Professional Documents
Culture Documents
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .
http://www.jstor.org/page/info/about/policies/terms.jsp
.
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of
content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms
of scholarship. For more information about JSTOR, please contact support@jstor.org.
Society for the Promotion of Roman Studies is collaborating with JSTOR to digitize, preserve and extend
access to Britannia.
http://www.jstor.org
INTRODUCTION
I N 1968 a fine and extensive group of Roman surgical and medical instruments (PL.XI)was
purchased by the British Museum from a London antiquity dealer.' With one or
perhaps two exceptions (Nos. 39, 33 below) there is little doubt that they comprise a
surgeon's instrumentarium which includes many normal types but also some very rare
objects: the three catheters are the largest set of such instruments to be found; the speculum
is only the third complete provenanced example of its type, while the bone chisels and sharp
spoon have few known parallels; the double blunt hook is one of the finest examples of this
rare class of object; the handled needles significantly increase the number of such specialist
instruments; the small tanged cautery is one of the very few survivors of a type of
instrument that was extremely common in Roman surgery: and the segmented form of one
of the medicine boxes is as yet unparallelled.
With almost forty objects this is one of the largest and richest sets yet found and
constitutes a major addition to the study of Roman surgical instruments. It is, therefore, to
be regretted that little information exists on the circumstances of discovery, the findspot
being recorded simply as 'Italy'. While such a provenance poses no difficulties and indeed
gains some support from the instruments themselves, it tells nothing of the precise context
of the set. That this is very likely to have been a tomb is indicated by the survival together of
such a large number of instruments and by the similarity of the corrosion products upon
them (see p. 164 ff. below). Furthermore the presence of soil particles within the mouldings
of several of the instruments and the comparatively fresh appearance of the corroded
surfaces would suggest that the discovery might have been made no very great time before
1968.
Apart from the Pompeii/Herculaneum assemblage, and site groups from a small number
of military hospitals, including Baden and Neuss (few of which, however, are specialist
instruments), as well as one or two other exceptional finds like that of the 'Paris surgeon',
the great majority of instrument groups has been found in graves. Ernst Kiinzl has
published 78 of these in his important study of medical instruments from Roman graves.2
There is a concentration of these graves in Gallia Belgica and the two Germanies, with an
apparent paucity of material in the Mediterranean provinces, Italy included. The explana-
tions of this phenomenon are undoubtedly several and complex, but amongst them may be
1 Brit. Mus. registration nos. GR 1968, 6-26, 1-39. At the time of writing they are on display in the 'Greek and
Roman Life' room of the British Museum.
2 E.
Kiinzl, Medizinische Instrumente aus Sepulkralfunden der romischen Kaiserzeit (Bonn, 1983) (off-printed
from Bonner Jahrbiicher clxxxii (1982), Iff.).
presumed to be the varying nature of ancient burial practice as well as the relative scale of
recent archaeological activity. The known Italian medical grave groups include a number of
interesting instruments, not least the bone forceps and elevator in the set from Luzzi,3 but
all are comparatively small groups. The present instrumentarium, larger than all of these, is
thus of considerable importance and is exceeded in size only by one other set, the grave
group from Bingen, near Mainz,4 which comprises over fifty pieces, though not all of certain
medical use.
The non-archaeological means of discovery of the present set may well account for a
number of notable absences. There are, for instance, no indeterminate fragments nor any
specifically non-medical objects of the kind often encountered in Roman medical grave
groups. For whatever reason, if any such objects existed they must have become separated.
More particularly there is neither a bleeding cup nor any other metal vessel. These are by
no means invariably found with sets of medical instruments, but they might have been
anticipated in a set as large as the present one. However, thin sheet metal, if it survives at
all, requires considerable care during and after excavation and such conditions are unlikely
to have prevailed in the present case. There is, in fact, some evidence to suggest that the set
did originally contain at least one sheet metal object (see p. 158) no longer in existence, and
it is probable that controlled-excavation would have yielded further traces of this, of the
wooden scalpel box (see pp. 135 f. below) and, perhaps, of other similarly vulnerable arte-
facts. However, it is important to bear in mind also the partial picture conveyed by the
surviving evidence even when it has been retrieved under optimum conditions. Medical aids,
instruments and apparatus made of organic materials rarely survive although they are
frequently mentioned in the classical medical literature. They include wooden directors,
dilators, sounds, spatulae, splints and ointment boxes, cloth tourniquets, horn pessaries,
and quills for the application of powdered medicaments or extraction of warts. It would be
surprising if none such had originally formed part of the present set.
Furthermore, it is by no means certain, if indeed the present set does derive from a tomb,
that a surgeon's complete instrumentarium is in question. Kiinzl's study of Roman medical
grave groups5 demonstrates the wide variety in size of these groups, some of which have a
very restricted range of instruments. It is preferable to view some, perhaps most, as 'token'
groups, rather than as complete instrumentariawhose limited size would have placed severe
constraints on the surgery their owner could have undertaken. Nonetheless, the size and
composition of the present set imply if not a complete instrumentarium then one which is
substantially so.
Chronologically the set belongs to the earlier Principate, probably to the first or early
second century A.D.It has, therefore, seemed particularly appropriate to consult above all
of the classical medical works the De Medicina of the encyclopaedist A. Cornelius Celsus.6
Written in Italy under Tiberius it has a particular relevance, both geographically and
chronologically, to the present set and helps to clarify the use of many of the instruments.
CATALOGUE
[Unless described otherwise all objects are of copper or its alloys. Metal analyses in Table 5
below.]
14
7 12
.......10 11
9
5lcm
I I 1 i I I I
FIG. I. The scalpel handles and forceps, Nos. 1-12. Scale 1:2.
attachment still retains fragments of an iron tang, and traces of mineralised wood
adhere to one face.
L. 6-33 cm (broken). (GR 1968, 6-26, 9)
very finely cut multi-faceted surface. A simple disc moulding, near the centre of the
instrument, separates the grip from the lower stem, of octagonal cross-section, which
tapers to a fine, sharp-pointed hook.
L. 14-o5 cm. (GR 1968, 6-26, 21)
17 18
7
13 14 15 -
161
---
0 5 15cm
I I i 11I
FIG. 2. The hooks, bone chisels and speculum, Nos. 13-19. Scale I:2.
When closed the tips meet, but a slight gap between the blades, increasing towards the
arms, gives a tapered priapiscus of round or sub-oval cross-section. There is a band of
iron corrosion around one of the blades, perhaps the remains of a dislodged collar or
slide.
L. I5-6 cm. L. priapiscus, tip to shoulder, 6-5 cm. Max. outer distance, open, between
blade tips, cm. Max. outer distance, open, between blades at shoulder, 5-4 cm.
4"4
Diam. of blade tips, closed, 0o8 cm. Diam. of blades at shoulder, closed c. I-o cm.
(GR 1968, 6-26, 27)
20. Male catheter (FIG. 3)
The characteristic S-shaped tube has a slender oval eye on the inner curve just above
the neatly tapered and rounded tip. It is made from a rolled strip whose butt join is
just visible over the whole instrument, except in the region of the eye where
considerable care was taken in the closing and smoothing of the seam. Wherever the
original metal surface survives it can be seen to be both even and very smooth. At the
top a small, lobate, plate-like bracket or collar encircles the end of the stem. It has
been soldered in place and may have been intended both for manipulation of the
instrument and to prevent the butted seam from pulling apart at the neck, its weakest
point.
L. 28.0 cm. Stem diameter, outer, 0-49-0-51 cm. (GR 1968, 6-26, 24)
20 21 23
22 0
-
S24
I -o
26
25
O 5 15cm
i r I i 1I
FIG. 3. The catheters, handled needles, cautery and stylus, Nos. 20-26. Scale 1:2.
27 28 30
31
32
29
0-
33
34
15-
35
O-
- - cm
FIG. 4. The probes, scoops, spoon and spatulae, Nos. 27-35. Scale 1:2.
38
36
37
15 39
II
IV
5
O-
cm
•
FIG. 5. The cylindrical boxes, palette and folding knife, Nos. 36-39. Scale 1:2.
face are stained with iron corrosion, and a small stripe of copper corrosion is present
on the underside.
L. 8-2 cm. (GR 1968, 6-26, 39)
DISCUSSION
Scalpels, Dissectors and Sharp Spoon (Nos. 1-9; FIG. I, I-9; PL. XI)
The surgical knife or scalpel is the surgeon's instrument par excellence. Boxed scalpels and
the bleeding-cup, potent symbols of the medical profession, were the instruments most
commonly chosen to be depicted on the tombstones of Greek and Roman surgeons.7 By the
Roman imperial period the scalpel had acquired the characteristic overall form which it was
to retain for many centuries, an iron/steel blade with bronze handle normally terminating in
a blunt dissector. Both components were variable in shape and size resulting in a few
common types with many variants. Through the inadequacy of classical descriptions and the
scarcity of surviving blades it has seldom proved possible to link any surviving scalpel of the
period with any one of the many different knives specified for particular operations in
classical medical literature. Taking the evidence both of depictions in stone and of scalpels
with surviving blade, however, the commonest blade shape appears to have been deep
bellied or sub-triangular. Where discernible the cutting-edge is on the front alone or on the
front and underside of the belly. Of the 9 scalpel blades in the Bingen instrumentarium, for
instance, 7 are bellied/sub-triangular,8 and 3 of the 5 scalpels in the instrument box depicted
on the tombstone of the medicus P. Aelius Pius Curtianus9 are of the same type. The form
was clearly suited to the majority of surgical work. Other blade shapes, again represented
both by surviving examples and on stone reliefs, comprise straight-edged, concave, convex
and hooked types in a variety of shapes and sizes. o
Many Roman surgical instruments were double-ended, and the scalpel is no exception.
Almost invariably the handle is in the form of a second instrument, a leaf-shaped spatula of
variable length, width and thickness. Its use as a blunt dissector is recorded time and again
by the classical medical writers, as in Celsus' description of surgery of the scrotum:"
'Now wherever the disease is found to be, the assistant should press the scrotum gently
upwards; the surgeon either with his finger, or with the handle of the scalpel (manu-
briolove scalpelli) separates the middle tunic from its connexion with the scrotal wall, and
brings it forwards;'
or in his description of an operation for the removal of dermoid cysts:12
The grip which united blade and dissector usually took one of two main forms, one
slender, the other of more robust construction. The slender form (Type II) has a plain,
narrow, octagonal-sectioned stem only rarely with any form of decoration. The leaf-shaped
blunt dissector terminal is almost invariably slender, sometimes excessively so. The other
type (Type I), the most frequently encountered grip, is a plain rectangular bar, of variable
dimensions. It is simply an extension of the socket for the tanged blade. The two sides
provide a flat field which was occasionally decorated with inlaid floral or faunal designs. The
leaf-shaped dissector varies in shape and size from short, broad examples to long slender
ones.
