MATERIAL, EXECUTION, AND ORNAMENTATION
_Steel and Iron._
The surgical instruments we meet with are, as a rule, of bronze. Not that
the Greeks and Romans did not make many of their instruments of iron and
steel, but the iron has mainly perished while more of the bronze has
persisted. Long before the date of the earliest medical writings, Greece
had passed into the iron age. The Homeric poems picture a civilization in
the state of transition from a bronze to an iron period, and weapons such
as sword, axe, and spear, are frequently described as made of iron. In the
_Iliad_ we even read of implements of agriculture made of iron, but it is
'hard to work' (πολύκμητος, _Iliad_ vi. 48, _Od._ xxi. 10). However, by
the time that Hippocrates wrote, it was in common use, and, if we had only
the evidence of the Hippocratic writings to go by, we could see that it
was in common use in the time of Hippocrates. Certain instruments, such as
the cautery, are always spoken of as made of iron, in fact, the term for
cautery is, as a rule, 'the iron,' and σίδηρος ὁ ὀξύς is a general term
for 'the knife'. The smelting of iron is even used as a simile by
Hippocrates:
'In the same way iron comes from stones and earth burnt together. In
the first exposure to the fire stones and earth mix together with
scoria, but at the second and third burning the scoria separate
themselves from the iron, and this phenomenon meets the eye, that the
iron remains in the fire fallen apart from the scoria, and becomes
solid and compact' (ii. 371).
Again, he uses as a simile a speculative theory as to the way in which
heating iron softens it and dipping it in water hardens it. He believes
that this comes about by the fire depriving the iron of its nourishing
substance, while the addition of water restores it.
Σιδήρου ὄργανα τέχνης· τὸν σίδηρον περιτήκουσι, πνεύματι ἀναγκάζοντες
τὸ πῦρ, τὴν ὑπάρχουσαν τροφὴν ἀφαιρέοντες, ἀραιὸν δὲ ποιήσαντες,
παίουσι καὶ συνελαύνουσιν. ὕδατος δὲ ἄλλου τροφῇ ἰσχυρὸν γίνεται (ii.
641).
'The instruments of ironworking soften iron by driving the fire with
wind and taking away the supporting substance, and when they have
rarefied it they strike and beat it. By the nourishment of water it is
again strengthened.'
This is the earliest reference to tempering steel by the Greeks with which
I am acquainted. It is a curious commentary on the relative destruction of
iron instruments compared with those of bronze, that cauteries, which are
always described as made of iron and which must have existed in enormous
numbers, are among the rarest surgical instruments found. We have a few
cauteries of iron, however, and some knives and knife-blades and other
instruments remain. Pots for ointments of certain kinds were made of iron,
and we have actually two of these which had been the property of a Roman
oculist whose full name is known. I have entered into this discussion
because there seems to be a general tendency to underestimate the extent
to which iron was employed by the Greeks and Romans. The quantity of
scoria left by the primitive founders should alone be sufficient to teach
us to how great an extent iron was in use. Wherever there was good iron in
any of the Roman provinces, veritable mountains of scoria are found. The
heaps of scoria left in the Forest of Dean by the Roman founders contained
such a large percentage of iron still remaining that they were smelted
over again in later times, and to do this occupied over twenty furnaces
for a couple of centuries. Tolouse calculated that similar heaps in Gaul
contained over 120,000 tons of scoria. If, however, we tend to
underestimate the extent to which iron was in use among the Greeks and
Romans, still more, I believe, do we tend to underrate the quantity and
the quality of the steel available in those times. This comes about from
the fact that in our day we require such enormous quantities of iron and
steel that we have to employ iron ores of a very low quality. The greater
part of the so-called steel of which battleships are made is got from a
ferruginous mud with only 30 per cent. of iron, less than there was left
in the scoria after the Roman founder had done with it. To the impurities
already existing in this we add others, because the coal we use contains
sulphur. It is getting rid of these impurities that makes the production
of steel such a roundabout process with us. We forget that, with primitive
methods but fine ores and a fuel devoid of sulphur, the production of
steel of fine quality is as easy a process as the manufacture of iron, in
fact the only difference between the method of procuring iron and steel
under these circumstances is the length of time the process is allowed to
go on. The ancient founders used the finest ores, often containing 75 per
cent. of iron, and, working with charcoal fuel, which was nearly pure
carbon, they could produce steel as easily as iron. The difference between
steel and iron is that steel contains carbon, and, by allowing the ore to
remain longer in contact with the charcoal, steel is formed, so that a
founder setting out to make iron with a pure ore and a pure fuel like
charcoal, may, if he is not careful, turn out steel of fine quality. This
primitive method of making steel is still in vogue in India, Burma,
Borneo, China, &c., and very fine qualities of steel are produced. The
majority of the tools found in the earliest Greek colonies on the
Nile--Naukratis and Daphnae--are of steel or iron, although those of the
Egyptians among whom they were living (circa 600 B. C.) were of bronze.
