SUTURES, ETC.
_Sponge._
Greek, σπόγγος; Latin, _spongia_.
Sponges were used for many purposes. Paul (VII. iii) says they should be
fresh and still preserve the smell of the sea. They were applied with
water, wine, or oxycrate to agglutinate wounds, and also soaked in asphalt
and set fire to and applied to wounds to stop haemorrhage.
Galen (_De Simp._ xi) says he has seen haemorrhage stopped by applying a
sponge dipped in asphalt to a bleeding wound and setting fire to it, and
leaving the unburnt part to cover the wound. Celsus says a sponge dipped
in oil and vinegar or cold water relieves gouty swellings. He also
recommends a sponge dipped in vinegar or cold water for stopping
haemorrhage.
Dioscorides says that fistulae may be dilated with sponge tents.
Scribonius Largus says that in epistaxis the nose may be plugged with
sponge:
Proderit et spongeae particulam praesectam apte forfice ad
amplitudinem et patorem narium figuratam inicere paulo pressius ex
aceto per se (xlvi).
Soranus (xli) says haemorrhage from the uterus may be stopped with a
sponge tent:
Ὁπότε τρυφερὸν καὶ καθαρὸν σπογγάριον ἐπιμήκες ὡσαύτως διάβροχον ὡς
ἐσωτάτω παρεντιθέναι προσήκει.
_Sutures._
Celsus (V. xxvi) says sutures should be of soft thread not overtwisted
that they may be the more easy on the part: 'Ex acia molli non nimis
torta quo mitius corpori insidat'. They were made of flax. The apolinose
described by Hippocrates (iii. 132) is directed to be made of crude flax
(ὠμολίνου), the strands of which were stronger than those of dressed lint.
This also is what Paul used for the deligation of arteries.
Galen alludes to sutures of wool, and Paulus Aegineta in the operation for
ectropion says:
'Afterwards we unite the divided parts with a needle carrying a
woollen thread, being satisfied with two sutures.'
We have no mention of catgut being used for this purpose, though that
substance was early known to the Greeks. The Homeric harp was strung with
catgut. In fact χορδή, the term for harp-string, simply means intestines.
Paul used a woman's hair in a needle to transplant hairs in trichiasis
(VI. xiii). Horsehair was used to raise a pterygium in Paul VI. xviii, but
it is not mentioned as being used for suturing wounds.
_Serres Fines._
Greek, ἀγκτήρ; Latin, _fibula_.
Celsus (V. xxvi) in describing the closing of wounds says:
Nam si plaga in molli parto est, sui debet, maximeque si discissa
auris ima est, vel imus nasus, vel frons, vel bucca, vel palpebra, vel
labrum, vel circa guttur cutis, vel venter. Si vero in carne vulnus
est hiatque, neque in unum orae facile attrahuntur, sutura quidem
aliena est; imponendae vero fibulae sunt; ἀγκτῆρας Graeci nominant;
quae oras paulum tamen contrahant, quo minus lata postea cicatrix sit.
'Suture is indicated if the lesion is in a soft part, especially in
the lobule of the ear, or the ala nasi, or the forehead, or cheek, the
edge of the eyelid, or the skin over the throat, or the abdominal
wall. But if the wound is in a muscular part and gape, and the edges
cannot easily be opposed, suture is contraindicated, and fibulae
(Graece ἀγκτῆρας) are to be used in order that the cicatrix afterwards
may not be wide.'
We have here contrasted two methods of closing a wound, and the conclusion
is readily arrived at that sutures in the first case and some metal
contrivance in the second are intended. Celsus goes on to say, however:
Utraque optima est ex acia molli, non nimis torta, quo mitius corpori
insidat. Utraque neque nimis rara, neque nimis crebra iniicienda.
'Both are best made of soft thread, not too hard twisted that it may
sit easier on the tissues, nor are too few nor too many of either of
them to be put in.'