A simple cut slot-socket for the blade is commonly found on Type II scalpels but is less
frequently encountered on those of Type I. Instead a more elaborate fixing comprises a
keyhole-like socket, often with rolled back terminals which sometimes form hollow 'tubes'.
A thin version of this socket type occurs on some Type II scalpels. For long an explanation
of this unusual but diagnostic feature has been in existence:13
'It is generally believed that the blades were fixed in the handle by a binding thread or
wire, and that the rolls and perforations were to give security to the mounting used. This
detachable arrangement would allow removal for cleaning, and also permit one handle
to be used with several varieties of blade'.
Whilst noting the current explanation Milne was disinclined to accept it, yet widespread
belief in this odd arrangement has continued up to the present. In fact it is extremely
unlikely that the keyhole blade fastening was ever intended to be temporary in the manner
described above. Had the blades really been easily interchangeable there would have been
little need for the 13 handles in the Bingen instrumentarium,14 all found with blade or blade
fragment in place (none of which bears any trace of wire binding), or even the 6 handles
with Type I grips in the present set (Nos. 1-6). It is also difficult to reconcile the suggested
makeshift binding, required to hold a temporary blade firmly in place, with the careful
function-specific design of other contemporary surgical instruments. Nor is it necessary to
invoke a practical use for the rolled terminals: few of the copper-alloy surgical instruments
of this period were without decoration, normally cast or cold-worked mouldings. Indeed a
similar rolled moulding occurs on some forceps's where nothing other than decoration was
intended. Furthermore, close examination of a Type I scalpel handle from London16 reveals
that it was probably cast on the iron blade and would have been impossible to detach other
than with smiths tools, while two Type I scalpels from Xanten17 and several of those in the
present set (see p. i6I below), bear remains of the solder used to secure the blade in its
socket.
In the case of Nos. I, 2, 5 and 6 the socket is of normal keyhole form with a slot
terminating in a cylindrical hole which passes through the width of the grip. With a vertical
rod-like terminal to its tang the iron blade could be slotted into the keyhole socket and the
two hammered firmly together. Alternatively, as seems to have occurred on the present
examples, a simpler tanged blade without the rod terminal could be fitted using solder as a
13 J.S. Milne, Surgical Instruments in Greek and Roman Times (Oxford 1907, reprinted Chicago, 1970), 24.
14 Como, op. cit. (note 4), fig. 2.
15 eg. Rheims: Kiinzl, op. cit. (note 2), fig. 34, 14.
16
Museum of London, A 6817.
17 Rheinisches Landesmuseum, Bonn.
bonding agent. Scalpels 3 and 4 demonstrate a variant of the keyhole socket. An angled-slot
was cut from top and bottom of the grip leaving a projecting uncut wedge within. A
corresponding wedge-shaped indentation in the end of the blade tang would have enabled a
precise and rigid fit. To hold the two in position solder was poured into the join by means of
a small, circular hollow drilled at the extremity of the slot from both the top and bottom
face. Analysis has shown this to be a soft solder of tin and lead (p. 161 below).
The fixing of the blade in these keyhole sockets was not, then, temporary. Whichever of
the various methods was employed, the union of blade and handle would be semi-
permanent, and the blade would only need to be removed if broken or whetted beyond use.
On these occasions, with a combination of hammer, punch and heat, the old blade could
normally be removed and a new one substituted. Although this might have been done by
the surgeon himself it is perhaps more likely, at least in an urban context, that it was carried
out by a metalsmith or cutler, perhaps by the instrument maker himself. A terra-cotta relief
from a second-century A.D. tomb on the Isola Sacra, Ostia,18 commemorates the work of
one such specialist smith, who probably made, sold and reconditioned iron implements. He
is depicted twice, both making and sharpening tools, and is surrounded by finished items or
those awaiting repair. They comprise almost exclusively cutting instruments, both domestic
utensils and craftsmens' tools and include a small boxed set of scalpels. These may have
been newly manufactured or alternatively may have had their blades reforged or replaced.
That simple replacement did not alwaysprove possible is demonstrated by a scalpel with
Type II grip from Neuss, Romerlager,l and another with Type I grip, of uncertain
provenance, in the Zentralmuseum, Mainz.20 In both these instances the blade had stuck
fast in the socket and could not be removed so that it had to be cut off flush with the socket
terminal, and a fresh socket cut at right angles to receive the new blade.
The robust keyhole socket of many Type I scalpels is in marked contrast to the short,
slender, simple slot-socket most often found on scalpels with the Type II grip. With such a
small bond between the handle and blade of these scalpels there can be no doubt that the
blade was attached permanently, although as with Type I scalpels, it must normally have
been possible to re-use the handle of a worn or broken blade. Scientific examination has
revealed that the blades of the Type II scalpels in the present set (Nos. 7, 8, 9), like those of
the Type I scalpels, were held in place with a soft solder.
The difference in socket type may imply a difference in function and there are a number
of indications in support of this. The slightness of the socket of Type II grips is in keeping
with the dimensions of the rest of the handle whose dissector is normally very slender and
the grip narrow. It is clear that these scalpels could not have withstood the sort of pressure
which might be applied to the Type I examples, and their use was probably restricted to fine
surgery. That their blades were generally smaller and thinner than those of Type I scalpels
may be inferred from the comparative infrequency of their survival. Two from Asia Minor21
and one from Luzzi22simply bear small examples of blades of the common bellied form, but
three scalpels from Wehringen, Bavaria,23 each with a different tiny blade of characteristic
form, appear to be specialist instruments. They are part of a small leather-cased set, found
with an inhumation, consisting also of forceps, a sharp hook and an elevator. One of the
scalpels is closely comparable to the drawing of a pterygotome with small, narrow,
24
25
Albucasis, On Surgery and Instruments, M.S. Spink and G.L. Lewis (London, 1973), II, 16, fig. 55.
op. cit. (note 2).
26 ibid., 93-6.
27 ibid., 61-7.
28 F.J. Hassel and E. Kiinzl, Medizinhistorisches Journal xv (1980), 407-9.
29
Como, op. cit. (note 4), fig. 2.
30
ibid., fig. 2, 6.
31 B. Vulpes, Illustrazione di tutti gli strumenti
chirurgici scavati in Ercolano e in Pompeii (Naples, 1847), pl. VII
fig.32I.
Inv. no. AI29o89.
33 Small samples of the mineralised wood fragments from scalpel handles Nos. I and 2 were sent for
examination to the Jodrell Laboratory, Royal Botanic Gardens, Kew. Dr Paula Rudall kindly reported on these:
'The wood is in too poor a condition to permit an exact identification. However, it is certainly a hard-wood (not a
conifer) and the vessels are clearly visible with marked spiral thickenings on their walls, although very little other
structure remains. This eliminates woods with spiral thickenings absent, such as Box, Olive, Ash or Oak. The most
likely candidates are Lime (Tilia sp.), Sycamore or Maple (Acer sp.), Cherry (Prunus sp.) or Spindle (Euonymus
sp.), but several other woods have spiral thickenings and cannot be ruled out. (eg. Pear, Pyrus sp., and other
Rosaceae and Elm, Ulmus sp.)'.
bubble on one face of the dissector indicates the manner in which they were placed in the
box, blade and dissector alternating at each end. Such an arrangement is clearly depicted on
an ex-voto tablet from Athens and on the tombstone of Curtianus.34
The Type II scalpel handles (Nos. 7-9) bear no traces of wood, but two of the three have
corroded blade traces on their dissector consistent also with a 'top to tail' arrangement.
They, two, were presumably held in a box, perhaps the same as that of the Type I scalpels,
but possibly in a separate case of leather.
Both the Wehringen find and the stone reliefs show that instruments other than scalpels
were commonly held in the scalpel boxes too - forceps, blunt and sharp hooks, and
elevators have all been recognised; traces of iron on some of the other instruments suggest
this may have been so with the present set. Probes, sounds and other slender instruments
were often held in long, slim cylindrical copper-alloy containers as well, presumably, as in
pouches or tubes of organic materials, while the bulkier instruments, the speculum and
catheters of the present set for instance, must have been carried in a 'doctor's bag' or case.
Only one other instrument in the set bears the same traces of storage as the Type I scalpels.
This is No. 6, also probably a scalpel handle, but with a finely made sharp spoon in place of
the normal blunt dissector. The socket is broken but is clearly of the keyhole form common
to Type I scalpels, and remains of mineralised wood, as well as corrosion from the missing
iron blade, are present on the sides of the grip.
Sharp spoons, that is to say those with a semi-cutting rim, are one of the more rarely
found surgical instruments. They were probably used as curettes, instruments with the dual
function of scraping away and removing unhealthy tissue from normal or abnormal body
cavities. In the Hippocratic Corpus a wrapped curette was advised for clearing thrombi
from the uterus, and a uterine curette has been identified in the fine instrumentarium from
Colophon.35 It is a single piece double-ended scoop of copper-alloy, cm in length, with
a stepped central grip. One scoop is smooth-rimmed, the other is19"5 finely toothed at its
extremity. The twinning on the present example of what was probably an iron scalpel blade
with a sharp spoon of copper-alloy, though not well suited to curetting the uterus, would
have been, nonetheless, a not unnatural combination. Both ends might be used in the
scraping away of carious bone resulting from chronic ulceration.36 Alternatively they might
be used to equal effect on fistulae and in particular in one of the operations for the removal
of nasal polypus. Galen recommended the excision of the tumour and scraping of its roots,
while Paul gave a fuller description:37
. holding in the right hand a polypus scalpel, having its extremity shaped like a
myrtle-leaf, we cut around the polypus or sarcomatous tumour ... Afterwards, turning
round the instrument, we bring out the separated fleshy body with its concave part'
However curettage might also be carried out with the scoop of some scoop-probes, and it
can be difficult to differentiate one from the other as, for example, an olivary-tipped probe
with broad-ended scoop in the Asia Minor instrumentarium.38Aetius recommended the use
of an ear specillum for curetting the interior of a small cyst on the eyelid,39 whilst it has been
suggested that the Hippocratic uterine curette might have been a wrapped strigil.4i
. a second physician's case, of simpler make, that you can carry in your hands when
on a journey. The most convenient is one methodically arranged, for the physician
cannot possibly go through everything.'
