Surgical Instruments from Ancient Rome

The original instruments were excavated from the House of the Surgeon at Pompeii, so named because of the materials that were recovered there. In 1947, reproductions of these instruments were presented to the Claude Moore Health Sciences Library by the from the University of Virginia after its service in Italy during World War II. The collection is one of the best surviving examples of the tools at a surgeon's disposal in the first century BCE. Since there was relatively little innovation in surgery and surgical tools from the time of Hippocrates (5th century BCE) and Galen (2nd century CE) this collection is typical of surgical practice for nearly a millenium. In fact, the technology of some tools, such as the vaginal speculum, did not change significantly until the 20th century.

The following display presents images and summaries of the known uses of each instrument. The extant comments of medical writers from antiquity--including Oribasius, Galen, Soranus, Aetius, and the Hippocratic corpus--have provided scholars with some clues about the use of some instruments. Some instruments, such as mixing instruments and tweezers, probably had other household uses, such as the application of cosmetics and paints.

---

Vaginal Speculum

Greek: dioptra

Latin: speculum magnum matricis

click image to enlarge

One of the most spectacular, if fearsome looking, Roman medical instruments is the vaginal dilator or speculum (dioptra). It comprises a priapiscus with 2 (or sometimes 3 or 4) dovetailing valves which are opened and closed by a handle with a screw mechanism, an arrangement that was still to be found in the specula of 18th-century Europe. Soranus is the first author who makes mention of the speculum specially made for the vagina. Graeco-Roman writers on gynecology and obstetrics frequently recommend its use in the diagnosis and treatment of vaginal and uterine disorders, yet it is one of the rarest surviving medical instruments.

Specula are large and readily recognizable and should not have suffered the same degree of destruction as thin instruments, such as probes, scalpels and needles. As a source of bronze, however, they may have been more subject to recycling than the smaller instruments.

Rectal Speculum

Greek: hedrodiastoleus

click image to enlarge

The earliest mention of the rectal speculum is to be found in the treatise on fistula by Hippocrates (iii.331): "…laying the patient on his back and examining the ulcerated part of the bowel by means of the rectal speculum…"

Bone Levers

Greek: mochliskos

click image to enlarge

From what Galen says, these instruments were used for levering fractured bones into position and may have been used for levering out teeth.

Bone Forceps

Greek: ostagra

click image to enlarge

Soranus (lxiv) says that in case of impaction of the foetal cranium, the head may be opened with a sharp instrument and the pieces of the skull removed with bone forceps. Paul Aigenita (VI.xc) says that in a depressed fracture of the skull "fractured bone is to be removed in fragments, with the fingers if possible, if not, with a bone forceps."

Cupping Vessels for Bloodletting (from two perspectives)

Greek: sikua

Latin: cucurbitulae

click image to enlarge

The larger cupping vesssel would have been used for larger areas on the body, such as the back or thighs. The smaller vessel would have been applied to the arms.

Tubes to Prevent Contractions & Adhesions

Greek: motos molubous

Latin: plumbea fistula

click image to enlarge

After operations on the nose, rectum, vagina, etc., it was usual to insert a tube of lead or bronze to prevent contraction or adhesion and also to convey medicaments.

Tile Cautery

Greek: kauterion

Latin: ferrum candens

click image to enlarge

The cautery was employed to an almost incredible extent in ancient times, and surgeons expended much ingenuity in devising different forms of this instrument. The cautery was employed for almost every possible purpose: as a ‘counter-irritant’, as a haemostatic, as a bloodless knife, as a means of destroying tumours, etc.

Portable Probe Case

Greek: kauterion

Latin: ferrum candens

click image to enlarge

This plain cylindrical case was used to store and protect the thin probes and curettes used by physicians. Hippocrates mentions a portable equipment case for use on housecalls.

Male Catheter

click image to enlarge

Clyster for Administering Enemas

Greek: metregchutes

click image to enlarge

Obstetrical Hooks/Sharp Hooks

Greek: agkistron

Latin: hamus, acutus

click image to enlarge

Hooks, blunt and sharp, are frequently mentioned in both Greek and Latin literature, and served the same possible purposes we use them for: the blunt for dissecting and raising blood-vessels like the modern aneurism needle; the sharp for seizing and raising small pieces of tissue for excision and for fixing and retracting the edges of wounds. In dissection, many of the manipulations which we perform with the dissecting forceps were performed by the ancients with sharp hooks.

Epilation Forceps

Greek: tricholabis

Latin: vulsella

click image to enlarge

By far the largest number of forceps of this type are not surgical instruments, but household implements. Many were used for epilation (hair removal) or by artists.

