A Set of Roman Medical Instruments From Italy

A Set of Roman Medical Instruments from Italy
Author(s): Ralph Jackson and Susan La Niece

Source: Britannia, Vol. 17 (1986), pp. 119-167
Published by: Society for the Promotion of Roman Studies
Stable URL: http://www.jstor.org/stable/526543 .
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A Set of Roman Medical Instruments
from Italy
By RALPH JACKSON
INTRODUCTION
I N 1968 a fine and extensive group of Roman surgical and medical instruments (PL.XI)was
purchased by the British Museum from a London antiquity dealer.' With one or
perhaps two exceptions (Nos. 39, 33 below) there is little doubt that they comprise a
surgeon's instrumentarium which includes many normal types but also some very rare
objects: the three catheters are the largest set of such instruments to be found; the speculum
is only the third complete provenanced example of its type, while the bone chisels and sharp
spoon have few known parallels; the double blunt hook is one of the finest examples of this
rare class of object; the handled needles significantly increase the number of such specialist
instruments; the small tanged cautery is one of the very few survivors of a type of
instrument that was extremely common in Roman surgery: and the segmented form of one
of the medicine boxes is as yet unparallelled.
With almost forty objects this is one of the largest and richest sets yet found and
constitutes a major addition to the study of Roman surgical instruments. It is, therefore, to
be regretted that little information exists on the circumstances of discovery, the findspot
being recorded simply as 'Italy'. While such a provenance poses no difficulties and indeed
gains some support from the instruments themselves, it tells nothing of the precise context
of the set. That this is very likely to have been a tomb is indicated by the survival together of
such a large number of instruments and by the similarity of the corrosion products upon
them (see p. 164 ff. below). Furthermore the presence of soil particles within the mouldings
of several of the instruments and the comparatively fresh appearance of the corroded
surfaces would suggest that the discovery might have been made no very great time before
1968.
Apart from the Pompeii/Herculaneum assemblage, and site groups from a small number
of military hospitals, including Baden and Neuss (few of which, however, are specialist
instruments), as well as one or two other exceptional finds like that of the 'Paris surgeon',
the great majority of instrument groups has been found in graves. Ernst Kiinzl has
published 78 of these in his important study of medical instruments from Roman graves.2
There is a concentration of these graves in Gallia Belgica and the two Germanies, with an
apparent paucity of material in the Mediterranean provinces, Italy included. The explana-
tions of this phenomenon are undoubtedly several and complex, but amongst them may be
1 Brit. Mus. registration nos. GR 1968, 6-26, 1-39. At the time of writing they are on display in the 'Greek and
Roman Life' room of the British Museum.
2 E.
Kiinzl, Medizinische Instrumente aus Sepulkralfunden der romischen Kaiserzeit (Bonn, 1983) (off-printed
from Bonner Jahrbiicher clxxxii (1982), Iff.).

120 RALPH JACKSON
presumed to be the varying nature of ancient burial practice as well as the relative scale of
recent archaeological activity. The known Italian medical grave groups include a number of
interesting instruments, not least the bone forceps and elevator in the set from Luzzi,3 but
all are comparatively small groups. The present instrumentarium, larger than all of these, is
thus of considerable importance and is exceeded in size only by one other set, the grave
group from Bingen, near Mainz,4 which comprises over fifty pieces, though not all of certain
medical use.
The non-archaeological means of discovery of the present set may well account for a
number of notable absences. There are, for instance, no indeterminate fragments nor any
specifically non-medical objects of the kind often encountered in Roman medical grave
groups. For whatever reason, if any such objects existed they must have become separated.
More particularly there is neither a bleeding cup nor any other metal vessel. These are by
no means invariably found with sets of medical instruments, but they might have been
anticipated in a set as large as the present one. However, thin sheet metal, if it survives at
all, requires considerable care during and after excavation and such conditions are unlikely
to have prevailed in the present case. There is, in fact, some evidence to suggest that the set
did originally contain at least one sheet metal object (see p. 158) no longer in existence, and
it is probable that controlled-excavation would have yielded further traces of this, of the
wooden scalpel box (see pp. 135 f. below) and, perhaps, of other similarly vulnerable arte-
facts. However, it is important to bear in mind also the partial picture conveyed by the
surviving evidence even when it has been retrieved under optimum conditions. Medical aids,
instruments and apparatus made of organic materials rarely survive although they are
frequently mentioned in the classical medical literature. They include wooden directors,
dilators, sounds, spatulae, splints and ointment boxes, cloth tourniquets, horn pessaries,
and quills for the application of powdered medicaments or extraction of warts. It would be
surprising if none such had originally formed part of the present set.
Furthermore, it is by no means certain, if indeed the present set does derive from a tomb,
that a surgeon's complete instrumentarium is in question. Kiinzl's study of Roman medical
grave groups5 demonstrates the wide variety in size of these groups, some of which have a
very restricted range of instruments. It is preferable to view some, perhaps most, as 'token'
groups, rather than as complete instrumentariawhose limited size would have placed severe
constraints on the surgery their owner could have undertaken. Nonetheless, the size and
composition of the present set imply if not a complete instrumentarium then one which is
substantially so.
Chronologically the set belongs to the earlier Principate, probably to the first or early
second century A.D.It has, therefore, seemed particularly appropriate to consult above all
of the classical medical works the De Medicina of the encyclopaedist A. Cornelius Celsus.6
Written in Italy under Tiberius it has a particular relevance, both geographically and
chronologically, to the present set and helps to clarify the use of many of the instruments.
P.G. Guzzo, Not. Scavi xxviii (1974), 449ff.

43 J. Germania ix (1925),
Como, 152-162.
5
6
op. cit. (note 2).
Celsus, De Medicina, English translation by W.G. Spencer, Loeb Classical Library.

