Surgical Instruments in Greek and Roman Times.

by John Stewart Milne.

PREFACE

The object of this book is to lay before the student of medical history an account of the various instruments with which the ancient Greek and Roman surgeons prosecuted their craft. It is self-evident that no clear conception of a surgical operation, ancient or modern, can be formed from a written description without some previous knowledge of the instruments intended to be used. Many interesting operations described in detail in the cla.s.sical authors are rendered obscure or quite unintelligible from lack of this knowledge. The learned Adams gives an accurate translation of a long and involved chapter by Paulus Aegineta on the use of the v.a.g.i.n.al speculum, but remarks that owing to our want of knowledge of the specula possessed by the ancients the chapter is unintelligible. Daremberg says it is impossible to say what was the shape of any of the cutting instruments mentioned by Hippocrates. The steady progress of archaeological discovery has gradually added find after find of surgical instruments, till now there is scarcely a museum with any considerable number of antique _pet.i.ts bronzes_ which does not number among its contents a few surgical instruments, and in the Naples Museum alone there are hundreds. In several cases we know even the name of the original possessor of these and the special branch of surgery which he practised. There are thus open to us materials which were not available to the men of learning to whom I have referred above, and the time seems opportune to undertake a systematic review of all the materials at our disposal, and attempt to reconstruct the surgical armamentarium of the ancients. Considering the importance of the subject, it is surprising that no such systematic attempt has previously been made. Indeed, comparatively little attention has been given to this department of archaeology. Literature bearing on it is comparatively scarce. What we have is entirely continental, and consists of a series of reports of different finds with attempts to indicate the uses of the instruments described. In addition to these reports and the actual instruments scattered over various museums, we have at our disposal the writings of the ancient authors themselves. In these a fair number of instruments are minutely described, while many others are named, and here and there points about their shape are mentioned in different places; and by piecing these particulars together and deducing other facts from the nature of the manipulations the instruments are employed in, we can describe in detail, with a tolerable amount of certainty, a surprisingly large number of instruments. It must be confessed that these ancient cla.s.sics are rather difficult of access, surprisingly so considering that until a few decades ago they were reverenced as works of authority for medical practice; but the fact seems to be that our predecessors were largely content to draw their knowledge of these authors from mediaeval Latin translations. Part of one of the most interesting authors has never been published in the original Greek, and for our knowledge of it we are dependent on a sixteenth-century Latin translation, supplemented, it may be, by fugitive consultations of codices in libraries and museums.

Others of the Greek texts have not been reprinted since the sixteenth century, and bristle with the ingenious but at first perplexing shorthand contractions with which the Renaissance typographer imitated the Compendia of the ma.n.u.scripts. These difficulties can be got over with patience, however, and the waste of gray matter necessary as a preliminary is not out of proportion to the results to be obtained. Even as a quarry for philological materials the medical cla.s.sics are far from being worked out, and it is surprising how many words one meets with which are not to be found in the best Greek-English dictionaries.

The method pursued in the present investigation was to make a complete examination of the cla.s.sical medical, surgical, anatomical, and pharmaceutical writings which have been preserved to us, copying out the portions in which an instrument was mentioned. These extracts were then rearranged in ledger form, each extract being cla.s.sified under the heading of the instrument it referred to. Out of the enormous number of references thus obtained, those pa.s.sages were selected which seemed to throw any light on the shape and size of the instrument to which they referred.

Next, an examination was made of the reports of finds in various localities; as many specimens in various museums were examined as possible; and annotations of cla.s.sical texts were searched for any further information they might give. The total information thus gained is so arranged that under the heading of each instrument will be found a series of selected extracts from different authors, with the deductions from them which it is possible to make regarding the appearance of the instrument, and an ill.u.s.tration is given of it from some ancient specimen where such is in existence. Failing actual ancient specimens, I have fallen back on mediaeval or ancient Arabian authors for ill.u.s.tration.

