CRANIAL TREPANATION: A VERY OLD MEDICAL PROCEDURE
“Palaeopathology studies have shed light on a surgical procedure that has been practised by numerous cultures since time immemorial: trepanation. This practice consists of removal of cranial bone slabs using an instrument called a trephine, from the Greek word for ‘drill’. Trepanning gives rise to many questions, such as the purpose of the procedure, whether it had precise indications, if it was part of a ritual, what were the most common complications, and the survival rate. [Source: S. Collado-Vázquez, J.M. Carrillo “La trepanación craneal en Sinuhé, el Egipcio Neurología,” Volume 29, Issue 7, September 2014, Pages 433-440 ^|^]
“Trepanning seems to have been prescribed as a treatment measure for headache, mental illness, epilepsy, and most of all, head trauma. In the latter case, the procedure was used to relieve pressure on the brain caused by fracture, to remove bone shards, or to drain haematomas. ^|^
“The procedures and instruments varied according to the culture and the moment in history. In general, however, the practitioner would detach the scalp, perforate the cranium, and clean the wound before covering it with a plate of precious metal and then applying a bandage. Instruments employed included trephines, knives, tumis (T-shaped knives), saws, chisels, burins, hammers, sharp stones, and forceps. The operation lasted between 30 and 60 minutes in adults and about 10 minutes in children.” ^|^
Websites and Resources on Prehistory: Wikipedia article on Prehistory Wikipedia ; Early Humans elibrary.sd71.bc.ca/subject_resources ; Prehistoric Art witcombe.sbc.edu/ARTHprehistoric ; Evolution of Modern Humans anthro.palomar.edu ; Iceman Photscan iceman.eurac.edu/ ; Otzi Official Site iceman.it
Archaeology News and Resources: Anthropology.net anthropology.net : serves the online community interested in anthropology and archaeology; archaeologica.org archaeologica.org is good source for archaeological news and information. Archaeology in Europe archeurope.com features educational resources, original material on many archaeological subjects and has information on archaeological events, study tours, field trips and archaeological courses, links to web sites and articles; Archaeology magazine archaeology.org has archaeology news and articles and is a publication of the Archaeological Institute of America; Archaeology News Network archaeologynewsnetwork is a non-profit, online open access, pro- community news website on archaeology; British Archaeology magazine british-archaeology-magazine is an excellent source published by the Council for British Archaeology; Current Archaeology magazine archaeology.co.uk is produced by the UK’s leading archaeology magazine; HeritageDaily heritagedaily.com is an online heritage and archaeology magazine, highlighting the latest news and new discoveries; Livescience livescience.com/ : general science website with plenty of archaeological content and news; Past Horizons, an online magazine site covering archaeology and heritage news as well as news on other science fields; The Archaeology Channel archaeologychannel.org explores archaeology and cultural heritage through streaming media; Ancient History Encyclopedia ancient.eu : is put out by a non-profit organization and includes articles on pre-history; Best of History Websites besthistorysites.net is a good source for links to other sites; Essential Humanities essential-humanities.net: provides information on History and Art History, including sections Prehistory
Cranial Trepanation in Prehistoric Times
“Trepanned skulls from the Neolithic and Mesolithic periods, some as much as 10 000 years old, have been found in Japan, the Iberian peninsula, Germany, Ukraine, the Czech Republic, Hungary, France, Syria, Chile, Mexico, Peru, and Bolivia. Many of these skulls exhibit new bone formation along the edges of the orifice, indicating that the subjects survived the intervention. [Source: S. Collado-Vázquez, J.M. Carrillo “La trepanación craneal en Sinuhé, el Egipcio Neurología,” Volume 29, Issue 7, September 2014, Pages 433-440 ^|^]
“It is believed that between 80% and 90% of the subjects may have survived and that many deaths were due to postoperative infection and not the operation itself. These figures vary greatly depending on the historical moment, geographical location, and the technique employed. In his study of more than 600 skulls, Verano calculates a survival rate of about 78%, although he is not able to distinguish between short-term and long-term survival. ^|^
“According to Laín Entralgo, the purpose of trepanation would have been twofold: firstly, to surgically remove real or suspected accumulated material from the cranial cavity, and secondly, to magically release harmful presences that might have entered the body as the result of a curse. Other authors support this assessment.^|^ “According to Reverte Coma, when primitive man removed a depressed bone fragment from the skull, smoothed the edges of the skull fracture, and removed necrotic tissue, his actions were rational. After repeating these actions many times, ancient practitioners would have become experts with numerous cases of successful trepanation using different methods, including grinding and drilling. These techniques were used as therapy for head trauma, headaches, mental illness, and epilepsy, but although their use implied a certain degree of rationality in ancient cultures, the process was also a magical act aiming to cure an illness caused by an evil spirit that had to be released. ^|^
“As many as 5 to 7 trepanations were performed on some skulls, which exhibit burr hole sizes ranging from 1 to 10 cm. In some cases, we find signs that the patient survived. Skulls have also been found showing incomplete trepanation; this was probably due to death of the patient during the procedure, which was then halted. Trepanned skulls most frequently belong to adult males, the group most likely to suffer head trauma, but others have been found from women and children under 12, and in some cases as young as 2 or 3 years.
