BLEEDING CUPS, CLYSTERS, ETC.
_Bleeding Cups._
Greek, σικύα, κύαθος; Latin, _cucurbitula_.
The extraction of blood by means of cups has been practised from remote
antiquity. The Hindoo Vedas mention it, and it is interesting to note that
one of the methods was to apply a gourd with fire in it, for both the
Latin _cucurbitula_ and Greek σικύα signify a gourd. The usual theory as
to its action was that in a diseased part there was a vicious πνεῦμα which
required removal.
Celsus (II. xi) thus describes the different kinds of cups:
Cucurbitularum vero duo genera sunt; aeneum, et corneum. Aenea, altera
parte patet, altera clausa, est; cornea, altera parte aeque patens,
altera foramen habet exiguum. In aeneam linamentum ardens coniicitur,
ac sic os eius corpori aptatur, imprimiturque donec inhaereat. Cornea
per se corpori imponitur; deinde ubi ea parte qua exiguum foramen est
ore spiritus adductus est, superque cera cavum id clausum est, aeque
inhaerescit. Utraque non ex his tantum materiae generibus, sed etiam
ex quolibet alio recte fit. Ac si cetera defecerunt, caliculus quoque,
aut pultarius oris compressioris, ei rei commode aptatur. Ubi
inhaesit, si concisa ante scalpello cutis est, sanguinem extrahit; si
integra est, spiritum.
'There are two kinds of cups, bronze and horn. The bronze is open at
one end and closed at the other, the horn, open at one end, as in the
previous case, has at the other end a small foramen. Into the bronze
kind burning lint is placed, and then the mouth is fitted on and
pressed until it sticks. The horn one is placed empty on the body, and
then by that part where the small foramen is, the air is exhausted by
the mouth, and the cavity is closed off above with wax, and it adheres
in the same way as before. Either may advantageously be constructed
not only of these varieties of material but of any other substance.
If other things are not to be had a small cup or a narrow mouthed jar
will answer the purpose. When it has fastened on, if the skin has
previously been cut with a scalpel it extracts blood; but if it be
entire, air.'
Paul says:
'When we are about to apply the empty instrument, having placed the
limb in an erect position, we fasten it to the side, for if we apply
the light above when lying down, the wick falling upon the skin with
the flame burns in a painful manner, and for this there is no
necessity. It is necessary that the size of the instrument be
proportionate to the part to which it is applied, and on that account
there is great difference of cupping-instruments with regard to the
smallness and greatness of size. Moreover those which are made with
longer necks and broader bellies are possessed of a strong power of
attraction' (VI. xli).
From Oribasius (_Med. Coll._ VII. xvi) we learn that sometimes the lips
were flat (ἐπίπεδα τὰ χείλεα) and sometimes concave (σεσιμωμένα τὰ
χείλεα). This does not, however, mean that the border was guttered, but
that the whole lip instead of lying in one plane was arched.
From a passage in Aretaeus we learn that one reason for the cup being
bellied out above was that there was oil floating free in the instrument,
which might otherwise escape and scald the patient. Aretaeus says:
'Apply plenty of heat so as to warm the part as well as attract. The
cup should be light earthenware (κεραμεοῦν κοῦφον) and adapted to the
side (ἁρμόζον τῇ πλευρᾷ), or bronze with flat lips (πρηνῆ τὰ χείλεα)
so as to comprehend the parts affected with pain, and we are able to
place inside it much fire with oil, so that it may keep alive for a
considerable time. We must not apply the lips closely to the skin, but
allow access to the air so that the fire may not be extinguished' (_De
Morb. Acut._ i. 10).
Antyllus says there are three materials of which cups are made, glass,
horn, and bronze. He rejects the silver ones because they heat too
readily. The bronze are the ones most commonly used. Glass is used where
we wish to mark the quantity of blood extracted. Horn ones are useful
about the head, where bronze ones would be difficult to remove, and also
in the case of nervous persons who dread the flame. Bronze and glass cups
may be used without flame like horn ones if a hole is bored in the summit
and the air sucked out, and the finger or a piece of wax is applied
immediately (Oribasius, _Collect._ VII. xvi).