A SET OF ROMAN MEDICAL INSTRUMENTS FROM ITALY 121
CATALOGUE
[Unless described otherwise all objects are of copper or its alloys. Metal analyses in Table 5
below.]
I. Scalpel/blunt dissector, Type I (FIG. I)

The leaf-shaped blunt dissector has a pronounced median ridge on each face giving a
markedly lozenge-shaped cross-section. The plain rectangular grip has rolled back
terminals and the tang of the iron blade is still in position. Although surface corrosion
obscures the fixing, radiography confirmed that it is of 'keyhole' type. Corroded to the
iron are fragments of mineralised wood (see p. 135 fn. 33 below), the grain running on
the main axis of the grip. There is a small patch of iron corrosion on one face of the
dissector.
L. 9-05 cm. Grip W. I-o cm. (Brit. Mus. reg. no. GR 1968, 6-26, 2)
2. Scalpel/blunt dissector, Type I (FIG. I)

A stout example whose short, broad, leaf-shaped dissector has a pronounced median
ridge on each face. The plain rectangular grip, with rolled back terminals, has a patch
of iron corrosion on one face. The iron blade tang remains in the 'keyhole' socket, and
there are mineralised wood remains on both sides of the grip (see p. 135 fn. 33 below).
L. cm. Grip W. o-9 cm. (GR 1968, 6-26, 5)
5"5
3. Scapel/blunt dissector, Type I (FIG. I)
The proportionately large leaf-shaped dissector has a median ridge lower on one face
than the other. The plain rectangular grip has rolled back terminals and a variant of
the 'keyhole' blade attachment with the iron tang still in position. Fragments of
mineralised wood adhere to one side of the grip and there are small patches of iron
corrosion on one face of the grip and dissector.
L. 8-3 cm. Grip W. 0o8 cm. (GR 1968, 6-26, 3)

The leaf-shaped dissector has a low median ridge on each face, on one of which is a
patch of iron corrosion. The plain rectangular grip has rolled back terminals and a
variant of the 'keyhole' socket with iron blade-tang in situ. There are fragments of
mineralised wood on one side. Scratch marks on one face may have been left by a file
at the finishing stage of manufacture.
L. 7.6 cm. Grip W. 0-77 cm. (GR 1968, 6-26, 4)

The long leaf-shaped dissector, which has a distinct median ridge on each face, is
slightly bent. The plain rectangular grip, long and slender, has rolled back terminals
and narrow 'keyhole' blade attachment with iron tang corroded in position. Fragments
of mineralised wood adhere to the sides, while a patch of iron corrosion is present on
one face of the grip and dissector.
L. 9.43 cm. Grip W. 0-7 cm. (GR 1968, 6-26, i)
6. Scalpel/sharp spoon (FIG. I)

A long, slender, thin-walled spoon or scoop with rounded V-section and upturned tip.
The grip, at the base of the spoon, is rectangular with finely cast mouldings. Its
terminals are broken but were probably of rolled back type. The broken 'keyhole'

122 RALPH JACKSON
14
7 12
.......10 11
9
5lcm
I I 1 i I I I
FIG. I. The scalpel handles and forceps, Nos. 1-12. Scale 1:2.

attachment still retains fragments of an iron tang, and traces of mineralised wood
adhere to one face.
L. 6-33 cm (broken). (GR 1968, 6-26, 9)
7. Scalpel/blunt dissector, Type II (FIG. I)

The slender, thin, leaf-shaped dissector has one flat face, the other with a very low
median ridge. The long, slender, octagonal-sectioned grip is flanked by multiple
ring-and-disc mouldings. The tang of the iron blade is corroded in position in the
simple slot socket which has a neatly chamfered end. There is a patch of iron corrosion
on one face of the dissector.
L. 11i6 cm. Grip W. 0-45 cm. (GR 1968, 6-26, 8)

The slender leaf-shaped dissector has a very low median ridge on each face. Otherwise
this example is identical to, though smaller than, No. 7.
L. cm. Grip W. o*42 cm. (GR 1968, 6-26, 6)
11"45
In form identical to Nos. 7 and 8, but smaller than both. A small iron blade fragment
adheres to the end of one face of the dissector.
L. 11-3 cm. Grip W. o039 cm. (GR 1968, 6-26, 7)
io. Smooth-jawed fixation forceps/(?)scalpel (FIG I)

A small simple forceps. The arms are short with a stepped shoulder and the jaws are
inturned with straight edges a little wider than the arms themselves. The second
element of this combination instrument, probably an iron blade, has corroded away,
but its iron tang survives in the slot socket cut through the multiple-ring moulding.
There is a patch of iron corrosion on the inner face of one of the forceps arms.
L. 8*25 cm. (GR 1968, 6-26, Io)
Ii. Toothed fixation forceps/ (?)scalpel (FIG.I)

A small coud6e type forceps whose thin, flat arms terminate in broad, angled,
inturned jaws with fine interlocking teeth, ten each side, the tips of most now
damaged. A thin band of corrosion marks the position of the small rectangular slide
when found. At this point the jaws are held in the 'locked' position. Like No. Io, this
forceps is part of a combination instrument, with the tang of an iron component,
probably a scalpel, held in the slot socket cut through the multiple-ring moulding.
L. 7.75 cm. (GR 1968, 6-26, I1)
12. Pointed-jawed forceps (FIG. I)

The long slender arms with carefully chamfered outer edges taper to thin pointed
jaws. Above the plain shoulder is a double-ring-and-baluster finial. The broad circular
slide is unlikely to be an original feature. It is ill-fitting and disproportionately large
and may originally have been a binding-ring or collar for the end of a tanged organic
handle. A white fibrous substance adheres to its inner face.
L. 14'15 cm. (GR I968, 6-26, 12)
I3. Sharp hook (FIG. 2)

Beneath the large, button-shaped finial the upper stem or grip is divided into two
unequal zones by a ring-and-squat-baluster moulding. In both zones the grip has a

124 RALPH JACKSON
very finely cut multi-faceted surface. A simple disc moulding, near the centre of the
instrument, separates the grip from the lower stem, of octagonal cross-section, which
tapers to a fine, sharp-pointed hook.
L. 14-o5 cm. (GR 1968, 6-26, 21)
14. Sharp hook (FIG. 2)

