'After opening let out pus once a day. After the tenth day, when everything has been evacuated, flush with wine and tepid oil. At night let out what you have put in, and when the pus becomes thin and watery insert a hollow tin tube' (??t????a? ?t?? ?a.s.s?t?????? ??????).

_Tubes to prevent Contractions and Adhesions._

Greek, ?t?? ??????; Latin, _plumbea fistula_.

After operations on the nose, r.e.c.t.u.m, v.a.g.i.n.a, &c. it was usual to insert a tube of lead, bronze, or tin, to prevent contraction or adhesion and also to convey medicaments.

Celsus says that after the operation for occlusion of the v.a.g.i.n.a a tube of lead is to be inserted during cicatrization:

Quumque iam ad sanitatem tendet, plumbeam fistulam medicamento cicatricem inducente illinere, eamque intus dare; supraque idem medicamentum iniicere, donec ad cicatricem plaga perveniat (VII.

xxviii).

A similar tube is recommended by Celsus and Paul for insertion after operations on the r.e.c.t.u.m and v.a.g.i.n.a. Hippocrates (ii. 244) and Paul (VI.

xxv) direct a leaden tube to be inserted in the nostril after the abstraction of nasal polypus.

After dilation of the cervix uteri a hollow tube was put in to keep it open. The tube was also filled with medicaments which were intended to have a beneficial effect on the interior of the uterus. The fullest description of this is given by Hippocrates (ii. 799). After describing the dilation of the womb with graduated dilators, he says:

'It is necessary to insert a leaden tube, similar in shape to the largest dilator but hollow so as to contain substances, and the width of the bore will be the same as that used for ulcers, in order that the mouth of the tent may be smooth and do no damage, and it will be prepared like the wooden dilators. When the tent has been prepared fill it with rubbed down mutton fat, and when ready extract the wooden dilator and insert the leaden one.'

This leaden dilator is referred to over and over again by Hippocrates.

There are in the Naples Museum three of these metal tubes. They are of bronze. One is 18 cm. long, 14 mm. wide at one end, narrowing gradually to 6 mm. at the point (Pl. x.x.xIX, fig. 1).

_Calamus Scriptorius._

Greek, ??af???? ???a??; Latin, _calamus scriptorius_.

The writing pen reed is frequently referred to as an implement of minor surgery.

Alexander Trallia.n.u.s (IV. viii) says that a calamus scriptorius whose joints have been removed may be used as an insufflator. Celsus (VII. v) says that when a weapon buried in the flesh has barbs too strong to be broken with forceps they may be shielded with split writing reeds, and the weapon thus withdrawn:

Fissis scriptoriis calamis contegenda, ac, ne quid lacerent, sic evellenda sunt.

Paul says 'Some apply a tube (?a?a?s???) round about the barbs' (VI.

lx.x.xviii).

Celsus (III) mentions a narrow tube of this sort for drinking water through in cases of nocturnal thirst.

Paul (VI. xxiv and III. xxiii) says that foreign bodies may be sucked from the ear with a reed.

_Quill._

Greek, pt????.

Galen (x. 1011) says that warts may be extracted by means of quills of feathers.

Paul quotes this (VI. lx.x.xvii):

'Some, among whom are Galen, advise us to scarify round the wart with the quill of a hard feather, such as those of old geese or of eagles, and to push it down so as to remove the wart from its roots. Others do the same with a copper or iron tube.'

Aretaeus says a quill may be used for blowing powder into the pharynx (408, vol. ii).

CHAPTER VII

CAUTERIES

_Cautery._

Greek, ?a?t?????, ?a?t??, ?a?t???d??? s?d??e??; Latin, _Ferrum candens_.

The cautery was employed to an almost incredible extent in ancient times, and surgeons expended much ingenuity in devising different forms of this instrument. A considerable number of these shapes are definitely mentioned. The cautery is nearly always spoken of as made of iron. Bronze becomes too soft to act well as a cautery, so that even the earliest references to the cautery in the authentic Hippocratic writings refer to cauteries as 'the irons' (s?d???a). It is true, of course, that in special cases bronze was used--and Priscia.n.u.s recommends a cautery of gold or silver for stopping haemorrhage from the throat (_Logicus_, xxii)--but iron was the usual thing, and in spite of the enormous numbers of cauteries which must have existed only a very few have come down to us, as the iron has perished. The cautery was employed for almost every possible purpose, as a 'counter-irritant', as a haemostatic, as a bloodless knife, as a means of destroying tumours, &c.

The following pa.s.sage is interesting as showing its application in two of these capacities (Aet. IV. iv. 45):

'I put the patient lying on her back, then I incise the sound part of the breast outside the cancer and burn the incision with cauteries until the eschar produced stops the flow of blood. By and by I incise again and dissect the depth of the breast and again burn the incision; and often repeat the same, both cutting and cauterizing to stop the haemorrhage, for then the danger of a rush of bleeding is avoided, and after the amputation is completed I again burn all the parts to desiccation. The first cauterization is for the sake of stopping the haemorrhage, the second for eradicating all traces of the disease.'

_Cautery Knife._

Greek, ????f???.

Paul on several occasions mentions the use of the cautery knife. In radical cure of hydrocele, as an alternative to the excision of the sac by the knife, he explains how it may be done with the cautery, and says, 'Afterwards, when the whole is laid bare, we stretch it with hooks and remove it with a sword-shaped cautery (a?a???t? ?a?t???)' (VI. lxii).

Galen, speaking of cancer, says, 'Some use heated razor blades (???af????), at once cutting and burning' (xiv. 786).

_Trident Cautery._

For forming issues over the spleen Paul (VI. xlviii) says:

'Some pick up the skin with hooks and push through it a long cautery, and repeat this three times so that there are six eschars. Marcellus, however, by using the instrument called a trident or trident-shaped cautery (t??a??? ? t??a???e?de? ?a?t????), formed six eschars at one application.'

Vulpes describes an instrument of bronze which he considers to be a trident-shaped cautery. It was found along side an instrument which I take to be a phlebotome. If it is for the purpose described above by Paul it is unusual in being of bronze, and it must have lost a good part of its teeth.

_Olivary Cautery._

Greek, p?????e?d?? ?a?t?????.

Malignant polypus of the nose is removed, says Paul (VI. xxv), with olivary pointed cauteries (p?????e?d?? ?a?t?????); and again, quoting Leonidas, he says empyema may be opened in the same way (VI. xliv).

The special cautery which was used for 'aegilops' (fistula lachrymalis) was probably an olivary pointed cautery, as the cautery recommended by both Scultetus and Pare for this is an olivary pointed one. Paul (VI.