A consideration of various passages in which the Greek authors use the
term leaves a distinct impression on one's mind that a metal clasp is
intended. Thus Paul (VI. cvii), in treating of compound fractures, says
that if a large portion of the bone is laid bare we use fibulae and
sutures (ἀγκτῆρσι καὶ ῥαφαῖς). It must be confessed, however, that the
words of Celsus render it difficult for us to assert with certainty that
fibulae were metal clasps, and we find ancient commentators in equal
difficulty. Fallopius and Fabricius d' Aquapendente think fibulae mean
interrupted sutures. Guido de Cauliac thinks they mean metal clasps. There
is just the possibility that a contrivance like our harelip pin with a
figure of eight thread may be indicated. This would satisfy both sides of
the question. If fibulae were metal clasps, however, we have several
varieties of ancient fibulae that might have been used for closing wounds.
That most suited for the purpose in hand seems to me to be one consisting
of a small bar terminating in two hooks. Several of these from Roman
London are in the Guildhall Museum (Pl. LII, figs. 5, 6, 7). They
represent a useful form of 'clip' still in use by cyclists, and they could
be applied to wounds to act on the principle of Malgaigne's hooks for the
patella. A modicum of support for this view may be derived from the fact
that whereas Galen, from whom the above passage on compound fractures is
quoted by Paul, uses the word ἀγκτῆρσι, the codices of Paul almost
unanimously have ἀγκίστροις. Fourteen out of fifteen give the latter
rendering.
_Band of Antyllus._
In the interesting dissertation which Oribasius gives on the subject of
phlebotomy (_Med. Collect._ vii) he states that Antyllus directs us to
apply a ligature of two fingers' breadth round the arm when going to let
blood at the elbow. He says that they are mistaken who affirm that the
same effect may be produced by applying the band below, for the veins will
not then swell even if the arm be fomented. When going to bleed at the
ankle the ligature is to be applied at the knee. When the blood does not
flow well he advises us to slacken the bandage if too tight. This is the
famous 'band of Antyllus'.
It is mentioned also in the pseudo-Hippocratic treatise on Ulcers (iii.
328):
'When you have opened the vein and after you have let blood and have
loosened the fillet (ταινίαν) and yet the blood does not stop.'
Paul also mentions the band, including one round the neck when the veins
of the forehead are to be opened for ophthalmia. So far as we know the
fillet was nothing more than a plain strip of linen or some such material,
but Deneffe, commenting on two bronze fibulae which were found in the
grave of the surgeon of Paris, conjectures that they may have been used to
fix the fillet in venesection. I give figures of these after Deneffe, but
it seems to me that these buckles are more likely to have belonged to the
straps of a portable instrument-case of canvas or leather which had
disappeared. One is a neat little heptagonal fibula, 2·8 cm. in its widest
part, with a tongue 27 mm. long (Pl. LII, fig. 2). The other fibula is in
the form of a penannular ring, formed by a two-headed serpent curved on
itself so that the two heads look at each other, separated from each other
by a space of a few millimetres (Pl. LII, fig. 8). Opposite the heads
there is a small rectangular opening to receive the end of the strap.
There is no tongue. It may have been fixed by a metal bar attached to the
other end of the strap.
_Sieves and Strainers._
Greek, ἠθμός, κυρτίς; Latin, _cribrum_.
Scribonius Largus mentions sieves of different sizes. In ch. xc a small
one is mentioned:
Contunditur hic cortex per se et cribratur tenui cribro.
In other places larger sizes are mentioned:
In his macerantur res quae infra scriptae sunt, contusae et
percribratae grandioribus foraminibus cribri (cclxix).
Marcellus (_De Medicamentis_, xxxiii. 9) says:
Pulverem facito, et cribello medicinali omnem pulverem cerne et
permisce, et cum vino vetere calefacto locum inline.
There are large numbers of sieves and strainers in bronze and earthenware
in the Naples Museum.
Paul (VII. xx) says oil of sesame is to be prepared from sesame pounded,
softened, and pressed in a strainer with screws (διὰ κυρτίδων τῶν
κοχλιῶν). The word κυρτίς literally means a basket or wicker eel-trap.
Here it must mean a strainer.