Uvula Forceps

Greek: staphylagra

click image to enlarge

In Aetius (II.iv.2), there is an interesting description of the amputation of the uvula by first crushing it in a forceps so as to prevent haemorrhage and then cutting it off. Hippocrates (I.63) mentions the uvula crusher as one of the instruments necessary for the outfit of the physician.

Abdominal Forceps

click image to enlarge

Osteotomes

click image to enlarge

Scalpels

click image to enlarge

Surgical Scissors

Greek: psalis

Latin: forfex

click image to enlarge

The surgical author Oribasius treats the cutting of hair as a regular medical procedure in a special chapter of his work. Celsus also frequently refers to cutting the hair as a therapeutic measure. Possibly the ancients found difficulty in putting an edge sufficiently smooth for surgical purposes on their shears. We have few references to the use of the shears for cutting tissues.

Spatula Probes

Greek: spathumele

click image to enlarge

Almost every medical writer mentions the spathomele. It consists of a long shaft with an olivary point at one end and a spatula at the other. It was a pharmaceutical rather than a strictly surgical instrument. The olive end was used for stirring medicaments, the spatula for spreading them on the affected part. The spathomele was used by painters for preparing and mixing their colors. The very large numbers in which they are found would indicate that their use was not confined to medical men.

Probes/Curettes

Greek: cyathiscomele

Latin: cyathiscomele

click image to enlarge

Medieval breakthrough

One of the key players who made the real breakthrough in surgical instrumentation was Abu al-Qasim al-Zahrawi, known in the West as Abulcasis, and considered the "father of modern surgery". The first observation one must make at the outset is that Al-Zahrawi wrote his famous Al-Tasrif liman 'Ajiza 'an Al Ta'leef (written in 1000), translated as The Method of Medicine, and often referred to as Al-Tasrif, after long experience accumulated over fifty years of practising medicine. The book, therefore, was aimed to establish the rules of thumb in the practical medicine by emphasising the "do" and "don’t" in almost every issue encountered and the solutions/ treatments he provided or invented during this long experience. To complete his practical guide to solving various surgical problems, Al-Zahrawi ended this thirty volumes medical encyclopaedia with a treatise in which he introduces his famous collection of surgical tools exceeding a staggering total of 200 pieces. With its innovative title “On Surgery”, the treatise is considered the earliest elucidation compiled on the subject, which remained as the single best medieval source on the matter until modern times. In the words of Leclerc: “Al-Zahrawi remains a leading scholar who transformed surgery into an independent science based on the knowledge of anatomy. His illustration and drawing of the tools is an innovation that keeps his contribution alive, reflected in its continuous influence on the works of those who came after him”

Additionally, Galen of Pergamum, one of the most profoung philosophers, surgeons, medical philologists and physicians of the ancient world, requested that his specialised surgical instruments be made of iron ore found only in a quarry in the Celtic kingdom of Noricum. Galen along with other early Arab doctors, pioneered the approach to medical instrumentation and his followers of the Medieval period manufactured their instruments based on Galen's early designs.

Hamidan, for example, listed a total of twenty six innovations that Al-Zahrawi introduced . One of such discoveries was his use of catgut for internal stitching, a method that still practised in most of today’s surgery. The catgut appears to be the only natural substance capable of dissolving and acceptable by the body.

Al-Zahrawi does not only illustrate the tool using clear hand drawn sketches but also provides detailed information on the material and how and when it is used. Much of these are illustrated in Spink and Lewis’s (1973) book, one of the best and most comprehensive work available. For example, in cauterisation he states that: “According to the opinion of the early (physicians) cauterisation using gold is better than when using iron. In our opinion the use of iron is quicker and more correct”. As he goes on to deal with particular instruments and their use he often gives a clear description of how it is applied in addition to an accompanying sketch.

A second example of such description is what he wrote about the scraper (majrad) tool and its use when turning a fistula into the nose. “Doctors give the name 'fistula' to what laymen call 'a quill'. When you have treated it with the cautery or with caustic according to the instructions given previously, and it is not healed, there is no clear method of treatment except to cut down on the tumour at its ripening and let out all the humidity or pus therein, till you reach the bone. When bone is reached and you see necrosis or blackness, scrape it with an instrument like this picture. It is called 'rough-head' and is made of Indian iron. Its head is round like a button 2 but is engraved with markings finely engraved, like those of a file or a rasp. Place it on the site of the diseased bone and spin it between your fingers, pressing down a little with your hand, till you are sure all the diseased bone has been scraped away. Do this several times. Then let the place be dressed with stanching and styptic remedies. And if the place heals and flesh is generated there and the flow of sanies is stayed and there is no return after leaving for forty days, and there is no swelling, and nothing emerges, you may know it is perfectly healed.”