Forceps, too, can be seen in another portable kit, the small double-leaved wooden box
depicted on the tombstone of Curtianus.45 Their slender form also allowed them to be
carried, together with hooks, probes and needles, in the thin tubular copper-alloy boxes
found in some numbers in graves and at Pompeii and Herculaneum.46 In the present set
evidence from corrosion products indicates that the forceps and Type II scalpels, perhaps
also the sharp hooks, may have been contained in the same box or case.
The forceps is an instrument of considerable antiquity having been used from the Early
Bronze Age onwards in conjunction with a razor for fixing and removing facial hair. It was
but a small step to more strictly surgical uses. Beyond their frequent toilet and cosmetic
functions, Greek and Roman doctors used forceps for many different tasks, and in response
a number of different forms evolved. A few were developed for particular functions or
operations and acquired specific names. The majority of surgical forceps, however,
belonged to one of three main types, each of which might be used in very many different
ways. The intention was to give maximum versatility with the minimum number of
instruments. It is, therefore, of interest to note that the present instrumentarium includes
one example of each of the three main types of forceps, clearly chosen as a set.
The pointed-jawed forceps (No. 12) is of normal form with long arms made by sawing a
bar up its centre to the base of a fine disc-and-baluster finial. The arms, carefully rounded
on the outer edge, taper to thin, pointed jaws, still accurately aligned. In addition to use as
splinter forceps this type must have been used for fine surgical work in many different
operations. A narrow-bladed forceps is specified by Paul in the removal of bone splinters in
fracture of the nose, and again in the extraction of foreign bodies from the ear.47 A few
examples have been found with rifled facetting on the inner face of the jaw tips,48 a feature
still to be seen on modern anatomical forceps. It allows a firmer grip without greatly
increasing the risk of damage to skin or tissue.
More commonly found is the smooth-jawed fixation forceps. No. io is a short but typical
example made, again, from a sawn bar, but this time with flat, inturned, square-ended jaws.
Like the third forceps of this set it may originally have had a ring-slide to aid prolonged
fixation. It would have found many uses in dissection but was also intended for surgical
epilation, the operation to remove ingrowing eyelashes (trichiasis), a condition consequent
on granular ophthalmia and, to judge from Greek and Roman medical writers, particularly
prevalent at that time. Celsus describes the operation49 and it is repeated by Paul, who
specifies the forceps to be employed:50
'Turn the eyelid outwards and, with an epilation forceps dragging out the offending hairs,
either one, or two, or three or whatever number there are. Then apply a heated olivary
probe or an aural probe or some such slender instrument to the place from whence the
hair or hairs have been removed'.
The third main type of forceps was, like the last, a dissecting forceps with square-ended,
inturned jaws, but with fine interlocking teeth enabling a still firmer and more secure grip.
It was, therefore, used for fixing and raising skin and wherever else traction was required,
especially in the seizing and excision of tumours. In classical medical literature it is
frequently referred to as the myzon. The present example (No. Ii) is a variant of this
simple form, with broad jaws angled to one side (coud6e type). Milne suggested this is the
forceps referred to by Paul in his description of the raising and excision of the surplus skin
of the eyelid in trichiasis. It may also have been the type of forceps used in the removal of
anal condylomata (warty excrescences) as described by Celsus:P2
'The tumours, which are called condylomata, when hardened are treated by the following
method. First of all the bowel is clystered; then the tumour is seized with a forceps close
to its roots and cut away.'
The hollow, toothed jaws were well designed to grip and contain excised skin or tumours
and in this respect they resemble the jaws of the staphylagra used both for crushing a
relaxed uvula and for strangling haemorrhoids. Although the present forceps lacks the
power of the scissor-action staphylagra, it does have a ring-slide for locking the jaws and
was quite probably used for both operations performed with the staphylagra. A passage
from Muscio would tend to confirm this:53
47
op. cit. (note 37), VI, xxiv.
eg. the pointed-jawed forceps/needle holder in the Milos set: V Deneffe, Etude sur la Trousse d'un
48
53 Muscio II, xxx, I 10 v.3; V. Moller-Christensen, The History of the Forceps (London, 1938), 135. In the fifth
century A.D. Muscio translated into Latin part of the important works of Soranus of Ephesus (first century A.D.).
'Hold the haemorrhoids firmly with a myzon or sarcolabum, in such a manner that the
roots drawn somewhat forward are first cut with a scalpel.. .
The coud6e fixation forceps is found less often than the normal toothed fixation forceps, but
examples are known both from occupation sites and from graves. Of the two which most
closely resemble No. I I, one is of first-century A.D. date from Pompeii/Herculaneum.54 It
has jaws of the same form and width, the same number of teeth, and the same simple
locking ring. The other example, from a tomb of probable third-century A.D. date, near
Ohrid, Yugoslavia,55 also has jaws of identical form and size. It is of particular interest in
the present context because it comprises one end of a double-ended instrument, sharing a
central disc-and-baluster moulding with a smooth-jawed fixation forceps of very similar
form and size to No. io. Like the Ohrid double forceps the two present fixation forceps are
each one end of a combination instrument.
Although infrequently so, forceps combined with other instruments do occur. They
include pointed-jawed forceps/elevators from Paris,56 from Gauting, near Miunich,57and
from Aschersleben, E. Germany,58 a pointed-jawed forceps/needle-holder from Milos,59 a
smooth-jawed fixation forceps/sharp hook and a smooth-jawed fixation forceps/probe from
Cologne.60 In all these cases, as with that from Ohrid, the instrument is dual-purpose but
made from a single piece of bronze. However, a smooth-jawed fixation forceps from Asia
Minor61 originally held an iron instrument at the other end, though only traces of iron
corrosion now remain in the region of the small circular socket. Each of the present forceps
is also the bronze component of a bronze and iron combination instrument, the stub of an
iron tang secured with soft solder surviving in the simple slot socket within the disc
mouldings.
Iron/steel was selected primarily for two purposes in Roman surgery, for blades and for
cauteries. Of these two possibilities the more probable combination is that of forceps and
blade, and the presence of similar simple slot blade fastenings (also employing soft solder as
a bonding-agent) on the Type II scalpel handles (Nos. 7-9 above) may be seen to lend
support to this suggestion. Furthermore, most cauteries would have had wooden or bone
handles and are unlikely to have been combined with another instrument.
Sharp Hooks (Latin: hamus, hamulus acutus.) (Nos. 13-15; FIG.2, 13-15; PL. XI)
Sharp hooks were an indispensable part of the Roman surgeon's instrumentarium. They
were used primarily to retract and fix the edges of incisions and wounds, and for that reason
several examples are often found together, as in the present case. However, like most
Roman surgical instruments they also served other functions, notably, in conjunction with a
scalpel, in the raising and excision of small pieces of tissue, as in the operation for
contraction of the vulva.62 Celsus describes the use of a hook in tonsilectomy and again in a
delicate eye operation:63
54 Vulpes, op. cit. (note 31), pl. V, fig. IV; Meller-Christensen, op. cit. (note 53), I29-130, fig. 197.
55 Kunzl, op. cit. (note 2), fig. 86, 4.
56 Milne, op. cit. (note 13), 94, pl. XXVII, I. Recent examination of this instrument has confirmed the terminal
as an elevator, not a rugine as Milne believed.
57 Prihistorische Staatssammlung, Minchen, Inv. no. 1951
8 440o.
Kiinzl, op. cit. (note 2), fig. 80, 2.
59 ibid., fig. IO, i; Deneffe, op. cit. (note 48), pl. 5, no. I.
60 Romisch-Germanisches Museum, K1oln, Inv. nos. Li 194, and 762.
" Romisch-Germanisches
Zentralmuseum, Mainz, Inv. no. 0.38310.
62 Paulus Aegineta, op. cit. (note
37), VI, xxx.
63 op. cit. (note
6), vii, 12, 2; vii, 7, 5.
'Sometimes, when the pterygium has not been quite cut away or from some other cause, a
small tumour, called by the Greeks encanthis, forms at the angle and this does not allow
the eyelids to be completely drawn down. It should be caught up with a hook (hamulo)
and cut round, but with so delicate a touch that nothing is cut away from the angle itself.'
Reflecting the different degrees of delicacy of treatment a range of types and sizes is
found. Identifiable hooks are invariably of copper-alloy and variation is normally restricted
to the length and decoration of the stem and upper terminal. A secure grip was necessary,
especially for retraction, and many, like Nos. 13 and 14, have elaborate mouldings or
exquisitely cut facets which were both decorative and functional. For this reason too the
hook was seldom combined with another instrument, although examples do occur, as for
example one in combination with a fixation forceps,64 and another with a fine cautery/
needle-holder.65
In retracting wound edges it was also important that the hook itself was as small as
possible to avoid inflammation and its potentially dangerous consequences. In fact,
wherever the hook has survived in good condition it can be seen to have been extremely
carefully made from polished tapered wire ending in the finest of points. It may well have
been in a further attempt to avoid the hazards of inflammation, rather than pure
ostentation, that a pair of bronze retractors from Cologne had the very tip of their hook
made of silver.66 They are part of a finely inlaid set of instruments from a surgeon's tomb in
the Luxemburgerstrasse cemetery.67
The sharp hook is one of the most commonly found of Roman surgical instruments and
examples occur widely throughout the Empire. The three hooks of the present set illustrate
the main types, from the simplicity of No. 15 to the elegant ring-and-baluster mouldings of
No. 14 and the strikingly faceted grip and button terminal of No. 13. Close parallels to the
latter include those from Pompeii/Herculaneum,68 Bingen,69 and South Shields.71
Blunt Hook (Latin: hamulus retusus) (No. I6; FIG. 2, 16; PLS. xi, xIIB)
Blunt hooks are mentioned not infrequently by Greek and Roman medical writers, but
unfortunately their appearance is not described. They performed a similar role to sharp
hooks (retracting, raising, stretching and fixing) but in operations in which puncturing had
to be avoided. To judge by the varying operations in which they were used they must have
existed in a number of different forms. Thus in the freeing of a lower eyelid adhering to the
eye,7' the hook used for stretching is likely to have been a comparatively small and slender
one. An instrument which could have been used for such work was found at Springhead,
Kent.72 It is 13-2 cm long with slender, finely-drawn stem and a small, narrow, carefully
rounded hook. Amongst other things it could also have been used in the manner described
by Celsus73 for the removal of foreign bodies from the ear.
