinaliasCinquantenaire. Étui with silver specilla brought from Italy by M. Ravenstein; three specilla; scalpels.

Charleroi.Fine bistoury.

Museums in Germany.

Mainz(Germano-Roman Museum). Spatula-probe, medicine box, staphylagra, four bleeding-cups.

Frankfort(Historical Museum). Four epilation forceps with sliding catch, two ligulae.

Kiel.Forceps of silver.

Cologne.Chisel, two forceps, pestle, phlebotome.

Museums in Austria.

Vienna.Staphylocaustus.

Museums in Greece.

Athens.Six knives (four from tomb in Milos, two from tomb in Tanagra); forceps and porte-caustic, large cup and chain (Tanagra); ex-voto tablet from Acropolis, representing box of scalpels and two cups, twenty-four spathomeles, one trivalve vaginal speculum.

Museums in Denmark.

Copenhagen(Thorwaldsen). Two epilation forceps, one ditto with leaf shaped ends and catch, three spoon probes, one spatula probe.

Museums in Switzerland.

The instruments from the Roman hospital atBaden, now in the Baden Museum, have already been summarized (page 22). Instruments in other museums in Switzerland are:

Basel Augst.(Augusta Rauracorum). Uvula forceps, probe, spoon-probe.

Avenches.Broken uvula forceps, two vulsella, spatula of bronze plated with silver, probes, needle.

Yverdon.Probes.

Bern.Two probes from Hermance, forceps and spatula probe from Tiefenau.

Lausanne.Spoon probe from Bosséaz and Allaz. Étui for probes, seal for medicament pots, vulsella.

Sierre.Four spoon probes, spatula probe, large needle.

Schaffhausen.Probe from Schleitheim.

Zürich(Landesmuseum). A. Fifteen specilla (spathomeles) all with a sharp-edged long and narrow spoon at one end and at the other an elongated knob; length 130-160 mm.; seven from Galgenbuck in Albisrieden, seven from Windisch, one from Upper Italy. B. Small bronze instrument probably for extracting weapons from wounds; present length 110 mm. (Naples). C. Probably a spatula for applying plaster (Athens). D. Ear spoons (three) of bone, 80-130 mm. long (two from Rome, one from Athens). E. Small bronze spatula, 125 mm. (Athens). F. Similar one of bone, 110 mm. (Windisch). G. Rod pointed at both ends, 155 mm. long (Zürich). H. Bronze rod with a depression 30 mm. long in the middle, 225 mm. long (Windisch).

Museums in Italy.

Naples.Bleeding-cups (fourteen), spoons with bone handles (two), lancet and spoon, shears (bronze), fleams (veterinary), cannulae for ascites (two), bone elevators (two), catheter (one male, one female), bone forceps, specula uteri, trivalve and quadrivalve, speculum ani, toothed forceps, cauteries (three), needles, tongue tie guard, enema tube, probes, whetstones, étui, scalpels, medicament boxes, balances, ointment slabs.

Rome, Capitoline Museum.Curved double olivary probe, four spathomeles, four cyathiscomeles, thirty-six forceps toothed and plain, bodkins (four) eight cm. in length, three ear specilla, four ascites tubes, large scalpel, votive tablet with box of instruments.

Rome, Lateran Museum.Votive tablet representing forceps and other instruments.

Milan.Many knife blades, two bodkins, spathomele, two ligulae, scoop and curette, olive and stylet.

II. BIBLIOGRAPHY

Choulant.—De rebus Pompeianis ad medicinam facientibus. Leipzig, 1823.

Kuehn.—De instrumentis chirurgicis veteribus cognitis et nuper effossis. Leipzig, 1823.

In 1846-7 Benedetto Vulpes made a series of communications to the Royal Academy of Archaeology at Herculaneum as follows:—

(1) Illustrazione di un forcipe Ercolanese a branche curve. (March 3, 1846.)

(2) Memoria concernente la interpretazione dell’ uso di un forcipe Ercolanese di bronzo con le estremità delle branche a semi-cucchiai dentellati: la illustrazione di due cannelli di bronzo anche trovati in Ercolano, de’ quali servivansi gli antichi per cavar l’acqua dall’ addomine degl’ idropici: l’indicamento di tre cannelli Pompejani di bronzo. (April 28, 1846.)

(3) Illustrazione degli specilli e di altri strumenti chirurgici affini trovati negli scavi di Ercolano e di Pompei. (September 15, 1846.)

(4) Descrizione dello speculum magnum matricis e dello speculum ani. (November 24, 1846.)