I have omitted a discussion of the many interesting mechanical contrivances for the reduction of deformities due to fracture and dislocation, and also of the splints, pads, and bandages for maintaining these injuries in position. These form such a well-defined group that they might fitly form the subject of a special monograph, and the ill.u.s.trations required are of a different nature from those in the present volume. The majority of these contrivances will be found described in a chapter by Heliodorus preserved in Oribasius. I have omitted also all reference to the numerous forms of vessels in which the ancients prepared and stored their medicaments, with the exception of those which are intended for carrying on the person. Some of these merge into forms which are common to both drug and instrument cases, and it is impossible to separate them. It has been necessary also to include as far as possible the instruments involved in the preparation and application of medicaments, as most of these are either actually or potentially implements of minor surgery.

The volume opens with a short account of the ancient authors whose writings have any bearing on the subject in hand. At the end of the book will be found a bibliography of reports on finds, and a list of the most interesting instruments to be found in various museums. The latter makes no pretence of being a complete inventory, although it might serve as a skeleton for the construction of a more comprehensive list at some future date. The bibliography, on the other hand, is believed to be fairly complete. The bulk of the book consists of an attempt to reconstruct, in the manner described above, the different instruments used in cla.s.sical times.

The books from which I have drawn most information are Brunner's _Die Spuren der romischen arzte auf dem Boden der Schweiz_, Deneffe's _etude sur la Trousse d'un Chirurgien Gallo-Romain du III{e} Siecle_, Adams'

translation of Paulus Aegineta, and the papers of Vulpes in the volume for 1851 of the _Memorie della Regale Accademia Ercolanese di Archeologia_.

During the five or six years which I have spent on this investigation I have unsparingly laid all my friends under contribution whenever opportunity occurred; but among those to whom I am particularly indebted I may mention Mr. M. G. Swallow of Baden, who has given me much a.s.sistance in working up the Swiss finds, Professor Alexander Ogston, under whom I spent many happy days as house-surgeon, and who has all along kept a fatherly eye on the progress of the work and encouraged me to proceed to the end with a task which at times seemed inclined to swamp me, Mr. R. C.

Bosanquet, late director of the British Archaeological School at Athens, who procured for me photographs of the instruments in the Athens museum, and Mr. H. R. Nielsen of Hartlepool, who has been the companion of my wanderings among the continental museums. I have also to thank my father, John Milne, LL.D., for much help at many different points.

The expense of visiting the museums in the North of France and of obtaining photographs of the instruments in them has been borne by a grant from the Carnegie University Research Fund.

This monograph was presented as the thesis which forms part of the examination for the degree of M.D. of the University of Aberdeen, and it was successful in gaining 'Highest Honours.'

HARTLEPOOL, _April 19, 1907_.

CHAPTER I

INTRODUCTORY

The earliest cla.s.sical writer on medical subjects is Hippocrates, who was born in 460 B. C. and who practised in Athens and other parts of Greece.

The 'Hippocratic Collection' is well known to consist of works which are not all by Hippocrates himself; but as the pseudo-Hippocratic works all belong to the cla.s.sical period they are all admissible as evidence for our purpose, and for the sake of brevity I shall throughout refer to them as if all were by Hippocrates. Many interesting instruments are named in the comparatively small collection of treatises which make up the admittedly genuine list of Hippocratic works, but, taking these along with the pseudo-Hippocratic works, the number of instruments named in the whole collection is surprisingly large, comprising as it does trephines, bone drills, probes, needles, tooth forceps, uvula forceps, bone elevators, uterine sounds, graduated dilators, cranioclasts, and others. After Hippocrates there is a break in the continuity of the literature, and for some hundreds of years Greek medicine is represented almost entirely by the Alexandrian Schools. The first printed edition of the Hippocratic works was a Latin translation printed at Rome in 1525, followed by the Aldine edition of the Greek text printed at Venice in the following year.

Other editions are the edition of Foes (1595), Van der Linden (1665), Kuhn (Leipzig, 1821). Later editions are the text with a French translation by Littre (10 vols., 1849-61), a scholarly edition by Ermerins with a Latin rendering (1859-64), and an excellent translation of the genuine works of Hippocrates by the world-famous Dr. Adams of Banchory (Sydenham Soc.