In another passage of Celsus74 the operation for excising a fold of a lax or drooping eyelid
is described. Similar surgery undertaken in the mid-19th century utilized special eyelid
64
Koln, Romisch-Germanisches Museum, Inv. no. Li. 194.
15 London, Museum of London, 19887.
66
Koln, Romisch-Germanisches Museum, Inv. nos. 1076-7.
67 Kunzl, op. cit. (note 2), 89-go, fig. 68, 5.
"` Tabanelli, op. cit. (note 7), pl. LVII.
69
Como, op. cit. (note 4), fig. 3, 15-17.
71 L. Allason-Jones, Arch. Ael.i vii (1979), 239-241, fig. I.
71 Aetius, Tet. III lib.i, 13; Milne, op. cit. (note
13), 87.
72 SF 2487. Miss D. French kindly allowed me to examine this instrument.
retractors,7", and two examples of almost identical form were found at Pompeii.76 They
have a short slender stem and broad, flat, acute hook with blunt crescentic edge.
However, the majority of references to the blunt hook record its use in the raising of
blood vessels, either to isolate them or as a preliminary to excision. Milne77 summarised a
passage from Aetius detailing one such operation:
'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 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.'
Again, for treatment of varicose veins where the veins were deemed too involuted for
cauterization, Celsus recommended careful excision using hooks and scalpel:78
'The skin is similarly incised over the vein, and the margins held apart by hooks
(hamulo); with a scalpel the vein is separated from surrounding tissue, avoiding a cut into
the vein itself; underneath the vein is passed a blunt hook (retusus hamulus); the same
procedure is repeated at the intervals noted above throughout the course of the vein
which is easily traced by pulling on the hook. When the same thing has been done
wherever there are swellings, at one place the vein is drawn forward by the hook and cut
away; then where the next hook is, the vein is drawn forwards and again cut away.
It is possible to envisage Z-shaped double blunt hooks like No. I6 being used in this way.
The blunt sides, rounded blunt tip and convex outer face of each spatulate hook would
protect vessels and tissue alike, while the flat inner face might be utilised as a small platform
for intricate dissection. In addition, the broad front edge of the hook would have minimised
the possibility of injury in passing beneath the vessel, and the smooth tapered sides would
have guided the vessel back to engage in the slender, rounded looped neck to be gently
raised.
The fact that there is no mention of a double blunt hook in the medical writings poses no
great problem. Many things were self-evident and did not require specific comment as, for
instance, in the above passage the word hamulo (hook) to describe the instrument used to
retract the incision edges. These were undoubtedly sharp hooks (hamulus acutus) and
would have been understood as such. Similarly, so many ancient surgical instruments were
double-ended that this, too, was not normally worthy of comment.
Only three other Z-shaped double blunt hooks of the same form as No. I6 are known to
the present writer. They are listed in Table I together with a further five related
instruments. It is to be noted that seven of these are definitely or probably from surgeons'
tombs ranging in date from the first to early third century A.D.All four double blunt hooks
(Table i, Nos. 1-4) bear one angular and one rounded leaf-shaped hook, and all have or
once had a pronounced 'swans-neck' loop behind each hook. Table i, Nos. 5-8 combine
either an angular or a leaf-shaped blunt hook with a sharp hook of normal form. Table
I,
No. 9 has a sharp hook combined with a serpentine or crozier-shaped blunt hook of rather
different form to the others. However, its moulded multiple-disc-and-foliate decorated
7' E. Bennion, Antique Medical Instruments (London, 1979), 147, fig. 17.
76 Milne, op. cit. (note 13), pl. XLVI, 2; Pompeii Antiquarium, Inv. no. 6955B.
77 ibid., 87.
78 op. cit. (note 6), vii, 31, 2--3.
central grip mirrors that of the present example79 (Table i, No. i) and of Table I, Nos. 8
and 3, although on the latter the decoration is inlaid not moulded. The grip of Table i, Nos.
4,80 5-6 and 7 has elegant multiple-disc-and-baluster mouldings, while that of No. 2 consists
of a central multi-faceted zone flanked by discs.81
I. Italy, prob. blunt, leaf- blunt, kite- prob. Ist-2nd present paper No. i6
from a tomb shaped shaped 15.9 century
2. Bingen, from blunt, leaf- blunt, kite- c.I8-o late ist-mid 2nd Como, op. cit. (note 4),
a tomb shaped shaped century fig. 2, 17.
3. Nea Paphos, blunt, leaf- blunt, kite- 17-8 mid 2nd-early 3rd Michaelides, op. cit. (note
from a tomb shaped shaped century 158), fig 1,20.
4. *Italy, prob. blunt, leaf- blunt, kite- 20.5 prob. Ist-2nd Kunzl, op. cit. (note o107), pl.
from a tomb shaped shaped century 65, 4. Museum of Classical
Archaeology, Cambridge, Inv.
no. 176.
5. Rheims, from blunt, leaf- sharp i7-i
late 2nd-mid 3rd Kunzl, op. cit. (note 107), pl.
a tomb shaped century 66, 3.
6. Rheims, from blunt, leaf- sharp 17-I late 2nd-mid 3rd Kiinzl, op. cit. (note 107), pl.
a tomb shaped century 66, 4.
-
7. (?) Asia blunt, leaf- sharp 17.5 Rimisch-Germanisches Zen-
Minor shaped tralmuseum, Mainz, Inv. no.
0-38217.
8. ? Italy blunt, kite- sharp c. i6o - City Museum and Art Gallery,
shaped Bristol. Fawcett Coll., FT
1450.
9. Aschersleben, blunt, sharp 17?7 ?3rd century, or Kuinzl,op. cit. (note 2), fig. 8o,
from a tomb serpentine earlier i.
* for provenance details see footnote 8o.
Although most of the double hooks are between 17-18 cm in length, the present example
measures just 15.9 cm while Table i, No. 4 is 20-5 cm long. Additionally there is some
variation in the stem thickness and hook size. Table I, Nos. 4-8 are slender and
small-hooked while the present example has both a stout stem and large robust hooks. To
an extent this may be presumed to reflect slightly different usage.
79 Elaborate moulded foliate decoration of a similar kind is to be seen on several instruments from Pompeii - a
small spoon, a spatula, and one of the trivalve specula (Vulpes, op. cit. (note 31), pl. VI, figs. I-II; pl. IV, figs.
I-III) - and on the MWridatrivalve speculum (Kiinzl, op. cit. (note 2), fig. 8i) indicating a first- to second-century
A.D. date for the present hook.
Classical
8o The set of surgical instruments, of which the double hook is a part, was donated to the Museum of
Archaeology, Cambridge in 1921/22. Found in Italy in the late nineteenth century, it is believed to have come from
a tomb either in the Campania or in the vicinity of Rome. Information kindly supplied by Mr W. Thompson.
81 Subsequent to its original manufacture the Bingen double hook was modified, apparently to suit a changed
role. A small hole was punched through each of the hooks and one hook was turned back on itself changing the
bow
shape of the instrument from an elongated Z to an elongated U. It may have been used as a small makeshift
for a simple drill or the crown trephines found in the set.
'this is so inserted that the smooth side is next the brain and is gradually pushed in under
the part where the bone is being cut through by the chisel: and if it is knocked by the
corner of the chisel it stops the chisel going further in: and so the surgeon goes on striking
the chisel with the mallet more boldly and more safely, until the bone, having been
divided all round is lifted by the same plate, and can be removed without any injury to the
brain'.
'. the plate which I suggested as a guard of this membrane is to be passed underneath
in order that all pointed fragments which project inwards may be cut away over the plate,
and any depressed bone is to be raised by means of the same plate'.
Certainly the present example and that from Nea Paphos are no less sturdy than some
elevators, and their Z-shape would not have been ill-suited to such use, whilst the potential
of the inner flat face of the hooks as small treatment platforms has already been noted.
Bone Chisels (Latin: scalper) (Nos. 17-I8; FIG. 2, I8--8; PLS. XI, XIIB)
The chisel is frequently referred to in Greek and Roman treatises on bone surgery. Celsus"
records its use in the excision of diseased or fractured bone, in particular that of the
cranium. Where small areas were to be removed the crown trephine (modiolus) was used,
and the small locating hole for its centre pin was made with the corner of the chisel blade.
After removal of the disc of bone the edges of the perforation were cut back with the chisel
until healthy bone was reached. For larger areas the chisel was used in conjunction with a
strap drill:86
'With this a hole is made exactly at the margin of the diseased and sound bone, then not
very far off a second, and a third, until the whole area to be excised is ringed round by
these holes;. .. Next the excising chisel (excissorius scalper) is driven through from one
hole to the other by striking it with a mallet, and cuts out the intervening bone, and so a
ring is made like the smaller one cut by the modiolus.'
In this operation Celsus recommended the use of a third instrument, the meningophylax"7
to protect the brain and cerebral membrane from a misplaced chisel stroke. Indeed he
underlined the inherent risks of this form of surgery and advised against the automatic
excision of bone fragments in cranial fracture, preferring first to try plasters and only if
these were ineffective, '. . . then at length we must resort to surgery with the chisel.'x
The drill and chisel were also used to free a weapon point or other missile embedded in a
bone. Again the role of the chisel was to divide the bone, here between the cavity of the
entry wound and an adjacent hole drilled by the surgeon. The removal of this small
wedge-shaped piece of bone loosened the embedded object and permitted its subsequent
removal.
Apart from cutting and dividing, the chisel was also employed for scraping, smoothing or
paring the bone. Where a cranial fracture was suspected but could not be confirmed either
by probing or by initial visual inspection, the bone was laid open and the following
procedure adopted:89
. ink is to be applied over the bone, then it is to be scraped with a chisel; for a fissure
will retain the blackness.'
Sharp projecting bone in compound fractures was cut off or filed down and then smoothed
with chisels,90"while for levelling the elevated section of a depressed cranial fracture, where
the minimum of bone was to be removed, Celsus91specified a flat chisel (scalprum planum),
whose blade was probably thinner and cutting edge wider than that of the ordinary chisel.
The third major role of the bone chisel was that of an osteotome, as in the removal of
supernumerary digits."2Sometimes a pair of chisels was used, one either side of the bone to
be divided, a technique described on more than one occasion by Greek writers. It was
recommended by Paul for treatment of a fragmented clavicle93 and earlier by Galen in the
operation for division of ribs:94
'Separate off the membranes adhering to the bone, which being properly done, divide the
bone of the rib by means of two chisels placed in opposition to one another secundum
artem.
