Chapter 4

Καί σοι διχόθεν ἔστι διεμβάλλειν αὐτοῦ τι τῶν παρασκευασμένων λεπτὸν εἴτε ἀμφίσμιλον, εἴτε διπύρηνον ὀνομάζειν ἐθέλεις, εἰ δέ τι λεπτότερον δέῃ καὶ μηλωτίδα (ii. 581).‘And in the double passage you must insert some one of the slender instruments you have at hand, either a double-ended probe (a ‘double olive’ if you prefer to call it so), or if something finer be necessary, even an ear probe.’

Καί σοι διχόθεν ἔστι διεμβάλλειν αὐτοῦ τι τῶν παρασκευασμένων λεπτὸν εἴτε ἀμφίσμιλον, εἴτε διπύρηνον ὀνομάζειν ἐθέλεις, εἰ δέ τι λεπτότερον δέῃ καὶ μηλωτίδα (ii. 581).

‘And in the double passage you must insert some one of the slender instruments you have at hand, either a double-ended probe (a ‘double olive’ if you prefer to call it so), or if something finer be necessary, even an ear probe.’

In dealing with fistulae Paul (VI. lxxvii) says:

‘We must first examine them with a sound if they be straight, or with a very flexible ‘double olive’ (διπυρήνῳ εὐκαμπεῖ), such as those made of tin or the smallest of those made of bronze, if they be crooked.’

Paul refers to its use as a cautery to destroy the roots of hairs after epilation (VI. xiv):

‘Some, preferring cauterizing to the operation of transplantation, evert the eyelid, and with a cilia forceps dragging out the offending hair, or two or even three hairs, apply a heated double-olive probe or an ear probe, or some such slender instrument, to the place from which the hair or hairs were removed’ (Διαπυρίνον ἢ μηλωτίδα ἤ τι τοιοῦτον λεπτὸν ὄργανον πεπυρωμένον εἴρουσι τῷ τόπῳ ὅθεν ἡ θρὶξ ἢ αἱ τρίχες ἐκομίσθησαν).

Here Briau reads πυρῆνα (an olivary point), but the balance of the evidence of the codices is in favour of διαπυρίνον, and the parallel to the passage 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 11·2 cm. long. The shaft is unequally divided by a ringed fluting into two portions; 4·5 cm. and 6·7 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(διπυρήνου τρήματι), and we push the other end of the probe (τὸ ἕτερον πέρας τοῦ διπυρήνου) 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 3show 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, ὑπάλειπτρον, σπαθομήλη; Latin,spathomele(Theodorus Priscianus),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 στρόγγυλον μήλην, the other μήλη πλατεῖα. 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 (μαλάξας ἐπὶ τῆς χειρὸς διὰ σπαθομήλης).

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 passage from Theodorus Priscianus refers to its use for applying ointment to an affected part:

Si veluti carbunculus innatus fuerit, lycium cum 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 scraped off after a moderate space of time with a spathomele (τῇ σπαθομήλῃ).

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.’

Priscianus 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.’

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 passage from Galen shows that it was used as a substitute for the meningophylax (q. v.):

‘Having separated the pleura from the rib and placed a thin meningophylax or a flat spathomele (σπαθομήλην πλατεῖαν) between the ribs, and taking care that you neithertear nor perforate the membrane, which being properly accomplished, cut the bone of the rib with two chisels placed opposed to each other’ (ii. 686).

Soranus (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’ (τοῦ πλάτεος τῆς μήλης).

An interesting passage in Aetius shows that it was used as a dissector in opening up an occluded vagina:

‘Pass 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 1·5 cm., the spatula 6 cm. The average diameter of the nucleus is 7·5 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. XIIshows 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. XIIIshow coarse, 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 edgesare 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 constitute a special class, which may be called the cyathiscomele class.

Cyathiscomele.

German,Löffelsonde.

