FORCEPS
_Epilation Forceps._
Greek, τριχολαβίς, τριχολάβιον (== τριχολαβίδιον); Latin, _vulsella_.
The removal of the hair from the face for cosmetic purposes is a custom
which has come down to us from prehistoric times, and seems to have been
very prevalent among all primitive races. In the bronze age the method by
which this was accomplished seems to have been to fix the hairs with a
broad jawed forceps and cut them off close to the skin by means of a knife
or 'razor'. Thus did primitive men 'shave', and very often in early bronze
age graves in Scandinavia and in the Swiss lake-dwelling excavations these
forceps and razors are found together. No doubt also epilation proper was
practised occasionally, but the majority of the prehistoric forceps are
not for epilation but for fixing the hairs to allow the knife to divide
them close to the skin. At a later time, with the more common use of
steel, the Greeks and Romans shaved as we do, and epilation proper was
practised for removing superfluous hairs from the face and also to remove
trichiasis. Aristophanes, a contemporary of Hippocrates (Ran. 516, Lys.
89, 151), Persius (iv. 37) and Juvenal (vii. 114) refer to the depilation
of the pubes as being common among certain classes, and the early
Christian Fathers deplore the practice. See also the remarks of Suetonius
on the conduct of Domitian (xxii). Prosper Alpinus, who visited Egypt in
the sixteenth century and wrote an interesting book on the state of
medicine in that country, found the custom still prevalent among the
Egyptian women, and thus explains the object with which it was practised
(_Medicina Aegyptiorum_, cap. III. xv):
A pulveribus, qui Aegyptiis fere toto anno ventorum terraeque
siccitatis occasione perpetuo familiares existunt, atque ab assiduis
sudoribus quibus coeli calore omnia corpora continue abundant,
illuvieque quadam immunda redduntur, atque foetentia, ex quo pleraque
ipsorum et foetere et pediculis abundare solent. Balneis omnes hi
populi utuntur familiarissime pro corporum abstersione, maximeque
mulieres, quibus curae magis est corpora ipsarum pulchriora facere
ipsorum, illuviem et foetorem corrigentes, ut cariores sint suis
viris. Eae etenim saepissime corpora in iis lavant, at mundant ab
illuvie, perlotaque variis ornant odoribus ut recte unguentis oleant.
Ac veluti Italae mulieres atque aliarum multarum etiam nationum ad
capillorum facieique omne cultum adhibent studium, ita Aegyptiae
capillorum cultum negligunt ex consuetudine omnes capillos in bursam
serico panno paratam concludentes, ac ad pudendorum abditarumque
corporis partium ornatum omnem diligentiam adhibent. Pudendis igitur
tota cura in balneis ab iis adhibetur. Ea siquidem in primis lavant,
pilisque nudant, locaque pudendorum perpetuo glabra gestant, turpeque
ibi est mulierum pilis obsitam vulvam habere. Demum lotas eas partes
glabrasque effectas variis unguentis etiam exornant.
The custom survived in France and Italy in the sixteenth century.
Epilation as a purely surgical operation was frequently necessary for the
trichiasis consequent on the granular ophthalmia which was so common among
the Romans. Paul (VI. xiii) says:
'Turn the eyelid outwards and, with an epilation forceps (τριχολαβίῳ)
dragging out the offending hairs, either one, or two, or three or
whatever number there are. Then apply a heated olivary probe or an
aural probe or some such slender instrument to the place from whence
the hair or hairs have been removed.'
The numbers of toilet epilation forceps which have been found are
enormous. Moreover, forceps of exactly similar form were in use in every
household as accessories of the lamp for raising and snuffing the wick,
and artisans used them also for the finer manipulations of their crafts;
so that by far the largest number of forceps of this type are not surgical
instruments, but household implements. However, we have plenty of
specimens from purely surgical finds.
Of the surgical instruments all forms agree in having no teeth. The
simplest form consists of a strip of metal bent on itself straight as in
Pl. XXVI, fig. 3, or with the jaws turned inwards, as in Pl. XXVI, fig. 5.
These are often pocket forceps. A 'pocket-companion', consisting of a
toilet forceps, an ear-pick and a nail-cleaner, such as is seen in Pl.
