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. 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. The first printed edition of the Hippocratic works was a Latin translation printed at Rome in 1525, followed by the Aldine edition of the Greek text printed at Venice in the following year. Other editions are the edition of Föes (1595), Van der Linden (1665), Kühn (Leipzig, 1821). Later editions are the text with a French translation by Littré (10 vols., 1849-61), a scholarly edition by Ermerins with a Latin rendering (1859-64), and an excellent translation of the genuine works of Hippocrates by the world-famous Dr. Adams of Banchory (Sydenham Soc. Trans., 1849). The best edition, however, is the edition of Kuehlewein, begun in 1894 and at present in course of publication by Teubner, Leipzig. The later volumes have not yet appeared. For the portion of the text which is not contained in the first two volumes of Kuehhrwein I have relied on the edition of Kühn for most of the readings, although occasionally those of Van der Linden or Föes are to be preferred. The references given are to the volumes and pages of Kuhn’s edition, but in this edition indications are given of the corresponding localities in the other editions so that cross-references to these can easily be made. There seems to be a different arrangement in different editions of Föes, for Liddell and Scott say the references in their Lexicon are to the pages in Föes but they do not correspond in any way to the pagination of the edition before me (Frankfort, 1595).
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 forcepsvulsella, while the Greeks use many compounds like hair forceps (τριχο-λαβίς), flesh forceps (σαρκο-λάβος), tooth forceps (ὀδοντάγρα), stump forceps (ῥιζάγρα). Indeed, in the case of the two latter words Celsus falls back on Greek to express himself. Celsus was first published in 1478. Another edition is that of Targa, 1769. The editions before me are those of Daremberg, published at Leipzig in 1859, and Védrènes (Paris, 1876). The latter contains illustrations of a considerable number of specimens from Italian and French museums.
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. The best edition is that of Daremberg, Paris, 1879. A Latin translation of his works will be found in Medicae Artis Principes (Stephanus).
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. There is a fine edition of the text, with an English translation by Adams of Banchory, in the Transactions of the Sydenham Society.
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. The most accessible edition is that of Kühn (20 vols., Leipzig, 1821), but it is slipshod in the text, and even more so in the translation, which is in Latin.
Oribasius (325 A. D.) wrote an encyclopaedia of medicine, which is called Συναγωγαὶ ’ΙατρικαίCollecta 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 called Σύνοψις, and a sort of first aid manual called Εὐπόριστα. I have used the edition of Daremberg and Bussemaker (1851-76).
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. I have used the edition of Rose published at Leipzig in 1882.
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. There is an Edition of this by Gesner (Basle, 1566). Finally, this Greek version of Moschion was translated back into barbarous Latin at some early date, Barbour thinks by some member of the Schola Salernitana. This was published at Venice by Aldus in the sixteenth century, and Rose has prefaced his edition of Soranus with it. This work of Moschion is only of interest to us from the fact that he preserves to us the substance of some chapters of which the original in Soranus is wanting.
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.
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. In 1534 an Aldine Edition of the first eight books was published, and, though a translation of the whole work was published by Cornarius in 1533-42 in Latin, six of the last eight books were never published in the original Greek. This is unfortunate for us, as for our purpose the original is the only thing of any great value, Greek being, as I have already pointed out, a language richer in compounds than Latin is, and lending itself better to the coining of special names for special instruments. Not that the sixteenth-century translator is ever at a loss for a turn by which to express himself in Latin, but the turn, as often as not, is by periphrasis just at the very point when we would have liked a very exact equivalent for the Greek. The translation of the part of the work of which we have the Greek shows that we cannot entirely depend on some of these periphrases even where they appear definite, as in some cases an unwarrantable assumption is made about the form of an instrument. Thus λιθουλκῷ is translated ‘forcipe ad id facta’ because in Cornarius’s time the instrument used for extracting stone from the bladder was a forceps, whereas it is doubtful whether there was in the Roman period anything more than a scoop, and, therefore, we are not entitled to translate λιθουλκός by anything more definite than ‘stone extractor’, its etymological equivalent. Although, therefore, I have examined the latter eight books of Aetius in the Latin translation, and although they contain some of the most interesting information to be found in the whole work, I have been very chary about laying stress on any deductions drawn from the Latin translation only. It may be noted that there are two ways of referring to the different books in Aetius, according to whether the Greek text or the translation of Comarius is meant. Cornarius arranged his version in four tetrabibli of four books each, whereas the Greek text is simply numbered from i-viii; ‘No vii.’ of the Greek text is, therefore, called by Cornarius’ Tetr. ii. lib. iii.’ The eleventh book was published by Daremberg in his edition of Rufus (1879), and the twelfth book was published by Costomeris at Paris in 1892.