_Mortar and Pestle._
Greek, ἰγδίον, mortar: δοῖδυξ, pestle; Latin, _mortarium_, _pilum_.
In the find of the oculist Severus is a bronze dish which Deneffe regards
as a mortar. It is 8 cm. in diameter and 3·5 deep, and rests on a base of
3 cm. diameter, so that it sits firmly. Marcellus (_De Medic._ i) mentions
a mortar of marble:
Haec universa conteres in mortario marmoreo, et aceto admixto fronti
inlines.
He also mentions one of wood:
Huius radicem colliges et findes in partes duas, quarum unam siccabis
ac minutatim concides et mittes in pilam ligneam atque illic
diligenter tundes (xxiii).
Scrib. Larg. speaks of pestles of wood:
Hoc medicamentum cum componitur pilum ligneum sit (clii).
In Paul we have a mortar of lead and a leaden pestle mentioned several
times:
Ἐν μολυβδίνῳ ἰγδίῳ καὶ μολυβδίνῳ δοίδυκι λειώσας.
'Triturate ceruse with wine and rose oil in a leaden mortar with a
leaden pestle and anoint with it' (III. lix).
Galen (_De Simpl._ x) speaks of bronze mortars:
'Wherefore, some call only the natural mineral by this name, but some
also the substance which is prepared in a bronze mortar with a copper
pestle by means of the urine of a boy, which some value according to
the differences of the verdigris. But it is better to prepare it in
summer, or at least in hot weather, rubbing up the urine in the
mortar, and it answers the more excellently if the bronze of which you
make the mortar is red and the pestle too, for more is thus rubbed off
by the turning of the pestle when the bronze is of a softer nature.'
Paul mentions a mortar of marble. A small mortar of bronze was found
amongst the instruments of the surgeon of Paris. Another small one from my
own collection is shown in Pl. LII, fig. 3. The excavation of the temple
of Aesculapius in the forum has brought to light a large number of mortars
of marble. They are mostly about six or seven inches in diameter, but are
much deeper in proportion than our modern mortars are. The spathomele and
other olivary probes were no doubt often used as small pestles.
_Whetstone._
Greek, ἀκόνη; Latin, _cos_.
We saw that several of the slabs on which ointments were prepared had
evidently been used for sharpening knives, and whetstones are often found
of varying degrees of roughness from sandstone to fine argillaceous smooth
stones. Paul (VII. iii) says:
Τό γε μὴν τῆς Ναξίας ἀκόνης ἀπότριμμα ψυκτικὸν εἶναι φασὶν ὥστε καὶ
τιτθοὺς παρθένων καὶ παίδων ὄρχεις προστέλλειν. τῆς ἐλαιακόνης δὲ τὸ
ἀπότριμμα ῥυπτικὸν ὑπάρχον ἀλωπεκίαις ἁρμόττει.
'The filings of the Naxian whetstone are said to be refrigerant,
repressing the breasts of maidens and the testicles of boys. The
filings of the oilstone being detergent suit with alopecia.'
It is uncertain what the Naxian whetstone was, but it was considered the
best variety of whetstone. It is mentioned in Pindar. From the fact that
emery is found in Naxos one might conclude that the Naxian whetstone was
of emery, but a few lines before the passage quoted from Paul he has
already mentioned the emery:
Ἡ δὲ σμύρις ῥυπτικὴν ἔχουσα δύναμιν ὀδόντας σμήχει.
'The emery having detergent powers cleanses teeth.'
Galen makes the Naxian stone a variety of ostracites which was apparently
marble formed of shells. One of the marble ointment tablets had, we saw,
been used as a whetstone, but the whetstones for which Naxos was famous
must, if not emery, have been some variety of shale or slate. It seems
contrasted to some extent with the 'oilstone', i. e. whetstone which
required oil. This was a clay slate (see Pliny, _H. N._ xxxvi. 47).
There are several whetstones from Stabiae in the Naples Museum which are
classed among surgical implements. Whetstones are common objects in the
finds from any Roman settlement, but they are not ground to regular shapes
as our whetstones are. They usually consist of fine sandy schistaceous
shale.