Cranial Trepanation in Mesopotamia and Ancient Egypt
“Babylonian and Egyptian inscriptions recommend trepanning in certain cases. In other cases, pronouncing invocations to expel the demons causing the disease would have been sufficient. This provides an idea of how closely medical practice was linked to magical and religious concepts at the time. [Source: S. Collado-Vázquez, J.M. Carrillo “La trepanación craneal en Sinuhé, el Egipcio Neurología,” Volume 29, Issue 7, September 2014, Pages 433-440 ^|^]
“Some authors state that trepanation was not frequently performed in ancient Egypt. Similarly, the Edwin Smith Papyrus (700 B.C.), a copy of a much older papyrus describing surgical techniques, does not mention this type of procedure. Elliot Smith, a professor in Cairo, studied some 15 000 Egyptian skulls and found no traces of trepanation. ^|^
“Scholars have found a few trepanned skulls from Ancient Egypt, but their numbers are low compared to other cultures. For example, the Czech anthropologist Hrdlicka discovered an Egyptian skull with trepanation marks and reported his find to Egyptologist James Breasted. The Qasr Al-Eini Museum of medicine, a dependency of Cairo University, conserves three trepanned skulls from the time of the pharaohs that show signs that the patients survived. Radiographic and tomographic studies of a pre-Ptolemaic mummy with a trepanned skull showed clear signs of osteoblastic bone reaction along the edges of the orifice, indicating that the patient survived. Likewise, the grand tomb of Maya and Merit in Saqqara also contained a skull with a burr hole in the occipital area and signs compatible with patient survival. This operation was probably carried out to drain a subdural haematoma.” ^|^
Cranial Trepanation in Ancient Greece and Rome
“Practitioners in ancient Greece and Rome used trepanning to treat convulsions, especially those resulting from trauma. Hippocrates of Kos (460–370 B.C.) was a pioneer in treating cranial lesions as we see in On Injuries of the Head. Here, he proposed a classification system for cranial fractures and indicated the cases in which trepanation might be indicated; at a later point, he improved that technique In the 1st century, Celsus (25 B.C.–50 A.D.) described trepanations and instruments such as terebras and trephines. [Source: S. Collado-Vázquez, J.M. Carrillo “La trepanación craneal en Sinuhé, el Egipcio Neurología,” Volume 29, Issue 7, September 2014, Pages 433-440 ^|^]
“Along with other Greco-Roman authors, Galen (129–200 A.D.) described this practice and recommended it for cranial fractures to relieve pressure and decrease pain. It was more controversial, however, as treatment for epilepsy, headache, or paralysis.12 Aretaeus of Cappadocia (120–200 A.D.) recommended trepanning in epilepsy cases when conservative treatment had failed. In contrast, Caelius Aurelianus (400 A.D.) criticised the practice of trepanning as harmful in some cases. ^|^
“Few trepanned skulls from Imperial Rome have been discovered, and this may have several explanations. It is possible that surgery was only used on rare occasions when conservative treatment had failed. Another explanation is that cremating corpses was a common practice in Rome, and therefore few skeletons from that period remain. ^|^
“During the Mediaeval period, trepanation was performed as therapy for head trauma and epilepsy as well as for superstitious reasons as a means of ousting evil spirits. Paintings depict these procedures, such as Cutting the Stone by Hieronymus Bosch. It was believed that madness was caused by the formation of stones below the cranial surface, and healers would make incisions in the head to extract them. After the operation, the healer would show bystanders a stone that he had palmed, claiming that it had come from the patient's head.” ^|^
Surgery in Mesopotamia
Nancy Demand of Indiana University wrote: “Among Hammurabi's laws were several that pertained to the liability of physicians who performed surgery. These laws state that a doctor was to be held responsible for surgical errors and failures. Since the laws only mention liability in connection with "the use of a knife," it can be assumed that doctors in Hammurabi's kingdom were not liable for any non-surgical mistakes or failed attempts to cure an ailment. [Source: The Asclepion, Prof.Nancy Demand, Indiana University - Bloomington +++]
“It is also interesting to note that according to these laws, both the successful surgeon's compensation and the failed surgeon's liability were determined by the status of his patient. Therefore, if a surgeon operated and saved the life of a person of high status, the patient was to pay ten shekels of silver. If the surgeon saved the life of a slave, he only received two shekels. However, if a person of high status died as a result of surgery, the surgeon risked having his hand cut off. While if a slave died from receiving surgical treatment, the surgeon only had to pay to replace the slave. This use of status to evaluate misdeeds does not seem to appear in other, similar "codes" however. +++
“Regardless of the risks associated with performing surgery, at least four clay tablets have survived that describe a specific surgical procedure. Unfortunately, one of the four tablets is too fragmentary to be deciphered. Of the remaining three, one seems to describe a procedure in which the asu cuts into the chest of the patient in order to drain pus from the pleura. The other two surgical texts belong to the collection of tablets entitled "Prescriptions for Diseases of the Head." One of these texts mentions the knife of the asu scraping the skull of the patient. The final surgical tablet mentions the postoperative care of a surgical wound. This tablet recommends the application of a dressing consisting mainly of sesame oil, which acted as an anti-bacterial agent.” +++
Hammurabi's Code of Laws 215-227: Physicians, Barbers and Vets
The Babylonian king Hammurabi (1792-1750 B.C.) is credited with producing the Code of Hammurabi, the oldest surviving set of laws. Recognized for putting eye for an eye justice into writing and remarkable for its depth and judiciousness, it consists of 282 case laws with legal procedures and penalties. Many of the laws had been around before the code was etched in the eight-foot-highin black diorite stone that bears them. Hammurabi codified them into a fixed and standardized set of laws. [Source: Translated by L. W. King]
If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money. [Source: Translated by L. W. King]
If the patient be a freed man, he receives five shekels.
If he be the slave of some one, his owner shall give the physician two shekels.
If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.
If a physician make a large incision in the slave of a freed man, and kill him, he shall replace the slave with another slave.
If he had opened a tumor with the operating knife, and put out his eye, he shall pay half his value.
If a physician heal the broken bone or diseased soft part of a man, the patient shall pay the physician five shekels in money.
If he were a freed man he shall pay three shekels.
If he were a slave his owner shall pay the physician two shekels.
If a veterinary surgeon perform a serious operation on an ass or an ox, and cure it, the owner shall pay the surgeon one-sixth of a shekel as a fee.
If he perform a serious operation on an ass or ox, and kill it, he shall pay the owner one-fourth of its value.
If a barber, without the knowledge of his master, cut the sign of a slave on a slave not to be sold, the hands of this barber shall be cut off.
If any one deceive a barber, and have him mark a slave not for sale with the sign of a slave, he shall be put to death, and buried in his house. The barber shall swear: "I did not mark him wittingly," and shall be guiltless.
Surgery in Ancient Egypt
Some surgery was done. Skulls with holes in them have been found. Surgical tools used by a Egyptian doctors included: knives, adrill, saw, forceps or pincers, censer, hooks, bags tied with string, beaked vessel, vase with burning incense, Horus eyes, scales, pot with flowers of Upper and Lower Egypt, pot on pedestal, graduated cubit or papyrus, scroll without side knot (or a case holding reed scalpels), shears, spoons. ~
The Temple of Sobek and Horus in Kom Ombo in Aswan contains sculpted wall reliefs with images of surgical instruments, bone saws and dental tools. The Cairo Museum has a collection of surgical instruments which include scalpels, scissors, copper needles, forceps, spoons, lancets, hooks, probes and pincers. [Source: Mark Millmore,discoveringegypt.com discoveringegypt.com ^^^]
According to Minnesota State University, Mankato: “Though Egyptian medical practices by no means could rival that of the present day physicians, Egyptian healers engaged in surgery, prescriptive, and many other healing practices still found today.The practices of Egyptian medical practitioners ranged from embalming to faith healing to surgery and autopsy. The use of autopsy came through the extensive embalming practices of the Egyptians, as it was not unlikely for an embalmer to examine the body for a cause of the illness which caused death. The use of surgery also evolved from a knowledge of the basic anatomy and embalming practices of the Egyptians. From such careful observations made by the early medical practitioners of Egypt, healing practices began to center upon both the religious rituals and the lives of the ancient Egyptians. [Source: Minnesota State University, Mankato, ethanholman.com]
Egyptians used splints to set broken bones. Anatomical knowledge appears to have been based more on animals than humans. Bodies were believed to have been cut open with obsidian blades. Bronze and copper knives were not sharp enough. In lieu of anesthesia patients were perhaps knocked on the head. The oldest set of bronze surgical blades dates to 2300 B.C.
