Surgical Instruments in Greek and Roman TimesMilne, John Stewart
History
Surgical Instruments in Greek and Roman Times
Milne, John Stewart
Surgery -- History; Surgical instruments and apparatus
Nam si plaga in molli parto est, sui debet, maximeque si discissa
auris ima est, vel imus nasus, vel frons, vel bucca, vel palpebra, vel
labrum, vel circa guttur cutis, vel venter. Si vero in carne vulnus
est hiatque, neque in unum orae facile attrahuntur, sutura quidem
aliena est; imponendae vero fibulae sunt; ἀγκτῆρας Graeci nominant;
quae oras paulum tamen contrahant, quo minus lata postea cicatrix sit.
'Suture is indicated if the lesion is in a soft part, especially in
the lobule of the ear, or the ala nasi, or the forehead, or cheek, the
edge of the eyelid, or the skin over the throat, or the abdominal
wall. But if the wound is in a muscular part and gape, and the edges
cannot easily be opposed, suture is contraindicated, and fibulae
(Graece ἀγκτῆρας) are to be used in order that the cicatrix afterwards
may not be wide.'
We have here contrasted two methods of closing a wound, and the conclusion
is readily arrived at that sutures in the first case and some metal
contrivance in the second are intended. Celsus goes on to say, however:
Utraque optima est ex acia molli, non nimis torta, quo mitius corpori
insidat. Utraque neque nimis rara, neque nimis crebra iniicienda.
'Both are best made of soft thread, not too hard twisted that it may
sit easier on the tissues, nor are too few nor too many of either of
them to be put in.'
A consideration of various passages in which the Greek authors use the
term leaves a distinct impression on one's mind that a metal clasp is
intended. Thus Paul (VI. cvii), in treating of compound fractures, says
that if a large portion of the bone is laid bare we use fibulae and
sutures (ἀγκτῆρσι καὶ ῥαφαῖς). It must be confessed, however, that the
words of Celsus render it difficult for us to assert with certainty that
fibulae were metal clasps, and we find ancient commentators in equal
difficulty. Fallopius and Fabricius d' Aquapendente think fibulae mean
interrupted sutures. Guido de Cauliac thinks they mean metal clasps. There
is just the possibility that a contrivance like our harelip pin with a
figure of eight thread may be indicated. This would satisfy both sides of
the question. If fibulae were metal clasps, however, we have several
varieties of ancient fibulae that might have been used for closing wounds.
That most suited for the purpose in hand seems to me to be one consisting
of a small bar terminating in two hooks. Several of these from Roman
London are in the Guildhall Museum (Pl. LII, figs. 5, 6, 7). They
represent a useful form of 'clip' still in use by cyclists, and they could
be applied to wounds to act on the principle of Malgaigne's hooks for the
patella. A modicum of support for this view may be derived from the fact
that whereas Galen, from whom the above passage on compound fractures is
quoted by Paul, uses the word ἀγκτῆρσι, the codices of Paul almost
unanimously have ἀγκίστροις. Fourteen out of fifteen give the latter
Public-domain text, read in full here on John Shaqi.
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