Trans., 1849). The best edition, however, is the edition of Kuehlewein, begun in 1894 and at present in course of publication by Teubner, Leipzig.

The later volumes have not yet appeared. For the portion of the text which is not contained in the first two volumes of Kuehlewein I have relied on the edition of Kuhn for most of the readings, although occasionally those of Van der Linden or Foes are to be preferred. The references given are to the volumes and pages of Kuhn's edition, but in this edition indications are given of the corresponding localities in the other editions so that cross-references to these can easily be made. There seems to be a different arrangement in different editions of Foes, for Liddell and Scott say the references in their Lexicon are to the pages in Foes but they do not correspond in any way to the pagination of the edition before me (Frankfort, 1595).

Aulus Cornelius Celsus is the next writer we have. His system of medicine in eight books is a marvel of lucid arrangement, and his beautiful style makes it a pleasure to read any of his works. The seventh book gives a most interesting review of the surgery of the Alexandrian School. He describes many instruments in detail, although he names fewer special instruments than some of the Greek writers as the Latin language lends itself less well to the formation of compound words than the Greek does.

To take one example only, Celsus has practically one word for all varieties of forceps--vulsella, while the Greeks use many compounds like hair forceps (t????-?a??), flesh forceps (sa???-????), tooth forceps (?d??t???a), stump forceps (??????a). Indeed, in the case of the two latter words Celsus falls back on Greek to express himself. Celsus was first published in 1478. Another edition is that of Targa, 1769. The editions before me are those of Daremberg, published at Leipzig in 1859, and Vedrenes (Paris, 1876). The latter contains ill.u.s.trations of a considerable number of specimens from Italian and French museums.

Rufus of Ephesus (98-117 A. D.) has left little to interest us for our particular purpose, as he merely mentions, without describing, a few instruments, all of which are already known to us from other sources. The best edition is that of Daremberg, Paris, 1879. A Latin translation of his works will be found in _Medicae Artis Principes_ (Stepha.n.u.s).

Aretaeus of Cappadocia has left us a work on Acute and Chronic Diseases.

He has few references to instruments, but such as they are they are interesting, as he names some which are given by no other author. He has a tantalizing allusion to a work by himself on surgery which has not been preserved. There is a fine edition of the text, with an English translation by Adams of Banchory, in the Transactions of the Sydenham Society.

Galen (130-200 A. D.) was a most voluminous writer, much of whose work remains and teems with matter of interest to us. Much information about instruments is to be gained from even his purely anatomical writings. The most accessible edition is that of Kuhn (20 vols., Leipzig, 1821), but it is slipshod in the text, and even more so in the translation, which is in Latin.

Oribasius (325 A. D.) wrote an encyclopaedia of medicine, which is called S??a???a? ?at???a?--Collecta Medicinalia, in seventy books, only about one third of which remain. This is the most interesting of his works from our point of view, but he has left also a synopsis of the encyclopaedia called S??????, and a sort of first aid manual called ??p???sta. I have used the edition of Daremberg and Bussemaker (1851-76).

Sora.n.u.s of Ephesus has left us a most valuable treatise on obstetrics and gynaecology, which, though written only for midwives, contains many interesting references to instruments such as the speculum, uterine sound, cephalotribe, decapitator, and embryo hook. He lived in the reign of Trajan. Some of the chapters, of which the Greek is lost, have been preserved to us by his abbreviator Moschion. I have used the edition of Rose published at Leipzig in 1882.

Moschion (fifth century) translated into Latin the gynaecological and obstetrical part of the works of Sora.n.u.s for the benefit of midwives who could not speak Greek. This version is now lost, but we have a translation of it into Greek, made after the fall of the Western Empire and the development of the Greek-speaking Empire at Constantinople in the sixth century. There is an Edition of this by Gesner (Basle, 1566). Finally, this Greek version of Moschion was translated back into barbarous Latin at some early date, Barbour thinks by some member of the Schola Salernitana.