The classical medical writings themselves are sufficient evidence of the
quality of the steel available in those times. Galen (ii. 683) says that
the best quality of steel (which came from Norica) yielded a knife which
neither blunted easily nor bent or chipped.
Ἐκ σιδήρου δὲ ἔστω τοῦτο τοῦ καλλίστου, οἷόν περ τὸ Νωρικόν ἐστιν, ἵνα
μήτ' ἀμβλύνηται ταχέως, μήτ' ἀνακάμπτηται ἢ θραύηται.
This shows that the Greek surgeon appreciated good steel, and what I have
said will show that there was plenty of it to be had. Yet modern writers
almost invariably speak of or describe even the cutting instruments of the
ancients as made of iron. Greek and Latin have each only one word to
indicate both steel and iron, but that is because, as I have shown, they
prepared both in the same way. The ancient Hindoo Vedas say that cutting
instruments were to be made of steel, well polished and sufficiently keen
to divide a hair. For sharpening, a stone was to be used, and they were to
be kept clean and wrapt in flannel and laid by in a box of sandalwood.
Albucasis in mentioning steel always specifies Indian steel. Many of the
Roman shears of steel retain their spring perfectly. As an illustration of
the keenness of edge which can be put by simple methods upon steel of
primitive manufacture, take the following account of the operations of an
African barber of the Hausa tribe, as reported in an account by Professor
R. W. Reid, Aberdeen, of a Hausa barber-doctor's outfit presented to the
Anthropological Museum of the University by Sir William MacGregor,
Governor of Lagos. The description of the outfit is quoted from Sir
William MacGregor, who says:
'The knife, made by an African bush blacksmith, he uses for shaving.
He employs no soap to soften the skin or roughen the hair, only a
little water. He sharpens his razor on a black leather strap, turning
the knife on the back so deftly that the eye cannot follow the
movement; the few last touches he gives to it by turning it with
splendid dexterity on the front of the left arm, where the skin is
worn and bare by this manipulation. He shaves the whole face, except
the nose. He leaves a fine line of eyebrow. The hair is cut short. The
outline of the hairy part of the scalp in front is very clearly
demarcated by shaving back about a half to an inch and a half. Then he
turns the front edge by a marvellous stroke. He holds the knife
horizontally, and, with a downward stroke cuts off all the projecting
ends of the hair round the forehead. No European barber could do it
without burying his razor in the skin. He never draws blood' (_Proc.
Anat. and Anthrop. Soc. Univ. Abdn._, 1900-2).
_Bronze._
Although, as I have shown, iron and steel were largely used in the
manufacture of instruments, fortunately for us bronze was the metal
usually selected, for thus many instruments have withstood the lapse of
time which would otherwise have been oxidized out of existence. Copper is
much more easily got from ore than iron, and consequently it was the first
to be used by man, and very early the advantage of combining it with tin
to form bronze was found out. Bronze was used by the Egyptians 6,000 years
ago, and the Phoenicians, who got it from them, passed it on to the whole
of Europe. The quantity of tin in the bronze is very constantly about
7-1/2 per cent.