Pliny the Younger. Plinius Secundus (Rose, Leipzig, 1875). The writings of Pliny contain little information of any kind and are absolutely of no use for our purpose.
Scribonius Largus (45 A.D.). The edition I have examined is named ‘Scribonii Largi Compositiones’ and is edited by Helmreich, Leipzig, 1887. The work of Scribonius Largus is entirely pharmaceutical, but he gives many references to appliances by which medicaments were prepared in the surgery.
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. Aldus published the text by Cornarius at Venice in his collection of Medici Antiqui (1547), republished by Stephanus (Medicae Artis Principes), 1567. The edition I have used is that of Helmreich (Leipzig, 1889).
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. The edition I have used is that of Rose, Leipzig, 1894. To this edition are tacked on the medical remains of Vindicianus Afer, mere fragments without anything to interest us.
The works of Alexander Trallianus (526-605 A.D.) contain practically no surgery at all, although I have managed to extract a few references of minor interest.
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. Aldus published the entire Greek text at Venice in 1527. A fine English translation, with a most valuable commentary, was published by Adams of Banchory for the Sydenham Society in 1846. No one who reads it can wonder that Adams had a worldwide reputation for his knowledge of medical history. The important sixth book was published along with a translation in French by Briau at Paris in 1855.
I have obtained a description of two very important instruments from the works of Hero of Alexandria (285-222 B.C., ed. 1575). 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.
It were a work of supererogation to recount the names of the other Greek and Roman writers whose works I have run through in a profitless search for references to instruments. Some of these, such as Dioscorides, are of great importance in themselves though valueless for our purpose. Others, such as many of the minor Greek writers contained in the collection by Ideler entitled Physici et Medici Graeci Minores (Berlin, 1841), and the minor Latin writers contained in the collection of Medici Antiqui Omnes (Aldus, 1547), are of little value of any kind.
Before the capture of Alexandria by Omar in 651, many Greek medical writings had been translated into Syrian. At a later date such of these as had escaped destruction were turned into Arabic by the scholars of Bagdad (Honain and his School), in the ninth century. These, introduced into Spain in the Middle Ages by the Moors, were again translated into Latin and supplied for many a day the greater part of the medical knowledge of Europe, until the study of the few Greek texts which had escaped destruction showed the true origin of Arabian medicine. It will thus be seen that there is some information, in fact a great deal, to be had from the study of the works of the Arabs, but the barbarous style of the Latin and the roundabout way in which the works have been preserved, having passed through translations of three different languages, preclude any very exact deductions being drawn from them. Some of these works are profusely illustrated with figures of instruments, but I have been careful not to fall back on any of the Arabs except to support deductions drawn from more direct sources.
The chief Arab writers of interest to us are:Serapion (800), Rhases (882), and Ali Abbas (after 950), all of Honain’s School at Bagdad. The huge work of Avicenna (born 980), The Canon, was much used by the Arabs. It was published at Cordova, which became the Bagdad of the West after the Arabs crossed to Spain in 811.
The work of Albucasis (ob. 1106) was also published at Cordova, and contains much surgical information and has many illustrations of surgical instruments, but these must be used with due caution. I have used the edition published at Strasburg in 1532.
A word must be said of the later writers such as Paré (1509-90), Scultetus (1650), and Heister (1739). The works of these are profusely illustrated with instruments, some of which can plainly be seen to tally exactly with the descriptions of the classical authors. In other cases, although the names given to the instruments are those of classical times, it is, to say the least, doubtful whether they are of the same form as the ancient instruments whose names they bear. That was an age of great activity in the manufacture of new forms of surgical instruments, and we must accept with caution illustrations professing to indicate ancient forms of instruments. At the same time it is very interesting to note the large number of primitive arrangements which remained in use till nearly 1800. The enema syringe figured by Heister is exactly the same as we find described in the Hippocratic worksthe bladder of an animal affixed to a tubeand many practitioners alive at the present day have seen the same simple arrangement in actual use.