Edwin Smith Surgical Papyrus
One of the most informative documents on Egyptian medical practices is the Edwin Smith Surgical Papyrus. It was written around 1700 B.C. but most of the information is based on texts written around 2640 B.C., Imhotep’s time. The papyrus mainly describes wounds, and how to treat them, and has surprisingly little to say about diseases. It describes 48 surgical treatments for injures of the head, neck, shoulders, breast and chest and contains a list of instruments — including lint, swabs, bandage, adhesive plaster, surgical stitches and cauterization tools — used in treatments and surgeries, plus instructions on how to sutur a wound using a needle and thread It is also the earliest document to make a study of the brain.. [Source: Page of Egyptian Medicine, discoveringegypt.com]
Joyce M Filer wrote for the BBC: The Edwin Smith Surgical Papyrus, named after its modern owner, “describes 48 cases of injury to the face, head, neck and upper spine. In each case a prognosis is given and, if this is favourable, suitable treatment is recommended. One case, number 11, describes the management of a broken nose, and the treatment, involving rolls of lint within the nostrils and external bandaging, can hardly be bettered even by modern doctors. As might be expected, no treatment is recommended for patients deemed fatally injured. The wise ancient Egyptian physician knew when a patient was beyond help. [Source: Joyce M Filer, BBC, February, 17, 2011 |::|]
An excerpt from the Edwin Smith papyrus on curing "Stupid Vision" reads: "Take the water (humor) contained in pigs eyes, take true antimony, red lead, natural honey, of each 1 Ro [about 15 cc]; pulverize it finely and combine it into one mass which should be injected into the ear of the patient and he will be cured immediately. Do and thou shalt see. Really excellent! Thou shalt recite as a spell: I have brought this which was applied to the seat of yonder and replaces the horrible suffering. Twice." ~
The Ebert papyrus is longer and more comprehensive. It runs for the equivalent of 110 pages and has 877 remedies. The papyrus is organized on treating particular parts of the body, but has sections on the head, toes, fingers and eyes. It also include remedies to parasitic stomach diseases and a small section on the heart. Among other things it say that a depressed skull fracture looks like a puncture in a pottery jar. ~
Surgery in Ancient Greece
A set of Greek medical instruments consisted of catheters, a rectal speculum, scoops, probes, hooks, forceps, traction hooks and bone chisels. Cauterizing (burning of part of a body to remove or close off a part of it) was a standard medical procedure in ancient times. Brain-swelling was sometimes relived with trephination, an ancient medical technique in which holes were cut into the brain to relieve pressure. It was procedure thought to be only performed on the elite.
Broken bones, surprisingly, were often not set, meaning that victims were disfigured for the rest of the lives. Other times bones were set with skill. "This was a remarkable surgical procedure," an archaeologist told National Geographic, displaying a thigh bone from an ancient Greek skeleton. "Someone used a lot of force to pull the lower part of the broken bone down, reset it, and keep it in place for weeks against the enormous pressures of contracting muscles."
According to the Canadian Museum of History: “There were several factors that influenced the development of medicine in ancient Greece. First, there was the potent force of religion with its gods and goddesses who dealt with healing, death and pestilence. Then there was the influence of trading contacts such as Egypt (which had learned much from its mummification practices) and Mesopotamia (which had published comprehensive medical documents on clay tablets well before 1000 B.C.). [Source: Canadian Museum of History historymuseum.ca |] “To cap it off, there was the sad result of war - a variety of wounds and amputations caused by arrows, swords, spears and accidents- and described so vividly and accurately in Homer's Iliad. Just dealing with these casualties provided lots of experience and practical information applicable elsewhere. Although Greek religion frowned on human dissection in the Archaic and Classical periods, after the founding of the Alexandrian School that changed. Physicians and researchers made advances in some areas that were not surpassed until the 18th Century.” |
Greek-Era Medical Scholars on Surgical Instruments
John Stewart Milne wrote in “Surgical Instruments in Greek and Roman Times”: “The earliest classical writer on medical subjects is Hippocrates, who was born in 460 B. c. and who practised in Athens and other parts of Greece. The ‘Hippocratic Collection’ is well known to consist of works which are not all by Hippocrates himself, but as the pseudo-Hippocratic works all belong to the classical period they are all admissible as evidence for our purpose, and for the sake of brevity I shall throughout refer to them as if all were by Hippocrates. [Source: “Surgical Instruments in Greek and Roman Times” by John Stewart Milne, M.A., M.D. Aberd. Oxford: Clarendon Press (1907) forumromanum.org ^*^]
Many interesting instruments are named in the comparatively small collection of treatises which make up the admittedly genuine list of Hippocratic works, but, taking these along with the pseudo-Hippocratic works, the number of instruments named in the whole collection is surprisingly large, comprising as it does trephines, bone drills, probes, needles, tooth forceps, uvula forceps, bone elevators, uterine sounds, graduated dilators, cranioclasts, and others. After Hippocrates there is a break in the continuity of the literature, and for some hundreds of years Greek medicine is represented almost entirely by the Alexandrian Schools.