Aristotle in his _Poetics_ discusses various tricks and arts of authors
and among these he mentions the riddle of which he gives as an example:
ἄνδρ' εἶδον πυρὶ χαλκὸν ἐπ' ἀνέρι κολλήσαντα 'I saw a man who had glued on
a man bronze by means of fire' the reference being to a bronze
cupping-vessel (see also Mayor's note to Juvenal xiv. 58). The cups
mentioned by Hippocrates are also of bronze. The earliest written
references are thus to bronze cups worked by fire. Ethnological research
would indicate, however, that horns worked by suction represent the more
primitive form.
A good number of cups have come down to us. There are fourteen in the
Naples Museum. There are two prevalent or usual types, one conical, and
the other flatter and more rounded. The largest cup known is in the Athens
Museum. Attached to it had been a chain 20 cm. long to hang it up by. It
is 16 cm. in height, and was found in a tomb at Tanagra. This cup with its
chain and attachment is shown in Pl. XXXIII.
In the British Museum there is one of bronze, 4 inches high and of the
elongated conical shape. It was found in Corfu (Pl. XXXIV). One in Naples
of similar shape has a ring attached to its summit as the Athens specimen
had (Pl. XXXV).
There are four very small cups in the museum at Mainz. These are 2·5 to 3
cm. in height and 3 to 3·5 cm. in diameter. Two of these are shown in Pl.
XXXVI, figs. 1, 3.
There are ten cups of glass in the Athens museum. They are of the general
shape of the Mainz cups, but vary in height from 4 cm. to 6·8 cm. and in
the Scottish National Museum of Antiquities there are two cupping-horns
which correspond to the description of Celsus. They were brought from
Shetland, where they were in use until comparatively recent times. Prosper
Alpinus, who visited Egypt in the sixteenth century and wrote a book on
the state of medicine in that country, found these cupping-horns in use
there, and he gives drawings of the instruments he saw (Pl. XXXVII, fig.
1). The horns used were those of young bulls, highly polished and with a
small hole at the tip, by which the air was extracted by suction. To close
this a small tab of parchment was taken into the mouth, and moistened and
affixed by the tongue. The Egyptians also used cupping-vessels of glass,
specially shaped and worked by suction. Pl. XXXVI, fig. 2 shows the shape
illustrated by Prosper Alpinus. The method of using fire with cups was not
known to the Egyptians at the time when Alpinus wrote (_De Med.
Aegyptiorum_, ed. 1541, lib. ii. ch. xii. p. 139).
Horn cups worked by suction are spoken of in the Hindoo Vedas.
It is interesting to find that these horn cupping-vessels are still in use
in some parts of Africa, and one, the property of a Hausa barber-surgeon,
was presented to the Aberdeen Anatomical Museum by Sir William Macgregor
(_Proc. Aberdeen Anat. Soc._ 1900-2).
An interesting form of cup is described by Hero of Alexandria (B. C.
285-222). Hero's description is quite intelligible, although it would be
difficult to give an accurate translation that would be readily
understood. I shall content myself with summarising his account. The
figure (Pl. XXXVII, fig. 2) shows a cup of ordinary flattened form,
divided into two by a diaphragm. Two tubes pass through the fundus, one
passing through the diaphragm, the other not. Each of these tubes is
fitted with another which is open at its inner end, but closed at its
outer end and provided with a small crossbar to rotate it. Each of these
sets of tubes is perforated by small openings. In the case of the short
tube these are outside the cup, in the case of the long tube they are
inside the cup, in the chamber shut off by the diaphragm. By rotating the
pistons these openings can be placed in apposition or not at will, thus
forming valves. Open valve A by placing the holes in apposition. Close
valve B by turning the holes away from each other. The inner chamber of
the cup is now shut off except for the small hole A. Apply the mouth to
the valve A and suck the air out of the chamber. Close valve A. Apply the
cup to the affected part. Open valve B and the negative pressure draws on
the affected part. The advantage of this arrangement is that the affected
part is not directly sucked upon by the mouth, and the instrument is
therefore more pleasant for the operator to use. Bleeding cups occur on
the coins of Epidaurus (300 B. C.), Atrax (400 B. C.) and Aegale (200 B.