This was published at Venice by Aldus in the sixteenth century, and Rose has prefaced his edition of Sora.n.u.s with it. This work of Moschion is only of interest to us from the fact that he preserves to us the substance of some chapters of which the original in Sora.n.u.s is wanting.

Caelius Aurelia.n.u.s Siccensis, an African of the fourth or fifth century, translated the works of Sora.n.u.s, both those on gynaecology and those on general diseases, and he preserves some of Sora.n.u.s which we would not otherwise possess; but he writes in a barbarous Latin which, like the Latin of some other African writers on medical subjects, is calculated to cause great pain to any one not familiar with this particular style.

Aetius lived in the first half of the sixth century, and compiled a voluminous treatise on medicine in sixteen books. He worked entirely with scissors and paste, but the result is the preservation to us of a large number of extracts from writers whose works would otherwise have entirely disappeared, and his work is of great value for the study of instruments.

In 1534 an Aldine Edition of the first eight books was published, and, though a translation of the whole work was published by Cornarius in 1533-42 in Latin, six of the last eight books were never published in the original Greek. This is unfortunate for us, as for our purpose the original is the only thing of any great value, Greek being, as I have already pointed out, a language richer in compounds than Latin is, and lending itself better to the coining of special names for special instruments. Not that the sixteenth-century translator is ever at a loss for a turn by which to express himself in Latin, but the turn, as often as not, is by periphrasis just at the very point when we would have liked a very exact equivalent for the Greek. The translation of the part of the work of which we have the Greek shows that we cannot entirely depend on some of these periphrases even where they appear definite, as in some cases an unwarrantable a.s.sumption is made about the form of an instrument.

Thus ???????? is translated 'forcipe ad id facta' because in Cornarius's time the instrument used for extracting stone from the bladder was a forceps, whereas it is doubtful whether there was in the Roman period anything more than a scoop, and, therefore, we are not ent.i.tled to translate ????????? by anything more definite than 'stone extractor', its etymological equivalent. Although, therefore, I have examined the latter eight books of Aetius in the Latin translation, and although they contain some of the most interesting information to be found in the whole work, I have been very chary about laying stress on any deductions drawn from the Latin translation only. It may be noted that there are two ways of referring to the different books in Aetius, according to whether the Greek text or the translation of Cornarius is meant. Cornarius arranged his version in four tetrabibli of four books each, whereas the Greek text is simply numbered from i-viii. 'No vii.' of the Greek text is, therefore, called by Cornarius 'Tetr. ii. lib. iii.' The eleventh book was published by Daremberg in his edition of Rufus (1879), and the twelfth book was published by Costomeris at Paris in 1892.

Pliny the Younger. Plinius Secundus (Rose, Leipzig, 1875). The writings of Pliny contain little information of any kind and are absolutely of no use for our purpose.

Scribonius Largus (45 A. D.). The edition I have examined is named 'Scribonii Largi Compositiones' and is edited by Helmreich, Leipzig, 1887.

The work of Scribonius Largus is entirely pharmaceutical, but he gives many references to appliances by which medicaments were prepared in the surgery.

Marcellus Empiricus (300 A. D.) wrote a work on pharmacy, of large size but little value, and in a poor style. There are a few pa.s.sages bearing on implements of minor surgery. A good deal is copied from Largus. Aldus published the text by Cornarius at Venice in his collection of Medici Antiqui (1547), republished by Stepha.n.u.s (_Medicae Artis Principes_), 1567. The edition I have used is that of Helmreich (Leipzig, 1889).

Theodorus Priscia.n.u.s, alias Octavius Horatia.n.u.s, lived in the fourth century and has left a work, in three books, called _Euporiston_. It is a compilation in African Latin of extracts from Galen, Oribasius, &c. The style of the Latin is so barbarous that it really must be seen to be believed. There is a little information to be gathered about minor instruments. The edition I have used is that of Rose, Leipzig, 1894. To this edition are tacked on the medical remains of Vindicia.n.u.s Afer, mere fragments without anything to interest us.

The works of Alexander Trallia.n.u.s (526-605 A. D.) contain practically no surgery at all, although I have managed to extract a few references of minor interest.