Not only the Al-Tasreef has exercised strong influence on later Muslim physicians but also became a reference book for most European medical schools and practitioners. It was first translated into Latin by Gherard of Cremona in the twelfth century to be followed by several other translations. Among the many European scholars to quote and cite from “Al-Tasreef” and many other Muslim medical works was the Frenchman Guy de Chauliac (d.1369) in his work “Chirurgia magna”. In fifteenth century Italian scholars rediscovered the works of Al-Zahrawi quoting his discoveries and remedies in their work. Among these one can refer to Mathieu de Gradibus who cited from Al-Zahrawi’s 27th treatise “Fi Tabai’a Al-Adwiyya and Aghdhiyya”. In the same period Arduinis de Passaro produced his book on the nature of poison “Liber de Venenis”, citing the work of Al-Zahrawi numerous occasions. Leclerc summarised the impact of Al-Tasreef admitting: “The translation (of Al-Tasreef) played a significant role in the development of Medieval surgery in Europe” The book constituted a central part of the medical curriculum in European countries for many centuries .

Sources:

Campell, D. (1974) ‘Arabian Medicine and its influence on the Middle Ages’, Philo press, Amesterdam. Hamidan Zohir (1993), ‘Abu-Al-Qassim Al-Zahrawi ; the Founder of Science of Surgery’, in Arabic, Dar Magallat Al-Thaqafa, Damascus. Lecrlerc Lucien (1877), ‘L’Histoire de la Medicine Arabe’, Paris, vol.1 p.456. Spink, M. S. and Lewis, G. L. (1973), ‘Albucasis On Surgery and Instruments’, The Wellcome Institute of the History of Medicine, London. Nasr Seyyed Hossein, (1976), ‘Islamic Science’, World of Islam Festival Publishing Company.

Renaissance and after

In the Renaissance and post-Renaissance era, new instruments were again invented and designed, in order to accompany the increased audacity of surgeons. Amputation sets originated in this period, due to the increased severity of war-inflicted wounds by shot, grapnel and cannon.

However, it was only with the discovery of anesthesia and surgical asepsis that new surgical instruments were invented to allow the penetration of the inner sanctum, or the previously forbidden body cavities, namely the skull, the thorax and the abdomen. A veritable explosion of new tools occurred with the hundreds of new surgical procedures which were developed in the 19th century and first decades of the 20th century. New materials, such as stainless steel, chrome, titanium and vanadium were available for the manufacturing of these instruments. Precision instruments for microsurgery in neurosurgery, ophthalmology and otology were possible and, in the second half of the 20th century, energy-based instruments were first developed, such as electrocauteries, ultrasound and electric scalpels, surgical tools for endoscopic surgery, and finally, surgical robots.

History

Surgical instruments have been manufactured since the dawn of pre-history (millions of years ago). Rough trephines for performing round craniotomies were discovered in neolithic sites in many places. It is believed that they were used by shamans to release evil spirits and alleviate headaches and head traumas caused by war-inflicted wounds.

Surgeons and physicians in India used sophisticated surgical instruments since ancient times. Sushruta (circa 500 BC) was probably the most important surgeon in ancient history, often known as the "father of surgery". In his text Sushruta Samhita he described over 120 surgical instruments, 300 surgical procedures and classified human surgery in 8 categories.

In Antiquity, surgeons and physicians in Greece and Rome developed many ingenious instruments manufactured from bronze, iron and silver, such as scalpels, lancets, curettes, tweezers, specula, trephines, forceps, probes, dilators, tubes, surgical knives, etc. They are still very well preserved in several medical museums around the world. Most of these instruments continued to be used in Medieval times, albeit with a better manufacturing technique.

Surgical instruments

A surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access or viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in surgery, while others are designed for a specific procedure or surgery. Accordingly, the nomenclature of surgical instruments follows certain patterns, such as a description of the action it performs (for example, scalpel, hemostat), the name of its inventor(s) (for example, the Kocher forceps), or a compound scientific name related to the kind of surgery (for example, atracheotome is a tool used to perform a tracheotomy).

The expression surgical instrumentation is somewhat interchangeably used with surgical instruments, but its meaning in medical jargon is really the activity of providing assistance to a surgeon with the proper handling of surgical instruments during an operation, by a specialized professional, usually a nurse.