C.).
_Clysters._
The ancients made frequent use of injections into the various orifices of
the body. The apparatus used was a bladder or skin of an animal fixed to a
tube. This form of instrument remained in use till the beginning of the
nineteenth century, although the elaborate enema syringe, on the principle
of the force pump, had been in use since the fifteenth century at least.
The following passage from Heister (anno 1739) is interesting as showing
exactly the method of its manipulation:
Pl. XXXVII, fig. 3 machinam clysteri iniiciendo adaptam designat, qua
Germani ut et Batavi vulgo utuntur. Litt. AA vesicam denotant cum
liquore contento; quae vero in adultis duplo vel triplo amplior quam
hic indicatur esse solet, pro libra circiter, et quo D excedit,
liquoris continenda; BB tubulum sive fistulam osseam ano immittendam,
per quam liquor in intestina iniicitur; CC vinculum superius, quod,
postquam fistula in ano est, solvitur ac removetur; DD vinculum
inferius, quo vesica clauditur, ne liquor immissus elabi queat (vol.
ii. p. 1117).
The rectal apparatus is called by Galen κλυστήρ, the uterine μητρεγχύτης,
and the bladder injector is called καθετήρ. In x. 328 we find all these
three terms used in one paragraph:
Ἐς ταῦτα μὲν γὰρ διὰ =κλυστῆρος= εἰς μήτραν δὲ διὰ =μητρεγχυτῶν= τῶν
ἐπιτηδείων τι φαρμάκων ἐνίεμεν ὥσπερ γε καὶ εἰς κύστιν διὰ τῶν
εὐθυτρήτων καθετήρων.
The different varieties of injection apparatus which are specially named
are as follows:
(1) Rectal: Greek, κλυστήρ, -ῆρος; Latin, _clyster_.
(2) Vaginal: Greek, μητρεγχύτης; Latin, _clyster_.
(3) Uterine: Greek, μητρεγχύτης; Latin, _clyster_.
(4) Bladder: Greek, εὐθύτρητος καθετήρ; Latin, _clyster_.
(5) Nasal: Greek, ῥινεγχύτης; Latin, _rhinenchytes_.
(6) Ear: Greek, ὠτεγχύτης; Latin, _oricularius clyster_.
(7) Sinus: Greek, πυουλκός; Latin, _oricularius clyster_.
_Rectal Clyster._
Early Egyptian writings refer to rectal enemas: numerous prescriptions,
including several for nutrient enemas, are given.
Oribasius gives us many interesting particulars about enemas (_Collect._
VIII. xxiv). The amount necessary is less for men than for women. In any
case the largest amount is three heminae (τρεῖς κότυλοι), the smallest one
hemina (a small half pint). In dysentery and other cases where the parts
would be easily hurt, and where a prompt evacuation was required, cannulae
with the opening placed in the side were used. Cannulae with the opening
in the end of the instrument were used where a large evacuation was
desired to be brought down from the higher parts. To destroy ascarides,
cannulae with a circle of small holes placed laterally were used.
From ch. xxxii we learn that the injection pipe varied in length also, for
Oribasius says that in making injections into the rectum for affections of
the bladder (e. g. to excite expulsion of urine in cases of retention),
the tube (τὸ κέρας τοῦ κλυστῆρος) ought to be short.
In the case of nutrient enemas Mnesitheus says the tube ought to be
extremely long, and in admitting an injection one ought to keep up
compression of the empty part of the clyster because it often happens that
the injection returns from the rectum unless this is done (Oribas. viii).
Hippocrates (ii. 276) mentions inflation of the rectum with air by an
enema in cases of ileus. A bladder is to be attached to a tube and the air
injected with this. It is then to be removed and a clyster injected.
In the excavations of the Roman Hospital at Baden there was found the tube
of a clyster in bronze. It is cast in one piece of stout bronze (Pl.
XXXVIII, fig. 2).
_Vaginal and Intrauterine Clysters._
Greek, μητρεγχύτης.