The last of the eminent Greek writers is Paulus Aegineta, a writer who probably lived in the sixth and seventh centuries. This is getting rather late in the day, it is true, but to omit the works of Paulus, or Paul, as he is affectionately called by his admirers, would be to omit some of the most valuable knowledge of ancient medicine we possess. Paul, like most of his time, was a compiler, but he was a skilful one, and while he entirely depends on Galen, Archigenes, Sora.n.u.s, &c. for his information, he has gathered up the best of the medical knowledge of his time in a little encyclopaedia whose artistic completeness and orderly arrangement are not surpa.s.sed by any work of a corresponding nature at the present day. The work is divided into seven books, the sixth of which deals with surgery and teems with information about instruments. Aldus published the entire Greek text at Venice in 1527. A fine English translation, with a most valuable commentary, was published by Adams of Banchory for the Sydenham Society in 1846. No one who reads it can wonder that Adams had a worldwide reputation for his knowledge of medical history. The important sixth book was published along with a translation in French by Briau at Paris in 1855.

I have obtained a description of two very important instruments from the works of Hero of Alexandria (285-222 B. C., ed. 1575). There are a few interesting references to instruments in the works of the early Christian fathers. Tertullian is the only one of these I can claim to have systematically searched, but in one of his sermons he refers to no less than four surgical instruments, one of which is not described by any other author.

It were a work of supererogation to recount the names of the other Greek and Roman writers whose works I have run through in a profitless search for references to instruments. Some of these, such as Dioscorides, are of great importance in themselves though valueless for our purpose. Others, such as many of the minor Greek writers contained in the collection by Ideler ent.i.tled _Physici et Medici Graeci Minores_ (Berlin, 1841), and the minor Latin writers contained in the collection of _Medici Antiqui Omnes_ (Aldus, 1547), are of little value of any kind.

Before the capture of Alexandria by Omar in 651, many Greek medical writings had been translated into Syrian. At a later date such of these as had escaped destruction were turned into Arabic by the scholars of Bagdad (Honain and his School), in the ninth century. These, introduced into Spain in the Middle Ages by the Moors, were again translated into Latin and supplied for many a day the greater part of the medical knowledge of Europe, until the study of the few Greek texts which had escaped destruction showed the true origin of Arabian medicine. It will thus be seen that there is some information, in fact a great deal, to be had from the study of the works of the Arabs, but the barbarous style of the Latin and the roundabout way in which the works have been preserved, having pa.s.sed through translations of three different languages, preclude any very exact deductions being drawn from them. Some of these works are profusely ill.u.s.trated with figures of instruments, but I have been careful not to fall back on any of the Arabs except to support deductions drawn from more direct sources.

The chief Arab writers of interest to us are:--Serapion (800), Rhases (882), and Ali Abbas (after 950), all of Honain's School at Bagdad. The huge work of Avicenna (born 980), _The Canon_, was much used by the Arabs.

It was published at Cordova, which became the Bagdad of the West after the Arabs crossed to Spain in 811.

The work of Albucasis (ob. 1106) was also published at Cordova, and contains much surgical information and has many ill.u.s.trations of surgical instruments, but these must be used with due caution. I have used the edition published at Strasburg in 1532.

A word must be said of the later writers such as Pare (1509-90), Scultetus (1650), and Heister (1739). The works of these are profusely ill.u.s.trated with instruments, some of which can plainly be seen to tally exactly with the descriptions of the cla.s.sical authors. In other cases, although the names given to the instruments are those of cla.s.sical times, it is, to say the least, doubtful whether they are of the same form as the ancient instruments whose names they bear. That was an age of great activity in the manufacture of new forms of surgical instruments, and we must accept with caution ill.u.s.trations professing to indicate ancient forms of instruments. At the same time it is very interesting to note the large number of primitive arrangements which remained in use till nearly 1800.

The enema syringe figured by Heister is exactly the same as we find described in the Hippocratic works--the bladder of an animal affixed to a tube--and many pract.i.tioners alive at the present day have seen the same simple arrangement in actual use.