XXVI, fig. 4, is a common object in museums, such as the Guildhall Museum,
where this object is. A variety of epilation forceps with rounded legs is
seen in Pl. XXVI, fig. 2. Several of these have been obtained from purely
surgical finds. Others are formed by sawing a bar of bronze up its centre,
as in the specimen shown in Pl. XXVI, fig. 1, which is 13 cm. 4 mm. long,
and with jaws 10 mm. broad. It is from the Naples Museum.
This is the form most typical of the surgical epilation forceps. Several
of this type were found in the grave of the oculist Gaius F. Severus at
Rheims (Pl. XXVI, fig. 6). They are very large powerful instruments, from
15 to 16 cm. long, and with jaws 7 to 8 mm. in breadth (Deneffe, _Oc. du
3{e} siècle_, ii. 1-8). This form was no doubt used as a dissecting
forceps or tumour vulsellum as well as for epilation, but the typical
tumour forceps was toothed, and it is convenient to classify all those of
the untoothed type as epilation forceps.
Other epilation forceps, which are however more likely to be toilet
articles, have the jaws of extreme breadth, as in Pl. XXVII, fig. 3 from
the Mainz Museum. It has a sliding catch. They are evidently intended to
remove a considerable number of hairs at once, or to fix them while they
were cut with razor or shears.
It is certain, however, that in addition to these broader forceps a
variety with quite narrow blades was used, as Paul (VI. xxiv) tells us
that stones, &c. may be removed from the ear with epilation forceps
(τριχολαβίῳ), and again in fracture of the nose Paul (VI. xxiv) says that
splinters of detached bone are to be removed with these forceps. We have
several forceps of this type. There are in the Naples Museum three, one
from Pompeii, two from Herculaneum (Deneffe). One from my own collection
is shown in Pl. XXVI, fig. 2. The points are narrow and rounded.
A very interesting form is seen in Pl. XXVII, fig. 4, which shows a
forceps in the Thorwaldsen Museum, Copenhagen. It is 12 cm. long, of which
6 cm. of the upper end are solid and round. The remainder of the length is
occupied by the blades of the forceps, each 5 mm. broad, except for 12 mm.
at the extremity, where it expands into a leaf-shaped portion, 10 mm.
broad in its broader part. These leaf-shaped expansions oppose each other
accurately, and on the narrow part of the blade above them there slides a
rectangular catch which serves to clamp the blades and fix them like the
jaws of a vice.
The surgical epilation forceps is, as we have seen, usually a simple
instrument. Occasionally we meet with a forceps combined with some other
instrument. These are, as a rule, toilet articles. A pocket ear-scoop and
epilation forceps combined was found in Paris. Precisely similar articles
of steel may be bought in chemists' shops to-day. Another has a small
unguent spatula combined with a forceps, while others carry olivary
probes. There are several of these in the St-Germain-en-Laye Museum (Pl.
XXVII, figs. 5, 2). One from Melos, in the Athens Museum, has a
porte-caustique.
_Polypus Forceps._
Greek, πολυποξύστης.
Galen (_Med. Sec. Loc._ xii. 685) alludes to the method of extraction of
polypus from the nose by means of a forceps (ἔπειτα λαβιδίῳ ἐξαίρει), and
from what Paul says it would seem that there was a special polypus
instrument, consisting of a forceps at one end and a rugine at the other.
After describing extraction by means of a knife and scoop he says:
'If, however, any part of the tumour be left behind, we take another
polypus eradicator (ἕτερον πολυποξύστην), and with the end of it
(ἐπάκμου αὐτοῦ ξυστηρίου) bring away what remains, by stretching,
twisting, and scraping it strongly.'
Ξυστήριον means a small rugine, but stretching and twisting can only be
done with a forceps. Rare as the combination of an antique forceps with
another instrument is, we have one example of the combination of a rugine
and a forceps, and, as it is admirably adapted for the extraction of nasal
polypus, I think we are quite justified in considering it to be the
instrument indicated by Paul. This instrument was found in the grave of
the Paris surgeon. It is elegantly formed and is of one piece of bronze
sawn down the middle. The upper part is surmounted by a rugine strongly
curved, pointed at the tip and cutting on one edge. The rugine measures 3
cm. in length, and 5 mm. in breadth (Deneffe, _Tr. d'un Chir._, pl. v,
fig. 1) (Pl. XXVII, fig. 1).