It is difficult to separate ancient descriptions of injections into the
vagina from those into the uterus, for the terms for the two parts are
frequently interchangeable. It is undoubted, however, that actual
intrauterine injections were made. Hippocrates (iii. 17) says:
'The end of the enema (i. e. the tube) is smooth like a sound. The
tube is of silver. A perforation will be made in the side not far from
the small tip of the tube (καθετήρ). There will also be other
perforations, which will be placed at equal distances on each side of
the tube throughout its length. The extremity of the injection tube
will be solid, all the rest hollow. To the tube will be attached the
bladder of a sow, which has first been well scraped. Place the milk of
a mare in the bladder, having taken the precaution to close the
perforations in the tube with a linen rag. The bladder is then closed
with a cord and given to the woman herself, and she, when the cord
shutting off the bladder has been removed, puts it inside the uterus.
For she herself will know where it ought to be placed. Then you press
the bladder with your hand as long as pus escapes.'
The description quoted already from Heister will help to make clear the
description of the manipulation. There is in the Naples Museum (No.
78,235) an injection tube of bronze answering to the description given. It
is 13 cm. long, and it has at the end a small opening, while on the side,
not far from the tip, eight small holes are arranged in two superposed
rings (Pl. XXXVIII, fig. 1).
There is a similar but slightly smaller instrument in the same museum.
_Bladder Clyster._
Greek, εὐθύτρητος καθετήρ.
There are frequent references to injection of the bladder. Although from
some passages it is clear that the injection really reached the bladder,
it is probable that at other times, under the heading of 'Injection of the
Bladder', only irrigation of the urethra is meant, just as sometimes by
irrigation of the uterus only vaginal douching is meant. Irrigation was
practised by means of a bladder fixed to the end of a catheter. Galen (x.
328), however, calls the bladder syringe εὐθύτρητος καθετήρ, which may
indicate that the eye was in the tip and not in the side, as in the
ordinary catheter, for a catheter with a straight bore would not reach the
male bladder.
Paul (VI. lix) says:
'But since we often have occasion to wash out an ulcerated bladder, if
an ear syringe be sufficient to throw in the injection it may be used,
and it is to be introduced in the manner described above. But if we
cannot succeed with it we must tie a skin, or the bladder of an ox, to
a catheter and throw in the injection through its lumen.'
It is highly improbable that with an ear syringe the injection would have
passed the triangular ligament and have actually reached the bladder in
the male; but the use of the ear syringe may refer to irrigation of the
female bladder, and then an ear syringe would suffice.
_Blacksmith's Bellows._
Greek, φῦσα.
In cases of volvulus, Hippocrates bids us insert a purgative suppository
and administer an enema. If these means are not successful:
'Insert a blacksmith's bellows (φῦσαν χαλκευτικήν) and inflate the
intestine in order that you may dilate the contraction both of the
colon and the intestine. Then remove it and give an enema' (ii. 305).
_Nasal Syringe._
Greek, ῥινεγχύτης; Latin, _rhinenchytes_.
A special nasal syringe with a double tube is mentioned by Aretaeus (ed.
Adams, vol. ii. 459). The medicament is made into liquid form and is
injected by means of a nasal pipe. The instrument consists of two pipes
united together by one outlet so that we can inject by both at one time,
for to inject each nostril separately is a thing which could not be borne.
Galen also mentions a nasal syringe (ῥινεγχύτης), though he does not
describe it (xi. 125).
Scribonius Largus also mentions it:
Per nares ergo purgatur caput his rebus infusis per cornu quod
rhinenchytes vocatur (_Compositiones_, vii).
_Aspiration Syringe and Sinus Irrigator._
Greek, πυουλκός.
Galen (xi. 125) says:
'In cases of sinus he uses a tube of bronze or horn with a straight
bore, or otherwise the instrument called the pus extractor (πυουλκόν),
which has a wide bore. But if you inject rosaceum into the former (i.
e. tube of bronze, &c.) it will not pass through the syringe
(πυουλκῷ), so that in that case a pipe of wide bore is to be fixed to
a sow's bladder.'