The majority of the instruments which have been preserved to us are of
bronze. Hippocrates (i. 58) says:
Χαλκώματι δὲ πλὴν τῶν ὀργάνων, μηδενὶ χρήσθω. καλλωπισμὸς γάρ τις
εἶναί μοι δοκεῖ φορτικὸς σκεύεσι τοιουτέοισι χρῆσθαι.
'Use bronze only for instruments, for it seems laboured ornamentation
to use vessels of it.'
We have, however, a good many specimens of vessels which prove that
physicians did not adhere to this advice. We know too that certain
medicaments were intentionally stored in copper vessels. Scribonius says:
Deinde in patella aeris Cyprii super carbones posita infervescit,
donec mellis habeat non nimium liquidi spissitudinem atque ita
reponitur puxide aeris Cyprii (_Compositiones_, xxxvii).
Pure copper was occasionally used for instruments, and of these we have a
few remaining, and vessels and instruments of it are frequently mentioned:
'Oportet autem moveri aquam ipsam rudicula vel spathomela aeris rubri'
(Marcellus, _De Medicamentis_, xiv. 44). Coins were frequently made of
brass (ὀρείχαλκος, _orichalcum_, _aurichalcum_), a mixture of copper, tin,
and zinc, and in Pompeii there have been found two scalpel handles of
brass composed of 25 per cent. of zinc and 75 per cent. of copper. The
copper was got mainly from Cyprus and Spain. A small amount, however,
came from Africa and Asia.
_Tin._
Tin came mainly from Britain. We have no instruments of tin preserved to
us, but they are frequently referred to. Hippocrates mentions, over and
over again, uterine sounds of tin, and he also speaks of sounds and eyed
probes for rectal work, which were made of tin so that they might be
flexible. Vessels of tin for storing medicaments in are spoken of by
Largus: 'Reponitur medicamentum fictili vel stagneo vase' (cclxviii). In
the Museum at Chesters (Chollerford) there is a tin weight for medicines.
_Lead._
Leaden sounds and tubes for intra-uterine medication are frequently
mentioned in the Hippocratic writings, and Celsus and Paul refer to leaden
tubes for insertion in the rectum and vagina to prevent cicatricial
contractions and adhesions after operations on these parts. The therapists
also mention medicament jars of lead. There is one in the Capitoline
Museum from the temple of Aesculapius in the forum.
_Gold._
There is in the Museum at Stockholm a forceps of gold, but it is more than
probable that this is a toilet article. I have a spatula-probe which had
been overlaid with gold, and I have met with several others similarly
treated. Theodorus Priscianus recommends a cautery of gold for stopping
haemorrhage from the throat (_Logicus_, xxii). Avenzoar speaks of a golden
probe for applying salve to the eye and for separating adhesion of the eye
to the lid. Avicenna lets out the pustules of small-pox with a golden
probe. Albucasis recommends burning the roots of hairs in trichiasis with
a probe of gold. Mesue recommends a heated scalpel of gold to excise the
tonsil. Hippocrates binds the teeth together in fracture of the jaw with a
gold wire (iii. 174): cf. Paul, VI. xcii. In one of his dialogues Lucian
satirizes a medical man who sought to conceal his ignorance by a display
of a fine library, bleeding-cups of silver, and scalpel handles inlaid
with gold--the devices of quacks, Lucian says, who did not know how to use
the instruments when necessity arose.
_Silver._
There is a forceps of silver in the Athens Museum, and another in the
Museum at Kiel. Both are, however, possibly toilet articles. Paul condemns
bleeding-cups of silver, as he says they burn, so it is evident that
Lucian had grounds for his statement. In the Musée de Cinquantenaire,
Brussels, there is in the section of ancient surgery a bronze instrument
case from Pompeii which contained a silver spoon and probe combined, a
plain probe, and a grooved director, all in silver. I have frequently met
with ligulae of silver and also of copper overlaid with silver, and styli,
which we shall see were used as implements of minor surgery, were
frequently made of silver. Medicament boxes of silver are mentioned by
Marcellus. Hippocrates describes a uterine syringe with a tube of silver.
