  PROBES Greek, ???, ??p?????, ?p??e?pt???, ?pa?e?pt???; Latin, specillum. This is a very comprehensive class. The original specillum was no doubt a simple sound. Varro thus defines the specillum: ‘Quo oculos inunguimus quibus specimus specillum est. Graecis ??? dicitur.’ Thus it meant a probe or sound. ??? is probably derived from ????, an apple or fruit, from the olivary enlargement at the end of a sound. The term ?p??e?pt???, which is frequently used by Hippocrates, originally meant an ointment spatula, being derived from ?pa?e?f?, to spread ointment. But the custom of combining two instruments on one shaft gradually led to the application of these terms, especially the term specillum, to denote a large variety of instruments. The name ??p????? is evidently derived from the resemblance of the probe to the pestle, which was such a frequent utensil in Greek homes. It is connected with ??pa???, ‘pestle,’ ??pa??st?????, ‘mortar,’ and ??pa????, ‘bray,’ and ??pt?????, a medicament pounded in a mortar (Dioscorides, iv. 190). The exact significance of the term ??p????? is sometimes difficult to determine. It is easy to prove that in general it is merely a sound. Thus Paul (VI. lxxviii), in quoting a passage from Hippocrates, substitutes ??p????? for the word ???, which Hippocrates uses to denote the sound used for exploring a fistula. Throughout this chapter, in which the word occurs ten times in all, Briau translates it by ‘manche du scalpel’, although the whole context shows that a probe is meant. Even where it is spoken of as an eyed The Specillum as a Sound. The ancients were fully aware of the value of the information to be gained by searching the recesses of a lesion with a rod of metal. Celsus (v. 28) says regarding fistulae: Ante omnia autem demitti specillum in fistulam convenit, ut quo tendat et quam alte perveniat scire possimus; simul etiam protinus humida an siccior sit: quod extracto specillo ‘But first it is well to put a probe into the fistula to learn where it goes and how deeply it reaches, also whether it is moist or rather dry as is evident when the probe is withdrawn. Further, if there be bone adjacent, it is possible to learn whether the fistula has entered it or not and how deeply it has caused disease. For if the part is soft which is reached by the end of the probe the disease is still intermuscular; if the resistance be greater it has reached the bone: if there the probe slip there is as yet no caries. If it does not slip but meets with a uniform resistance there is indeed caries, but it is as yet slight. If what is below is uneven and rough the bone is seriously eroded, and whether there is cartilage below will be known by the situation, and if the disease has reached it will be evident from the resistance.’ These remarks show that with the probe the ancients had cultivated the tactus eruditus to a high degree, and the remarks of Aetius and Paul are equally to the point. The tips of the probes which have survived vary considerably in size and shape. Some have a point which is almost sharp like a stylet; in others the natural thickness of the shaft is kept right to the tip, which is simply rounded off or there is an oval enlargement like that on our olivary probes and sounds. In rare cases the enlargement is globular. The oval enlargement was named by the Greeks p????, which means ‘olive-kernel’. The sixteenth-century translators uniformly render this by ‘nucleus’, which is a convenient term to use, but it has no classical Latin authority. Indeed, there is no classical Latin equivalent used by medical authors. Theodorus Priscianus uses baca (sic), a berry, and bacula, little berry, and in the Additamenta A probe without enlargement at the tip was called ?p???????? or ?p??????. The ear probe is frequently referred to as belonging to this class. These probes without nuclei were specially adapted for wrapping round with wool to apply medicaments, or wipe away discharge. The size of the nucleus varied in different varieties of probe, but was pretty constant in each particular. It was largest in the probe known as the spathomele—a combination of spatula and probe which was in extremely common use for pharmaceutical purposes. The nucleus of this probe was such a well-known object that it is frequently referred to as a standard of size and shape. Galen (ii. 898) says: ‘In the cervix uteri is the foramen by which the woman both passes the monthly flux and receives the semen of the husband. By it also the foetus leaves the womb. It is marvellous how it varies in size according to circumstances. When the woman is not pregnant it admits the nucleus of a probe or something slightly larger’ (p????a ?? ???? ?p?d??eta? ? ?a?? t? t??t?? pa??te???). Here KÜhn translates p????a by ‘acuminatum capitulum specilli’, which is incorrect. It is an olivary enlargement, not sharp point. In Paul (VI. xc), we have the nucleus given at the measure of distance between the perforations by which a bone was surrounded preparatory to its excision by means of chisels: ‘the space between the perforations made by the drills should be the breadth of the nucleus of a probe’ (t? ???? p??????). Aetius (III. i. 16) says in volvulus the sphincter ani is so contracted that the nucleus of a probe cannot be got in. Paul (VI. xxi) says that in couching a cataract we must enter the couching needle a nucleus breadth from the iris. Besides its use as a sound the nucleus was frequently used as a means of applying medicaments, either in the form of ointments or dry powder, to affected parts. Aetius (II. iv. 23), quoting from Galen, says that in caries of the teeth some wax may be warmed on the nucleus of a probe (p?????? ????), and again (II. iv. 14) he directs us to use it for application of pomade to the face (p????? ????). It would seem that this, and not the exploration of wounds, was the original use to which the olivary-pointed probe was put, for in early Egyptian tombs small pestle-like probes are, as a rule, found accompanying the toilet pigment boxes which are so common. They are mostly made of wood (Pl. X, fig. 2). The kohl-stick was not unknown to Greek ladies. (See Eustathius, Comment. in Iliad.) Hitherto I have spoken of the probe as if it were a single instrument; but, as a matter of fact, the ends of the shaft are usually fashioned to serve different purposes. Thus at one end there will be a probe, at the other a spatula, a spoon, or a hook. Some of these combinations have names of their own, and others are so frequently met with that they too seem to have been constant types. It may simplify matters if we anticipate a little and remark that while the uses of the probes in actual surgery were the same as at the present day, in the minor surgery, consisting of the application of medicaments and toilet preparations, they were used in a slightly different manner. Semi-solids, like eyebrow pigment and eye ointments, were applied on olivary-pointed probes. Liquids, like ear and eye drops, were usually instilled by squeezing a ball of wool dipped in the liquid and placed round the middle of a probe, and letting it run off the point. Thus a common form of toilet instruments consists of a probe-like instrument with an olive at one end and a sharp stylet at the other. Ligulae with scoops were used to withdraw drops of fluid essences, The specilla which remain to us are mostly made of bronze. A few are overlaid with gold and silver, and a few are solid gold or solid silver. We read, however, of specilla of lead, tin, copper, and wood, and of the use of a boar’s bristle