(5) Delle pinzette, degli ametti, degli aghi chirurgici e del tridente scavati en Ercolano e in Pompeii. (December 1, 1846.)

(6) Illustrazione degli strumenti chirurgici di ferro trovati in Ercolano e in Pompeii. (January 19, 1847.)

In March, 1846, Quaranta made a communication to the same Societyentitled ‘Osservazioni sopra nu forcipe Pompeiano’, in which he expressed a different opinion from that held by Vulpes, and pointed out that the forceps described by the latter in his first communication was found in Pompeii. This is the famous forceps which is always referred to as the ‘Pompeian Forceps’.

These valuable papers of Vulpes and Quaranta were published in vol. vii of theMemorie della Regale Academia Ercolanese di Archeologia. These articles are profusely illustrated. In 1847 Vulpes gathered these papers together, and with some slight alterations published them under the title of ‘Illustrazione di tutti gli instrumenti chirurgici scavati in Ercolano e in Pompeii’.

At the time when Vulpes wrote there were in the Museum among other things 45 probes of various kinds, upwards of 90 forceps, 13 bleeding-cups of bronze, and 16 scalpels.

Vacher.—Les instruments de chirurgie à Herculanum et Pompeï. (Gazette Médicale, 1867, xxii. pp. 491-94.)

Scoutetten.—Histoire des instruments de chirurgie trouvés à Herculanum et à Pompeï. (France Médicale, Paris, 1867, xiv. p. 483.)

Overbeck.—Pompeji, 1884, p. 461.

Museo Borbonico, Vol. xiv. Pl. 35, Vol. xv. Pl. 23.

Ceci.—Piccoli bronzi del Museo Nazionale di Napoli.

Neugebauer.—Warsaw Medical Transactions, 1882.

Neugebauer.—Über Pincetten alter Völker. (Korrespondenzblatt der Deutschen Anthropologischen Gesellschaft, 1884, No. 11.)

Haeser.—Lehrbuch der Geschichte der Medicin, 1875, p. 499.

GuhlandKohner.—Life of the Greeks and Romans, 1862, p. 296.

Monaco.—Guide Général du Musée National de Naples. (Naples, 1900.)

Monaco.—Les monuments du Musée National de Naples.

Monaco.—Specimens of domestic articles from the Naples Museum (Naples, n.d.).

Lindenschmidt.—Die Altertümer unserer heidnischen Vorzeit, Bd. iv. Heft iii.

Anzeiger für schweizerische Geschichte and Altertumskunde, Jahrgang 1857, No. 3.

Ulrich.—Jahrbücher des Vereins für Altertumsfreunde in den Rheinländen, xiv. 1849.

Ulrich.—Catalogue of the Collection of the Antiquarian Society of Zürich (now placed in the Landesmuseum). Pt. I. Roman and Pre-Roman, by R. Ulrich, Conservator. (Published by Ulrich & Co., 1890, p. 140, pl. 1037.)

Brunner.—Die Spuren der römischen Aerzte auf dem Boden der Schweiz. (Zürich, 1894.)

Anonymous.—Un hôpital militaire romain. Zürich. (A sketchy pamphlet published as an advertisement by the town of Baden.)

Mitteilungen der Antiquarischen Gesellschaft, Zürich.—References of interest occur in the following volumes: vol. vii, Meyer, Geschichte der XI. und XXI. Legion; vol. ix, Mommsen, Die Schweiz in römischer Zeit (15); vol. xii, Die römischen Ansiedelungen in der Ostschweiz (19. M. B.); vol. xiv, Bochat, Recherches sur les antiquités d’Yverdon; vol. xvi, Römische Alterthümer aus Vindonissa; Römische Ansiedelungen in der Ostschweiz, ii; vol. xvi, Bursian, Aventicum Helvetiorum, Mosaikbild von Orbe.

Tolouse.—Recherches historiques et archéologiques sur divers points du vieux Paris (Mémoires de la Société Dunkerkoise pour l’encouragement des Sciences, des Lettres et des Arts, 1885).

Haeser.—Lehrbuch der Geschichte der Medicin, 1875.

Freind.—History of Physick from the time of Galen to the beginning of the Sixteenth Century, 1725.

Daremberg.—Histoire des sciences médicales, 1870.

McKay.—History of ancient Gynaecology, 1901.

Lambros.—Περὶ σικυῶν καὶ σικυάσεως παρὰ τοῖς ἀρχαίοις. Athens, 1895. An exhaustive monograph with many illustrations of ancient cups.

I. INDEX OF SUBJECTS

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