Although this variety of the spathomele is not one which is specially mentioned by any classical 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. 3shows 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:

Pl. XV, fig. 1shows a similar arrangement, except that the cavity is more marked, and the tip instead of being sharp is rounded. InPl. XIV, fig. 1the 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 inPlates XIV,XV.Pl. XV, fig. 4shows a very coarse, 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 Vendée in 1847. Among a number of colour pots and alabaster mortars for rubbing down and mixing colours was an étui similar to the typical cylindrical instrument case of the ancient surgeon, and in this were two spoon probes like the one shown inPl. XIV, fig. 1. Evidently they were favourite instruments of the painter, and had been used by her for mixing and preparing her colours.[2]

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.

These writers, then, all take note of the possibility of wounding the vein, but give no clue that they knew of the utility of a cloven plate in preventing the accident. Further, the Arabs, timid operators all and fond of describing safeguards such as this, give no mention of it, although Albucasis, Rhases, Avicenna, and Haly Abbas all describe the operation. I can find no reference to the use of a guard for this purpose until quite recent times.

Ear specillum.

Greek, μηλωτίς, -ίδος, μηλωτρίς, ἀπυρομήλη, τῇ πυρῆνα μὴ ἐχούσῃ τούτεστι τῇ μηλωτρίδι (Galen, Lexicon); ὠτογλυφίς, μήλην ἐξωτίδα (Galen, Lexicon); Latin,oricularium specillum(Celsus);auriscalpium(Scrib. Largus); German,Ohrlöffel.

Of all the specilla this is one of the most frequently mentioned by name. It consists of a small narrow scoop at one end and a simple probe without olivary enlargement atthe other. We shall discuss the scoop first. The following passage from Archigenes describes it (Galen, xii. 652):

‘If a bean, stone, &c., fall into the ear remove it with the small narrow scoop of the ear specillum’ (κυαθίσκῳ στενῷ μικρῷ μηλωτρίδος).

Again Galen (loc. cit.) and Paul (VI. xxiv) say that in cases where foreign bodies cannot be got out of the ear by more simple methods, we must incise behind the ear and remove them by means of the ear scoop. The removal of foreign bodies from the ear by means of this instrument is very frequently referred to and shows that the scoop was small. Celsus says (VI. vii):

‘When a person begins to experience a dullness of hearing, which very often happens after long continued headaches, first of all we must examine the ear itself, for there will appear either a scab such as occurs upon ulcers, or a collection of sordes. If there is a scab it ought to be fomented with warm oil or with verdigris in honey, or leek juice or a little nitre in hydromel, and when the scabs have been detached from the part, the ear is to be washed out with tepid water, in order that being spontaneously separated it may be the more easily extracted with the ear specillum (oriculario specillo). If there is cerumen and it is soft, it is to be extracted with the same specillum, or if it is hard vinegar with a little water is to be put in, and when it is softened the ear is to be washed out and evacuated in the same way.’

In VI. vii he says:

Ubi vero vermes orti sunt, protrahendi oriculario specillo sunt.‘Where worms have arisen they are to be extracted with an ear specillum.’

Ubi vero vermes orti sunt, protrahendi oriculario specillo sunt.

‘Where worms have arisen they are to be extracted with an ear specillum.’

Celsus also recommends it for extracting a calculus from the meatus urinarius (VII. xxvi):

Eum, si fieri potest, oportet evellere vel oriculario specillo, vel eo ferramento quo in sectione calculus protrahitur.‘It, if possible, is to be extracted with the specillum or the instrument for extracting the calculus in lithotomy.’

Eum, si fieri potest, oportet evellere vel oriculario specillo, vel eo ferramento quo in sectione calculus protrahitur.

‘It, if possible, is to be extracted with the specillum or the instrument for extracting the calculus in lithotomy.’

Aetius (III. v) also describes removal of urethral calculus in this way.

The following passage from Paul (VI. xl) on venesection shows that in cases where the band of Antyllus could not be applied, the back of the ear scoop was pressed on the proximal end of the vein, in order to obstruct the flow of blood and cause it to discharge by the opening made with the phlebotome:

‘Tie a ligature round the neck, and when the frontal vein is properly filled divide it with the point of a phlebotome or a scalpel. In the same way we open the external jugulars for chronic ophthalmia, producing a discharge of blood with the scoop of a probe’ (κυαθίσκου μήλης).