_Tumour Vulsellum (Myzon)._
Greek, μύδιον, μύγδιον, σαρκολαβίς, σαρκολάβος; Latin, _myzon_,
_sarcolabon_, _vulsella_.
The form vulsellum has got so well established by usage in modern medical
writings that it would seem pedantic to write 'vulsella forceps', but so
far as I am aware it is not a form which has any classical authority. The
classical usage is _vulsella_, _-ae_, feminine. I shall follow custom and
use the modern term when using it as an English word.
The myzon, or tumour forceps, was a toothed instrument of the dissecting
forceps type. Ducange says it takes its name from the shells which are
called μυτίλοι, vulgo μύδια (mussels). It was used whenever it was desired
to make traction on any object--such as a tumour--to excise it, or to
raise and fix a piece of skin. Aetius (xvi. 106) says:
Μυδίῳ πλατυστόμῳ συλλαβὼν τὴν νύμφην διὰ τῆς εὐωνύμου χειρὸς
ἀποτεινέτω τῇ δὲ δεξιᾷ ἀποτεμνέτω παρὰ τοὺς ὀδόντας τοῦ μυδίου.
'Seizing the clitoris with a broad jawed vulsellum in the left hand,
put it on the stretch, and with the right cut it off close to the
teeth of the instrument.'
Paul gives pretty much the same instructions (VI. lxx):
Μυδίῳ κατασχόντες τὸ περιττὸν τῆς νύμφης ἐκτέμνομεν σμίλῃ.
'Seizing the hypertrophied portion of the clitoris with a vulsellum,
excise it with a scalpel.'
Aetius (xvi. 107) also says:
Ὥσπερ οὖν ἐπὶ τῆς νύμφης προείρηται σχηματίζειν χρὴ τὴν γυναῖκα καὶ
μυδίῳ ἀποτείνειν τὴν ὑπεροχὴν καὶ τῷ πολυπικῷ σπαθίῳ ἐκβάσεως ὅλον τὸ
περιττὸν ἀφαιρεῖν.
Cf. also Paul, VI. lxxi and again Aetius (iv. ii. 3).
Again Aetius says:
'If there is a large and malignant excrescence in the angle of the
orbit, the enlarged part must be seized with vulsella (μυδίῳ) and cut
off' (vi. 74).
In the corresponding passage in Paul (VI. xvii) another name for the
vulsellum is used, viz. σαρκολάβος:--'granuloma of the inner canthus we
seize with vulsella and excise' (σαρκολάβῳ). In treating of epulis he
again uses the same term: 'Epulis we seize with vulsella and excise'
(σαρκολάβῳ).
In Moschion (II. xxx), in the chapter 'De Haemorrhoidibus quae in matrice
nascuntur', we find a Latin transliteration of the two terms μύδιον and
σαρκολάβος side by side:
Myzo vel sarcolabo haemorrhoides teneantur ita ut in aliquantum
extensas scalpello prius radices earum scarifes, et in aliquantum
artifex sarcolabo convertat.
Here, in all probability, Soranus, from whom Moschion is copying, has
simply used μύδιον, and the added 'vel sarcolabo' is simply a gloss, for
the terms μύδιον and σαρκολάβος are synonymous. However this part of
Soranus is lost. Extant specimens of the vulsellum are common. A simple
variety is formed by folding a plate of bronze on itself, as in Pl.
XXVIII, fig. 1, which shows a specimen in the British Museum. The jaws are
finely toothed.
More usually the myzon is formed by sawing a plate of bronze partly along
its midline as in Pl. XXIX, fig. 2, which is taken from the find of the
oculist Severus.
An interesting variation is seen in the specimen shown in Pl. XXVIII, fig.
3 which is from my own collection. The line of junction of the jaws
instead of being in the median plane is sloping. The object of this
arrangement is not quite clear. A small variety of the vulsellum is
referred to by Aetius:
'Epulis we seize with a small vulsellum and excise with a small
scalpel' (ἡ ἐπουλὶς μυδιοσκέλλῳ ἀποταθεῖσα ἐκτεμνέσθω σμιλαρίῳ στενῷ,
vii. 24, 25).