For most of the operations described a chisel rather smaller than the normal woodworking
firmer chisel would be preferable, but otherwise the two were interchangeable. Carpenters'
chisels were of iron with wood, bone or iron handles, and many surgeons' chisels may have
been made of the same materials. An iron blade from Pompeii/Herculaneum,'95 though
rather large, may have been the cutting edge of a bone chisel. Certainly the chisels, gouge
and drill-bit in the Bingen instrumentariumiw are essentially carpenters' tools. Their
presence in the large set of surgical and medical instruments is enigmatic: it is equally
possible to view them as carpentry tools, perhaps for the manufacture of medical apparatus
(splints, traction equipment etc), or as instruments of bone surgery in their own right.
Although their size might favour the former identification, they might also be seen to
complement the crown trephines and elevators of the set. Suffice it to note that tools,
implements and apparatus of primarily non-medical function (styli, shears, strigils, spoons,
vessels etc.) are often included in grave groups of medical and surgical instruments, and the
surgical use of many is specified in the contemporary medical literature.
A small iron chisel with organic handle can survive intact only under optimum conditions.
Normally corrosion, if not totally destructive, obscures the object and hinders or prevents
identification. This is doubtless a partial explanation of the rarity of bone chisels. Those few
that have been identified in medical contexts are of a sufficiently characteristic form to allow
future recognition in less certain contexts. They have a narrow blade and slender
copper-alloy handle with lightly domed head. One in a grave group from Kallion, Greece,97
slightly smaller than the pair in the present set, has a particularly slender blade with splayed
cutting edge. A rather larger example from Pompeii/Herculaneum is figured by Vulpes,9"
but the drawing is not sufficiently detailed to permit a certain identification. Milne"
identified as a bone chisel a diminutive example all of bronze from Cologne.
The closest parallels to the present chisels are two of near identical form found with two
scalpels and an (?) elevator in a room in the baths at Xanten.""' They have slender, slightly
waisted, octagonal-sectioned handles with narrow blades in good enough condition to
discern a slight bevel on one face of the cutting edge. They are a pair, of almost identical
size, like Nos. 17 and 18, and also display a lightly burred head, the product of use with a
mallet. In view of the manipulation for osteotomy involving the use of a pair of chisels, the
presence of two chisels in each of these sets is of some interest.
Speculum (Latin: speculum ani) (No. 19; FI(;. 2, I9; PLS.xi., XIA)
In Greek and Roman medical texts the anal speculum, a simple bivalve dilator, was
distinguished from the vaginal speculum, a larger trivalve or quadrivalve dilator, (speculum
magnum matricis). Galen,"" for instance, refers to 'the catopter, which is called the anal
dilator, in the same way as the diopter is called the female dilator'. While such a distinction
might be made, and while the screw mechanism of the trivalve and quadrivalve dilators
particularly suited them to gynaecological work, there is no reason why the bivalve dilator
should not have been used also as a vaginal speculum. However, its primary role was to
allow visual examination of the anus and rectum, and to simplify access for treatment.
There is no doubt that in the absence of anaesthesia this would have occasioned
considerable discomfort and pain. Yet the success of the instrument may be gauged by its
longevity: specula, both anal and vaginal, remained almost unchanged until the 18th
century.1
"• Como, op. cit. (note 4), fig. 6, nos. 6, 7, 12, 13.
97 Kiinzl, op. cit. (note 2), fig. II , 4.
98 op. cit. (note 31), pl. VII, fig. VII.
" op. cit. (note 13). pl. XLI, 2.
"o Rheinisches Landesmuseum, Bonn.
(ii Galen, transcribed in Milne,
op. cit. (note 13), 150.
102 See,
for instance, Scultetus' illustration of seventeenth-century anal and vaginal specula in Tabanelli, op. cit.
(note 7), pl. CXVI.
Milne points to the earliest recorded use of the anal speculum in the Hippocratic treatise
on fistula and in the treatment of piles.'03 Paul also refers to its use in the operation for
piles:104
'with regard to blind fistulae Leonidas says: "We dilate the anus as we do the female
vagina, with the anal or small speculum".'
The combination of frequent horseback riding and generally poor personal hygiene must
have made fistula in ano, haemorrhoids, and other linked complaints a common occurrence
in the ancient world. To combat this were such things as the specially soft padded saddle,
the subject of one of Martial's epigrams:'05
'Take, hunter, the housing of a nimble steed, for from a bare-backed horse piles are wont
to spring'.
Somewhat earlier the inimitable Cato recommended a less orthodox preventive measure:106
'To prevent chafing: when you set out on a journey, keep a small branch of pontic
wormwood under the anus'.
The present example is only the seventh Roman bivalve speculum to come to light and is
closely similar to four of these (see Table 2). Each has two stout handles which pivot on a
strong hinge and terminate in powerful jaws, each with an out-turned, blunt, prong-like
blade or valve. The hinge, braced in all but one case (Table 2, No. 4) by a pair of
disc-washers, is positioned close to the blades in order to achieve the considerable leverage
required in such an instrument, while the solidity of jaws and hinge provided the necessary
strength. The plain handles have a flat inner face but are carefully rounded on the exterior
surface and at the tip. Their lack of decoration is notable and in marked contrast to the fine
cast mouldings on the screw-handle terminals of the trivalve dilators.
The priapiscus, formed by the two solid out-turned blades, varies slightly in shape from
one example to another. Each blade has a flat inner face with a smooth and carefully
rounded outer surface and rounded blunt tip to minimise the discomfort in use. A common
characteristic is a slight swelling near the tip of the priapiscus which may have been
designed to counter any tendency of the instrument to slip out of position when in use. This
feature is lacking only on the present example on which the priapiscus is both very slender
and simply tapered.
Two of the specula (Table 2, Nos. 5-6) are markedly smaller and slighter than the others
and have a maximum span between the blade tips of only c. I cm. Their use as anal specula is
questionable and they should perhaps be regarded as nasal specula.
I. Italy 15-6 7-6 large prob. Ist-2nd present paper, No. 16.
(c.5-o) century
2. Pompeii I) 15-0 c.7-o large 79 or earlier Milne, op. cit. (note 13), pl.XLVI,
(c.7-o) cit. (note
I; Vulpes, op. 3I), pl.
IV, fig. IV. Naples, Museo
Nazionale, Inv no. 78,03I.
3. Pompeii 2) 18-4 8-9 large 79 or earlier Tabanelli, op. cit. (note 7),
(5.2) pl.CXI. Naples, Museo
Nazionale, Inv. no. I16436.
4. ? -
16-8 large LJ Bliquez, Bull. Hist. Medicine,
9"5 Ivi (1982), 195-217, fig 8. Balti-
more, Welch Medical Library.
? 6-2 small - E. Kiinzl, Der Wormsgau, xiii
13.9
5-
(c. I.O) (1979-81), 49-63, pl.3, no. 5.
Worms Sttidt. Mus.
6. ? 6-o small - London, Wellcome Museum, Inv.
14-o
(c. I1-) no. A645719.
-
7. River Tiber ? ? ? Tabanelli, op. cit. (note 7), 151.
Rome, Museo Nazionale delle
Terme.
Catheters (Latin: fistula aenea) (Nos. 20-22; FIG.3, 20-22; PL. XI)
A slender instrument designed to reach the bladder via the urethra, the Roman catheter
served a number of differing roles (manipulation, injection and extraction) related to
urinary diseases and disorders. Such conditions, no doubt in large part due to low levels of
hygiene and dietary deficiencies, seem to have been very prevalent in the ancient world.
Urethral calculus (bladder stone) is mentioned by most Greek and Roman medical writers
and its treatment formed one of the few areas of specialisation in early surgery. "'7 Although
107
E. Kiinzl, Archiiologisches Korrespondenzblatt xiii (1983), 487-493.
clearly a very unpleasant and painful operation, lithotomy was nonetheless often preferred
to the continuing agony of the condition. Pliny the Elder'"" noted that '. .. the experience
of time has concluded that the disease causing the sharpest agony is strangury from stone in
the bladder', and the relief which a patient felt on being cured was, as in later times,
doubtless expressed in the form of a high fee for the surgeon.
An alternative or a preliminary to lithotomy, when the stone was impacted in the urethra
or lodged at the neck of the bladder, was to use a catheter to push the stone back into the
bladder, a procedure advocated both by Rufus of Ephesus and Soranus. "' In another role,
this time as an injector, the catheter might be used as a clyster for the irrigation of an
ulcerated bladder:'"•
'But since we often have occasion to wash out an ulcerated bladder, . . . we must tie a
skin, or the bladder of an ox, to a catheter and throw in the injection through its lumen.
However, the primary role of the catheter seems to have been in treatment for retention
of urine:"l
'When urine is not passed on account of excessive dilation of the bladder so that it cannot
contract, we draw off the urine with a catheter. Therefore an instrument like the Roman
letter S is let down into the bladder by the urethra.'
By their very nature (slender, flexible, thin-walled tubes) catheters are particularly delicate
instruments, easily damaged, destroyed or corroded beyond recognition. It is hardly
surprising that few ancient examples have been identified. When broken, for instance,
unless the tip with characteristic eye is present, they are almost indistinguishable from the
upper stem of a broken split-nib pen.
Those few Roman catheters that do remain can be seen to be closely similar to their
modern counterparts. There are two types, a long S-shaped instrument and a shorter
straight or lightly J-shaped instrument, corresponding respectively to our male and female
catheters. A passage in Celsus makes it clear that the differing position of male and female
bladder was known, and he describes the use of differing catheters accordingly:12
'For this purpose bronze tubes (aenaefistulae) are made, and the surgeon must have three
ready for males and two for females in order that they may be suitable for everybody
large and small: those for males should be the longest, fifteen finger-breadths (digiti) in
length, the medium twelve, the shortest nine; for females, the longer nine, the shorter
six. They ought to be a little curved but more so for men, and they should be very smooth
and neither too large nor too small.'
Celsus' specific reference to the use of 'tubes of bronze' finds confirmation in the surviving
examples, all of which are of bronze, or copper-alloy. In post-Renaissance Europe a variety
of metals was used for catheters (lead and pewter as well as silver, copper and brass) and
this may have influenced Tabanelli'13 in his description of the Pompeii example as made of
lead. Close examination, however, confirms that it is of copper-alloy, its greyish appearance
probably the result of post-depositional surface enrichment. The present three examples
are all of sheet bronze (see Table 5 and scientific report below).