Adams evidently misunderstood this passage. He translates it ‘with the concave part of a scalpel’, which is meaningless. This use of the scoop will also explain an otherwise obscure passage in Hippocrates (iii. 678). He says:

‘In letting blood avoid pressing hard with the specillum (καὶ ὅταν ἀφαιρῇς τὸ αἷμα τῇ μήλῃ μὴ κάρτα πιέζειν ὡς μὴ φλάσις προσγίνηται) lest injury be caused.’

Of the use of the ear scoop as a curette we have several instances. Thus Aetius (II. iii. 81) recommends it for curetting the interior of a chalazion, and again (II. iii. 84), cf. Galen,Comp. Med.vii. 2. The scoop was also used for applying medicaments, especially to the eye. Liquid applications were poured from it, semi-solid were applied with the back of it (averso specillo). This use of the back of the scoop has often been misunderstood. The natural translation of the phraseaverso specillois ‘with the probe turned away’, i. e. the back of the probe. Scultetus, however (Tab.VIII. vii), considers that it refers to a spatula probe, and says it means the probe turned end for end. Other translators adopt this meaning. Deneffe (Les Oculistes Gallo Romains, p. 108), e. g., says:

Il faut entendre paraverso specillola partie de la spatuleopposée à celle qui sert comme sonde, c’est-à-dire son extrémité large, l’autre bout étant le plus souvent olivaire.

Scribonius Largus puts the true meaning of the phrase beyond doubt. He directs us, after the application of caustic to haemorrhoids, to endeavour to get them to fall off by the back of an ear scoop, which part the Greeks called the spoon (‘auriscalpio averso quam partem κυαθίσκον Graeci vocant’).

Marcellus copies this passage from Scribonius, but alters it. He says: ‘de specilli latitudine illinendae sunt’ (xxxi. 6, p. 329).

I shall now proceed to give a few instances of this use of the back of the scoop in minor surgical manipulations.

In ancyloblepharon Celsus says the eyelids are to be separated with the back of the scoop.

Igitur aversum specillum inserendum, diducendaeque eo palpebrae sunt (VII. vii. 6).

The back of the scoop was used as a retractor for delicate structures. In radical cure of hernia Celsus directs us to keep the bowel from prolapsing by means of it:

‘For if the piece be small it is to be pushed back over the groin into the abdomen, either with the finger or the back of the specillum.’Nam quod parvulum est super inguen in uterum vel digito vel averso specillo repellendum est (VII. xxi).

‘For if the piece be small it is to be pushed back over the groin into the abdomen, either with the finger or the back of the specillum.’

Nam quod parvulum est super inguen in uterum vel digito vel averso specillo repellendum est (VII. xxi).

In the cure of varicocele it is used to replace the veins in position:

Tum venae, quaecunque protractae sunt, in ipsum inguen averso specillo compelli debent (VII. xxii).‘Then the veins which have been drawn upon ought to be replaced with the back of a specillum.’

Tum venae, quaecunque protractae sunt, in ipsum inguen averso specillo compelli debent (VII. xxii).

‘Then the veins which have been drawn upon ought to be replaced with the back of a specillum.’

In sloughing ulcer of the bladder it is used to separate the lips of the perineal wound:

Quod si antequam vesica purgata est orae se glutinarunt, dolorque et inflammatio redierunt, vulnus digitis vel averso specillo diducendum est (VII. xxvii).‘But, if before the bladder has become cleansed the lips unite and pain and inflammation have returned, the wound is to be separated with the fingers or the back of a specillum.’

Quod si antequam vesica purgata est orae se glutinarunt, dolorque et inflammatio redierunt, vulnus digitis vel averso specillo diducendum est (VII. xxvii).

‘But, if before the bladder has become cleansed the lips unite and pain and inflammation have returned, the wound is to be separated with the fingers or the back of a specillum.’

We shall next proceed to discuss the other end of the ear specillum. This was a simple probe. It had no nucleus. In his Lexicon Galen defines it thus:

Ἀπυρομήλῃ· τῇ πυρῆνα μὴ ἐχούσῃ τούτεστι τῇ μηλωτρίδι.‘Probe without olivary enlargement—that is to say “the ear specillum”.’