A multiple-ring-and-disc moulding divides the upper and lower stem. The upper stem
or grip, of circular cross-section, has a distinct 'waist' beneath the disc-and-baluster
finial. The lower stem, of octagonal cross-section, tapers to a fine, sharp-pointed
hook.
L. 12*4 cm. (GR 1968, 6-26, 22)
15. Sharp hook (FIG. 2)

A simple example with octagonal-sectioned stem, tapered in both directions from its
point of maximum girth. The lower stem terminates in a fine, sharp-pointed hook.
Most of the upper stem or grip is missing, together with the finial.
L. 11-76 cm (broken). (GR 1968, 6-26, 23)
16. Double blunt hook (FIG. 2, PL. XIIB)

A finely made, Z-shaped instrument with elaborately decorated stem and blunt,
spatulate, hook terminals bent back in opposing directions. The central ring-and-
foliate moulding is flanked by a finely engraved candy-twist decoration, beyond which
the stem tapers to form a swansneck loop at the back of each hook. Both hooks are of
plano-convex cross-section, with a marked median ridge on the outer (convex) face.
One is of rounded leaf shape; the other, of angular kite shape, is bent to a more acute
angle with the stem than the former. There is a patch of iron corrosion on the loop
behind the kite-shaped terminal.
L. 15-85 cm. (GR 1968, 6-26, 13)
17. Bone chisel (FIG. 2, PL. XIIB)

The octagonal-sectioned handle is very slightly waisted. Its lightly domed head bears
only slight traces of burring. The narrow iron blade, of rectangular cross-section, has a
slightly splayed cutting edge preserved well enough to show that it is lightly bevelled
on one face.
L. 15*25 cm. (GR 1968, 6-26, 19)
18. Bone chisel (FIG. 2, PL. XIIB)

Almost identical to No. 17. Although slightly shorter in overall length, the width of
the cutting edge appears to have been the same. The octagonal-sectioned handle has a
more pronounced waist and the head is more heavily burred.
L. 15-o cm. (GR 1968, 6-26, 20)
I9. Anal speculum (FIG. 2, PL. XIIA)

A small bivalve dilator, or speculum ani. When together the handles, of plano-convex
cross-section, form a slender, elongated tear shape, their tips carefully tapered and
rounded. The arms do not cross but pivot on a simple strong hinge secured by a central
rivet and two ribbed disc washers. Beyond the pivot the arms, of softened rectangular
cross-section, terminate in a carefully rounded end. To one side, above a slight
shoulder, the two slender blades (valves) project perpendicularly to the arms. They
are of solid semi-circular cross-section with carefully tapered, rounded, blunt tip.

17 18
7
13 14 15 -
161
---
0 5 15cm
I I i 11I
FIG. 2. The hooks, bone chisels and speculum, Nos. 13-19. Scale I:2.

126 RALPH JACKSON
When closed the tips meet, but a slight gap between the blades, increasing towards the
arms, gives a tapered priapiscus of round or sub-oval cross-section. There is a band of
iron corrosion around one of the blades, perhaps the remains of a dislodged collar or
slide.
L. I5-6 cm. L. priapiscus, tip to shoulder, 6-5 cm. Max. outer distance, open, between
blade tips, cm. Max. outer distance, open, between blades at shoulder, 5-4 cm.
4"4
Diam. of blade tips, closed, 0o8 cm. Diam. of blades at shoulder, closed c. I-o cm.
(GR 1968, 6-26, 27)
20. Male catheter (FIG. 3)
The characteristic S-shaped tube has a slender oval eye on the inner curve just above
the neatly tapered and rounded tip. It is made from a rolled strip whose butt join is
just visible over the whole instrument, except in the region of the eye where
considerable care was taken in the closing and smoothing of the seam. Wherever the
original metal surface survives it can be seen to be both even and very smooth. At the
top a small, lobate, plate-like bracket or collar encircles the end of the stem. It has
been soldered in place and may have been intended both for manipulation of the
instrument and to prevent the butted seam from pulling apart at the neck, its weakest
point.
L. 28.0 cm. Stem diameter, outer, 0-49-0-51 cm. (GR 1968, 6-26, 24)
21. Male catheter (FIG. 3)

The form is almost identical to No. 20, but this example is both longer and more
strongly curved. The eye is slightly smaller, and the butt seam is discernible only at the
neck and within the patch of corrosion, where it has parted slightly. A tiny patch of
white metal at the neck is probably a remnant of solder used to attach a small bracket
of the kind seen on No. 20.
L. 30.25 cm. Stem diameter, outer, 0-51-0-52 cm. (GR 1968, 6-26, 25)
22. Female catheter (FIG. 3)

The short, gently tapered tube is lightly curved at its lower end with an oval eye on the
inner curve, just above the neatly rounded tip. Like the two male catheters this
instrument was made from a rolled strip, and the carefully smoothed butt join can be
discerned over the entire length, particularly below the eye where corrosion has
forced the edges slightly apart.
t cm. Stem diameter, outer, 0-51-0o59 cm. (GR 1968, 6-26, 26)
L. t-4
23. C -ract needle (FIG. 3, PL. XIII)

An extremely fine instrument with circular-sectioned spirally cut stem. At one end is a
slender round-pointed needle beneath a disc-moulded shoulder. At the other end a
large olivary probe extends beyond a multiple-disc-and-baluster moulding.
L. 14.15 cm. (GR 1968, 6-26, 31)
24. Needle-/cautery-holder (FIG. 3, PL. XIII)

The slender grip of a double-ended instrument. Either side of the central multiple-ring
moulding the stem (grip) is of plain, circular cross-section. A simple ring moulding
separates both upper and lower stem from its socketed terminal. One terminal is
straight, with a sub-oval socket, c. cm wide internally; the other is angled, with
flattened sides and a sub-triangular 0"25
socket, c. 0O25 cm. wide internally.
L. cm. (1968, 6-26, 36)
I4"o

20 21 23
22 0
-
S24
I -o
26
25
O 5 15cm
i r I i 1I
FIG. 3. The catheters, handled needles, cautery and stylus, Nos. 20-26. Scale 1:2.