or a stalk of garlic for searching fistulae. I shall now proceed to classify and discuss these different varieties, premising, however, that no hard and fast line can be drawn between different types. They shade off into each other by imperceptible gradations, so that whatever system of classification we adopt bastard forms are sure to occur. Double Simple Probe. Greek, ?p????????, ?p??????; Latin, specillum. The simplest form of specillum is a plain rod of metal rounded off at either end. These are not infrequently met with. I figure one from my collection. Its length is 14.5 cm., its diameter 2 mm. At either end it tapers rapidly off to a blunt point. At a distance of 3 cm. from one end is a raised ring (Pl. X, fig. 4). A similar probe in silver may be seen in the MusÉe de Cinquantenaire, Brussels. It was found with other probes in an Étui. Pl. X, Fig. 3 shows a rather longer specimen from the Naples Museum. A variety with non-tapered ends is seen in Pl. X, fig. 1. It is also from the Naples Museum. Pl. XI, fig. 4 shows a probe, from my own collection, which carries the snake of Aesculapius at one end. One with a double snake (caduceus form) was found in the Roman Hospital at Baden (Pl. XI, fig. 2). Specilla with two olivary ends. Greek, d?p?????? ???, ?f?s????. A slender sound with slight olivary enlargement at either end is very frequently mentioned under the name d?p?????? ??? by Galen. He also calls it ?f?s????. Thus he says: ‘And in the double passage you must insert some one of the slender instruments you have at hand, either a double-ended probe (a ‘double olive’ if you prefer to call it so), or if something finer be necessary, even an ear probe.’ In dealing with fistulae Paul (VI. lxxvii) says: ‘We must first examine them with a sound if they be straight, or with a very flexible ‘double olive’ (d?p????? e??ape?), such as those made of tin or the smallest of those made of bronze, if they be crooked.’ Paul refers to its use as a cautery to destroy the roots of hairs after epilation (VI. xiv): ‘Some, preferring cauterizing to the operation of transplantation, evert the eyelid, and with a cilia forceps dragging out the offending hair, or two or even three hairs, apply a heated double-olive probe or an ear probe, or some such slender instrument, to the place from which the hair or hairs were removed’ (??ap?????? ? ???t?da ? t? t????t?? ?ept?? ???a??? pep??????? e????s? t? t?p? ??e? ? ???? ? a? t???e? ????s??sa?). Here Briau reads p????a (an olivary point), but the balance of the evidence of the codices is in favour of d?ap??????, and the parallel to the passage quoted from Galen is so complete that I have no hesitation in adopting the reading given above. I give an example of the dipyrene from my own collection. It is 11·2 cm. long. The shaft is unequally divided by a ringed fluting into two portions; 4·5 cm. and 6·7 cm. long respectively. The shorter portion of the shaft is plain, the longer is grooved longitudinally by eight grooves (Pl. XI, fig. 1). In many instances the dipyrene carried an eye in one of its olives. This variety is frequently mentioned. Thus Paul (VI. xxv) says, under treatment of nasal polypus: ‘Taking then a thread moderately thick like a cord, and having tied knots on it at the distance of two or three finger-breadths, we introduce it into the eye of a dipyrene Pl. XI, figs. 5 and 3 show single olive probes for the application of semi-solid medicaments. The former is from the outfit of the oculist of Rheims, in the Museum at St-Germain-en-Laye; the latter, more highly ornamented by spirally twisting the stem, is from my own collection. Spathomele or Spatula probe. Greek, ?p??e?pt???, spa?????; Latin, spathomele (Theodorus Priscianus), spathomela (Marcellus); German, Spatelsonde. Almost every medical writer mentions the spathomele. It consists of a long shaft with an olivary point at one end and a spatula at the other. Galen (Lex.) calls the one st???????? ????, the other ??? p?ate?a. It was a pharmaceutical rather than a strictly surgical instrument. The olive end was used for stirring medicaments, the spatula for spreading them on the affected part or on lint. Galen (xiii. 466) says that certain applications are to be softened in the hand with rosaceum by means of the spathomele (a???a? ?p? t?? ?e???? d?? spa??????). Marcellus frequently refers to it as used for stirring liquids in a vessel: Immo manu vel digitis moderantibus paulatim insperges et adsidue spathomela commovebis et permiscebis, post haec omnia mittes oleum chamaemelinum, et iterum igni non nimio adposita olla lente et paulatim decoques medicamen, ita ut illud manu non contingas, sed spathomela agites (vii. 19). In xiv. 44 he mentions a spathomele of copper: Oportet autem moveri aquam ipsam rudicula vel spathomela aeris rubri. The following passage from Theodorus Priscianus refers to its use for applying ointment to an affected part: Aetius (II. iv. 16) directs a particular medicament to be rubbed in and to be scraped off after a moderate space of time with a spathomele (t? spa?????). The spathomele was used by painters for preparing and mixing their colours. The very large numbers in which they are found would indicate that their use was not confined to medical men. Although the nucleus of the spathomele was too large to admit of its use as a probe for small lesions, it is evident that in exploring large cavities it must have been a valuable instrument. Galen (ii. 712) says: ‘In small bodies the opening into the torcular Herophili may not be large enough to admit a spathomele nucleus, and therefore we must try some of the other olivary probes or even an ear probe, and cut alongside it.’ Priscianus alludes to plugging the nares with it: Prius spathomeles extremo in baca molli lana obvoluto glebas sanguinis e naribus frequentius purgare nos convenit, post lana identidem obturando perclaudere (xiv). ‘First of all we must frequently wipe away the clots of blood from the nose with the end of a spathomele wrapped on the ‘berry’ with soft wool, and then occlude it by plugging with wool in the same way.’ From Leonidas (Aetius, VI) we learn that it was used as a tongue depressor. He says: ‘In inflammation of the throat in adults seat the patient, open his mouth and depress the tongue with a tongue depressor or a spathomele, and open the abscess with a scalpel or a needle-knife.’ The following passage from Galen shows that it was used as a substitute for the meningophylax (q. v.): ‘Having separated the pleura from the rib and placed a thin meningophylax or a flat spathomele (spa?????? p?ate?a?) between the ribs, and taking care that you neither Soranus (xxvii) refers to its use as a cautery: ‘After cutting off the umbilical cord, cauterize the umbilicus with a heated reed, or the flat of a probe’ (t?? p??te?? t?? ????). An interesting passage in Aetius shows that it was used as a dissector in opening up an occluded vagina: ‘Pass a sound into the cervix, and dissect with the spathomele below the spot marked out by the sound’ (Aet. IV. iv. 96). This probably means blunt dissection only, as none of the spathomeles found have edges sharp enough to be actually cutting. Large numbers of this instrument have been found. It is the commonest surgical instrument in museums. It must be remembered, however, that not every spathomele is a surgical instrument strictly speaking, as pharmacopolists and even artists used exactly similar instruments. The average length of twenty specimens measured by me was 16 cm. Of this the nucleus occupies 1·5 cm., the spatula 6 cm. The average