  CAUTERIES Cautery. Greek, ?a?t?????, ?a?t??, ?a?t???d??? s?d??e??; 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’ (s?d???a). 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, ????f???. 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 (a?a???t? ?a?t???)’ (VI. lxii). Galen, speaking of cancer, says, ‘Some use heated razor blades (???af????), 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 (t??a??? ? t??a???e?de? ?a?t????), 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, p?????e?d?? ?a?t?????. Malignant polypus of the nose is removed, says Paul (VI. xxv), with olivary pointed cauteries (p?????e?d?? ?a?t?????); 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 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 G (?a?e?d?? ?a?t????) and two cautery knives, we must first burn the scrotum through with the G-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’ (?? ?p? ????? ?????). Lunated Cautery. Greek, ???e?d?? ?a?t?????. Paul says in cases of sloughing of the prepuce we must cut it off, and if there be haemorrhage we must use lunated cauteries (???e?d?s? ?a?t??????). 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 (???t???) cauteries heated in the fire, and afterwards burn the triangle with gamma-shaped cauteries, and afterwards level the triangle with cauteries shaped like bricks (p?????t???) or lentils (fa??t???).’ 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 (p?????). For thus they pass more readily through’ (iii. 151). Galen has a long note in explanation of this term: Fa?a??? ??????e t? pe??f??e?a? ????ta ?at? t? p??a? ???? ?? ?at? t?? as???a? ????s? p????a? ?t?? t? d?ap????a ?a???e?a ?a? ‘He (Hippocrates) calls fa?a??? (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 p?????, 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 (sf???s???s? s?d?????s?). 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: 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’(?ta? ??t?? ???, ?????ta ??? s?????a ?a?sa? s?d?????s?? ? t???s?? ? t?ssa?s??) (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 (p??????s?? ?t???t??s? ?pt?? ?? ??a??? ????) (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 (?s?a?) 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 ????, a fungus, is used—? ???s?? ??t? ?s???a? ?a?sa? (or with fungi burn eight scars). |
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