In all other respects the catheter changed hardly at all from the Ist century to the 20oth
century. Both male and female instruments were provided with an eye a short distance back
from the lower end to ensure a completely smooth tip, and to prevent any blockage of the
eye occurring before the neck of the bladder was reached. The tip itself was tapered,
round-ended and very smooth like the rest of the instrument and, in common with many
sounds, in particular those most slender ones used for especially sensitive probing, the
handle region was also completely smooth enabling great delicacy of touch. A variety of
lubricants may have been pressed into service, but undoubtedly the most usual would have
been olive oil, and Paul" describes the immersion of the catheter in oil before insertion
into the urethra.
Of particular interest in the present context is Celsus' stipulation that the surgeon should
possess a graded set of catheters, a requirement also implicit in a passage in Paul: 15
'Wherefore, taking a catheter proportionate to the age and sex we prepare the instrument
for use'.
It would appear that the single female and two male catheters of the present instrumentar-
ium formed such a set, albeit of a limited range. There is certainly a difference both in
degree of curvature and overall length, as well as a slight difference in gauge, between the
two male catheters, so that they complement rather than duplicate each other; and, as
Celsus reveals, there was seen to be less of a need for variation in size of female catheters.
Indeed, as recently as the 18th century a single size was deemed sufficient for all female
patients."
The three present examples comprise the largest single find of Roman catheters (see
Table 3), and they substantially increase the total now known (from 9 to 12). Most of these
are site or loose-finds, only the male catheter from the Ephesus instrumentariumapparently
deriving from a grave.117 Milne' 18 knew of three male catheters, two fragmentary examples
from Baden and the well-known complete instrument from Pompeii, House of the Surgeon.
The latter he equated with a modern 'no. II English', one of the former to a 'no. io
English'. The two present male catheters compare closely in shape and length to that from
Pompeii and the larger example from Colophon"9 though they are of slightly narrower
gauge. Surprisingly, in comparison to the wide range in length measurements, the gauge of
the surviving Roman catheters varies very little. For instance, the short Ephesus catheter is
no more slender than the three long examples from Pompeii and Italy, and the gauge of the
two female catheters is also much the same. Only the smaller of the two Colophon
instruments is of markedly narrower gauge, and it is proportionately short. Although
Caton1?"was of the opinion that it was incomplete, it may have been intended for boy
patients.
With such a restricted sample it is not possible to make close comparisons between the
length of these catheters and the scale of sizes mentioned by Celsus.121 Nonetheless, as
Table 3 illustrates, the two present male catheters (Table 3, Nos. 1-2), and Table 3, Nos. 4,
6 and 9 would appear to be at the upper end of this scale, and Table 3, Nos. 7-8 at the lower
end, while of the two female catheters, Table 3, No. 5 is at the top end of the scale, the
present example (Table 3, No. 3) almost exactly midway between Celsus' two suggested
sizes. Presumably a catheter which was strictly rather too long could nonetheless be used on
occasion in place of a smaller one, whereas the reverse situation would not be feasible; a
catheter that was too short simply would not suffice. One might therefore expect, in a
restricted set, a tendency towards longer examples. Alternatively the catheters of the
present set may simply be part of a once more extensive range, since there is some evidence
elsewhere that sometimes only a selection of instruments might be interred in a surgeon's
tomb.122
Handled Needles (Latin: acus) (Nos. 23-24; FIG. 3, 23-24; PLS.XI. XIII)
Until the introduction of spectacles in the I8th century defective eyesight must have been a
common affliction for which little could be done. Cataract was the one impediment to vision
which early proved susceptible of correction. There is some literary evidence and, recently,
some archaeological evidence'23 for the extraction of cataract at least by the time of Galen,
but the earliest operation was that for the moving away (couching) of cataract. One of the
most famous passages of Celsus describes the careful procedures involved:124
'. the patient . . is to be seated opposite the surgeon in a light room facing the light,
while the surgeon sits on a slightly higher seat; the assistant from behind holds the head
so that the patient does not move: for vision can be destroyed permanently by a slight
movement . . . Thereupon a needle (acus) is to be taken pointed enough to penetrate,
yet not too fine; and this is to be inserted straight through the two outer tunics at a spot
intermediate between the pupil of the eye and the angle adjacent to the temple, away
from the middle of the cataract, in such a way that no vein is wounded. The needle should
not be, however, entered timidly ... When the spot is reached, the needle is to be sloped
against the suffusion itself and should gently rotate there and little by little guide it below
the region of the pupil; . . . If it sticks there the cure is accomplished; if it returns to some
extent it is to be cut up with the same needle and separated into several pieces, which can
be the more easily stowed away singly and form smaller obstacles to vision. After this the
needle is drawn straight out.'
Clearly the operation required considerable care, and the surgeon needed a light but steady
and precise touch. Nonetheless it was a comparatively straightforward if delicate piece of
surgery requiring little specialist equipment, and it was this simplicity together with the low
incidence of septicaemia consequent on it that ensured the operation a good chance of
success.125 For these reasons the method continued in use almost unchanged for centuries,
in some parts of the world until recent times.
From Paul's account of the same operation, based in part on Celsus, there emerges a
clearer picture of the couching needle itself:'12
'. then mark with the olivary end of the couching needle the place to be perforated ...
Bringing round the pointed end of the perforator which is round at the tip we push it
firmly through ... 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 . . . we gently extract the needle with a rotatory movement.'
122
Kunzl, op. cit. (note 2), IO-II.
23 E. Kiinzl, Jahrbuch RGZM xxxii (1985), 436-508.
124
op. cit. (note 6), vii, 7, 14.
125
However it was not without risk. Within two years in the mid-eighteenth century Handel lost his vision and
J.S. Bach his life as a result of the operation for cataract: Bennion, op. cit. (note 75), 136.
126 Paulus Aegineta, op. cit. (note 37),
VI, xxi; an amended reading by Milne, op. cit. (note 13), 70.
Pooling the informationfrom both writers, it may be seen that the cataractneedle was a
double-endedinstrumentwith an olivaryterminalat one end and a round-pointedneedle at
the other. The needle was of bronze, was slender but not excessively so, and may
occasionally have had a tiny expansion at the tip. Kiinz1'27has recognised such an
instrumentin a bronzehandledneedle fromthe palaestra,Pompeii,128in one from the Asia
Minorinstrumentarium'29 and in anotherfromthe Milos set.'13The presentneedle (No. 23)
is undoubtedlya further example, and there are at least two more from Pompeii.131
Althoughthe gripof the Pompeiipalaestraneedle is rathershorterthe form is otherwise
very close to that of the present one, with a slender grip, long olivaryterminalat one end
and round pointed needle at the other. The Milos needle also has one olivary and one
needle terminal,and Milne132illustrateda similarinstrument,though with broken needle
tip, fromhis own collection, apparentlyfound in Bedfordshire.The Asia Minorinstrument
has, in place of an olivaryterminal,a second needle, with tiny spatulateexpansionnearthe
tip. All of these needles closely fit the descriptiongleaned from the accountsof Celsus and
Paul and could have been used successfully in their operation for cataract. It seems
legitimate to regard them as couching needles.
It is interestingto note that four of these couchingor cataractneedles (Milos; Pompeii,
palaestra;Pompeii (II16444A);and the present example) were found in association with
anotherform of handledneedle, a slendersocketedvariety.This type has been found more
commonlythan the cataractneedles and in a greatervariety of forms (see Table 4). It is
invariablya double-endedinstrument,normallya slender grip with a small socket at each
end (Table 4, Nos. 1-6), but sometimes with a single socket combined with another
instrument,e.g. with a pointed-jawedforceps (Table 4, No. ii), with a slender pointed
probe (Table 4, No. io), or with a sharp hook (Table 4, Nos. 8-9).
The double socketed form compriseseither two straightsockets or one straightand one
angled socket, as in the case of the present example (Table 4, No. I). Similarly,those
combinedwith anotherinstrumentmay have either a straightsocket (Table 4, No. 8) or an
angled socket (Table 4, Nos. 9-11). That they were grips for fine instrumentsis beyond
doubt, and from their occasionalassociationwith cataractneedles, their slender stem and
tiny socket, and the presenceof iron corrosionin the socket of at least one (Table4 No. 8),
it may be inferredthat they held very slenderiron needles. Indeed the examplefrom Milos
(Table4, No. II) had, at the time when Deneffe's plate was made,133what appearsto have
been a short, fine needle projectingfrom the end of the socket. At present there is no
evidence for the precise form of the needle, nor as to whether it was permanent or
removable.
needles; and Pompeii Antiquarium, Inv. no. 10123, from Pompeii, Region II, Insula II, 'vicino al tempietto, 1953'.
132
op. cit. (note 13), pl. XVI, 7.
33
op. cit. (note 48), pl. 5, I.
i. Italy straight socket angled socket 14-0 late Ist/early present paper No. 24.
2nd century
2. Colophon straight socket angled socket 13*75 Caton, op.cit (note 35), pl.
XI, 28
3. Bingen straight socket angled socket 13.5 late Ist/early Como, op.cit. (note 4),
2nd fig.3, 20.
4. Pompeii, Casa straight socket angled socket 12-6 pre-79 Pompeii Antiquarium
di Giulia Felice Inv.no. 9040.52
5. Savaria straight socket straight socket 13-2 3rd century Kuinzl, op.cit. (note 2,
fig.92, 5
6. Nijmegen straight socket straight socket ? 3rd century Kiinzl, op.cit. (note 2), fig.
75, I3
7. Pompeii, straight socket broken prob. 79 Kiinzl, op.cit. (note 2), fig.
palaestra 4, far right; Pompeii Anti-
C.12"5 quarium, Inv. no. 6128F
8. Pompeii straight socket sharp hook pre-79 Naples, Mus. Naz. Inv. no.
14"4 116444 c.
9. London sharp hook angled socket 144 - Museum of London, Acc.
no. 19887
io. Pompeii, pointed probe angled socket 13-o pre-79 Pompeii Antiquarium Inv.
Reg. I, Ins. no. I11530
13, N.2.