Ἀπυρομήλῃ· τῇ πυρῆνα μὴ ἐχούσῃ τούτεστι τῇ μηλωτρίδι.

‘Probe without olivary enlargement—that is to say “the ear specillum”.’

Not only was its tip not expanded into a nucleus, it was actually sharp. Galen (xiv. 787) treating of fistula in ano, says in non-perforating fistulae we perforate all the sound flesh with the sharp end of an ear probe (τῷ ὀξεῖ τῆς μηλωτίδος). The chief use of an ear probe in aural work was to instil liquids into the ear. A large ball of wool saturated with the liquid was wrapped round the middle of the probe, and on squeezing this the liquid ran down and dropped into the meatus. There are many mediaeval illustrations showing the ear probe used in this fashion. Sometimes, however, we read of the tip of the probe being wrapped in a small ball of wool, which was dipped in some sticky substance to extract foreign bodies from the ear. Galen (xii. 689) says foreign bodies may be removed thus by a probe dipped in resin.

The ear probe seems to have been much used for probing wounds and fistulae when a very slender instrument was required. Galen (ii. 581), in describing the torcular Herophili, says:

‘And in the double passage you may be able to insert some of the slender instruments you have at hand, a double ended probe—a ‘double-olivary’ if you prefer to call it so—or if something smaller be necessary even an ear specillum’ (καὶ μηλωτρίδα).

In his chapter on the extraction of weapons (VI. lxxxviii) Paul says:

‘If the weapon has a tang, which is ascertained by examination with an ear probe’ (ἐκ τῆς μηλωτῆς).

As a cautery it was used to destroy the roots of hairs, which had been removed for trichiasis. Paul says:

‘We may apply a double olive or an ear probe (μηλωτίδα) or some such fine instrument heated’ (VI. xiii).

In fistula in ano Paul says it may be used as a director to cut upon.

‘Having introduced a sound or an ear probe (ὑποβάλλοντες κοπάριον ἢ μηλωτίδα) through its orifice, we cut the skin over it at one incision’ (VII. lxxviii).

Illustrations of two ear probes are given. What I regard as the type is seen inPl. XV, fig. 5, which shows an instrument from the Roman Hospital at Baden. Typical specimens are not by any means common.Pl. XV, fig. 2shows another variety from my own collection.

Screw Probes.

On probes for wrapping round with wool we frequently raise a screw thread to enable the wool to adhere better. This useful contrivance was also known to the ancients. I give a figure of one in my possession. It was found in the Roman Camp at Sandy (Pl. XXI, fig. 5). It measures 9·7 cm. in length and is 1·5 mm. thick. The screwed portion occupies 7 mm. of one end. The other end is plain. The little instrument is well adapted for treating small cavities, such as an ear or a carious tooth by wrapping round the screw portion with wool and dipping in medicaments.

Ear specillum for wounds.

Greek, τραυματικὴ μήλη; Latin,specillum vulnerarium.

There was a special variety of ear specillum which was adapted for wounds. Paul (VI. lxxxviii) says:

‘Stones and other missiles from slings may be removed by levers or the scoop of an ear probe adapted for wounds’ (κυαθίσκου τραυματικῆς μηλωτίδος).

This was probably an instrument on the same principle as the ear probe, i. e. a combined probe and scoop, but on a larger scale. Possibly it may have had a slight olivary enlargement. That it was large we learn from Galen’sLexicon, where μήλην ἰσχυράν is stated to mean τὴν τραυματικὴν μήλην. It will easily be seen that thespecillum vulnerariumhas considerable affinity with the other class of spoon probes which I constituted, viz. the class of cyathiscomeles—for these had a scoop at one end—and this being specially intended for wounds most likely had a certain amount of olivary enlargement at its tip, but smaller than the olive of a cyathiscomele, which was too large for ordinary wounds. The typical ear specilla and the typical cyathiscomeles both form well defined groups, but between these innumerable gradations occur among the specimens extant. For practical purposes it is convenient to class all these intermediate forms asspecilla vulneraria.

Handled Needles.