128 RALPH JACKSON
25. Iron cautery (?) (FIG.3, PL.XIIC)

The slender tang, of square cross-section, is broken short. It bears mineralised traces
of its wooden handle. Beyond the tang the stem is circular-sectioned with a plump
ring-and-band moulding terminating in an elongated baluster with small spatulate
end. Despite some corrosion, the spatulate end appears to be both substantially
complete and blunt-edged.
L. cm. (GR 1968, 6-26, 34)
6"95
26. Iron stylus (? cautery) (FIG. 3)
A plain, circular-sectioned stem, now distorted, with broad, tulip-shaped eraser/
spatula and broken point. The breakage and distortion probably occurred after burial.
L. 11-5 cm. (GR 1968, 6-26, 33)
27. Dipyrene (FIG. 4)

A very slender, double-ended olivary probe. The olivary tips are narrow and
elongated, while the flexible circular-sectioned stem is a mere o013 cm in diameter.
L. 16i15 cm. (GR 1968, 6-26, 17)
28. Ligula (FIG. 4)

A very slender-stemmed example of normal form, one end terminating in a simple
point, the other in a small, circular, angled plate. Just below the point of maximum
girth of the plain, circular-sectioned stem is a simple paired-ring moulding. There are
traces of iron corrosion on the lower stem.
L. 15-8 cm. (GR 1968, 6-26, 28)
29. Ear probe (FIG. 4)

The slender upper stem, of plain circular cross-section, is broken at one end. At the
other end, beyond a reel-and-baluster moulding, the spirally engraved stem tapers
towards a tiny circular spoon. After discovery, but before its acquisition by the British
Museum, this piece was cleaned. Probably at the same time an unsuccessful attempt
seems to have been made to repair the stem; there is a trace of solder on the broken
end and a marked blackening of the adjacent stem. It has not proved possible to find a
prospective join with any of the other broken instruments in the set.
L. 9-o cm (broken). (GR 1968, 6-26, 29)
30. Scoop probe (FIG. 4)

The mouldings divide this finely made example into three zones - grip, olivary probe
and scoop. The slender grip is of square cross-section with finely swaged corner
moulding at each angle. The scoop is separated from the grip by a multiple-ring-and-
squat-baluster moulding, while at the other end the dlivary probe (which is covered in
iron corrosion) projects beyond a small double-ring moulding.
L. 16-5 cm. (GR 1968, 6-26, 18)
31. (Scoop) probe (FIG. 4)

The plain, tapered stem, of circular cross-section, terminates at one end in a blunt
point which may have been re-worked. At the other end is a multiple-disc-and-
hourglass moulding surmounted by a lattice-engraved baluster broken (in antiquity) at
the neck. The missing part was probably a scoop, while the opposing end may have
comprised a plain probe, as now, or an olivary tip.
L. cm (broken). (GR 1968, 6-26, 32)
12-35

27 28 30
31
32
29
0-
33
34
15-
35
O-
- - cm
FIG. 4. The probes, scoops, spoon and spatulae, Nos. 27-35. Scale 1:2.

130 RALPH JACKSON
32. Spoon (FIG.4)

The tip of the slender, tapered handle is broken. The thin-walled circular bowl has a
white-metal coating on both faces. On one side the rim is chipped and slightly
distorted.
L. 12*5 cm (broken). (GR 1968, 6-26, 30)
33. Spatula probe (FIG.4)

A double-ring moulding separates the olivary tip and its long, slender stem from the
grip. At the other end a multiple-ring-and-squat-baluster moulding precedes the
spatula with its spirally engraved neck. The spatula is plano-convex in cross-section
with a marked median ridge on one face. In profile it has a clear concavo-convex
curve. The grip has been adorned with a carefully applied tubular sheet covered with
fine linear engraving. The butted vertical seam is clearly visible.
L. I9-8 cm. (GR 1968, 6-26, 14)

A plain example of normal form with slender leaf-shaped spatula and large,
blunt-ended olivary probe. The grip, of octagonal cross-section, has a patch of iron
corrosion. The spatula, turned slightly to one side, has a plano-convex cross-section.
In profile, like No. 33, the spatula has a concavo-convex curve.
L. I8-6 cm. (GR 1968, 6-26, 15)

A small, plain example with slender olivary tip, octagonal-sectioned stem, and small
oval spatula of plano-convex cross-section. In profile the spatula is turned slightly to
one side. There is iron corrosion on the olivary tip.
L. cm. (GR 1968, 6-26, 16)
15"55
36. Cylindrical box system (FIG. 5, PL. XIV)
A large example comprising four stacked segments: I) lid, with plain, 'dimpled' end, II)
box, open at the top and rebated at both ends, IiI) box, open at the top and rebated at
the lower end, Iv) base, with recessed, concentric ring decoration on the end. The
contrast both in patina and decoration between I-IIIand Iv makes it clear that the latter
is of different origin. I is removeable and reveals a solid, powdery, buff-coloured
substance within Segment II. All segments are decorated with simple girth rings.
L. i, 5-75 cm; ii, 6-o cm; IIi, 5-8 cm; Iv, 4.55 cm. Diam. 2-9-3-0 cm. (GR 1968, 6-26,
37)
37. Cylindrical box (FIG. 5)
A short example. The end of the base segment is plain, while that of the lid bears
engraved concentric ring decoration. The interior is empty.
L. maximum, c. 14-5 cm, minimum, o10-5cm. L. lid, 4-75 cm. L. base, 9'55 cm.
Diam. I-9-2-0 cm. (GR 1968, 6-26, 38)
38. Stone palette (FIG. 5)

A comparatively small, narrow rectangular example, of fine-grained grey stone.
Although the facet angles on the underside are rounded off, and three of the corners
were chipped in antiquity, there is little sign of wear on the working face, and saw/file
marks are still visible on the squared-off edges. The long sides and part of the working

38
36
37
15 39
II
IV
5
O-
cm
•
FIG. 5. The cylindrical boxes, palette and folding knife, Nos. 36-39. Scale 1:2.