“Aulus Cornelius Celsus is the next writer we have. His system of medicine in eight books is a marvel of lucid arrangement, and his beautiful style makes it a pleasure to read any of his works. The seventh book gives a most interesting review of the surgery of the Alexandrian School. He describes many instruments in detail, although he names fewer special instruments than some of the Greek writers as the Latin language lends itself less well to the formation of compound words than the Greek does. To take one example only, Celsus has practically one word for all varieties of forceps—vulsella, while the Greeks use many compounds like hair forceps, flesh forceps, tooth forceps, stump forceps. Indeed, in the case of the two latter words Celsus falls back on Greek to express himself. I have obtained a description of two very important instruments from the works of Hero of Alexandria (285-222 B.C., ed. 1575). ^*^
Roman-Era Medical Scholars on Surgical Instruments
John Stewart Milne wrote in “Surgical Instruments in Greek and Roman Times”: “Rufus of Ephesus (98-117 A.D.) has left little to interest us for our particular purpose, as he merely mentions, without describing, a few instruments, all of which are already known to us from other sources. [Source: “Surgical Instruments in Greek and Roman Times” by John Stewart Milne, M.A., M.D. Aberd. Oxford: Clarendon Press (1907) forumromanum.org ^*^]
“Aretaeus of Cappadocia has left us a work on Acute and Chronic Diseases. He has few references to instruments, but such as they are they are interesting, as he names some which are given by no other author. He has a tantalizing allusion to a work by himself on surgery which has not been preserved. ^*^
“Galen (130-200 A.D.) was a most voluminous writer, much of whose work remains and teems with matter of interest to us. Much information about instruments is to be gained from even his purely anatomical writings. ^*^
“Oribasius (325 A. D.) wrote an encyclopaedia of medicine, which is called Collecta Medicinalia, in seventy books, only about one third of which remain. This is the most interesting of his works from our point of view, but he has left also a synopsis of the encyclopaedia and a sort of first aid manual. ^*^
“Soranus of Ephesus has left us a most valuable treatise on obstetrics and gynaecology, which, though written only for midwives, contains many interesting references to instruments such as the speculum, uterine sound, cephalotribe, decapitator, and embryo hook. He lived in the reign of Trajan. Some of the chapters, of which the Greek is lost, have been preserved to us by his abbreviator Moschion..^*^
“Caelius Aurelianus Siccensis, an African of the fourth or fifth century, translated the works of Soranus, both those on gynaecology and those on general diseases, and he preserves some of Soranus which we would not otherwise possess; but he writes in a barbarous Latin which, like the Latin of some other African writers on medical subjects, is calculated to cause great pain to anyone not familiar with this particular style. ^*^
“Marcellus Empiricus (300 A.D.) wrote a work on pharmacy, of large size but little value, and in a poor style. There are a few passages bearing on implements of minor surgery. A good deal is copied from Largus. ^*^
“Theodorus Priscianus, alias Octavius Horatianus, lived in the fourth century and has left a work, in three books, called Euporiston. It is a compilation in African Latin of extracts from Galen, Oribasius, &c. The style of the Latin is so barbarous that it really must be seen to be believed. There is a little information to be gathered about minor instruments.
“There are a few interesting references to instruments in the works of the early Christian fathers. Tertullian is the only one of these I can claim to have systematically searched, but in one of his sermons he refers to no less than four surgical instruments, one of which is not described by any other author. ^*^
Byzantine -Era Medical Scholars on Surgical Instruments
John Stewart Milne wrote in “Surgical Instruments in Greek and Roman Times”: “Moschion (fifth century) translated into Latin the gynaecological and obstetrical part of the works of Soranus for the benefit of midwives who could not speak Greek. This version is now lost, but we have a translation of it into Greek, made after the fall of the Western Empire and the development of the Greek-speaking Empire at Constantinople in the sixth century. [Source: “Surgical Instruments in Greek and Roman Times” by John Stewart Milne, M.A., M.D. Aberd. Oxford: Clarendon Press (1907) forumromanum.org ^*^]
“Aetius lived in the first half of the sixth century, and compiled a voluminous treatise on medicine in sixteen books. He worked entirely with scissors and paste, but the result is the preservation to us of a large number of extracts from writers whose works would otherwise hive entirely disappeared, and his work is of great value for the study of instruments. ^*^
“The last of the eminent Greek writers is Paulus Aegineta, a writer who probably lived in the sixth and seventh centuries. This is getting rather late in the day, it is true, but to omit the works of Paulus, or Paul, as he is affectionately called by his admirers, would be to omit some of the most valuable knowledge of ancient medicine we possess. Paul, like most of his time, was a compiler, but he was a skilful one, and while he entirely depends on Galen, Archigenes, Soranus, &c. for his information, he has gathered up the best of the medical knowledge of his time in a little encyclopaedia whose artistic completeness and orderly arrangement are not surpassed by any work of a corresponding nature at the present day. The work is divided into seven books, the sixth of which deals with surgery and teems with information about instruments. ^*^
Steel and Iron Surgical Tools from the Greco-Roman Era
John Stewart Milne wrote in “Surgical Instruments in Greek and Roman Times”: “The surgical instruments we meet with are, as a rule, of bronze. Not that the Greeks and Romans did not make many of their instruments of iron and steel, but the iron has mainly perished while more of the bronze has persisted. Long before the date of the earliest medical writings, Greece had passed into the iron age. The Homeric poems picture a civilization in the state of transition from a bronze to an iron period, and weapons such as sword, axe, and spear, are frequently described as made of iron. In the Iliad we even read of implements of agriculture made of iron, but it is ‘hard to work’ (Iliad vi. 48, Od. xxi. 10). However, by the time that Hippocrates wrote, it was in common use, and, if we had only the evidence of the Hippocratic writings to go by, we could see that it was in common use in the time of Hippocrates. Certain instruments, such as the cautery, are always spoken of as made of iron, in fact, the term for cautery is, as a rule, ‘the iron,’ and is a general term for ‘the knife’. The smelting of iron is even used as a simile by Hippocrates: ‘In the same way iron comes from stones and earth burnt together. In the first exposure to the fire stones and earth mix together with scoria, but at the second and third burning the scoria separate themselves from the iron, and this phenomenon meets the eye, that the iron remains in the fire fallen apart from the scoria, and becomes solid and compact’ (ii. 371). [Source: “Surgical Instruments in Greek and Roman Times” by John Stewart Milne, M.A., M.D. Aberd. Oxford: Clarendon Press (1907) forumromanum.org ^*^]