In the find of the oculist Severus were no less than nine handles for needles. Of these, six were merely cylinders of bronze, expanded slightly at one end and perforated at the other with a small hole for a needle. They were from 72 to 40 mm. long and 7 to 5 mm. in diameter. Two were hexagonal, four were round (Pl. XXI, figs. 2, 4,Pl. XVI, figs. 3, 4, 5, 6). Two others had the same holes for needles at one end, but at the other they were pierced with a slot, 10 mm. deep, for the insertion of a knife blade. One was 60 x 7 mm., the other 53 x 5 mm. (Pl. II, figs. 1, 2). Another, perforated at one end as before, carried at the other an olive-pointed probe. It was 8 cm. in length, and of this 3·5 cm. consisted of a hexagonal handle 3·5 cm. in diameter. The remainder was cylindrical, and it terminated in a probe point with a slight olivary enlargement (Pl. XVI, fig. 2). In all cases the needles had evidently been made of steel and had entirely disappeared.

We have many allusions to the use of handled needles in ophthalmic work. In describing the couching of cataract Celsus says:

Tum acus admovenda est, acuta ut foret sed non nimium tenuis (VII. vii).‘Then a needle is to be applied, sharp so as to penetrate, but not too fine.’

Tum acus admovenda est, acuta ut foret sed non nimium tenuis (VII. vii).

‘Then a needle is to be applied, sharp so as to penetrate, but not too fine.’

Sextus Platonicus (Med. ex Animalibus) says that cataract is depressed with a specillum.

A full description of the operation is given by Paul:

‘We measure off a nucleus’ breadth (ὅσον πυρηνομήλης) from the part called the iris and in the direction of the outer canthus, then mark with the olivary end of the couching needle (πυρῆνι παρακεντηρίου) the place to be perforated. If it is in the left eye, we work with the right hand, and vice versa. Bringing round the pointed end of the perforator, which is round at the tip (καὶ ἀναστρέψαντες τὴν ἀκμὴν στρογγύλην κατὰ τὸ πέρας ὑπάρχουσαν τοῦ κεντηρίου), we push it firmly through at the part which was marked out until we come to an empty space. The depth of the perforation should be as great as the distance of the cornea from the iris. Then raising the needle to the apex of the cataract (the bronze of it is plainly visible through the transparent part of the cornea) we depress the cataract to the underlying parts. After the couching of the cataract we gently extract the needle with a rotatory movement’ (VI. xxi).

It will be seen from Paul’s vivid description that the couching instrument consisted of a handle with a nucleus at one end, to measure off the spot at which to perforate, and a needle at the other. We saw that the outfit of the oculist Severus contained one such instrument (Pl. XVI, fig. 2). The same combination is not infrequently met with. In the Museum at Aarau there are four from the station at Vindonissa. I have one in my collection which is interesting as showing a screw thread for fitting on a cover to protect the needle (Pl. XVI, fig. 7). It was found in Bedfordshire. It reminds one very strongly of the couching needle figured by Paré. Other handled needles were used in eye work as cauteries. Of trichiasis Celsus says (VII. vii):

Si pili nati sunt qui non debuerunt, tenuis acus ferrea ad similitudinem spathae lata in ignem coniicienda est: deinde candens, sublata palpebra sic ut eius perniciosi pili in conspectum curantis veniant, sub ipsis pilorum radicibus ab angulo immittenda est ut ea tertiam partem palpebraetranssuat; deinde iterum, tertioque usque ad alterum angulum; quo fit ut omnes pilorum radices adustae emoriantur.

Ophthalmic Probe.

Greek, ὀφθαλμικὴ μήλη.

In Hippocrates (ii. 100) we find an ophthalmic probe mentioned.

Λεπίδος μῆλαι τρεῖς τῷ πλατεῖ καὶ ἀλήτου σητανίου κόλλης, πάντα ταῦτα λεῖα τρίψας, καταπότια ποιήσας δίδου.‘Of squama aeris three times the full of a specillum and [as much] of the gluten of wheat. Levigate all up fine, form into pills and administer.’

Λεπίδος μῆλαι τρεῖς τῷ πλατεῖ καὶ ἀλήτου σητανίου κόλλης, πάντα ταῦτα λεῖα τρίψας, καταπότια ποιήσας δίδου.