132 RALPH JACKSON
face are stained with iron corrosion, and a small stripe of copper corrosion is present
on the underside.
L. 8-2 cm. (GR 1968, 6-26, 39)
39. Folding knife (FIG. 5)

The clasp/handle comprises a sawn bar. At one end is a worn and somewhat crude
multiple-ring-and-baluster moulding terminating in a circular eyed plate, in which is
held a simple butted ring. At the other end a knife blade is hinged on a small rivet
which also secures the handle plates. The blade is small, thin and apparently heavily
whetted, with a burred tip.
L., blade extended, 17.4 cm. (GR 1968, 6-26, 35)
DISCUSSION
Scalpels, Dissectors and Sharp Spoon (Nos. 1-9; FIG. I, I-9; PL. XI)
The surgical knife or scalpel is the surgeon's instrument par excellence. Boxed scalpels and
the bleeding-cup, potent symbols of the medical profession, were the instruments most
commonly chosen to be depicted on the tombstones of Greek and Roman surgeons.7 By the
Roman imperial period the scalpel had acquired the characteristic overall form which it was
to retain for many centuries, an iron/steel blade with bronze handle normally terminating in
a blunt dissector. Both components were variable in shape and size resulting in a few
common types with many variants. Through the inadequacy of classical descriptions and the
scarcity of surviving blades it has seldom proved possible to link any surviving scalpel of the
period with any one of the many different knives specified for particular operations in
classical medical literature. Taking the evidence both of depictions in stone and of scalpels
with surviving blade, however, the commonest blade shape appears to have been deep
bellied or sub-triangular. Where discernible the cutting-edge is on the front alone or on the
front and underside of the belly. Of the 9 scalpel blades in the Bingen instrumentarium, for
instance, 7 are bellied/sub-triangular,8 and 3 of the 5 scalpels in the instrument box depicted
on the tombstone of the medicus P. Aelius Pius Curtianus9 are of the same type. The form
was clearly suited to the majority of surgical work. Other blade shapes, again represented
both by surviving examples and on stone reliefs, comprise straight-edged, concave, convex
and hooked types in a variety of shapes and sizes. o
Many Roman surgical instruments were double-ended, and the scalpel is no exception.
Almost invariably the handle is in the form of a second instrument, a leaf-shaped spatula of
variable length, width and thickness. Its use as a blunt dissector is recorded time and again
by the classical medical writers, as in Celsus' description of surgery of the scrotum:"
'Now wherever the disease is found to be, the assistant should press the scrotum gently
upwards; the surgeon either with his finger, or with the handle of the scalpel (manu-
briolove scalpelli) separates the middle tunic from its connexion with the scrotal wall, and
brings it forwards;'
or in his description of an operation for the removal of dermoid cysts:12
7 M. Tabanelli, Lo strumento chirurgico e la sua storia (Milan, 1958), pls. 10-15.

8 Como, op. cit.
(note 4), fig. 2.
9 Tabanelli, op. cit. (note 7), pls. XIII-XIV.
1o See, for example, ibid., pls. XII, XIV, XV, XIX-XXI.
" op. cit. (note 6), vii, 19, 7.
12
ibid., vii, 6, 4.

'Then as soon as the white and tight coat is seen, it is to be separated from the skin and
flesh by the handle of the scalpel, and turned out together with its contents.'
The grip which united blade and dissector usually took one of two main forms, one
slender, the other of more robust construction. The slender form (Type II) has a plain,
narrow, octagonal-sectioned stem only rarely with any form of decoration. The leaf-shaped
blunt dissector terminal is almost invariably slender, sometimes excessively so. The other
type (Type I), the most frequently encountered grip, is a plain rectangular bar, of variable
dimensions. It is simply an extension of the socket for the tanged blade. The two sides
provide a flat field which was occasionally decorated with inlaid floral or faunal designs. The
leaf-shaped dissector varies in shape and size from short, broad examples to long slender
ones.
A simple cut slot-socket for the blade is commonly found on Type II scalpels but is less
frequently encountered on those of Type I. Instead a more elaborate fixing comprises a
keyhole-like socket, often with rolled back terminals which sometimes form hollow 'tubes'.
A thin version of this socket type occurs on some Type II scalpels. For long an explanation
of this unusual but diagnostic feature has been in existence:13
'It is generally believed that the blades were fixed in the handle by a binding thread or
wire, and that the rolls and perforations were to give security to the mounting used. This
detachable arrangement would allow removal for cleaning, and also permit one handle
to be used with several varieties of blade'.
Whilst noting the current explanation Milne was disinclined to accept it, yet widespread
belief in this odd arrangement has continued up to the present. In fact it is extremely
unlikely that the keyhole blade fastening was ever intended to be temporary in the manner
described above. Had the blades really been easily interchangeable there would have been
little need for the 13 handles in the Bingen instrumentarium,14 all found with blade or blade
fragment in place (none of which bears any trace of wire binding), or even the 6 handles
with Type I grips in the present set (Nos. 1-6). It is also difficult to reconcile the suggested
makeshift binding, required to hold a temporary blade firmly in place, with the careful
function-specific design of other contemporary surgical instruments. Nor is it necessary to
invoke a practical use for the rolled terminals: few of the copper-alloy surgical instruments
of this period were without decoration, normally cast or cold-worked mouldings. Indeed a
similar rolled moulding occurs on some forceps's where nothing other than decoration was
intended. Furthermore, close examination of a Type I scalpel handle from London16 reveals
that it was probably cast on the iron blade and would have been impossible to detach other
than with smiths tools, while two Type I scalpels from Xanten17 and several of those in the
present set (see p. i6I below), bear remains of the solder used to secure the blade in its
socket.
In the case of Nos. I, 2, 5 and 6 the socket is of normal keyhole form with a slot
terminating in a cylindrical hole which passes through the width of the grip. With a vertical
rod-like terminal to its tang the iron blade could be slotted into the keyhole socket and the
two hammered firmly together. Alternatively, as seems to have occurred on the present
examples, a simpler tanged blade without the rod terminal could be fitted using solder as a
13 J.S. Milne, Surgical Instruments in Greek and Roman Times (Oxford 1907, reprinted Chicago, 1970), 24.
14 Como, op. cit. (note 4), fig. 2.
15 eg. Rheims: Kiinzl, op. cit. (note 2), fig. 34, 14.
16
Museum of London, A 6817.
17 Rheinisches Landesmuseum, Bonn.