Albucasis mentions silver catheters.
A mixture of gold and silver, which was called electrum, was much used for
coinage, and I have met with one or two ligulae of this metal. It was
found mixed naturally in the mountain districts of Tmolus and Sipylus in
Lydia, and it was also artificially produced by alloying the two metals.
_Horn._
Hippocrates (iii. 331) speaks of a pessary of horn inserted into the
rectum. It would seem that the tube of various syringes was often made of
horn, as both Greek and Latin writers speak of the 'horn' of the syringe.
Scribonius Largus (_Compositiones_, vii) says:
Per nares ergo purgatur caput his rebus infusis per cornu, quod
rhinenchytes vocatur (cf. Galen, xi. 125).
_Wood._
Galen speaks of sounds or directors of wood, and ointment spatulae of wood
are very frequently mentioned in the therapeutic works, as are also boxes
for storing ointments in.
_Bone and Ivory._
Numbers of bone ligulae were found in a Roman hospital lately excavated at
Baden.
In the Naples Museum there are two ointment spoons with carved bone
handles. Needles such as Hippocrates and Celsus speak of for stitching
bandages to fix them were very frequently made of bone and ivory. Knife
handles of bone and ivory are common. A carved ivory medicament box with
sliding lid will be fully described later. Scribonius Largus describes
knives of bone and ivory for preparing plants for pharmaceutical purposes
(_Compositiones_, lxxxiii). An ivory pestle was found with a surgeon's
outfit in Cologne.
_Stone._
Medicaments were prepared on stone slabs, and the great majority of
oculists' seals were of stone.
_Execution and Ornamentation._
The execution of the instruments is, as a rule, all that could be desired,
and the weight and thickness are no more than is consistent with the
requisite strength.
Hippocrates points out the necessity for this:--
Τάδ' ὄργανα πάντα εὐήρη πρὸς τὴν χρείαν ὑπάρχειν δεῖ τῷδε μεγέθει, καὶ
βάρει, καὶ λεπτότητι.
'All instruments ought to be well suited for the purpose in hand as
regards their size, weight, and delicacy' (i. 58).
The ornamentation is simple and effective. In the round instruments like
the probes it consists usually of raised circular ornamentation, with or
without a secondary ornamentation on the raised ringing. In others there
are longitudinal or spiral grooves running along the instrument. In some
cases the bronze is decorated with an inlay of silver damascening. This is
rare in the instruments from Pompeii, though there are two probes with a
spiral inlay in the Naples Museum. The majority of the instruments treated
in this way have been found in the western provinces, and they are of
later date than the Pompeian. The handles of some scalpels belonging to
the third century are beautifully inlaid with silver. Lucian, as I have
mentioned, speaks of scalpels inlaid with gold. In the Mainz Museum there
is a medicament box on the lid of which is inlaid a snake coiled round a
tree, the tree and the snake's body being outlined in copper and the
snake's head in silver. So far no damascened instruments are reported from
Greece. Damascening began in Europe apparently in the first century, and
reached its height in the time of the Merovingian kings.
Examples of plated instruments are not uncommon. I have a spatula
dissector thinly plated with gold, and I have met with several ligulae
plated with silver. One of these was so thickly plated that on cutting
into it the silver, which was deeply oxidized on the outside and was,
therefore, quite black, showed also a layer of metallic silver still
bright on section.
All the surgical instruments found in the provinces have an _air de
famille_ which would lead one to suppose that they had been manufactured
in Italy, but this is not certain. The ointment slabs, however, are rarely
of the stone of the country in which they are found. On the other hand,
the orthographical faults on the oculists' seals would indicate that they
were cut in the provinces. Wherever possible two instruments are combined
into one. Thus very few of the probes are simple instruments but carry a
spatula, a scoop or spoon, an eye, or a hook, at the opposite end.