I1. Milos pointed-jawed angled socket c.15-o prob. Ist-2nd Deneffe, op.cit. (note 48),
forceps century pl.5,I
It seems probable that these needle-holders held both dissecting needles and needle
cauteries of the kinds frequently mentioned, in particular in ophthalmic surgery. A very fine
needle would have been required in Celsus' operation for the removal of small tumours on
the eyeball: 134
Again as a cautery, a fine needle was recommended for a piece of cosmetic surgery on the
ear:136
'Where the ears . . have been pierced and have become offensive, it is enough to pass a
red hot needle (candente acu) quickly through the hole in order to blister its margins
superficially . . . afterwards to put on applications . . . and induce a scar.'
Iron/steel was the preferred metal for cauteries, but could also provide the hardest and
sharpest needle points and it is conceivable that socketed needle-holders held the
instruments which performed all of the above operations and many more. Some may even
have been used for cataract, although this seems inherently unlikely in view of the existence
of a specific couching needle, and those needle-holders with an angled socket would
certainly not have been suitable for that operation. On the other hand, in use as a small
cautery or dissecting needle, an angled socket, especially in combination with a straight
one, would have proved a distinct advantage allowing a far wider range of manipulations.
The length of the needle-holders, without the needles themselves, is similar to, though a
little more constant than, that of the cataract needles, varying from c. 12-5-15 cm. Like the
cataract needles too they are widely but thinly scattered, with examples from Greece to
Britain, and they range in date from the Ist to the 3rd century A.D.
Cautery (Latin: ferrum candens) (No. 25; FIG. 3, 25; PLS.XI, XIIC)
To judge from Greek and Roman medical literature the cautery was almost as important a
surgical instrument as the scalpel. It had a seemingly endless list of uses, and in Celsus'37
alone the following are attested: to check haemorrhage in a wound (v, 26, 21); to cauterize
varicose veins (vii, 31), scrotal varices (vii, 22, I) and blood-vessels and bone on the temple
and scalp to stop eye discharge (vii, 7, 15 E-K); to check gangrene (v, 26, 33-4); to disperse
pus over a fractured rib (viii, 9, I) and in liver abscess (iv, 15,4); to treat an ulcerated nostril
(vii, Ii); to destroy diseased bone (vii, 7, 7C; viii, 2, 2; viii, 3, lo); to kill the root of
abnormal eyelashes (vii, 7, 8B); to remove a carbuncle (v, 28, I) and a whitlow (vi, 19, 3);
to promote discharge in dropsy (iii, 21, IO); to heal split lips (vii, 12, 6) and infected pierced
ears (vii, 8, 3); to alleviate painful joints (iv, 29, 3; iv, 30), treat the bite of a mad dog (v,27,
2) and create a saline drip over a diseased limb (ii, 17, io).
Most of these in fact fall into
three broad categories: the staunching of a flow of blood (haemostasis); the removal by in
situ destruction of unhealthy tissue; and the removal of living tissue by the same means to
give access to underlying structures etc. The sobriquet 'bloodless knife' may thus be seen to
be particularly appropriate, and the cautery later prospered at the expense of the scalpel in
Arabian surgery in which Islamic religion forbade the cutting of human flesh and spilling of
blood. It remained popular with surgeons throughout the medieval period and beyond, and
not until the i8th century did it gradually give way to cauterizing styptics.138
Although usage was also wide in Greek and Roman medicine it was certainly not
indiscriminate. From Hippocrates onward the cautery was generally regarded very much as
a last resort. Burnt tissue heals more slowly than cleanly cut tissue and cauterization was
therefore employed only when other methods had been tried without success or were seen
to be inappropriate. In Celsus, for instance, the use of the cautery is frequently preceded by
such phrases as 'the ultimate measure' (iv, 29, 2), 'If even these are not effective .. .' (v,
26, 33c), 'If the malady is still not checked . . .' (v, 26, 34C), 'when circumstances do not
136
ibid., vii, 8, 3.
137op. cit. (note 6).
13 Bennion, op. cit. (note 75), I85.
. if the fissures have penetrated deeper, it is necessary to burn them with a fine
cautery (tenui ferramento), spearhead shaped, which should as it were skim over them
without being pressed down'.
Certainly the modest size of both the Lake Trasimene and present cautery would suit them
to such 'medium-range' work.
Probes, Scoops, Spoons and Spatulae (Nos. 26-35; FIG. 3, 26; FIG. 4, 27-35; PL. xi)
The study of anatomy in Roman medicine was severely hindered by the many constraints on
human dissection. It was rarely encouraged (even Celsus152was ambivalent on the subject)
and it was frequently the cause of vehement attacks on surgeons.153 While sporadic
observation of internal structure and organs would have occurred in the treatment of
wounds suffered in accidents, in battle, or in the arena, knowledge was still defective. In
compensation the tactile sense became very highly developed, and detailed exploratory
work using a wide range of probes preceded many operations. Celsus' instructions for
sounding fistulae testify to the high level of proficiency reached by some practitioners:154
'first of all, however, it is proper to pass a probe (specillum) into the fistula that we may
learn both its direction and depth, and at the same time whether it is moist or rather dry
... if what is touched by the end of the probe is soft, the disease is still limited to the
flesh; if it meets with more resistance, the fistula has reached the bone. But when the
1'• Paulus Aegineta, op. cit. (note 37), VI, lxii; Galen xiv, 786.
'1 Hassel and Ktinzl, op. cit. (note 28), pl. III, I2.
British Museum GR 1932, 11-I2, 7.
15""
15
op. cit. (note 6), vii, 12, 6.
152
ibid., Prooemium, 73-5.
153
See J. Scarborough, Roman Medicine (London, 1969), 168-170.
154
op. cit. (note 6), v, 28, I2C-D.
probe slides smoothly, there is not yet decay; if it does not so slide, but meets with an
even surface, there is some decay although still slight; if what underlies is uneven also and
rough, the bone has become more seriously eaten away
For such sensitive work Paul155 specified 'a double-headed specillum of a very flexible
nature, such as those made of tin, and the smallest of those made of copper'. The fine,
slender probe, No. 27, is an example of this instrument. It has a tiny olivary expansion at
each end and the stem still retains some of its former flexibility. Termed dipyrene by Greek
writers it also served a number of other roles including that of a fine cautery for destroying
the roots of hairs after epilation.156 Surviving instruments include one each from the
third-century A.D.Asia Minor instrumentarium,57 the second-third century A.D. surgeon's
tomb at Nea Paphos,158 and the first-century A.D. Luzzi set,159 as well as one from
London160 and at least one from Pompeii.6'1 A variant with a small circular eye in the olive
is also known both from the classical medical literature'62 and from surviving examples
which include two from Caerwent,'63 one from Asia Minor,'164 and one from a late first- to
mid second-century context in London.'65 But for the vulnerability of such slight instru-
ments many more would be known, for it may safely be assumed that the Roman surgeon's
probe case was seldom without at least one fine dipyrene.
Although unusual variants or modified instruments are occasionally found the assortment
of other probes and sounds would normally have comprised a number of common types. It
is interesting to note that the present set, in addition to the fine dipyrene, includes at least
one example of each of these types - ligula (No. 28), ear probe (oricularium specillum) (No.
29), scoop probe (cyathiscomele) (No. 30), three spatula probes'66 (spathomele) (Nos.
33-35), as well as a stylus (No. 26), a spoon (No. 32), and what is probably a modified scoop
probe (No. 31). There is little doubt that they were carefully selected as a set to cover all
eventualities. An almost identical range of probes, still held in their cylindrical copper-alloy
box, was found amongst the large set of instruments in the second/third-century A.D.
surgeon's tomb at Nea Paphos, Cyprus.167 They comprised a fine dipyrene, a fine olivary
probe, a ligula, a scoop probe, and a spatula probe. The Pompeii palaestra find included a
similar though slightly more restricted set of probes within a cylindrical box,'68 and many
similar boxed sets, normally comprising 2-6 probes, exist in the collections of the Pompeii
Antiquarium and the Naples National Museum.
These were all multi-purpose instruments serving many different functions. The ligula
was primarily used to extract ointments and powdered medicaments from their containers,
but it could also be used to apply these substances. Additionally it could have served as a
dental scaler, while its small angled plate might be used as a fine cautery or as a blunt hook.
The slender pointed stem of the present example is essentially a fine simple probe
(specillum) and is likely to have been used as such, and also perhaps, as a perforator.
The ear probe is very frequently mentioned in the extraction of wax and foreign bodies
from the ear, and the instilling of liquid applications into the ear by squeezing them from a
twist of wool wrapped around the stem of the ear probe so that it ran down and fell in
droplets from the simple pointed end. Beyond its aural role the ear probe was recom-
mended for removing urethral calculus, for pouring liquid applications, especially to the
eye, for curetting tiny cavities and for a host of delicate surgical manipulations.
The spatula probe and scoop probe, like the ligula, served both as toilet implements and
medical instruments. They vary considerably in size and shape'69 according to the specific
usage or range of functions intended. In medicine they were used primarily in pharmacy, in
the preparation of medicaments (extracting, crushing, stirring, mixing) and in their
application (dabbing, pouring, spreading). Additionally the spatula probe might be used
as a tongue depressor, a cautery, a blunt dissector or a substitute for the meningophylax,
while the scoop probe could be employed in the removal of foreign bodies, as a curette, and
as a director. The olivary terminal was recommended as a small cautery, as a probe for
exploring large cavities, and, wrapped in wool, as a plug for occluding the nostrils.
In addition to the tiny spoon of the ear probe and the scoop probe larger spoons have
occasionally been found in medical instrumentaria. They may be specialised types designed
for medical use, as for example the large-bowled spoon with pouring lip in the 'Paris
surgeon' instrumentarium,'70 but they are often normal domestic utensils, like the fiddle-
shaped spoon of the Asia Minor set71 or the simple round-bowled spoon in the present set.
They were used in pharmacy for dispensing, measuring, heating and pouring medicaments,
but the slender pointed handle of the present type of spoon would have permitted its use as
a simple surgical probe in its own right.
Another household utensil, the stylus, is often found together with medical instruments.
Its medical uses included that of a perforator, a cautery (see above, p. 155), a simple probe
and tooth extractor.
It might be expected that all of the probes as well, perhaps, as some of the other slender
instruments of this set would have been held in the two cylindrical copper- alloy boxes (Nos.
36-37). That this was not so is indicated not by the manner of burial, which is unknown, but
by an examination of the two boxes, both of which are too short to have held instruments
and were undoubtedly medicine boxes. From the presence of iron corrosion on several of
the probes it may be inferred either that they were held in cases, boxes or pouches made
partially of iron, or that they were held in containers alongside iron instruments.