“Again, he uses as a simile a speculative theory as to the way in which heating iron softens it and dipping it in water hardens it. He believes that this comes about by the fire depriving the iron of its nourishing substance, while the addition of water restores it. ‘The instruments of ironworking soften iron by driving the fire with wind and taking away the supporting substance, and when they have rarefied it they strike and beat it. By the nourishment of water it is again strengthened.’ (ii. 641). ^*^
“This is the earliest reference to tempering steel by the Greeks with which I am acquainted. It is a curious commentary on the relative destruction of iron instruments compared with those of bronze, that cauteries, which are always described as made of iron and which must have existed in enormous numbers, are among the rarest surgical instruments found. We have a few cauteries of iron, however, and some knives and knife-blades and other instruments remain. Pots for ointments of certain kinds were made of iron, and we have actually two of these which had been the property of a Roman oculist whose full name is known. I have entered into this discussion because there seems to be a general tendency to underestimate the extent to which iron was employed by the Greeks and Romans. The quantity of scoria left by the primitive founders should alone be sufficient to teach us to how great an extent iron was in use. Wherever there was good iron in any of the Roman provinces, veritable mountains of scoria are found. The heaps of scoria left in the Forest of Dean by the Roman founders contained such a large percentage of iron still remaining that they were smelted over again in later times, and to do this occupied over twenty furnaces for a couple of centuries. Tolouse calculated that similar heaps in Gaul contained over 120,000 tons of scoria. If, however, we tend to underestimate the extent to which iron was in use among the Greeks and Romans, still more, I believe, do we tend to underrate the quantity and the quality of the steel available in those times. This comes about from the fact that in our day we require such enormous quantities of iron and steel that we have to employ iron ores of a very low quality. The greater part of the so-called steel of which battleships are made is got from a ferruginous mud with only 30 per cent. of iron, less than there was left in the scoria after the Roman founder had done with it. To the impurities already existing in this we add others, because the coal we use contains sulphur. It is getting rid of these impurities that makes the production of steel such a roundabout process with us. We forget that, with primitive methods but fine ores and a fuel devoid of sulphur, the production of steel of fine quality is as easy a process as the manufacture of iron, in fact the only difference between the method of procuring iron and steel under these circumstances is the length of time the process is allowed to go on. The ancient founders used the finest ores, often containing 75 per cent. of iron, and, working with charcoal fuel, which was nearly pure carbon, they could produce steel as easily as iron. The difference between steel and iron is that steel contains carbon, and, by allowing the ore to remain longer in contact with the charcoal, steel is formed, so that a founder setting out to make iron with a pure ore and a pure fuel like charcoal, may, if he is not careful, turn out steel of fine quality. This primitive method of making steel is still in vogue in India, Burma, Borneo, China, &c., and very fine qualities of steel are produced. The majority of the tools found in the earliest Greek colonies on the Nile—Naukratis and Daphnae—are of steel or iron, although those of the Egyptians among whom they were living (circa 600 B.C.) were of bronze. The classical medical writings themselves are sufficient evidence of the quality of the steel available in those times. Galen (ii. 683) says that the best quality of steel (which came from Norica) yielded a knife which neither blunted easily nor bent or chipped. ^*^
“This shows that the Greek surgeon appreciated good steel, and what I have said will show that there was plenty of it to be had. Yet modern writers almost invariably speak of or describe even the cutting instruments of the ancients as made of iron. Greek and Latin have each only one word to indicate both steel and iron, but that is because, as I have shown, they prepared both in the same way. The ancient Hindoo Vedas say that cutting instruments were to be made of steel, well polished and sufficiently keen to divide a hair. For sharpening, a stone was to be used, and they were to be kept clean and wrapt in flannel and laid by in a box of sandalwood. Albucasis in mentioning steel always specifies Indian steel. Many of the Roman shears of steel retain their spring perfectly. As an illustration of the keenness of edge which can be put by simple methods upon steel of primitive manufacture, take the following account of the operations of an African barber of the Hausa tribe, as reported in an account by Professor R. W. Reid, Aberdeen, of a Hausa barber-doctor’s outfit presented to the Anthropological Museum of the University by Sir William MacGregor, Governor of Lagos. The description of the outfit is quoted from Sir William MacGregor, who says: ^*^
“‘The knife, made by an African bush blacksmith, he uses for shaving. He employs no soap to soften the skin or roughen the hair, only a little water. He sharpens his razor on a black leather strap, turning the knife on the back so deftly that the eye cannot follow the movement; the few last touches he gives to it by turning it with splendid dexterity on the front of the left arm, where the skin is worn and bare by this manipulation. He shaves the whole face, except the nose. He leaves a fine line of eyebrow. The hair is cut short. The outline of the hairy part of the scalp in front is very clearly demarcated by shaving back about a half to an inch and a half. Then he turns the front edge by a marvellous stroke. He holds the knife horizontally, and, with a downward stroke cuts off all the projecting ends of the hair round the forehead. No European barber could do it without burying his razor in the skin. He never draws blood’ (Proc. Anat. and Anthrop. Soc. Univ. Abdn., 1900-2). ^*^
Greco-Roman Surgical Instruments Made From Bronze, Gold and Other Materials
John Stewart Milne wrote in “Surgical Instruments in Greek and Roman Times”: “Although, as I have shown, iron and steel were largely used in the manufacture of instruments, fortunately for us bronze was the metal usually selected, for thus many instruments have withstood the lapse of time which would otherwise have been oxidized out of existence. Copper is much more easily got from ore than iron, and consequently it was the first to be used by man, and very early the advantage or combining it with tin to form bronze was found out. Bronze was used by the Egyptians 6,000 years ago, and the Phoenicians, who got it from them, passed it on to the whole of Europe. The quantity of tin in the bronze is very constantly about 7 1/2 per cent. [Source: “Surgical Instruments in Greek and Roman Times” by John Stewart Milne, M.A., M.D. Aberd. Oxford: Clarendon Press (1907) forumromanum.org ^*^]
“The majority of the instruments which have been preserved to us are of bronze. Hippocrates (i. 58) says: ‘Use bronze only for instruments, for it seems laboured ornamentation to use vessels of it.’ We have, however, a good many specimens of vessels which prove that physicians did not adhere to this advice. We know too that certain medicaments were intentionally stored in copper vessels.