134 RALPH JACKSON
bonding agent. Scalpels 3 and 4 demonstrate a variant of the keyhole socket. An angled-slot
was cut from top and bottom of the grip leaving a projecting uncut wedge within. A
corresponding wedge-shaped indentation in the end of the blade tang would have enabled a
precise and rigid fit. To hold the two in position solder was poured into the join by means of
a small, circular hollow drilled at the extremity of the slot from both the top and bottom
face. Analysis has shown this to be a soft solder of tin and lead (p. 161 below).
The fixing of the blade in these keyhole sockets was not, then, temporary. Whichever of
the various methods was employed, the union of blade and handle would be semi-
permanent, and the blade would only need to be removed if broken or whetted beyond use.
On these occasions, with a combination of hammer, punch and heat, the old blade could
normally be removed and a new one substituted. Although this might have been done by
the surgeon himself it is perhaps more likely, at least in an urban context, that it was carried
out by a metalsmith or cutler, perhaps by the instrument maker himself. A terra-cotta relief
from a second-century A.D. tomb on the Isola Sacra, Ostia,18 commemorates the work of
one such specialist smith, who probably made, sold and reconditioned iron implements. He
is depicted twice, both making and sharpening tools, and is surrounded by finished items or
those awaiting repair. They comprise almost exclusively cutting instruments, both domestic
utensils and craftsmens' tools and include a small boxed set of scalpels. These may have
been newly manufactured or alternatively may have had their blades reforged or replaced.
That simple replacement did not alwaysprove possible is demonstrated by a scalpel with
Type II grip from Neuss, Romerlager,l and another with Type I grip, of uncertain
provenance, in the Zentralmuseum, Mainz.20 In both these instances the blade had stuck
fast in the socket and could not be removed so that it had to be cut off flush with the socket
terminal, and a fresh socket cut at right angles to receive the new blade.
The robust keyhole socket of many Type I scalpels is in marked contrast to the short,
slender, simple slot-socket most often found on scalpels with the Type II grip. With such a
small bond between the handle and blade of these scalpels there can be no doubt that the
blade was attached permanently, although as with Type I scalpels, it must normally have
been possible to re-use the handle of a worn or broken blade. Scientific examination has
revealed that the blades of the Type II scalpels in the present set (Nos. 7, 8, 9), like those of
the Type I scalpels, were held in place with a soft solder.
The difference in socket type may imply a difference in function and there are a number
of indications in support of this. The slightness of the socket of Type II grips is in keeping
with the dimensions of the rest of the handle whose dissector is normally very slender and
the grip narrow. It is clear that these scalpels could not have withstood the sort of pressure
which might be applied to the Type I examples, and their use was probably restricted to fine
surgery. That their blades were generally smaller and thinner than those of Type I scalpels
may be inferred from the comparative infrequency of their survival. Two from Asia Minor21
and one from Luzzi22simply bear small examples of blades of the common bellied form, but
three scalpels from Wehringen, Bavaria,23 each with a different tiny blade of characteristic
form, appear to be specialist instruments. They are part of a small leather-cased set, found
with an inhumation, consisting also of forceps, a sharp hook and an elevator. One of the
scalpels is closely comparable to the drawing of a pterygotome with small, narrow,
18 R. Meiggs, Roman Ostia (Oxford, I960), pl. XXVII, a.

19 Rheinisches Landesmuseum, Bonn, Inv. no. 11846.
21
Inv. no. 0.22534.
21 R6misch-Germanisches Zentralmuseum, Mainz, Inv. nos. 0o.38210-I.
22
Guzzo, op. cit. (note 3), fig. 32, 91.
23
Kiinzl, op. cit. (note 2), fig. 96, 2.

sharp-pointed blade which accompanied Albucasis' translation of Paul's description of the