169
see eg. Milne, op. cit. (note 13), pls. XII-XV.
17'Deneffe, op. cit. (note 48), pl. 4, 14.
17' Hassel and Kuinzl, op. cit. (note 28), pl. II, 3.
172
Kiinzl, op. cit. (note 2), figs. 95-6.
The instruments were examined to determine how they were made and whether, on the
grounds of composition of the metal and corrosion products, any could be excluded from
the group. All of the metal objects were examined for joins and constructional information
by radiography and optical microscopy. Metal corrosion products and the stone palette
(No. 38) were identified by Debye-Scherrer powder X-ray diffraction analysis.1" All the
copper-alloy objects were analysed by X-ray fluorescence spectrometry using an energy
dispersive system.184 The corrosion products were polished away to reveal the area of
analysis and copper, zinc, lead and tin were quantified. Some of the pieces have no flat
surface suitable for quantitative analysis so for these it was only possible to obtain
semi-quantitative results. These are not noted in Table 5 but are discussed in the text.
action; the metal still retains its resilience. The technique of manufacture is probably similar
to that used to make Nos. Io and II. The tips have been sharpened to fine points which are
still perfectly aligned. The ring now with No. 12 does not belong: its metal composition is
completely different and there is no evidence in the patina that the ring was buried with the
forceps. There is some organic material, probably wood, adhering to the inside of the ring.
115
W.A. Oddy, Gold Bulletin Vol. io, no. 3, (1977), 79-87.
probably contamination from the metal box and its burial environment. However, a little
lead was also present, which is not found in any significant quantity (c. 0-03%) in the metal
of the box. This may well be an ingredient, though apparently a minor one, of the
medication. A wax, probably beeswax, was identified by XRD.186
GENERAL SCIENTIFICCONCLUSIONS
Most of the instruments in this set have a very similar patina. Many of the objects are
stained with iron and have a calcareous deposit which has been identified by XRD as calcite
(CaCO3) and dolomite (CaMg(C03)2), indicating burial in a region of limestone, rich in
magnesium. The items on which no traces of such a deposit were found are the scalpels,
1-6, which appear to have been protected by a box, and also sharp hook 13, ear probe 29,
spatula probe 33, and cataract needle 23, all of which appear to have suffered cleaning since
excavation, and folding-knife 39. Nos. 33 and 39 both have basic copper chlorides in their
surfaces, whereas all the other items in the set have blue and green basic copper carbonate
corrosion. This indicates different burial conditions for 33 and 39, suggesting that they do
not belong to the set. The evidence for needle No. 23 was not conclusive as it was not
possible to identify the green corrosion products present, but it is possible that cleaning
since excavation has confused the evidence.
The metal composition of the set is surprisingly varied. Both brass and bronze, which
were in everyday use in the Roman period,188 are present. In contrast 21 Roman needles
analysed by Riederer189produced only I brass, I mixed alloy, 13 bronzes and 6 of copper.
The scalpels (Nos. 1-6) which seem such a clear group, linked by their form, patination and
the evidence of contact with wood are particularly surprising in their differences. It may be
that the tools were in use over a long time and breakages were replaced or special
requirements were filled by adding new instruments over the years. The clearest groups by
metal composition within the set are firstly, the pair of bone chisels (Nos. 17 and 18);
"' Professor G.
Eglinton of the Organic Geochemistry Unit at the University of Bristol has kindly agreed to
carry out further analysis of the material.
187 Examination by Dr Ian Freestone and Mavis Bimson, British Museum Research Laboratory.
88
P.T. Craddock, Journ. of Arch. Science, v (1978), 1-16.
89
J. Riederer, 'Romische Nihnadeln', Technikgeschichte xli (1974), 153-172.
secondly, Scalpels 7-9, together with Forceps Io and I I; and thirdly, the Catheters 20-22
and Needle-holder No. 24.
Most of the metal items in the set show evidence of working and the standard of finish is
high for all except knife No. 39.
TABLE 5: RESULTSOF QUANTITATIVEANALYSIS
CONCLUSIONS
Apart from the intrusive folding-knife (no. 39) the instruments have in common a high
level of craftsmanship. Like most Roman surgical instruments they are made primarily of
copper-alloy or iron/steel or a combination of the two. The surface of the metal, as far as
can be seen, is unflawed and where decoration exists it is regular and crisply cut or cast.
Some of the probes have a particularly finely swaged stem, while the workmanship of the
catheters is of the highest calibre. Few of the iron/steel components survive intact but there
is no reason to doubt that they were of equally high quality. Like the copper-alloy
instruments variation may have occurred in the metal, although how far this may be viewed
as a deliberate choice and how much as a consequence of the use of recycled metal is
difficult to assess.
If careful and specific choice did not enter into the matter of metal alloys then it certainly
did so in the selection of types and groups of instruments. Immediately apparent is the lack
of repetition. The probes and sounds complement rather than duplicate one another, as do
the forceps, while the scalpels, hooks and catheters form graded sets within the main
instrumentarium. Scalpels 1-5, though of a standard and simple type, have a distinct 'air de
famille' and, while differing widely in metal composition, they may yet have had a common
source. Scalpels 7-9 are so similar, both in form and in composition, that they must have
been acquired as a set, together, almost certainly, with the combination forceps Nos. io-i I.
By the same token both the bone chisels and the catheters may be regarded as sets acquired
together. Other instruments, the hooks and the probes, for example, bear no such close
similarity and may well have been added individually or in small groups, while at least one
piece (No. 31) appears to have been used in a modified form.
In short, the set gives every appearance of having been built up gradually, though
perhaps over no very great period of time. Such processes as inheritance, purchase,
damage, repair, commission, replacement and reconditioning may all be envisaged, the
changing size of the set, which would perhaps have reflected the fluctuating fortunes of its
owner, terminating only with its burial.
In the absence of contextual evidence dating of the set has perforce to be based on the
form of the instruments themselves. The scalpels are of the form characteristic of the
Roman Imperial period, a type which has as yet no certain dated context prior to the first
century A.D.;like the other instruments of the set the scalpels bear no inlaid decoration, a
fashion which seems to have flourished in the second and third centuries A.D.In a set of such
size and quality this absence argues for a first- or early second-century date. This is also
implied by the similarity of several instruments and their style of decoration, in particular
the fine foliate moulding of the blunt hook, to examples from Pompeii/Herculaneum as well
as to several other independently dated grave groups of that period.
In its present form the instrumentariumwould have enabled a wide range of surgical and
medical treatment. It comprises three groups:
I) A large number of 'basic' surgical instruments: - scalpels, hooks, forceps and probes.
2) A group of pharmaceutical pieces: - cylindrical medicine boxes, scoop probes, palette,
spatula probes and spoon.
3) A number of specialist or rarely found instruments: - bone chisels, sharp spoon, blunt
hook, catheters, speculum, cataract needle, cautery.
With the equipment belonging to the first two categories the surgeon could have operated
on and prescribed for many of the more common diseases and afflictions, but the
instruments of the third category would have permitted more specialised operations. Eye
surgery, including the operation for couching cataract, is represented by the fixation forceps
and the handled needles; the chisels and sharp spoon as well, perhaps, as the blunt hook
were instruments of bone surgery; the catheters would have permitted treatment of patients
with urinary disorders, especially strangury, though not those with urethral calculus, while
anal lesion, fistula in ano and internal haemorrhoids could have been operated upon
through use of the speculum.
The skill and success of a surgeon may by no means be gauged by the quality and quantity
of his instruments, a point made by several classical authors, but if used effectively the
present set could clearly have embraced an impressive list of operations. The surgeon who
ACKNOWLEDGEMENTS
I have received help and advice from many colleagues, in particular from Mr Brian Cook,
Mr Donald Bailey, Mr Ian Jenkins, Miss Judith Swaddling, Miss Catherine Johns and
Professor Larry Bliquez. I am grateful to them and to many others who have provided
details of instruments. Above all I have benefitted from Dr Ernst Kinzl's extensive know-
ledge of Roman surgical instruments. It is a pleasure to record my thanks to him for
stimulating and friendly discussion on both specific instruments and Roman medicine in
general.
~'"-::::
::.:::.~
~:::j:;:-:?:
::
~jjj;:::::: C-
;i" E
C
CC
B
C
C)
Ev
C
C:
V
::
:::
ii
I
iii
::
::
a~:::
~? rara~
C
I
:;-': - ::::: ?: ?:
?:::::'
:::
:::
::::
: :::
:::::~
:::--:::
::::::::::::::::
::::
i:-::::::::-::::i:-:::i-,-i-i-iiii--i-,i
i-:i:-:---iiii-:i-i--i:--i:_ii:_:i:_i-:i
::
:::::ii::
::-:ii:i:iii:i-i:i-_-_:iii
::-::
li::-:i_:-:::::i-ii-ii:ii-i-
-ii:ii-----::-:::::i
_::i--ii:i-i:i-:ii:iiii-ii:::-:irii:iii: I:----i--ii-i:i:::-::I--i:iii;iii-.:ii::
:i?:il-i-iiii:
-:-i-:::
i.ii.i:iii-iii-i:i
i:--
--
i:: ::
:::::::: ::::::: ::::::
:::::::::: :::_:?:i:-:ii:i:--i::::--:-::---
::-::-?-:--::
::::::::::::: -:::
-:-: ???::::::::::
::: :: ::::: ::::::::::
:::::::::::::
:: ::::::--??-??? ::
:::-:---i------i:-----:
i--iii---i:i-ii-i:i-i:-:---:-?-i.::-
:-:--::--i---
??i--i:--i:--::-i:--::i----:-:--------:-
. . . . . . .
A. Roman medical instruments from Italy. The anal speculum, No. 19. Actual size 15-6 cm. (p. 124).
I:?
ii• i
?
i:
i;
.
i
...ii;
i!•
.
..........
....
i•-~iii •
? • ,:-i:ii
•,
•!ii:ii.:i:i,
,•,•
?,• ?? ?..::::.:,:.::, -::,!,::::i:i:i::::
Roman medical instruments from Italy. The handled needle and needle-holder, Nos. 23-24. Scale I:I. (p. 126).
.. ....
i . .....
......
........
........
IvI IIW.
.........
( t C
k
".1
xo1
......
....... .......
............ -----
........
Roman medical instruments from Italy. The 'stacking' medicament box, No. 36, with radiograph to show
construction. Scale 1:1. (p. 130).