“Pure copper was occasionally used for instruments, and of these we have a few remaining, and vessels and instruments of it are frequently mentioned: Coins were frequently made of brass , a mixture of copper, tin, and zinc, and in Pompeii there have been found two scalpel handles of brass composed of 25 per cent. of zinc and 75 per cent. of copper. The copper was got mainly from Cyprus and Spain. A small amount, however, came from Africa and Asia. ^*^
Tin came mainly from Britain. We have no instruments of tin preserved to us, but they are frequently referred to. Hippocrates mentions, over and over again, uterine sounds of tin, and he also speaks of sounds and eyed probes for rectal work, which were made of tin so that they might be flexible. Vessels of tin for storing medicaments in are spoken of by Largus. In the Museum at Chesters (Chollerford) there is a tin weight for medicines. ^*^
“Leaden sounds and tubes for intra-uterine medication are frequently mentioned in the Hippocratic writings, and Celsus and Paul refer to leaden tubes for insertion in the rectum and vagina to prevent cicatricial contractions and adhesions after operations on these parts. The therapists also mention medicament jars of lead. There is one in the Capitoline Museum from the temple of Aesculapius in the forum. ^*^
“Gold: There is in the Museum at Stockholm a forceps of gold, but it is more than probable that this is a toilet article. I have a spatula-probe which had been overlaid with gold, and I have met with several others similarly treated. Theodorus Priscianus recommends a cautery of gold for stopping haemorrhage from the throat (Logicus, xxii). Avenzoar speaks of a golden probe for applying salve to the eye and for separating adhesion of the eye to the lid. Avicenna lets out the pustules of small-pox with a golden probe. Albucasis recommends burning the roots of hairs in trichiasis with a probe of gold. Mesue recommends a heated scalpel of gold to excise the tonsil. Hippocrates binds the teeth together in fracture of the jaw with a gold wire (iii. 174); cf. Paul, VI. xcii. In one of his dialogues Lucian satirizes a medical man who sought to conceal his ignorance by a display of a fine library, bleeding-cups of silver, and scalpel handles inlaid with gold—the devices of quacks, Lucian says, who did not know how to use the instruments when necessity arose. ^*^
“Silver: “There is a forceps of silver in the Athens Museum, and another in the Museum at Kiel. Both are, however, possibly toilet articles. Paul condemns bleeding-cups of silver, as he says they burn, so it is evident that Lucian had grounds for his statement. In the Musée de Cinquantenaire, Brussels, there is in the section of ancient surgery a bronze instrument case from Pompeii which contained a silver spoon and probe combined, a plain probe, and a grooved director, all in silver. I have frequently met with ligulae of silver and also of copper overlaid with silver, and styli, which we shall see were used as implements of minor surgery, were frequently made of silver. Medicament boxes of silver are mentioned by Marcellus. Hippocrates describes a uterine syringe with a tube of silver. Albucasis mentions silver catheters. ^*^
“A mixture of gold and silver, which was called electrum, was much used for coinage, and I have met with one or two ligulae of this metal. It was found mixed naturally in the mountain districts of Tmolus and Sipylus in Lydia, and it was also artificially produced by alloying the two metals. ^*^
“Horn: Hippocrates (iii. 331) speaks of a pessary of horn inserted into the rectum. It would seem that the tube of various syringes was often made of horn, as both Greek and Latin writers speak of the ‘horn’ of the syringe. Stone: Medicaments were prepared on stone slabs, and the great majority of oculists’ seals were of stone. Wood: Galen speaks of sounds or directors of wood, and ointment spatulae of wood are very frequently mentioned in the therapeutic works, as are also boxes for storing ointments in. ^*^
“Bone and Ivory: Numbers of bone ligulae were found in a Roman hospital lately excavated at Baden. In the Naples Museum there are two ointment spoons with carved bone handles. Needles such as Hippocrates and Celsus speak of for stitching bandages to fix them were very frequently made of bone and ivory. Knife handles of bone and ivory are common. A carved ivory medicament box with sliding lid will be fully described later. Scribonius Largus describes knives of bone and ivory for preparing plants for pharmaceutical purposes (Compositiones, lxxxiii). An ivory pestle was found with surgeon’s outfit in Cologne.” ^*^
Production of Surgical Instruments in Greco-Roman Times
John Stewart Milne wrote in “Surgical Instruments in Greek and Roman Times”: “The execution of the instruments is, as a rule, all that could be desired, and the weight and thickness are no more than is consistent with the requisite strength. Hippocrates points out the necessity for this: ‘All instruments ought to be well suited for the purpose in hand as regards their size, weight, and delicacy’ (i. 58). [Source: “Surgical Instruments in Greek and Roman Times” by John Stewart Milne, M.A., M.D. Aberd. Oxford: Clarendon Press (1907) forumromanum.org ^*^]
“The ornamentation is simple and effective. In the round instruments like the probes it consists usually of raised circular ornamentation, with or without a secondary ornamentation on the raised ringing. In others there are longitudinal or spiral grooves running along the instrument. In some cases the bronze is decorated with an inlay of silver damascening. This is rare in the instruments from Pompeii, though there are two probes with a spiral inlay in the Naples Museum. The majority of the instruments treated in this way have been found in the western provinces, and they are of later date than the Pompeian. The handles of some scalpels belonging to the third century are beautifully inlaid with silver. Lucian, as I have mentioned, speaks of scalpels inlaid with gold. In the Mainz Museum there is a medicament box on the lid of which is inlaid a snake coiled round a tree, the tree and the snake’s body being outlined in copper and the snake’s head in silver. So far no damascened instruments are reported from Greece. Damascening began in Europe apparently in the first century, and reached its height in the time of the Merovingian kings. ^*^
“Examples of plated instruments are not uncommon. I have a spatula dissector thinly plated with gold, and I have met with several ligulae plated with silver. One of these was so thickly plated that on cutting into it the silver, which was deeply oxidized on the outside and was, therefore, quite black, showed also a layer of metallic silver still bright on section. ^*^
“All the surgical instruments found in the provinces have an air de famille which would lead one to suppose that they had been manufactured in Italy, but this is not certain. The ointment slabs, however, are rarely of the stone of the country in which they are found. On the other hand, the orthographical faults on the oculists’ seals would indicate that they were cut in the provinces. Wherever possible two instruments are combined into one. Thus very few of the probes are simple instruments but carry a spatula, a scoop or spoon, an eye, or a hook, at the opposite end. Vulsella are more difficult to combine with other instruments, but here again we meet with combinations such as vulsella at one end and scoop, raspatory, or probe, at the other. The typical scalpel handle carries at the end opposite the blade a spatula for blunt dissection. We have needles at one end and probes, scalpel blades, &c., at the other end of a handle. This combination of two instruments in one is still in use in our day. We must notice the fact that the majority of instruments we know were all of metal, not folding into hollow handles of wood, bone, &c., as the instruments of a decade ago did, so that they were easily cleaned. In fact we shall see that where the scalpel and handle were not forged in one piece they were united by something very like our aseptic joint. Hippocrates insists on the importance of keeping everything in the surgery absolutely clean. ^*^