diameter of the nucleus is 7·5 mm. The width of the spatula averages 15 mm., but the size and shape of the spatula both vary considerably. The different varieties of shape will be better understood by a reference to the accompanying figures of actual specimens than from a written description. Pl. XII shows neatly formed specimens from various sources; the specimen shown in fig. 3 having ornamental grooves along the length of the shaft. Figs. 3 and 4, Pl. XIII show coarse, thick specimens, which are most likely to have been used for non-medical purposes. All have the characteristic oar-blade shape, though the outline varies greatly. In some the blade widens out at the end, so that the tip is broad and rounded. In others the blade slopes to a rounded point, or the point is quite acute. The edges of the blade are usually thick and blunt. In some specimens, however, the edges The shaft, as a rule, is plain, occasionally it is ornamented with longitudinal or spiral fluting. More rare is a silver band, inlaid in a spiral round the shaft. I have seen a few specimens which have been entirely plated with gold. Hitherto I have taken no notice of spathomeles in which the spatulae are not flat. In many specimens, however, the blades are hollowed. For these it seems advisable to constitute a special class, which may be called the cyathiscomele class. Cyathiscomele. German, LÖffelsonde. Although this variety of the spathomele is not one which is specially mentioned by any classical writer, it is convenient to have a name by which we can denote that variety of the spathomele in which the blade is not flat. It has the same large oval nucleus as the flat spathomele, and the same shaft, plain, or fluted, or overlaid with silver, but the spatula is replaced by a spoon, the outline of which shows the same variety of form as we met with in the spatula. The depth of the spoon varies greatly. Pl. XIV, fig. 3 shows an instrument in which the two lateral halves of the blade, instead of lying exactly in the same plane, meet in the midline at a slight angle so as to form a cavity obtusely angular on cross section, and gently rounded on longitudinal section:
Pl. XV, fig. 1 shows a similar arrangement, except that the cavity is more marked, and the tip instead of being sharp is rounded. In Pl. XIV, fig. 1 the cavity is so marked that a typical spoon is formed. This specimen is interesting as showing the ornamentation of the shaft by overlaying a spiral silver wire. It is from the Naples Museum, and it is figured by Vulpes. Other varieties are seen in Plates XIV, The form of cyathiscomele, in which the two lateral halves of the scoop meet at an angle (Pl. XIV, fig. 1), has a tendency to split along the ridge in the middle of the scoop if roughly handled. One of these, to which this accident has happened, is in the Naples Museum (Pl. XV, fig. 3) and has an interesting history. In 1847 Vulpes described it as a guard for dividing the fraenum linguae, and successive writers have copied this ever since, and it is so described in the catalogue. As the photograph shows, it is only a spoon probe which had been trod on or otherwise damaged, and which had split down the centre, or rather near the centre, for the crack has deviated at its termination from the midline. The termination of the notch thus formed has quite a different appearance from the figure by Vulpes. The accident is not an uncommon one. There is in the Capitoline Museum an instrument to which precisely the same has happened, and I have a probe in my own possession which has split, and which with a little manipulation would make a beautiful duplicate of the one in the Naples Museum (Pl. XV, fig. 1). Many ancient writers point out the danger of wounding the vein, but none mention the guard. Thus Celsus says: Horum extrema lingua vulsella prehendenda est, sub eaque membrana incidenda: magna cura habita ne venae quae iuxta sunt violentur et profusione sanguinis noceant (VII. xii). Paul says: ‘The patient is to be placed in a proper seat, the tongue is to be raised to the roof of the mouth and the membranous fraenum cut transversely. But if the curvature is occasioned by a cicatrix we transfix the callus by a hook and draw it upwards, and making a cross incision free the bent parts, taking care not to make deep incisions of the parts, for haemorrhages, which have been found difficult to stop, have thereby been occasioned’ (VI. xxix). Aetius gives a similar account. These writers, then, all take note of the possibility of wounding the vein, but give no clue that they knew of the utility of a cloven plate in preventing the accident. Further, the Arabs, timid operators all and fond of describing safeguards such as this, give no mention of it, although Albucasis, Rhases, Avicenna, and Haly Abbas all describe the operation. I can find no reference to the use of a guard for this purpose until quite recent times. Ear specillum. Greek, ???t??, -?d??, ???t???, ?p??????, t? p????a ? ????s? t??test? t? ???t??d? (Galen, Lexicon); ?t????f??, ???? ???t?da (Galen, Lexicon); Latin, oricularium specillum (Celsus); auriscalpium (Scrib. Largus); German, OhrlÖffel. Of all the specilla this is one of the most frequently mentioned by name. It consists of a small narrow scoop at one end and a simple probe without olivary enlargement at ‘If a bean, stone, &c., fall into the ear remove it with the small narrow scoop of the ear specillum’ (??a??s?? ste?? ???? ???t??d??). Again Galen (loc. cit.) and Paul (VI. xxiv) say that in cases where foreign bodies cannot be got out of the ear by more simple methods, we must incise behind the ear and remove them by means of the ear scoop. The removal of foreign bodies from the ear by means of this instrument is very frequently referred to and shows that the scoop was small. Celsus says (VI. vii): ‘When a person begins to experience a dullness of hearing, which very often happens after long continued headaches, first of all we must examine the ear itself, for there will appear either a scab such as occurs upon ulcers, or a collection of sordes. If there is a scab it ought to be fomented with warm oil or with verdigris in honey, or leek juice or a little nitre in hydromel, and when the scabs have been detached from the part, the ear is to be washed out with tepid water, in order that being spontaneously separated it may be the more easily extracted with the ear specillum (oriculario specillo). If there is cerumen and it is soft, it is to be extracted with the same specillum, or if it is hard vinegar with a little water is to be put in, and when it is softened the ear is to be washed out and evacuated in the same way.’ In VI. vii he says: Ubi vero vermes orti sunt, protrahendi oriculario specillo sunt. ‘Where worms have arisen they are to be extracted with an ear specillum.’ Celsus also recommends it for extracting a calculus from the meatus urinarius (VII. xxvi): Eum, si fieri potest, oportet evellere vel oriculario specillo, vel eo ferramento quo in sectione calculus protrahitur. ‘It, if possible, is to be extracted with the specillum or the instrument for extracting the calculus in lithotomy.’ The following passage from Paul (VI. xl) on venesection shows that in cases where the band of Antyllus could not be applied, the back of the ear scoop was pressed on the proximal end of the vein, in order to obstruct the flow of blood and cause it to discharge by the opening made with the phlebotome: ‘Tie a ligature round the neck, and when the frontal vein is properly filled divide it with the point of a phlebotome or a scalpel. In the same way we open the external jugulars for chronic ophthalmia, producing a discharge of blood with the scoop of a probe’ (??a??s??? ????). Adams evidently misunderstood this passage. He translates it ‘with the concave part of a scalpel’, which is meaningless. This use of the scoop will also explain an otherwise obscure passage in Hippocrates (iii. 678). He says: ‘In letting blood avoid pressing hard with the specillum (?a? ?ta? ?fa???? t? a?a t? ??? ? ???ta p???e?? ?? ? f??s?? p??s????ta?) lest injury be caused.’ Of the use of the ear scoop as a curette we have several instances. Thus Aetius (II. iii. 81) recommends it for curetting the interior of a chalazion, and again (II. iii. 84), cf. Galen, Comp. Med. vii. 2. The scoop was also used for applying medicaments, especially to the eye. Liquid applications were poured from it, semi-solid were applied with the back of it (averso specillo). This use of the back of the scoop has often been misunderstood. The natural translation of the phrase averso specillo is ‘with the probe turned away’, i. e. the back of the probe. Scultetus, however (Tab. VIII. vii), considers that it refers to a spatula probe, and says it means the probe turned end for end. Other translators adopt this meaning. Deneffe (Les Oculistes Gallo Romains, p. 108), e. g., says: Il faut entendre par averso specillo la partie de la spatule Scribonius Largus puts the true meaning of the phrase beyond doubt. He directs us, after the application of caustic to haemorrhoids, to endeavour to get them to fall off by the back of an ear scoop, which part the Greeks called the spoon (‘auriscalpio averso quam partem ??a??s??? Graeci vocant’). Marcellus copies this passage from Scribonius, but alters it. He says: ‘de specilli latitudine illinendae sunt’ (xxxi. 6, p. 329). I shall now proceed to give a few instances of this use of the back of the scoop in minor surgical manipulations. In ancyloblepharon Celsus says the eyelids are to be separated with the back of the scoop. Igitur aversum specillum inserendum, diducendaeque eo palpebrae sunt (VII. vii. 6). The back of the scoop was used as a retractor for delicate structures. In radical cure of hernia Celsus directs us to keep the bowel from prolapsing by means of it: ‘For if the piece be small it is to be pushed back over the groin into the abdomen, either with the finger or the back of the specillum.’ Nam quod parvulum est super inguen in uterum vel digito vel averso specillo repellendum est (VII. xxi). In the cure of varicocele it is used to replace the veins in position: Tum venae, quaecunque protractae sunt, in ipsum inguen averso specillo compelli debent (VII. xxii). ‘Then the veins which have been drawn upon ought to be replaced with the back of a specillum.’ In sloughing ulcer of the bladder it is used to separate the lips of the perineal wound: Quod si antequam vesica purgata est orae se glutinarunt, dolorque et inflammatio redierunt, vulnus digitis vel averso specillo diducendum est (VII. xxvii). We shall next proceed to discuss the other end of the ear specillum. This was a simple probe. It had no nucleus. In his Lexicon Galen defines it thus: ?p??????· t? p????a ? ????s? t??test? t? ???t??d?. ‘Probe without olivary enlargement—that is to say “the ear specillum”.’ Not only was its tip not expanded into a nucleus, it was actually sharp. Galen (xiv. 787) treating of fistula in ano, says in non-perforating fistulae we perforate all the sound flesh with the sharp end of an ear probe (t? ??e? t?? ???t?d??). The chief use of an ear probe in aural work was to instil liquids into the ear. A large ball of wool saturated with the liquid was wrapped round the middle of the probe, and on squeezing this the liquid ran down and dropped into the meatus. There are many mediaeval illustrations showing the ear probe used in this fashion. Sometimes, however, we read of the tip of the probe being wrapped in a small ball of wool, which was dipped in some sticky substance to extract foreign bodies from the ear. Galen (xii. 689) says foreign bodies may be removed thus by a probe dipped in resin. The ear probe seems to have been much used for probing wounds and fistulae when a very slender instrument was required. Galen (ii. 581), in describing the torcular Herophili, says: ‘And in the double passage you may be able to insert some of the slender instruments you have at hand, a double ended probe—a ‘double-olivary’ if you prefer to call it so—or if something smaller be necessary even an ear specillum’ (?a? ???t??da). In his chapter on the extraction of weapons (VI. lxxxviii) Paul says: ‘If the weapon has a tang, which is ascertained by examination with an ear probe’ (?? t?? ???t??). ‘We may apply a double olive or an ear probe (???t?da) or some such fine instrument heated’ (VI. xiii). In fistula in ano Paul says it may be used as a director to cut upon. ‘Having introduced a sound or an ear probe (?p??????te? ??p????? ? ???t?da) through its orifice, we cut the skin over it at one incision’ (VII. lxxviii). Illustrations of two ear probes are given. What I regard as the type is seen in Pl. XV, fig. 5, which shows an instrument from the Roman Hospital at Baden. Typical specimens are not by any means common. Pl. XV, fig. 2 shows another variety from my own collection. Screw Probes. On probes for wrapping round with wool we frequently raise a screw thread to enable the wool to adhere better. This useful contrivance was also known to the ancients. I give a figure of one in my possession. It was found in the Roman Camp at Sandy (Pl. XXI, fig. 5). It measures 9·7 cm. in length and is 1·5 mm. thick. The screwed portion occupies 7 mm. of one end. The other end is plain. The little instrument is well adapted for treating small cavities, such as an ear or a carious tooth by wrapping round the screw portion with wool and dipping in medicaments. Ear specillum for wounds. Greek, t?a?at??? ???; Latin, specillum vulnerarium. There was a special variety of ear specillum which was adapted for wounds. Paul (VI. lxxxviii) says: ‘Stones and other missiles from slings may be removed by levers or the scoop of an ear probe adapted for wounds’ (??a??s??? t?a?at???? ???t?d??). This was probably an instrument on the same principle as the ear probe, i. e. a combined probe and scoop, but on a larger scale. Possibly it may have had a slight olivary enlargement. That it was large we learn from Galen’s Handled Needles. In the find of the oculist Severus were no less than nine handles for needles. Of these, six were merely cylinders of bronze, expanded slightly at one end and perforated at the other with a small hole for a needle. They were from 72 to 40 mm. long and 7 to 5 mm. in diameter. Two were hexagonal, four were round (Pl. XXI, figs. 2, 4, Pl. XVI, figs. 3, 4, 5, 6). Two others had the same holes for needles at one end, but at the other they were pierced with a slot, 10 mm. deep, for the insertion of a knife blade. One was 60 x 7 mm., the other 53 x 5 mm. (Pl. II, figs. 1, 2). Another, perforated at one end as before, carried at the other an olive-pointed probe. It was 8 cm. in length, and of this 3·5 cm. consisted of a hexagonal handle 3·5 cm. in diameter. The remainder was cylindrical, and it terminated in a probe point with a slight olivary enlargement (Pl. XVI, fig. 2). In all cases the needles had evidently been made of steel and had entirely disappeared. We have many allusions to the use of handled needles in ophthalmic work. In describing the couching of cataract Celsus says: Tum acus admovenda est, acuta ut foret sed