We have one or two of these instruments. They remind one of fixation
forceps. I illustrate one in Pl. XXIX, fig. 3. It is from the Mainz
Museum. There are four similar ones in the Frankfort Historical Museum.
The specimen shown in Pl. XXVIII, fig. 2, from the Naples Museum, is
interesting as being stamped with the name of the maker, Acachcolus.
We have now to consider an interesting variation produced by extending the
extremity of the blade to one side so as to increase the width of the
blade (coudée type). This is a rare type.
Pl. XXIX, fig. 1 represents one of two from the find of the surgeon of
Paris. It is 17 cm. long, and the legs of the forceps are 8 mm. wide. The
jaws debouch to one side at an obtuse angle for a distance of 2 cm. and
end in a fairly sharp point. The jaw is thus increased to 2 cm. in
breadth. They are finely toothed. They are concave internally and convex
externally. The other forceps was 14·5 cm. long and 8 mm. wide. The Museum
at Naples has a forceps of this type, but having a sliding ring to fix the
jaws after they have been applied (Pl. XXIX, fig. 4).
This angled type of forceps may be the one referred to by Paul in his
description of the plastic operation on the eyelid for trichiasis (VI.
viii), when he directs us to raise the redundant skin of the lid with a
fixation forceps and cut it off with a scalpel (βλεφαροκατόχῳ μυδίῳ, τοῦτ'
ἔστι πρὸς τὴν περιφέρειαν τοῦ βλεφάρου ἐσχατισμένῳ ἀνατείναντες τὸ
περιττὸν δέρμα, σμιλίῳ ἀποκόπτουσι). It may be noted that this coudée type
of forceps has considerable affinity with the type of forceps presently to
be described for strangling haemorrhoids and the relaxed uvula, the only
essential difference being that the blades are not crossed here.
_Uvula Forceps._
Greek, σταφυλάγρα.
In Aetius (II. iv. 12) we have an interesting description of the
amputation of the uvula by first crushing it in a forceps so as to prevent
haemorrhage and then cutting it off:
'Then inserting a vulsellum and making traction on it, the uvula
crusher (τὴν σταφυλάγραν) is fitted on about the middle of the uvula
or a little below it, and then it is pulled and twisted (by the
vulsellum). By the torsion it becomes lifeless and, as it were, snared
off; it curls up, becomes livid and comes off without much effusion of
blood. Wherefore it is well to wait some time and hold it till the
patient can stand it no longer, and then cut it off--the cut being
made close to the vulsellum but nearer the tip than to it.'
The σταφυλάγρα therefore corresponds in its action to a pile-crusher. This
instrument I believe to be represented by the type of forceps shown in Pl.
XXX, fig. 1. It is in the British Museum. The two branches of the forceps
cross like scissor blades, and at their ends the jaws are formed in such a
way as to project forwards and enclose a cavity 1 cm. deep and 18 mm.
long. Over all the forceps is 18 cm. long. The jaws are finely toothed.
There is in the same museum another instrument similar in all respects
except that it is 1 cm. shorter, and that in each blade, which is 16 mm.
long (Pl. XXX, fig. 2), there is a small hole near the proximal end. A
posterior view of a similar instrument is seen in Pl. XXXI, fig. 1. It is
from the find of the surgeon of Paris. A similar specimen is in the Mainz
Museum.
Pl. XXXII, fig. 3 shows a smaller specimen from the Naples Museum. It is
11 cm. in length. A large powerful variety with a different arrangement of
the handles is seen in Pl. XXXI, fig. 2 from a specimen in the Antiquarian
Museum at Basle. It is 20 cm. long.
A forceps which I take to be a staphylagra occurs on the coins of Atrax in
Thessaly (_circa_ 400 B. C.). The forceps stands alongside a bleeding cup.
The object of the holes in several of the specimens is to permit the
insertion of a cord to bind the jaws firmly together, and thus keep up the
strangulation of the part for some time, as Aetius directs. The
application of a ligature in this way would, of course, not be possible
while the instrument was applied to the uvula, but the following passage
from Leonidas (Paul, vi. 79) shows that the uvula crusher was also used to
clamp piles in the same way:
'Having seized the haemorrhoids and held them there for some time with
the uvula crusher (σταφυλάγρᾳ) he cuts them off with a scalpel.'