“A few instruments bear the image of deities connected with medicine, or attributes of these. The figures of Aesculapius and his daughter Hygeia are found on medicament boxes, the former with the serpent entwining his staff, the latter feeding a serpent from a bowl. The serpent is sometimes found on a probe. A uterine dilator from Pompeii also carries it. A probe surmounted by a double serpent (caduceus form) was found in the Roman Hospital at Baden. Two scalpels in the Naples Museum carry on their ends the head of Minerva Medica. The quadrivalve speculum in the Naples Museum has each end of the crossbar tipped with fine image of a ram’s head. There is also a medicine shovel with the same symbol. Illustrations of these instruments will be found later. ^*^
Greco-Roman Surgical Instruments: Archaeological Finds
John Stewart Milne wrote in “Surgical Instruments in Greek and Roman Times”: “Finds of ancient surgical instruments, though not by any means common, are still sufficiently numerous for specimens to have found their way into most of our larger museums; and private collectors have here and there acquired considerable numbers. The most prolific source has been the excavations at Herculaneum and Pompeii, which have now been systematically pursued for nearly three hundred years, while the objects found have been deposited in the National Museum at Naples. In 1818 a physician’s house with a large number of surgical instruments was discovered in the Strada del Consulare of Pompeii, and two chemists’ shops have also been found with instruments in them. Besides these there is a large number of instruments from other finds in the two buried cities. [Source: “Surgical Instruments in Greek and Roman Times” by John Stewart Milne, M.A., M.D. Aberd. Oxford: Clarendon Press (1907) forumromanum.org ^*^]
“The custom of burying personal effects along with the ashes of a deceased person, which prevailed among the Romans from the second to the fourth century, has preserved to us a number of interesting finds. In 1880 M. Tolouse, a civil engineer in Paris, in executing some alterations in the neighbourhood of the Avenue Choisy, discovered the grave of a surgeon, containing a bronze pot full of surgical instruments. Among these were numerous forceps and vulsella, ointment tubes, bleeding cup, scalpel handles for blades of steel, probes, and spatulae. Sixty-six coins of the reigns of Tetricus I and II showed that the grave belonged to the end of the second or the beginning of the third century. The instruments are now in the Archaeological Museum at Namur
“In 1854 there were discovered at Rheims the remnants of a wooden chest containing two little iron jars for ointments, several scalpel handles, a small drill, eight handles for needles, five hooks (two blunt and three sharp), two balances, various probes and spatulae, seven forceps, medicament box, a mortar, and a seal showing that the instruments had belonged to an oculist named Gaius Firmius Severus. The instruments are all of the most beautiful pattern and finish, several being finely inlaid with silver. Some coins of the reigns of Antoninus Pius and Marcus Aurelius showed that the interment belonged to the end of the third century. These instruments, &c., are now in the Museum of St-Germain-en-Laye. ^*^
“Find of Sextus Polleius Sollemnis, oculist of Fonviel, Saint-Privat-d’Allier. In levelling a heap of earth which had fallen from a cliff above as the result of a landslide, there were found at Fonviel in 1864 a number of bronze surgical instruments. The place where they were found is at the intersection of two old Roman roads, and the instruments had been buried in the grave of a Roman surgeon high up above the valley on the edge of a cliff. Eighteen coins of the reigns of Julia Augusta, Trajan, Hadrian, Commodus, Gordian, Philip, Valerian, and Gallus, showed that the interment had been made at the end of the third century. The instruments found included three scalpel handles, fragments of two forceps, and an oculist’s seal in stone showing that the grave was that of Sextus Polleius Sollemnis. Many more instruments had probably been buried originally. Those enumerated are now in the Museum of Le Puy-en-Velay.. ^*^
“One of the most prolific finds of late years has been the discovery of a Roman military hospital at Baden, the ancient Roman station of Aquae, or Vicus Aquensis. From time to time isolated discoveries of instruments had been made, including a catheter, a scalpel, and several varieties of probes, and in March, 1893, MM. Kellersberger and Meyer proceeded to excavate systematically the remains of some Roman buildings on their property. A large chamber 10.35 metres by 12.5, with walls 60 cm. thick, was discovered, and later others were discovered varying from 3 to 27 metres in length. There were in all fourteen rooms. Along the side of the building on which a Roman road ran, there were the remains of an imposing façade, running the whole length of the building. It had consisted of a portico with colonnades, the foundations of which were found at regular intervals. It is possible that some of the larger rooms had been subdivided into others by thin walls or partitions, for fragments of partitions of plaster with wood lathing were found. ^*^
“A large number of objects—tiles, lamps, vases, pots, knives, spearheads, nails, glass, fibulae, beads, weavers’ weights, three amphorae a metre high—were found near the surface. Then, at a depth of two metres, surgical instruments began to be found. These included probes to the number of 120, unguent spoons in bone and bronze, a fragment of a catheter 13 cm. long, bronze boxes for powder, needles, earscoops, unguentaria, spatulae, a fragment of an étui for instruments, and cauteries. Many coins of the reigns of Claudius, Nero, Domitian, Vespasian, and Hadrian were found, showing that the hospital had been in use between 100 and 200 A.D. ^*^
“A case containing a surgeon’s outfit was found in the Luxemburgerstrasse, Cologne. It contained a phlebotome, a chisel, and some fragments of other instruments of steel, two forceps and two sharp hooks in bronze, and a small ivory pestle-like instrument. These are now in the Cologne Museum. This is a most interesting and important little find. The phlebotome is by far the best preserved and best authenticated example which we possess of this instrument. Probably the same may be said of the chisel as a purely surgical instrument.” ^*^
Surgical Knives from the Greco-Roman Era
Types of cutting instruments use in the Greco-Roman times included: 1) straight blades with one cutting edge; 2) scalpel; 3) bistoury; 4) scarificator single or multiple; 5) razor type; 6) blunt-pointed bistoury; 7) ring knife for dismembering the foetus; 8) straight two-edged knives; 9) Galen’s long dissecting knife; 10) phlebotome; 11) fleams; 12) katias; 13) spathion; 14) hemispathion; 15) polypus knife; 16) lithotomy knife; 17) knife for lithotomy invented by Meges; 18 ) perforator for foetal cranium; 19) probe-pointed bistoury with two edges; 20) curved bistoury; 21) crow-bill; 22) pterygium knife; 23) knife for plastic operation for entropion; 24) uvula knife; 25) tonsil knife; 26) fistula knife; 27) curved two-edged blades; 28) Galen’s cartilage knife; 29) curved myrtle-leaf-shaped blade; 30) shears. [Source: “Surgical Instruments in Greek and Roman Times” by John Stewart Milne, M.A., M.D. Aberd. Oxford: Clarendon Press (1907) forumromanum.org ^*^]