‘Of squama aeris three times the full of a specillum and [as much] of the gluten of wheat. Levigate all up fine, form into pills and administer.’

Galen in his Lexicon explains that μῆλαι τρεῖς τῷ πλατεῖ means τῷ κυαθίσκῳ ὀφθαλμικῆς μήλης. This is the only mention which we have of a special ophthalmic probe with scoop. In applying medicaments to the eye with a probe whenever any variety of probe is mentioned it is always the ear specillum which is named. It seems most likely that either the ear specillum or some variety of it is referred to here. It may have had a nucleus for applying medicaments at one end and a scoop at the other.

Rasping Specillum.

Greek, βλεφαρόξυστον; Latin,specillum asperatum(Celsus).

A special burred specillum, for curetting the granular lids so common as a result of the ophthalmia which is endemic in most Eastern countries, and which was rampant in ancient Greece and Rome, is described by Celsus and also by Paul. Celsus says:

In hoc genere valetudinis quidam crassas durasque palpebras et ficulneo folio, et asperato specillo, et interdum scalpello eradunt, versasque quotidie medicamentis suffricant (VI. vi).

Paul says:

‘But if the granulation be hard and yield to none of these things we must evert the eyelid, and rub it down with pumicestone, or the shell of the cuttlefish, or fig-leaves, or the surgical instrument called blepharoxyston’ (διὰ τοῦ βλεφαροξύστου καλουμένου, III. xxii).

Heister (vol. i. tab. xvi. p. 591) figures the blepharoxyston as a spoon-shaped instrument burred on the convex side. There is in the Orfila Museum, Paris, an instrument of similar form. It consists of a handle with an olivary point at one end, and at the other a plate with transverse ridges. This agrees well enough with what we know of the classical instrument. It was found in Herculaneum. (Pl. XVI, fig. 1).

Styli and Styloid Specilla.

Greek, γράφιον, γραφεῖον, γραφίς; Latin,stylusorstilus.

The difficulty of deciding as to whether any particular instrument is a surgical or a domestic article is often well illustrated by styloid instruments. In the British Museum several types of instrument will be found classed among surgical instruments, and a series of exactly similar articles will be found repeated among the styli used for inscribing and erasing characters on wax tablets. As even the writing stylus was occasionally used for surgical manipulations we are justified in looking on all styloid instruments as potentially implements of minor surgery. The claims of any doubtful instrument to be considered as once having been one of a surgeon’s tools must be decided on such grounds as the circumstances of its discovery.

Galen (xii. 865) says teeth may be extracted with the stylus (γραφείῳ ἀνάλαβε) or with the finger.

Hippocrates (i. 46) thus describes the method of extraction of the secundines:

‘Place the patient on the obstetric chair and, leaving the cord uncut, place the child on two bladders filled with water and puncture each of the bladders with a stylus (γραφίῳ) so that the water may slowly flow away.’

The writing stylus, then, from the fact of its being at hand and of suitable shape was occasionally, perhaps often, used as a surgical instrument.

I give a figure of a stylus in silver, beautifully oxidized, which was found at York while making excavations there in constructing the railway (Pl. XVII, fig. 3).

Pl. XVII, fig. 6shows an instrument which is figured by Vulpes (op. cit.) as a specillum. Personally, I think its highly ornamented form shows that it is rather a domestic article, but, as no information is available as to the surroundings among which it was found, we can only say that its shape fits it equally well either for writing or minor surgical manipulations.

Grooved Director.

Although we have no actual description of a grooved director, we have many manipulations described in which such an instrument would be used nowadays. For example, in describing the treatment of fistulae Celsus says:

In has demisso specillo ad ultimum eius caput incidi cutis debet (VII. iv).‘A director being inserted into them down to their termination the skin ought to be incised.’

In has demisso specillo ad ultimum eius caput incidi cutis debet (VII. iv).

‘A director being inserted into them down to their termination the skin ought to be incised.’

It is interesting to find that we have at least one grooved director extant to prove that this instrument was known to the Romans. It is in the Section of Surgical Antiquities of the Musée de Cinquantenaire, Brussels, and it was discovered, along with several other surgical instruments, in a surgeon’s case of the usual cylindrical form.