Vulsella are more difficult to combine with other instruments, but here
again we meet with combinations such as vulsella at one end and scoop,
raspatory, or probe, at the other. The typical scalpel handle carries at
the end opposite the blade a spatula for blunt dissection. We have needles
at one end and probes, scalpel blades, &c., at the other end of a handle.
This combination of two instruments in one is still in use in our day. We
must notice the fact that the majority of instruments we know were all of
metal, not folding into hollow handles of wood, bone, &c., as the
instruments of a decade ago did, so that they were easily cleaned. In fact
we shall see that where the scalpel and handle were not forged in one
piece they were united by something very like our aseptic joint.
Hippocrates insists on the importance of keeping everything in the surgery
absolutely clean.
A few instruments bear the image of deities connected with medicine, or
attributes of these. The figures of Aesculapius and his daughter Hygeia
are found on medicament boxes, the former with the serpent entwining his
staff, the latter feeding a serpent from a bowl. The serpent is sometimes
found on a probe. A uterine dilator from Pompeii also carries it. A probe
surmounted by a double serpent (caduceus form) was found in the Roman
Hospital at Baden. Two scalpels in the Naples Museum carry on their ends
the head of Minerva Medica. The quadrivalve speculum in the Naples Museum
has each end of the crossbar tipped with a fine image of a ram's head.
There is also a medicine shovel with the same symbol. Illustrations of
these instruments will be found later.
_Preservation._
Some of the instruments of silver retain their brightness as when they
were made, but under certain circumstances a considerable amount of
oxidation takes place, and then they have a thick black coating. Very few
bronze articles are found to have retained their colour. In volcanic
districts the various sulphur compounds formed give rise to a beautiful
patina of varying shades of green and blue, sometimes so evenly
distributed as to resemble enamel. This, when fine, much enhances the
value of the article.
Articles of iron are sometimes but little destroyed. It is surprising in
how good condition the iron or steel may be. The bow of a shears is
sometimes quite springy. In some cases a steel or iron article is often
represented by a mass of oxide bearing some resemblance to the original.
In others only a shapeless mass of oxide remains.
_Finds of Instruments._
Finds of ancient surgical instruments, though not by any means common, are
still sufficiently numerous for specimens to have found their way into
most of our larger museums; and private collectors have here and there
acquired considerable numbers. The most prolific source has been the
excavations at Herculaneum and Pompeii, which have now been systematically
pursued for nearly three hundred years, while the objects found have been
deposited in the National Museum at Naples. In 1818 a physician's house
with a large number of surgical instruments was discovered in the Strada
del Consulate of Pompeii, and two chemists' shops have also been found
with instruments in them. Besides these there is a large number of
instruments from other finds in the two buried cities.
The custom of burying personal effects along with the ashes of a deceased
person, which prevailed among the Romans from the second to the fourth
century, has preserved to us a number of interesting finds. In 1880 M.
Tolouse, a civil engineer in Paris, in executing some alterations in the
neighbourhood of the Avenue Choisy, discovered the grave of a surgeon,
containing a bronze pot full of surgical instruments. Among these were
numerous forceps and vulsella, ointment tubes, bleeding cup, scalpel
handles for blades of steel, probes, and spatulae. Sixty-six coins of the
reigns of Tetricus I and II showed that the grave belonged to the end of
the second or the beginning of the third century. The find was reported by
M. Tolouse in a volume entitled _Mes fouilles dans le sol du vieux Paris_
(Paris, 1888). In 1892 the find was fully described by Professor Deneffe
of Ghent, in the _Revue Archéologique_, under the title 'Notice
descriptive sur une trousse de médecin au III{me} siècle', and reprinted,
with photogravures, in 1893 in a monograph _Étude sur la trousse d'un
chirurgien Gallo-Romain du III{me} siècle_ (Antwerp, 1893). It is
convenient to refer to this find as that of the 'Surgeon of Paris'.
Another grave containing surgical instruments was found at Wancennes in
the canton of Beauraing, Namur, in a cemetery of the first or second
century. The instruments are now in the Archaeological Museum at Namur
(Deneffe, op. cit., p. 35).