This passage shows that the pyulcus differed in principle from the syringe
formed by fixing a bladder on a tube. Hero (_De Spiritalibus_, c. 57)
shows that it was a syringe formed of a cylinder of metal with a
well-fitting plunger.
Hero says:
'And the instrument called pyulcus works on the same principle.
'For a long tube AB is made, to which let there be fitted another CD,
and let C, the end of it, be closed by a plate. At D let it have a
handle EF, and let the mouth of the tube AB at A be blocked by a plate
furnished with a slender syringe GH, perforated.
'When therefore we wish to draw out pus, applying the extreme mouth H
of the little syringe to the place in which the pus is, by the handle
we draw the tube CD outward, and the space which is in the tube being
emptied something else is of necessity drawn in, and since there is no
other space than the mouth of the tube the liquid at and near it must
of necessity be drawn into it.
'Again when we wish to inject some liquid we put it into the tube AB
and taking hold of EF and pressing in the tube CD we press out as much
as we think necessary.'
Note that Hero's description does not tally with the drawings which
accompany the edition of his works which we possess (Pl. XXXVIII, figs. 3,
4, 5). These show an instrument with a piston formed by a plug at the end
of a rod, whereas Hero says the piston is to be formed of a second tube
fitting inside the first. This is interesting, because it is much easier
to get a well-fitting piston in this way than in the other; and this
principle has been reverted to in many of our best hypodermic syringes and
in some of the best air pumps, such as Edwards's.
_Ear Syringe._
Greek, ὠτεγχύτης, ὠτικὸς κλυστήρ; Latin, _oricularius clyster_.
The ear syringe is very frequently referred to by both Greek and Latin
writers; in fact, Celsus uses the term so often to denote a syringe for a
large variety of uses that it is evident that it is almost a general term
for any small syringe.
In addition to its use in washing out the ear in cases of foreign bodies,
impacted cerumen, &c. he uses it to wash out the foreskin in balanitis, to
syringe fistulae, to wash out the bladder through a lithotomy wound, &c.
In cases of foreign bodies in the ear he says:
Sternutamenta quoque admota id commode elidunt, aut oriculario
clystere aqua vehementer intus compulsa (VI. vii).
Aetius and Paul tell us it was used to wash out the vagina, and Paul says
it might be used to make injections into the bladder. Oribasius says:
'We use flushing with an ear syringe in abscess of the intercostal
space, and in fistulas to expel first the pus with warm water, then to
cleanse the cavity with melicrate' (_Collect._ viii. 24).
From a consideration of the various uses to which this instrument was put,
and from the fact that it is contrasted at times (e. g. in Paul, VI. lix)
with syringes formed by adding a bladder to a tube, I am of the opinion
that this instrument, like the pyulcus, was a syringe of the form of a
metal cylinder with a plunger like the ear syringe of to-day, and used, as
the ear syringe was a few years ago, for flushing sinuses and irrigating
wounds, and as a handy instrument for all general purposes of the kind.
This is borne out by the fact that the ear syringe, described in detail by
Albucasis (p. 157), is a cylinder of bronze or silver, wide above and
narrowed to a point with a small opening in it and with a well-fitting
plunger wrapped with a little cotton at one end. His figure, though quite
intelligible, is too conventionalised to give any additional information.
_Insufflator for Powder._
Insufflation in powder form was a common method of applying medicaments to
the throat and nose. All writers mention this, but the fullest description
of the tube used is given by Oribasius, who says (_Collect._ xii):
'Those things which evacuate the head we use in the following manner.
A reed slender and with a straight bore, six inches in length, and of
such a size that it can be placed in the nares, is taken and its
cavity entirely filled with medicament. The reed may be either natural
or of bronze. This being placed in the nares, we propel the medicament
by blowing into the other end.'
Alexander Trallianus (IV. viii) describes the insufflation of the woolly
hairs of the platanus to stop epistaxis, and Aretaeus mentions the
insufflation of sternutatories (459, vol. ii), and again (408, vol. ii) he
says medicines may be blown into the pharynx by a reed, or quill, or wide
long tube (καλάμῳ ἢ πτίλῳ ἢ καυλῷ παχεῖ καὶ ἐπιμήκει).