In such a case the application of a cord to clamp the jaws together would
be a distinct convenience. The short variety is more suitable for external
operations, as for haemorrhoids; the long variety for manipulations in the
throat.
Hippocrates mentions the uvula crusher as one of the instruments necessary
for the outfit of the physician (i. 63).
_Forceps for applying Caustic to Uvula._
Greek, σταφυλοκαύστης.
A remarkable variety of forceps, of which there is only one extant
specimen (which is in the Vienna Museum) is shown in Pl. XXXII, fig. 2. It
is formed of two branches which cross and are fixed by a rivet near the
middle of the instrument. The jaws are 3·5 cm. long, concave internally,
and fit accurately together, enclosing an oval cavity 1 cm. in diameter.
This forceps is, I believe, the one which Paul describes as used for
destroying the uvula with caustic. He says (VI. xxi) that if from timidity
the patient decline excision of the uvula, we are to take the caustic used
for operations on the eyelids, or some such caustic, and fill with it the
hollows of the caustic holder for the uvula (τοῦ σταφυλοκαύστου τὰς
κοιλότητας), and directing the patient to gape wide, and getting the
tongue pressed down with a tongue depressor, we open the instrument
sufficiently and grasp with it as much of the uvula as we cut off in the
other operation. The medicament must neither be of too liquid consistence,
lest it run down from the uvula and burn the adjoining parts, nor very
hard, that it may quickly act on the uvula. And if from one application
the uvula becomes black this will be sufficient, but if not, we must use
it again. In VI. lxxix he says that some, filling the hollows of the
staphylocaustes (τὰς κοιλίας σταφυλοκαύστου) with caustic, burn off
haemorrhoids in the same way as they do the uvula. An interesting use of
this instrument is mentioned by the same author in the chapter above
referred to, while describing the method of treating haemorrhoids by the
ligature:
'By means of the forceps for applying caustic to haemorrhoids, or the
forceps for applying caustic to the uvula (τῷ αἱμορροϊδοκαύστῃ ἢ τῷ
σταφυλοκαύστῃ), we surround them close to the jaws of the instrument
(πρὸς τὰ χείλη) with a five-ply thread of lint, and strangle the
haemorrhoids separately with this ligature.'
It would seem then that, just as there was a long instrument for crushing
the uvula and a short one for crushing haemorrhoids, there were
corresponding instruments for cauterizing these parts, probably differing
from each other only in the length of the handle.
The passage above quoted has given much trouble to the scribes and
commentators apparently from a lack of knowledge of the instrument
referred to. About a third of the codices omit τῷ αἱμορροϊδοκαύστῃ, and
Cornarius and Dalechamps reject the words τῷ αἱμορροϊδοκαύστῃ ἢ τῷ
σταφυλοκαύστῃ as superfluous and interpolated. Apparently they were
unaware that both instruments were forceps of similar principle but
different lengths, and quite suitable for putting a haemorrhoid on the
stretch. The reason why these instruments are preferred, for this purpose,
to the staphylagra is apparently that not being toothed like the latter
instrument they would be both less painful and less likely to cause
bleeding.
_Pharyngeal Forceps._
Greek, ὁ ἀκανθοβόλος.
Paul (VI. xxxii) describes a forceps for removing foreign bodies from the
pharynx:
'Prickles, fish-bones and other substances are swallowed in eating and
stick in different places. Wherefore such as can be seen we are to
extract with the special fish-bone forceps' (τοῖς ἰδίως ἀκανθοβόλοις
προσαγορευομένοις ἐξέλκομεν).
This is the only reference to the acanthobolus I have met with, and it
gives us no information as to the appearance of the instrument. It is
noteworthy, however, that Paul in his chapter on the removal of spiny
bodies from the pharynx is copying Aetius, and the instrument Aetius names
is an epilation forceps. He says 'bones stick near the tonsil or back of
the pharynx and can be seen, and if a considerable part projects out of
the tonsil it can be removed with an epilation forceps (τριχολαβίῳ)'. A
forceps of the epilation type, but angled in its length, is figured by
Védrènes. It was found in Pompeii. This forceps is eminently suitable for
pharyngeal work (Pl. XXXII, fig. 1). Albucasis figures an acanthobolus
with an up-and-down, not lateral, movement.