operation to cure pterygium.24 At least one of the other two Wehringen scalpels would also
be well suited for eye surgery, perhaps implying that the surgeon was an oculist.
A little supporting evidence for this link between the Type II scalpel and eye-surgery comes
from an analysis of the groups of surgical instruments from burials published by Kiinzl.25 Of
the four groups which contain several Type II scalpel grips, three also include instruments
indicative of eye surgery - Nijmegen: handled needles, double needle-holder;26 Rheims:
handled needles, collyrium stamp, collyria pieces;27 Asia Minor: cataract needle.28 The Asia
Minor set also includes lithotomy instruments, however, and these associations probably
only indicate the use of Type II scalpels in delicate surgery. With so few blades available for
study it would certainly be incautious to say more. The present set cannot bring further
information to bear on the matter. The double needle-holder (No. 24) need not have been
restricted to, if used at all for eye-surgery, and the three Type II scalpel handles are perhaps
more reasonably viewed as part of a fairly comprehensive range of scalpels.
The eight dissector handles of the scalpels in the present instrumentarium are all slightly
different in shape, length or thickness and may have been intentionally selected or
commissioned as a graded set. The same wide variety is seen in the dissectors of the other
large group of scalpels from a single closed find, the 13 examples from Bingen.29 As the
scalpel blade survives so rarely in comparison to the handle it would clearly be of interest if
its shape and form could be inferred from that of its grip and dissector. Apart from the
differences between blades of Type I and Type II handles discussed above, however, the
evidence both from the Bingen set, nine of whose blades survived intact, and from other
finds of complete scalpels, is that no such simple inference can be made. The only possible
exception is the broad, short, thick leaf-shaped dissector of No. 2. The only complete
parallels, one of the Bingen scalpels,30 one from Pompeii,31 and another in the Wellcome
Museum,32 all have long straight blades with cutting edge angled gently upwards to the tip.
It is probable that a similar blade was fitted to No. 2. Otherwise, apart from a not
unexpected tendency towards larger blades for the broader grips, there is little else at
present discernible.
In conformity with the evidence from stone reliefs, the present scalpels were held 'top to
tail' in a wooden box, probably of hinged double-compartment type, separated from one
another by small wooden blocks. This may be stated with some certainty, for, although the
box has perished, its mineralised traces still adhere to the sides of the Type I scalpel grips
(Nos. 1-5),33 while the consistent appearance of an iron blade fragment or iron corrosion
24
25
Albucasis, On Surgery and Instruments, M.S. Spink and G.L. Lewis (London, 1973), II, 16, fig. 55.
op. cit. (note 2).
26 ibid., 93-6.
27 ibid., 61-7.
28 F.J. Hassel and E. Kiinzl, Medizinhistorisches Journal xv (1980), 407-9.
29
Como, op. cit. (note 4), fig. 2.
30
ibid., fig. 2, 6.
31 B. Vulpes, Illustrazione di tutti gli strumenti
chirurgici scavati in Ercolano e in Pompeii (Naples, 1847), pl. VII
fig.32I.
Inv. no. AI29o89.
33 Small samples of the mineralised wood fragments from scalpel handles Nos. I and 2 were sent for
examination to the Jodrell Laboratory, Royal Botanic Gardens, Kew. Dr Paula Rudall kindly reported on these:
'The wood is in too poor a condition to permit an exact identification. However, it is certainly a hard-wood (not a
conifer) and the vessels are clearly visible with marked spiral thickenings on their walls, although very little other
structure remains. This eliminates woods with spiral thickenings absent, such as Box, Olive, Ash or Oak. The most
likely candidates are Lime (Tilia sp.), Sycamore or Maple (Acer sp.), Cherry (Prunus sp.) or Spindle (Euonymus
sp.), but several other woods have spiral thickenings and cannot be ruled out. (eg. Pear, Pyrus sp., and other
Rosaceae and Elm, Ulmus sp.)'.

136 RAL1PH1JACKSON
bubble on one face of the dissector indicates the manner in which they were placed in the
box, blade and dissector alternating at each end. Such an arrangement is clearly depicted on
an ex-voto tablet from Athens and on the tombstone of Curtianus.34
The Type II scalpel handles (Nos. 7-9) bear no traces of wood, but two of the three have
corroded blade traces on their dissector consistent also with a 'top to tail' arrangement.
They, two, were presumably held in a box, perhaps the same as that of the Type I scalpels,
but possibly in a separate case of leather.
Both the Wehringen find and the stone reliefs show that instruments other than scalpels
were commonly held in the scalpel boxes too - forceps, blunt and sharp hooks, and
elevators have all been recognised; traces of iron on some of the other instruments suggest
this may have been so with the present set. Probes, sounds and other slender instruments
were often held in long, slim cylindrical copper-alloy containers as well, presumably, as in
pouches or tubes of organic materials, while the bulkier instruments, the speculum and
catheters of the present set for instance, must have been carried in a 'doctor's bag' or case.
Only one other instrument in the set bears the same traces of storage as the Type I scalpels.
This is No. 6, also probably a scalpel handle, but with a finely made sharp spoon in place of
the normal blunt dissector. The socket is broken but is clearly of the keyhole form common
to Type I scalpels, and remains of mineralised wood, as well as corrosion from the missing
iron blade, are present on the sides of the grip.
Sharp spoons, that is to say those with a semi-cutting rim, are one of the more rarely
found surgical instruments. They were probably used as curettes, instruments with the dual
function of scraping away and removing unhealthy tissue from normal or abnormal body
cavities. In the Hippocratic Corpus a wrapped curette was advised for clearing thrombi
from the uterus, and a uterine curette has been identified in the fine instrumentarium from
Colophon.35 It is a single piece double-ended scoop of copper-alloy, cm in length, with
a stepped central grip. One scoop is smooth-rimmed, the other is19"5 finely toothed at its
extremity. The twinning on the present example of what was probably an iron scalpel blade
with a sharp spoon of copper-alloy, though not well suited to curetting the uterus, would
have been, nonetheless, a not unnatural combination. Both ends might be used in the
scraping away of carious bone resulting from chronic ulceration.36 Alternatively they might
be used to equal effect on fistulae and in particular in one of the operations for the removal
of nasal polypus. Galen recommended the excision of the tumour and scraping of its roots,
while Paul gave a fuller description:37
. holding in the right hand a polypus scalpel, having its extremity shaped like a
myrtle-leaf, we cut around the polypus or sarcomatous tumour ... Afterwards, turning
round the instrument, we bring out the separated fleshy body with its concave part'
However curettage might also be carried out with the scoop of some scoop-probes, and it
can be difficult to differentiate one from the other as, for example, an olivary-tipped probe
with broad-ended scoop in the Asia Minor instrumentarium.38Aetius recommended the use
of an ear specillum for curetting the interior of a small cyst on the eyelid,39 whilst it has been
suggested that the Hippocratic uterine curette might have been a wrapped strigil.4i
34 Tabanelli, op. cit. (note 7), pls. XII and XIII-XIV.

35 R. Caton, JHS xxxiv (1914), 114-118, pl. XI, 24.
31
Celsus, op. cit. (note 6), viii, 2, 2-3.
37 Paulus Aegineta, English translation by F. Adams, London, Sydenham Society, VI, XXV.
3' Hassel and Kiinzl, op. cit. (note 28), pl. III, 15.
39 Milne, op. cit. (note 13), 65.
411ibid., 157.