John Stewart Milne wrote in “Surgical Instruments in Greek and Roman Times”: “The surgical knife had, as a rule, the blade of steel and the handle of bronze. We find specimens all of steel or all of bronze but these are exceptional forms; and hence it happens that many more handles than blades have been preserved to us, as usually the blade has oxidized away leaving no trace of its shape. It will be well, therefore, to commence with the study of the handle. ^*^
“The scalpel handle consists, as a rule, of a bar of bronze, which may be round, square, hexagonal, or trapezoidal in section. At one end there is a slot to receive the steel blade, varying in depth from 2 cm. in the larger, to 1 cm. in the smaller, instruments. The other end of the handle carried a leaf-shaped spatula to act as a blunt dissector. A groove is often formed near the end of the handle, or the end is raised into a cylindrical roll on each side, and this roll again is sometimes perforated with a hole. ^*^
“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 of removal for cleaning, and also permit one handle to be used with several varieties of blade. A consideration of the slots in a large number of handles leads me to believe, however, that this was, to say the least, not the usual arrangement. The proportion of the depth of the slot to the size of the blade to be supported is in most cases not large enough to allow of a temporary mounting to fix the blade firmly, and I believe that most blades were either luted or brazed in permanently. These processes were well known to the ancients, and in fact we have them in evidence in other surgical instruments. Those bleeding-cups from Pompeii which carry rings on their summits have the top part brazed or soldered on. Galen (ii. 717) alludes to the blowpipe which goldsmiths used, and Paulus Aegineta has a chapter on the fluxes used by these artists. We frequently meet with ornaments fixed on boxes by means of solder. ^^ “On the other hand, the slot in some handles expands at its termination into a wider portion which would carry a cylindrical expansion on the other end of the blade. This form of blade could not be pulled outwards, and might well be fixed with a temporary mounting. ^^
“Different varieties of handles are shown in Plates I-III. Some are beautifully damascened with silver. These are mostly of the third century, but Sambon reports some damascened handles of the first century. A rare form is seen in a specimen in the Museum at Le Puy-en-Velay, where the handle is round and decorated with a spiral band of silver inlaid round it. It is from the find of the oculist Sollemnis. ^*^
“A few variations from the characteristic combination of handle and spatula-shaped dissector occur. Thus we have a handle ending in a conical point, which Deneffe regards as a drill for perforating the nasal septum in cases of fistula lachrymalis. Archigenes describes this operation, and the handle was found in the grave of the oculist Severus. Along with it were found two other handles, which, instead of a spatula, had carried a steel needle. The needles have disappeared of course, but there are the holes to receive them. In other cases the handle was round, and either quite plain or ornamented with raised rings. Some of these ended in a small round knob. Others carry the head of Minerva Medica like the spoon. There are three of these handles in the Naples Museum. Rufus of Ephesus describes a lithotomy knife which had a scoop at the end of the handle with which to extract the stone. An example of this is seen in the box of scalpels from Athens (Pl. IV). ^*^
Blades and Scalpels from the Greco-Roman Era
John Stewart Milne wrote in “Surgical Instruments in Greek and Roman Times”: “For the study of the different varieties of blade we have at our disposal first of all the specimens that have actually survived. Of these the largest number are to be seen in the Naples Museum, but a considerable number are to be found scattered over various museums. An ex voto tablet found on the site of the temple of Aesculapius on the Acropolis at Athens shows a box of scalpels, among which are some interesting forms (Pl. IV). The scalpels, it will be noted, are arranged head and tail alternately. A few varieties are actually described in detail in the classical authors, and, by piecing together other references to parti¬cular instruments and drawing inferences from the various uses to which we find them put, we are able to describe a surprisingly large number of forms. The sixteenth-century writers, such as Paré, and seventeenth-century writers, such as Scultetus, illustrate with great confidence many of the cutting instruments mentioned by ancient writers, but it is easy to show that in several instances they are wrong, and, therefore, I have drawn on them as little as possible.
As a basis of classification we may select the following points about the blade. The form may be straight or curved. There may be only one cutting edge or there may be two, and the point may be sharp or blunt. We shall examine combinations of these in the following order: 1) Blade straight—(A) Cutting on one side only (a) sharp-pointed, (b) blunt-pointed.; “(B) Cutting on two edges (a) sharp-pointed, (b) blunt-pointed. 2) Blade curved—(A) Cutting on one edge (a) sharp-pointed, (b) blunt-pointed; (B) Cutting on two edges, sharp-pointed.
Ordinary Scalpel. The ordinary scalpel had apparently a straight, sharp-pointed blade. The word which Galen, Aetius, and Paulus use to denote scalpel is sμ???. Latin authors use scalpellus, the diminutive of scalper. From the etymology of these terms we can learn nothing as to the shape of the blade; they are merely general terms denoting a cutting blade of any kind—chisel, graving tool, knife, &c. The word Hippocrates uses, μ??a??a or μa?a?????, has a more definite meaning. It is from μ??a??a, the old Lacedaemonian sword, a broad blade cutting on one edge, sharp-pointed, and straight or with the tip turned slightly backwards. Thus, even in Hippocratic times the scalpel was apparently much of the same shape as it is now. Good examples of the ordinary scalpel may be seen in Pl. V, figs. 1 and 2 from the British Museum. They are all of steel. A variety with the point turned back at the tip is seen in one of the scalpels in the scalpel box from the Acropolis (Pl. IV).
Image Sources: Wikimedia Commons
Text Sources: Internet Ancient History Sourcebook: Rome sourcebooks.fordham.edu ; Internet Ancient History Sourcebook: Late Antiquity sourcebooks.fordham.edu ; Forum Romanum forumromanum.org ; “Outlines of Roman History” by William C. Morey, Ph.D., D.C.L. New York, American Book Company (1901), forumromanum.org \~\; “The Private Life of the Romans” by Harold Whetstone Johnston, Revised by Mary Johnston, Scott, Foresman and Company (1903, 1932) forumromanum.org |+|; BBC Ancient Rome bbc.co.uk/history/ ; Perseus Project - Tufts University; perseus.tufts.edu ; MIT, Online Library of Liberty, oll.libertyfund.org ; Gutenberg.org gutenberg.org Metropolitan Museum of Art, National Geographic, Smithsonian magazine, New York Times, Washington Post, Los Angeles Times, Live Science, Discover magazine, Times of London, Natural History magazine, Archaeology magazine, The New Yorker, Encyclopædia Britannica, "The Discoverers" [∞] and "The Creators" [μ]" by Daniel Boorstin. "Greek and Roman Life" by Ian Jenkins from the British Museum.Time, Newsweek, Wikipedia, Reuters, Associated Press, The Guardian, AFP, Lonely Planet Guides and various books and other publications.
Last updated October 2018