non nimium tenuis (VII. vii). Sextus Platonicus (Med. ex Animalibus) says that cataract is depressed with a specillum. A full description of the operation is given by Paul: ‘We measure off a nucleus’ breadth (?s?? p?????????) from the part called the iris and in the direction of the outer canthus, then mark with the olivary end of the couching needle (p????? pa?a?e?t?????) the place to be perforated. If it is in the left eye, we work with the right hand, and vice versa. Bringing round the pointed end of the perforator, which is round at the tip (?a? ??ast???a?te? t?? ???? st???????? ?at? t? p??a? ?p?????sa? t?? ?e?t?????), we push it firmly through at the part which was marked out until we come to an empty space. The depth of the perforation should be as great as the distance of the cornea from the iris. Then raising the needle to the apex of the cataract (the bronze of it is plainly visible through the transparent part of the cornea) we depress the cataract to the underlying parts. After the couching of the cataract we gently extract the needle with a rotatory movement’ (VI. xxi). It will be seen from Paul’s vivid description that the couching instrument consisted of a handle with a nucleus at one end, to measure off the spot at which to perforate, and a needle at the other. We saw that the outfit of the oculist Severus contained one such instrument (Pl. XVI, fig. 2). The same combination is not infrequently met with. In the Museum at Aarau there are four from the station at Vindonissa. I have one in my collection which is interesting as showing a screw thread for fitting on a cover to protect the needle (Pl. XVI, fig. 7). It was found in Bedfordshire. It reminds one very strongly of the couching needle figured by ParÉ. Other handled needles were used in eye work as cauteries. Of trichiasis Celsus says (VII. vii): 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 Ophthalmic Probe. Greek, ?f?a???? ???. In Hippocrates (ii. 100) we find an ophthalmic probe mentioned. ?ep?d?? ??a? t?e?? t? p?ate? ?a? ???t?? s?ta???? ??????, p??ta ta?ta ?e?a t???a?, ?atap?t?a p???sa? d?d??. ‘Of squama aeris three times the full of a specillum and [as much] of the gluten of wheat. Levigate all up fine, form into pills and administer.’ Galen in his Lexicon explains that ??a? t?e?? t? p?ate? means t? ??a??s?? ?f?a????? ????. This is the only mention which we have of a special ophthalmic probe with scoop. In applying medicaments to the eye with a probe whenever any variety of probe is mentioned it is always the ear specillum which is named. It seems most likely that either the ear specillum or some variety of it is referred to here. It may have had a nucleus for applying medicaments at one end and a scoop at the other. Rasping Specillum. Greek, ?efa????st??; Latin, specillum asperatum (Celsus). A special burred specillum, for curetting the granular lids so common as a result of the ophthalmia which is endemic in most Eastern countries, and which was rampant in ancient Greece and Rome, is described by Celsus and also by Paul. Celsus says: In hoc genere valetudinis quidam crassas durasque palpebras et ficulneo folio, et asperato specillo, et interdum scalpello eradunt, versasque quotidie medicamentis suffricant (VI. vi). Paul says: ‘But if the granulation be hard and yield to none of these things we must evert the eyelid, and rub it down with pumice Heister (vol. i. tab. xvi. p. 591) figures the blepharoxyston as a spoon-shaped instrument burred on the convex side. There is in the Orfila Museum, Paris, an instrument of similar form. It consists of a handle with an olivary point at one end, and at the other a plate with transverse ridges. This agrees well enough with what we know of the classical instrument. It was found in Herculaneum. (Pl. XVI, fig. 1). Styli and Styloid Specilla. Greek, ???f???, ??afe???, ??af??; Latin, stylus or stilus. The difficulty of deciding as to whether any particular instrument is a surgical or a domestic article is often well illustrated by styloid instruments. In the British Museum several types of instrument will be found classed among surgical instruments, and a series of exactly similar articles will be found repeated among the styli used for inscribing and erasing characters on wax tablets. As even the writing stylus was occasionally used for surgical manipulations we are justified in looking on all styloid instruments as potentially implements of minor surgery. The claims of any doubtful instrument to be considered as once having been one of a surgeon’s tools must be decided on such grounds as the circumstances of its discovery. Galen (xii. 865) says teeth may be extracted with the stylus (??afe?? ????ae) or with the finger. Hippocrates (i. 46) thus describes the method of extraction of the secundines: ‘Place the patient on the obstetric chair and, leaving the cord uncut, place the child on two bladders filled with water and puncture each of the bladders with a stylus (??af??) so that the water may slowly flow away.’ The writing stylus, then, from the fact of its being at hand and of suitable shape was occasionally, perhaps often, used as a surgical instrument. Pl. XVII, fig. 6 shows an instrument which is figured by Vulpes (op. cit.) as a specillum. Personally, I think its highly ornamented form shows that it is rather a domestic article, but, as no information is available as to the surroundings among which it was found, we can only say that its shape fits it equally well either for writing or minor surgical manipulations. Grooved Director. Although we have no actual description of a grooved director, we have many manipulations described in which such an instrument would be used nowadays. For example, in describing the treatment of fistulae Celsus says: In has demisso specillo ad ultimum eius caput incidi cutis debet (VII. iv). ‘A director being inserted into them down to their termination the skin ought to be incised.’ It is interesting to find that we have at least one grooved director extant to prove that this instrument was known to the Romans. It is in the Section of Surgical Antiquities of the MusÉe de Cinquantenaire, Brussels, and it was discovered, along with several other surgical instruments, in a surgeon’s case of the usual cylindrical form. It is 15 cm. long, 2 mm. in diameter. A deep groove runs for 6 cm. from one end. The other end terminates in a small button. It is of silver, as also were the other contents of the case. It is possible that grooved specilla may have been in quite common use, but may have been made of wood or tin, and have therefore not survived; because we learn from Galen’s Manual of Dissection that probes which were used as directors in dissecting work were generally of wood, such as boxwood, so that they might not chip the scalpel (ii. 711). Surgical Needle (three cornered). Before discussing the eyed probes it will be well to clear the way by disposing of the needles, and of these, as the most easily defined class, it will be best to take the surgical needles first. We have innumerable references to the surgical needle though we have no actual description of it. There must have been many different sizes of it, for the manipulations vary greatly in magnitude. I shall content myself with giving two quotations describing respectively one of the largest and one of the smallest of these. Both passages are from Celsus. He thus describes the operation of suturing the abdominal parietes: Sutura autem neque summae cutis neque interioris membranae per se satis proficit; sed utriusque: et quidem duobus linis