A fine example of a bronze insufflator was discovered among the
instruments of the surgeon of Paris. It is 15-1/2 cm. in length, and 5 mm.
in diameter. It is formed by a plate of bronze bent round and soldered. It
terminates in a little elliptical shovel slightly cup-shaped, of which the
transverse diameter is 3 cm. and the longitudinal 3 mm.; it had originally
been overlaid with gold (Pl. XL, fig. 4).
_Cannulae for draining Ascites and Empyema._
Celsus describes the cannula for draining ascites (VII. xv):
Ferramentum autem demittitur magna cura habita ne qua vena incidatur.
Id tale esse debet ut fere tertiam digiti partem latitudo mucronis
impleat; demittendumque ita est ut membranam quoque transeat qua caro
ab interiore parte finitur; eo tum plumbea aut aenea fistula
coniicienda est vel recurvatis in exteriorem partem labris vel in
media circumsurgente quadam mora, ne tota intus delabi possit. Huius
ea pars quae intra paulo longior esse debet quam quae extra, ut ultra
interiorem membranam procedat. Per hanc effundendus humor est; atque
ubi maior pars eius evocata est claudenda demisso linteolo fistula
est; et in vulnere si id ustum non est relinquenda. Deinde per
insequentes dies circa singulas heminas emittendum, donec nullum aquae
vestigium appareat.
The following passage from Paul shows that the tip was bevelled off like a
writing pen:
Χαλκοῦν καλαμίσκον ... καθίσομεν ἔχοντα τὴν ἐκτομὴν παραπλησίαν τοῖς
γραφικοῖς καλάμοις.
'We introduce through the incision in the abdomen and peritoneum, a
bronze cannula having a tip like that of a writing pen' (VL. l).
Two instruments answering to the above description are to be seen in the
museum on the Capitol at Rome.
Another, answering more closely to the description of Celsus, is to be
seen at Naples (Pl. XXXIX, fig. 2). It consists of a bronze tube, 9 cm. in
length, 7 mm. wide at one end, narrowing to 4 mm. at the other end, which
is bevelled off as described by Paul. Surrounding the tube and 2·5 cm.
from the bevelled tip is a ring 2·5 cm. in diameter.
A more elaborate form of the cannula for ascites is seen in another
specimen, also in the Naples Museum (Pl. XXXIX, fig. 3). A tube 6·5 mm. in
diameter and 39·2 cm. long, has one end rounded and closed, except for a
small hole in its tip and another in the side near the first. The other
end carries a circular plate 2·5 cm. in diameter. Near the middle of the
tube there is a slightly raised projection as if to carry a circular disc.
Inside the cannula is fixed by oxidation an obturator, which carries on
its end a small handle fixed on in T-fashion. Scoutetten described this to
the Royal Academy of Medicine of Paris as a trocar and cannula, but the
formation of the end is not such that the instrument could have pierced
its own way through. It is rather an instrument which could be inserted in
an incision made by a scalpel, and which could be closed after the
abstraction of a certain amount of fluid--the obturator acting as an
improvement on the pledget of wool described by Celsus--but otherwise
inserted like the previous example. A tube on similar principles to the
ascites cannula was employed in empyema (Hippocrates, ii. 259):
'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' (ἐντιθέναι μοτὸν κασσιτέρινον κοῖλον).
_Tubes to prevent Contractions and Adhesions._
Greek, μοτὸς μολυβοῦς; Latin, _plumbea fistula_.
After operations on the nose, rectum, vagina, &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 vagina 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 rectum and vagina. 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. XXXIX, fig. 1).
_Calamus Scriptorius._
Greek, γραφικὸς κάλαμος; Latin, _calamus scriptorius_.
The writing pen reed is frequently referred to as an implement of minor
surgery.
Alexander Trallianus (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 (καλαμίσκον) round about the barbs' (VI.
lxxxviii).
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, πτίλον.
Galen (x. 1011) says that warts may be extracted by means of quills of
feathers.
Paul quotes this (VI. lxxxvii):
'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).