In 1854 there were discovered at Rheims the remnants of a wooden chest
containing two little iron jars for ointments, several scalpel handles, a
small drill, eight handles for needles, five hooks (two blunt and three
sharp), two balances, various probes and spatulae, seven forceps,
medicament box, a mortar, and a seal showing that the instruments had
belonged to an oculist named Gaius Firmius Severus. The instruments are
all of the most beautiful pattern and finish, several being finely inlaid
with silver. Some coins of the reigns of Antoninus Pius and Marcus
Aurelius showed that the interment belonged to the end of the third
century.
These instruments, &c., are now in the Museum of St-Germain-en-Laye. The
majority of these will be found described and figured later.
Find of Sextus Polleius Sollemnis, oculist of Fonviel,
Saint-Privat-d'Allier. In levelling a heap of earth which had fallen from
a cliff above as the result of a landslide, there were found at Fonviel in
1864 a number of bronze surgical instruments. The place where they were
found is at the intersection of two old Roman roads, and the instruments
had been buried in the grave of a Roman surgeon high up above the valley
on the edge of a cliff. Eighteen coins of the reigns of Julia Augusta,
Trajan, Hadrian, Commodus, Gordian, Philip, Valerian, and Gallus, showed
that the interment had been made at the end of the third century. The
instruments found included three scalpel handles, fragments of two
forceps, and an oculist's seal in stone showing that the grave was that of
Sextus Polleius Sollemnis. Many more instruments had probably been buried
originally. Those enumerated are now in the Museum of Le Puy-en-Velay. An
account of this find, with illustrations, is to be found in the _Annales
de la Société d'Agriculture, Sciences, Arts et Commerce du Puy_ (tome
xxvi. 1864-5). It is also described, along with the find of Gaius Firmius
Severus, in a monograph by Deneffe, under the title of _Les Oculistes
Gallo-Romaine au III{me} siècle_ (Antwerp, 1896).
One of the most prolific finds of late years has been the discovery of a
Roman military hospital at Baden, the ancient Roman station of Aquae, or
Vicus Aquensis. From time to time isolated discoveries of instruments had
been made, including a catheter, a scalpel, and several varieties of
probes, and in March, 1893, MM. Kellersberger and Meyer proceeded to
excavate systematically the remains of some Roman buildings on their
property. A large chamber 10·35 metres by 12·5, with walls 60 cm. thick,
was discovered, and later others were discovered varying from 3 to 27
metres in length. There were in all fourteen rooms. Along the side of the
building on which a Roman road ran, there were the remains of an imposing
façade, running the whole length of the building. It had consisted of a
portico with colonnades, the foundations of which were found at regular
intervals. It is possible that some of the larger rooms had been
subdivided into others by thin walls or partitions, for fragments of
partitions of plaster with wood lathing were found.
A large number of objects--tiles, lamps, vases, pots, knives, spearheads,
nails, glass, fibulae, beads, weavers' weights, three amphorae a metre
high--were found near the surface. Then, at a depth of two metres,
surgical instruments began to be found. These included probes to the
number of 120, unguent spoons in bone and bronze, a fragment of a catheter
13 cm. long, bronze boxes for powder, needles, earscoops, unguentaria,
spatulae, a fragment of an étui for instruments, and cauteries. Many coins
of the reigns of Claudius, Nero, Domitian, Vespasian, and Hadrian were
found, showing that the hospital had been in use between 100 and 200 A. D.
The objects mentioned are still the private property of MM. Kellersberger
and Meyer. In 1905, by the kindness of these gentlemen, I was allowed to
make a complete examination of the collection.
A case containing a surgeon's outfit was found in the Luxemburgerstrasse,
Cologne. It contained a phlebotome, a chisel, and some fragments of other
instruments of steel, two forceps and two sharp hooks in bronze, and a
small ivory pestle-like instrument. These are now in the Cologne Museum.
This is a most interesting and important little find. The phlebotome is by
far the best preserved and best authenticated example which we possess of
this instrument. Probably the same may be said of the chisel as a purely
surgical instrument.