iniicienda est, spissior quam alibi; quia et rumpi facilius motu ventris potest, et non aeque magnis inflammationibus pars ea exposita est. Igitur in duas acus fila coniicienda, eaeque duabus manibus tenendae; et prius interiori membranae sutura, iniicienda est sic ut sinistra manus in dexteriore ora, dextra in sinisteriore a principio vulneris orsa, ab interiore parte in exteriorem acum immittat: quo fit ut ab intestinis ea pars semper acuum sit quae retusa est. Semel utraque parte traiecta, permutandae acus inter manus sunt, ut ea sit in dextra quae fuit in sinistra, ea veniat in sinistram quam dextra continuit: iterumque eodem modo per oras immittendae sunt: atque ita tertio et quarto, deincepsque permutatis inter manus acubus plaga includenda. Post haec, eadem fila eaedemque acus ad cutem transferendae similique ratione ei quoque parti sutura iniicienda; semper ab interiore parte acubus venientibus, semper inter manus traiectis: dein glutinantia iniicienda (VII. xvi). In the next case, where Celsus describes the treatment of staphyloma of the cornea, a very small needle must have been used: Haec fere circa oculum in angulis palpebrisque incidere consuerunt. In ipso autem oculo nonnunquam summa attolitur tunica, sive ruptis intus membranis aliquibus sive laxatis; et similis figura acino fit: unde id staf???a Graeci vocant. Curatio duplex est: altera, ad ipsas radices Now for suturing tissues, and more especially tissues of such toughness and thickness as the abdominal parietes, a round needle is absolutely of no use. A surgical needle not only requires to have cutting edges, as our three-cornered needles have, but these edges need to be in good condition to work well. Three-cornered surgical needles were in use from very early times. They are fully described in the Vedas of the Hindoos (Wise, Hindoo System of Medicine, p. 171). A few three-cornered needles of Roman origin have been found, although they are rare. Those which exist are of bronze. Probably the majority were of steel, and of these none have survived. I give a photograph of a three-cornered needle from my collection (Pl. XVII, fig. 4). It is imperfect at the point. It measures 7·2 cm. in length, and the sides are each 2 mm. in breadth. It is important to emphasize the fact that only needles with cutting edges are to be looked on as surgical, because it is not unusual to find needles, which are round and of large calibre, described as surgical, although they are quite unfitted for surgical work. Such is the one figured by Vulpes (op. cit.). Needles of this kind are sometimes found, as this one was, among surgical instruments. But they are not surgical needles in the sense that they are intended for suturing tissues. They are for fixing bandages. I shall describe them in the next section. Round Needles and Bodkins. Hippocrates tells us that bandages for fixing dressings and splints on a fractured limb ought to be finished off by stitching with a thread (iii. 55), and Celsus repeats the advice: The round sewing needle was therefore part of the recognized outfit of the surgeon, and numbers have been found associated with surgical instruments. Apart from this association with other instruments it is quite impossible to distinguish them from domestic needles. The same may be said of bodkins, as these too occur in surgical finds, and are also quite indistinguishable from the domestic articles for embroidering. Pl. XVII, fig. 2 shows a bronze needle from Roman London. A similar one from Pompeii, now in the Naples Museum, is given by Vulpes as a surgical needle, owing to the fact that it was found along with surgical instruments; but it is evident that it is only a needle for sewing bandages, &c. Other types of needles and bodkins are found in bronze, but many also are of bone and ivory. Even the latter are quite serviceable, and in spite of their being comparatively thick will stitch compact cloth easily. An ivory needle from Roman London is shown in Pl. XVII, fig. 5. Eyed Probes. We have frequent references to eyed probes, and we also possess a considerable number of different types. In dealing with the dipyrene I quoted a passage to show that it sometimes carried an eye in one of its olives. Hippocrates refers to an eyed probe of tin. In treating of fistula he directs us to take a rod of tin having one end pierced with an eye (???? ?ass?te????? ?p' ????? tet??????), and having put one end of a twisted piece of lint through the eye put the probe into the fistula, get the end of the specillum, bend it and hold the thread with the finger and withdraw the ends. Paul quotes this passage (VI. lxxvii), but alters the wording slightly: ‘Hippocrates directs us to pass a thread consisting of five pieces through the fistula by means of an eyed probe or a dipyrene’ (d?? tet?????? ??pa???? ? d?p??????). An example of a scoop at one end and an eyed probe at the other was found at Augst, and is now in the Museum at Basle (Brunner, loc. cit., Taf. I, fig. 14). It is 16 cm. long, of which the spoon, slightly defective at its tip, occupies 3 cm. About 2 cm. from its tip, which is fine, there is an elongated eye, 5 mm. in length. Various other combinations are met with. Ligula type of Specillum. Greek, ??a??s???; Latin, ligula. Ligulae are found in enormous numbers and in very great variety. They are toilet articles for extracting from tubes and boxes ointment, the various salves, balsams, and powders which entered into the mysteries of the Roman lady’s toilet. The ligula is therefore not strictly speaking a surgical instrument, but as it was used by the laity, and no doubt also by physicians, for making applications to affected as well as to unaffected parts, and as it is often found associated with surgical instruments, it is advisable to bring it within the scope of this investigation. It is also convenient to do so, because some varieties approach so closely in form to the true surgical specilla that it is often difficult to decide which class to place a particular specimen in. In doubtful cases it is well to remember that the specillum is most usually a combination of two instruments Plate XVIII shows a variety of ligulae from various sources, some simple, some combined instruments. Figs. 4, 5, 8 are most typical forms. Some of this simple type are two feet in length. They are often overlaid with gold. Fig. 7 shows a ligula which has so been treated. It carries a small fork on which to poise a pellet of semi-solid medicament. Spoons for measuring, preparing, and pouring medicaments. A type of spoon not uncommonly met with has a round bowl about 2 cm. in diameter, and a handle of about 10 cm. long. Usually they are of bronze; but occasionally they are of silver, and a considerable number in bone were found in the Roman Hospital at Baden. They are for measuring medicaments, heating them, and removing them from unguentaria, &c. They are often found alongside the glass unguentaria which contained the salves. They were also used for religious purposes. Similar spoons with pointed handles are common in finds of domestic articles. The sharp end is for extracting shellfish, &c. A larger variety of the unguent spoon has a spout to assist in pouring the contents. This variety is rather rare. Pl. XIX, fig. 4 is from the British Museum. The bowl is 2.5 cm. in diameter and the handle is 15 cm. long. The handle is round, and it has a small ringed ornamentation at its end and one close to the bowl. The bottom has been thinned out with heat, and there is a small perforation visible in it. A similar spoon was found in the grave of the Paris surgeon. Traces of medicament remain on it. This type is probably intended for warming salves and pouring them into the eye and other affected parts. Another variety Tongue Depressor. Greek, ???ss???t????. To open a quinsy Aetius says (II. iv. 45): ‘If the patient is adult, seat him and make him open his mouth, and depress the tongue with a spathomele, or a tongue depressor, and open the abscess with a probe or a needle knife.’ In excision of the tonsil Paul (VI. xxx) bids us seat the patient in the sun and depress the tongue with a tongue depressor (???ss??at???). Pl. XX, fig. 6 shows one of six bronze tongue depressors, burnished like small mirrors, from the LÉpine collection (VÉdrÈnes, Celse). Uterine Sound. The uterine sound is frequently mentioned by Hippocrates I have already referred to Galen’s statement that the non-pregnant os is of such a size that it will just admit an olive-pointed probe (p. 54). Hippocrates (ii. 836) directs us to treat hysteria by dilating the cervix, first with an ointment probe and then with the finger. ?a? ?p??e?pt??? ?a????a? ?a? ??ast???? ?a? t? ?e da?t??? ?sa?t?? ?e????. Soranus (II. x) describes plugging for uterine haemorrhage by means of the sound: ?a? t??fe??? ????? ??? t??? t?? e??????? ????? d??????? d?? da?t???? ? ???? pa?e?t???s?? t? st?at? t?? ?st??a?. ?a? p??? ????? ??te??e? t?? a????a??a? ?pa????s??. Hippocrates (iii. 34) alludes to applying medicament to the internal os with the sound: ‘Grind the pulp of colocynth, &c., and rub it up with honey and smear it on the sound (pe?? ????) making the consistence such that it can enter the os and always be pushed beyond until it has penetrated to the interior of the uterus. When the medicament has liquefied extract the sound, and again in the same way apply elaterium.’ If pus collect in the uterus post partum, or after abortion or from any other cause, it is good practice to pass a sound (???? ?pa?e?pt??da) into the cervix (i. 471). In another place we are directed to draw off gas in the uterus by fomenting the whole body and the uterus with vinegar and water, warmed specilla being afterwards inserted (??a? d?ap????? ??????ta). Again we find the sound applied to correct malposition of the uterus (iii. 140): In all these cases there is no special instrument designated as being used for a uterine sound, only the spathomele (?p??e?pt???) and the olivary probe named. With both of these we have met before. However, I have thought it of historical interest to cast these passages together. It will also clear the way for the discussion of other instruments, whose use is entirely reserved for the purpose of dilation of the cervix. A more questionable use of the sound is referred to by many authors. During the Empire the death of the foetus was frequently procured both by abortifacients and instruments. Frequent references to the use of drugs for this purpose may be found in the lay writers such as Juvenal and Suetonius (Domitian), and the later medical authors do not hesitate to describe the composition of abortifacient pessaries. It will be remembered that the Hippocratic oath specially forbids this practice. Uterine Dilators—Solid, graduated wooden. Greek, d?ast??t???, ???? t?? d?ast?????sa?—t?? d?ast???a (Galen, Lexicon). Besides the ordinary probes, which we have just seen that Hippocrates used occasionally for dilating the os, we have frequent mention made of a special variety of dilators which, although they are called ??? by Hippocrates, are not, strictly speaking, probes or sounds, but a graduated set of dilators of wood, tin, or lead. They correspond, in fact, to our Hegar’s dilators. Hippocrates describes these dilators (ii. 799). The patient Metal Dilators mounted on handles of wood. Hippocrates (i. 473) mentions a variety of dilator made of tin or lead, and hollow behind for mounting on a wooden handle: ‘After douching and fumigation, dilate, and, if necessary, straighten the cervix with a dilator of tin or lead (t? ??? t? ?ass?te???? ? ???da???), beginning with a fine one, and then a thicker if it be admitted, until it seems to be in proper position. Dip the dilators in some emollient. The dilators are to be made hollow behind, and fitted round rather long pieces of wood and thus used.’ This evidently refers to a portable set of dilators, each capable of fitting on a common handle, like Fritsch’s, Peaslee’s, or Lawson Tait’s of modern times. Bifurcated Probe. Greek, ??? d??????, ????. In treating of polypus naris Hippocrates directs us to take a sponge and tie it into a hard ball, and attach a four ply thread to it. Next to pass the end of this thread by means of an eyed probe of tin till it is caught at the back of the mouth, and drawing it out of the mouth to place a bifurcated probe under the palate, and using this as a fulcrum pull until the polypus is extracted (De Morbis, ii. 243: ?pe?ta ????? ?p??e?? ?p? t?? ?a??a?e??a ??te?e?d?? ???e?? ?st' ?? ??e???s?? t?? p???p??). In Galen’s Lexicon we find ???? explained as meaning a notched probe, split like a hoof at the point (???? d??????, ?at? t? ????? ??tet????? ?fe??? ????). And again under the heading d?????? he gives t? ???? d???a???, ?pe? ?a? d?s??d?? ???????s? t? d? a?t? ?a? d????, ‘what they call cloven and also cleft.’ The same word also means the notch of an arrow. In De Morbis (ii. 245), Hippocrates describes another method of extracting polypus with the same instrument. Taking a piece of stringy gut (???d??) and making a loop on it pass the end through the loop, thus making a second larger one, i. e. a noose. Pass the end of the gut through the nose into the mouth with a tin probe. Pull the loop into the nose and adjust it round the polypus with a notched probe (??? t? ??tet????), and when this is done pull on the gut, using the notched probe as a fulcrum. There must have been one form of bifurcated probe with a rounded end bearing a notch like an arrow. This is the only form of cleft probe which it would be safe to use in the back of the throat in the manner described by Hippocrates. We know, however, of other forms of bifurcated probes. Celsus describes a bifurcated retractor used for the extraction of weapons buried in the flesh: Saepius itaque ab altera parte quam ex qua venit recipienda est; praecipueque quia fere spiculis cingitur; Variant readings are V and ?. The Aldine edition has ?. The reading I have adopted is Daremberg’s; but whichever is correct matters little, as all indicate a bifurcated instrument, except the Aldine, which would indicate a three-pronged one. There are several bifurcated specilla in the British Museum (Pl. XXII). One in the Orfila Museum, Paris, of slender construction, carries a hook at the other end. It is from Herculaneum (Pl. XXI, fig. 1). A plain variety is shown in Pl. XXI, fig. 6. The specimen shown in Pl. XXI, fig. 3 is interesting as showing a possible fallacy. It has considerable affinity to the Roman netting-needle, and may not be a probe at all. The typical netting-needle has, however, blunt points, and the planes in which the forks lie are at right angles to each other. Blunt Dissectors. In his chapter on Angiology (or Division of the Temporal Blood Vessels) for headache and ophthalmia (VI. v), Paul mentions the use of dissectors: ‘Having therefore first shaven the hairs of the temples we make an examination by palpation, applying warm fomentations or even a fillet round the neck, and mapping out the vessels with ink as they become apparent, we stretch the skin to either side with the fingers of our own left hand and those of an assistant, and make a superficial incision along the vessel. Then cutting down and retracting with hooks and exposing the vessel with dissectors (d?' ???e??st????) we must raise it up completely isolated. If it be small, having stretched it and applied torsion we may divide it through in such a way as to remove a piece of it at one stroke.’ The typical scalpel handle ends in a leaf-shaped dissector, and Celsus always describes blunt dissection as being performed with the manubriolus of the scalpel. We have, Curved Dissectors. Greek, ?d????????? ??p?????. On the cure of hydrocele Paul (VI. lxii) says: ‘When the fluid is in the tunica vaginalis we make the incision where the apex of the tunica makes its appearance, and, separating the lips of the incision with a hook, and having dissected off the fascia with the hydrocele specillum and the scalpel (???e??sa?te? t? te ?d???????? ??p???? ?a? t? s????), we divide it through the middle with a lancet.’ Treating of the excision of varices (VI. lxxxii) he says: ‘Having separated the lips of the wound with hooks, and dissected away the fascia with curved hydrocele specilla, and laid bare the vein and freed it all round’ (?d?????????? ?p??ap?s? ??pa?????). A curved dissector from the find of the oculist Severus, now in the Museum of St-Germain-en-Laye, has a neatly ornamented handle with a small hook at one end, and at the other it curves first backward and then forward to join a small leaf-shaped dissector 3 cm. long and 1 cm. in its greatest breadth (Pl. XXIII, fig. 2). Sharp Hooks. Greek, ????st???, ?????????; Latin, hamus, hamulus acutus. Hooks blunt and sharp are frequently mentioned in both Tum idem medicus hamulum acutum, paulum mucrone intus recurvato, subiicere extremo ungui debet eumque infigere; atque eam quoque palpebram tradere alteri; ipse, hamulo apprehenso, levare unguem eumque acu traiicere linum trahente (VII. vii). Aetius also mentions this use of the sharp hook: ‘And, transfixing the pterygium with a hook (?a? ????st?? ?atape????te? pe?? t? ?sa t? pte??????), we gently make traction on it’ (Tet. II. iii. 60). Paul also says: ‘Seizing the pterygium with a hook with a small curve, (????st?? ?????ape? ??ade???e???) we stretch it’ (VI. xviii). The method of excision of the tonsil described by Celsus, Aetius, and Paul is to bring the tonsil into view by dragging on it with a sharp hook and then amputating it. Thus Paul says: ‘Wherefore seating the person in the light of the sun, and, directing him to open his mouth, while one assistant holds his head and another presses down the tongue to the lower jaw with a tongue depressor we take a hook (????st???) and transfix the tonsil with it and draw it outwards as much as we can without drawing the capsule along with it, and then we cut it out by the root with the tonsil knife suited to that hand’ (VI. xxx). In contraction of the vulva, Paul says: ‘Having transfixed the connecting body, whether flesh or membrane, with hooks, we stretch it and divide it with the fistula knife’ (VI. lxxii). At si caro increvit, necessaria est recta linea patefacere; tum ab ora, vel vulsella vel hamo apprehensa, tamquam habenulam excidere. In dissection, many of the manipulations which we perform with the dissecting forceps were performed by the ancients with sharp hooks. Pl. XXIV, figs. 1-5 represent specimens from various sources; some simple, others combined with another implement. Blunt Hooks. Greek, t?f?????st???; Latin, hamus retusus. Aetius (Tet. III. i. 13) says: ‘Whatever adhesions there are of the lower border of the lids to the tunics of the eye, we must put them on the stretch with a blunt hook (t?f?a???st??) and with a pterygotome free the adhesion.’ In Aetius (Tet. II. iii) we see the blunt hook used in the same way as we use an aneurism needle, except that the ligature is not introduced with it, but with another needle. He says we transfix the lips of the incisions with two hooks and gradually dissecting with the scalpel we free the vessel from the underlying fascia. Then with a blunt hook (t?f?????st???) placed under the vessel we raise it up from the depth, and beneath it when raised we place a two ply thread by means of a needle, and doubly tie and cut between. Paul says: ‘Exposing the vessel with dissectors we must raise it up when it is separated all round. If it be small, having stretched and twisted it with a blunt hook, we may divide it through in such a way as to remove part of it. But if it be large we must apply a double ligature under it with a needle, either a piece of raw flax or some other strong thing’ (VI. v). The ‘eyed hook’ is mentioned by Galen in describing the dissection of the spinal cord: ‘It is advisable that the manipulation be performed not with a needle but with an eyed hook, as is usually done in the case of the tendons in the neighbourhood of the carotid arteries.’ A small variety of the blunt hook is mentioned by Celsus, Galen, and Paul. Of the extraction of foreign bodies from the ear Celsus says: Sin aliquid exanime est, specillo oriculario protrahendum est, aut hamulo retuso paulum recurvato (VI. vii). Paul says that if stones of fruits, &c. fall into the ear they must be extracted with an ear scoop, a hook, or a forceps. Both types of blunt hook are represented by extant specimens; see Pl. XXIII, figs. 3, 4. These remind us of our aneurism needles, and it is interesting to note that Galen (ut supra) speaks of an ‘eyed hook’. The instruments shown in Pl. XXIII, figs. 2, 4 we might look on either as curved retractors or dissectors as they are half sharp. Pl. XXV, fig. 2 shows a hook of crotchet-hook type combined with a scoop. It is from Herculaneum. The Strigil. Greek, ??st?a. Latin, strigil. It seems to have been a common method of applying remedies to the auditory canal to warm them in a strigil and pour them in with it. Galen frequently mentions this. In Med. Sec. Loc. (xii. 622) he says: Having warmed the fat of a squirrel in a strigil, instil it. Celsus (VI. vii. l) says: In aurem vero infundere aliquod alimentum oportet quod semper ante tepefieri convenit; commodissimeque per strigilem instillatur. Marcellus (IX. l) says: Conteres et in strigili calefacies, et infundes, et lana occludes aurem. Ad auriculae dolorem et tumorem sine ulcere prodest herbae urceolaris aut cucurbitae ramentorum sucus tepens per strigilem in foramen auris dolentis infusus. The strigil varied much in size and shape. A common form was a sickle-shaped instrument, the circular part being hollow and semicircular on section, and admirably adapted for warming and pouring oil and other medicaments into the ear as above described. Pl. XXV, fig. 1 shows a small strigil from my collection. Spoon for applying astringent liquids to the uvula. Greek, staf??ep??t??. In his description of the medical treatment of diseases of the mouth Paul (III. xxvi) says: ‘When the uvula is inflamed we must use the gargles recommended for inflammation of the tonsils, and those of a moderately astringent nature, such as the juice of pomegranate, applied by means of a spoon or the instrument called the “uvula medicator”’ (staf??ep??t??). It is evident that it is quite a different instrument from the staphylocaustus (q. v.), which we are specially told had more than one hollow and was a grasping instrument like a forceps. The present instrument is for applying liquids, and was apparently of the form of a spoon. Fabricius describes and figures such an instrument. It is a small round spoon with a long handle. |
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