CAUTERIES
_Cautery._
Greek, καυτήριον, καυτήρ, καυτηρίδιον σιδήρεον; 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' (σιδήρια). It is true, of course, that in special
cases bronze was used--and Priscianus 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 passage 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, ξυράφιον.
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 (μαχαιρωτῷ καυτῆρι)' (VI. lxii).
Galen, speaking of cancer, says, 'Some use heated razor blades
(ξυραφίοις), 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 (τριαίνῃ ἢ τριαινοειδεῖ καυτηρίῳ), 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, πυρηνοειδὲς καυτήριον.
Malignant polypus of the nose is removed, says Paul (VI. xxv), with
olivary pointed cauteries (πυρηνοειδὲς καυτήριον); 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 Paré for this is an olivary pointed one. Paul (VI.
xxii) says, 'Some after excision of the flesh use a perforator, and make a
passage for the fluid or matter to the nose, but we are content with
burning alone, using the cauteries for fistula lachrymalis (αἰγιλωπικοῖς
καυτηρίοις) and burning down till a lamina of bone exfoliates.'
_Gamma-shaped Cautery._
Paul (VI. lxii), describing the radical cure of hernia, says:
'Wherefore having heated ten or twelve cauteries shaped like the Greek
letter Γ (γαμμοειδῶν καυτήρων) and two cautery knives, we must first
burn the scrotum through with the Γ-shaped ones, &c.'
_Obol Cautery._
In the treatise on haemorrhoids (iii. 340) Hippocrates says:
'I order, therefore, seven or eight instruments to be prepared, a palm
long, and the thickness of a thick specillum, bent towards the end and
flattened on the point like a small obol' (ὡς ἐπὶ ὀβολοῦ μικροῦ).
_Lunated Cautery._
Greek, μηνοειδὲς καυτήριον.
Paul says in cases of sloughing of the prepuce we must cut it off, and if
there be haemorrhage we must use lunated cauteries (μηνοειδέσι
καυτηρίοις). They both stop the haemorrhage and prevent the spreading of
the sore (VI. lvii).
_Nail, Tile and Button Cautery._
Treating of bubonocele, Paul says (VI. lxvi):
'Make a triangular mark over the centre of it and apply to the mark
nail-shaped (ἡλωτούς) cauteries heated in the fire, and afterwards
burn the triangle with gamma-shaped cauteries, and afterwards level
the triangle with cauteries shaped like bricks (πλινθωτοῖς) or lentils
(φακωτοῖς).'
Cauteries of nail shape are also referred to by Hippocrates in the
treatment of recurrent dislocation of the shoulder:
'Raise up the skin. Burn with cauteries which are not thick nor much
rounded but of an elongated shape (προμήκη). For thus they pass more
readily through' (iii. 151).
Galen has a long note in explanation of this term:
Φαλακρὰ κέκληκε τὰ περιφέρειαν ἔχοντα κατὰ τὸ πέρας οἷον οἱ κατὰ τὰς
μασχάλας ἔχουσι πυρίνας ἤτοι τὰ διαπύρινα καλούμενα καὶ αἱ
σπαθομήλαι, προμήκη δὲ τὰ τούτοις ἐναντίως διακείμενα προσηγόρευσεν,
ὧν οὐκ ἔστι περιφερὲς τὸ πέρας ἀλλ' ὀξύτεραν περ' ἐμπλήρωμα
παραπλήσιόν πως τοῖς εἰς τὰς παρακεντήσεις ἐπιτηδείοις ὀργάνοις.
'He (Hippocrates) calls φαλακρά (globose) those having a ball at the
tip, such as those for the axilla, which have olivary points and also
those which are called double olivary probes and spathomeles. But
those which are the reverse he calls προμήκη, i. e. those which have
the end not globose but rather sharp, exactly like the instruments for
paracentesis' (xviii. 376).
In the Naples Museum there are three tile-shaped cauteries, one of iron
and two of bronze. One of the latter is shown in Pl. XL, fig. 1.
_Wedge-shaped Cautery._
Hippocrates (iii. 223) says that the oblique veins of the head are to be
burned with wedge-shaped cauteries (σφηνίσκοισι σιδηρίοισι).
_Needle Cautery._
Celsus (VII. viii) says:
At ubi aures in viro puta, perforatae sunt et offendunt, traiicere id
cavum celeriter candente acu satis est, ut leviter eius orae
exulcerentur.
Treating of trichiasis he says (VII. vii. 8):
Si pili nati sunt qui non debuerunt tenuis acus ferrea, ad
similitudinem spathae lata, in ignem coniicienda est; deinde candens,
sublata, palpebra sic ut eius perniciosi pili in conspectum curantis
veniant, sub ipsis pilorum radicibus ab angulo immittenda est, ut ea
tertiam partem palpebrae transsuat; deinde iterum, tertioque usque ad
alterum angulum; quo fit ut omnes pilorum radices adustae emoriantur.
This indicates a needle beaten out into the shape of one of our spuds for
removing foreign bodies from the eye. The needle handles from the find of
the oculist Severus are well adapted for this work, but are dealt with
elsewhere (p. 69).
_Cautery guarded by a Tube._
In the treatise on haemorrhoids (iii. 345) Hippocrates says:
'We must make a [tubular] cautery like a writing reed and fit it to a
well-fitting iron' (καυτῆρα χρὴ ποιήσασθαι οἷον καλαμίσκον φραγμίτην,
σιδήριον δὲ ἐναρμόσαι καλῶς ἁρμόζον).
Again, in the treatment of polypus of the nose, he says:
'When that occurs we must insert a tube and cauterize with three or
four irons'(ὅταν οὕτως ἔχῃ, ἐνθέντα χρὴ σύριγγα καῦσαι σιδηρίοισιν ἢ
τριοσὶν ἢ τέσσαρσιν) (ii. 244).
Celsus says this tube may be a calamus or a tube of pottery:
Apud quosdam tamen positum est, vel fictilem fistulam vel enodem
scriptorium calamum in narem esse coniiciendum, donec sursum ad os
perveniat: tum per id tenue ferramentum candens dandum esse ad ipsum
os (VII. xi).
_Wood dipped in boiling Oil._
Hippocrates, in diseases of the liver, says that cauterization may be
performed with boxwood spindles dipped in boiling oil (πυξίνοισιν
ἀτράκτοισι βάπτων ἐς ἔλαιον ζέον) (ii. 482). Aetius (XII. iii) says that
the root of the birthwort (aristolochia) may be used in the same way.
_Ignited Fungi, &c._
In the passage in Hippocrates on cauterizing for disease of the liver,
Hippocrates, as an alternative to the hot iron, says that eschars may be
produced by fungi. This must mean that they were set on fire like the old
moxa.
This is probably what is meant by Paul when, in treating of cauterizing
over the stomach, he says (VI. xlix):
'But some do not burn with iron but with the substances called iscae.
The iscae (ἴσκαι) are spongy bodies forming on oaks and walnut trees,
and are mostly used among the barbarians.'
Aetius (II. iii. 91) says iscae are the medullary wood of the walnut tree.
In Hippocrates (ii. 482) the word μύκης, a fungus, is used--ἢ μύκησιν ὀκτὼ
ἐσχάρας καῦσαι (or with fungi burn eight scars).