It is 15 cm. long, 2 mm. in diameter. A deep groove runs for 6 cm. from one end. The other end terminates in a small button. It is of silver, as also were the other contents of the case. It is possible that grooved specilla may have been in quite common use, but may have been made of wood or tin, and have therefore not survived; because we learn from Galen’s Manual of Dissection that probes which were used as directors in dissecting work were generally of wood, such as boxwood, so that they might not chip the scalpel (ii. 711).

Surgical Needle (three cornered).

Before discussing the eyed probes it will be well to clear the way by disposing of the needles, and of these, as the most easily defined class, it will be best to take the surgical needles first. We have innumerable references to the surgical needle though we have no actual description of it. There must have been many different sizes of it, for the manipulations vary greatly in magnitude. I shall content myself with giving two quotations describing respectively one of the largest and one of the smallest of these. Both passages are from Celsus. He thus describes the operation of suturing the abdominal parietes:

Sutura autem neque summae cutis neque interioris membranae per se satis proficit; sed utriusque: et quidem duobus linis iniicienda est, spissior quam alibi; quia et rumpi facilius motu ventris potest, et non aeque magnis inflammationibus pars ea exposita est. Igitur in duas acus fila coniicienda, eaeque duabus manibus tenendae; et prius interiori membranae sutura, iniicienda est sic ut sinistra manus in dexteriore ora, dextra in sinisteriore a principio vulneris orsa, ab interiore parte in exteriorem acum immittat: quo fit ut ab intestinis ea pars semper acuum sit quae retusa est. Semel utraque parte traiecta, permutandae acus inter manus sunt, ut ea sit in dextra quae fuit in sinistra, ea veniat in sinistram quam dextra continuit: iterumque eodem modo per oras immittendae sunt: atque ita tertio et quarto, deincepsque permutatis inter manus acubus plaga includenda. Post haec, eadem fila eaedemque acus ad cutem transferendae similique ratione ei quoque parti sutura iniicienda; semper ab interiore parte acubus venientibus, semper inter manus traiectis: dein glutinantia iniicienda (VII. xvi).

In the next case, where Celsus describes the treatment of staphyloma of the cornea, a very small needle must have been used:

Haec fere circa oculum in angulis palpebrisque incidere consuerunt. In ipso autem oculo nonnunquam summa attolitur tunica, sive ruptis intus membranis aliquibus sive laxatis; et similis figura acino fit: unde id σταφύλωμα Graeci vocant. Curatio duplex est: altera, ad ipsas radicesper mediam transsuere acu duo lina ducente; deinde alterius lini duo capita ex superiore parte, alterius ex inferiore adstringere inter se; quae paulatim secando id excidunt: altera in summa parte eius ad lenticulae magnitudinem excidere (VII. vii).

Now for suturing tissues, and more especially tissues of such toughness and thickness as the abdominal parietes, a round needle is absolutely of no use. A surgical needle not only requires to have cutting edges, as our three-cornered needles have, but these edges need to be in good condition to work well. Three-cornered surgical needles were in use from very early times. They are fully described in the Vedas of the Hindoos (Wise,Hindoo System of Medicine, p. 171). A few three-cornered needles of Roman origin have been found, although they are rare. Those which exist are of bronze. Probably the majority were of steel, and of these none have survived. I give a photograph of a three-cornered needle from my collection (Pl. XVII, fig. 4). It is imperfect at the point. It measures 7·2 cm. in length, and the sides are each 2 mm. in breadth. It is important to emphasize the fact that only needles with cutting edges are to be looked on as surgical, because it is not unusual to find needles, which are round and of large calibre, described as surgical, although they are quite unfitted for surgical work. Such is the one figured by Vulpes (op. cit.).

Needles of this kind are sometimes found, as this one was, among surgical instruments. But they are not surgical needles in the sense that they are intended for suturing tissues. They are for fixing bandages. I shall describe them in the next section.

Round Needles and Bodkins.

Hippocrates tells us that bandages for fixing dressings and splints on a fractured limb ought to be finished off by stitching with a thread (iii. 55), and Celsus repeats the advice:

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