A SET OF ROMAN MEI)ICAL INSTRUMENTS FROM ITALY 137
While there is little doubt about the identification of the present example the substitution
of more commonly available instruments (scoop probes and strigils) would certainly
account for the rarity of the purpose-made curette. The latter might, logically, be restricted
to the larger instrumentaria, or the sets of specialist surgeons. The Colophon curette was
part of a clearly prestigious instrumentarium, while it is noteworthy that one of the two close
parallels to the present curette comes from the large Bingen set.4' It is of similar
dimensions, with a finely toothed rim, and formed one end of a combination instrument,
the iron component of which has corroded away. The small but specialist set of instruments
from Milos incorporates the closest parallel.42 The proportions and curve of its elongated
scoop with softly upturned tip are almost identical, though the Milos example is apparently
a single-ended instrument.
Forceps (Latin: vulsella, myzon.) (Nos. 10-12; FIG. I, PL. XI)

The forceps was one of the most common Roman surgical 10--12;
instruments. Together with the
scalpel and sharp hook it formed the basis of the surgeon's instrumentarium. Even the
simplest or smallest sets normally include at least one example as, for instance, the
third-century A.D. set of instruments from Wehringen43 which had been held in a small
leather case. It comprised an elevator, three scalpels, a sharp hook and a forceps. This is
unlikely to represent a surgeon's complete instrumentarium and probably equates with the
portable outfit advocated by Hippocrates. In addition to the full equipment of the surgery
he recommended:44
. a second physician's case, of simpler make, that you can carry in your hands when
on a journey. The most convenient is one methodically arranged, for the physician
cannot possibly go through everything.'
Forceps, too, can be seen in another portable kit, the small double-leaved wooden box
depicted on the tombstone of Curtianus.45 Their slender form also allowed them to be
carried, together with hooks, probes and needles, in the thin tubular copper-alloy boxes
found in some numbers in graves and at Pompeii and Herculaneum.46 In the present set
evidence from corrosion products indicates that the forceps and Type II scalpels, perhaps
also the sharp hooks, may have been contained in the same box or case.
The forceps is an instrument of considerable antiquity having been used from the Early
Bronze Age onwards in conjunction with a razor for fixing and removing facial hair. It was
but a small step to more strictly surgical uses. Beyond their frequent toilet and cosmetic
functions, Greek and Roman doctors used forceps for many different tasks, and in response
a number of different forms evolved. A few were developed for particular functions or
operations and acquired specific names. The majority of surgical forceps, however,
belonged to one of three main types, each of which might be used in very many different
ways. The intention was to give maximum versatility with the minimum number of
instruments. It is, therefore, of interest to note that the present instrumentarium includes
one example of each of the three main types of forceps, clearly chosen as a set.
The pointed-jawed forceps (No. 12) is of normal form with long arms made by sawing a
41 Como, op. cit. (note 4), fig. 2, 14.

42
Kuinzl, op. cit. (note 2), fig. 10, 5.
43 ibid., figs. 95-6.
4 Hippocrates, Decorum, vii, I. -13. English translation by W.H.S. Jones, Loeb Classical Library.
-5Tabanelli, op. cit. (note 7), pls. XIII-XIV.
46
eg. Pompeii: Antiquarium, Inv. no. 5389, 1992/4; Pompeii, House of the Physician, Milne, op. cit. (note 13),
169.

I38 RALPHJACKSON
bar up its centre to the base of a fine disc-and-baluster finial. The arms, carefully rounded
on the outer edge, taper to thin, pointed jaws, still accurately aligned. In addition to use as
splinter forceps this type must have been used for fine surgical work in many different
operations. A narrow-bladed forceps is specified by Paul in the removal of bone splinters in
fracture of the nose, and again in the extraction of foreign bodies from the ear.47 A few
examples have been found with rifled facetting on the inner face of the jaw tips,48 a feature
still to be seen on modern anatomical forceps. It allows a firmer grip without greatly
increasing the risk of damage to skin or tissue.
More commonly found is the smooth-jawed fixation forceps. No. io is a short but typical
example made, again, from a sawn bar, but this time with flat, inturned, square-ended jaws.
Like the third forceps of this set it may originally have had a ring-slide to aid prolonged
fixation. It would have found many uses in dissection but was also intended for surgical
epilation, the operation to remove ingrowing eyelashes (trichiasis), a condition consequent
on granular ophthalmia and, to judge from Greek and Roman medical writers, particularly
prevalent at that time. Celsus describes the operation49 and it is repeated by Paul, who
specifies the forceps to be employed:50
'Turn the eyelid outwards and, with an epilation forceps dragging out the offending hairs,
either one, or two, or three or whatever number there are. Then apply a heated olivary
probe or an aural probe or some such slender instrument to the place from whence the
hair or hairs have been removed'.
The third main type of forceps was, like the last, a dissecting forceps with square-ended,
inturned jaws, but with fine interlocking teeth enabling a still firmer and more secure grip.
It was, therefore, used for fixing and raising skin and wherever else traction was required,
especially in the seizing and excision of tumours. In classical medical literature it is
frequently referred to as the myzon. The present example (No. Ii) is a variant of this
simple form, with broad jaws angled to one side (coud6e type). Milne suggested this is the
forceps referred to by Paul in his description of the raising and excision of the surplus skin
of the eyelid in trichiasis. It may also have been the type of forceps used in the removal of
anal condylomata (warty excrescences) as described by Celsus:P2
'The tumours, which are called condylomata, when hardened are treated by the following
method. First of all the bowel is clystered; then the tumour is seized with a forceps close
to its roots and cut away.'
The hollow, toothed jaws were well designed to grip and contain excised skin or tumours
and in this respect they resemble the jaws of the staphylagra used both for crushing a
relaxed uvula and for strangling haemorrhoids. Although the present forceps lacks the
power of the scissor-action staphylagra, it does have a ring-slide for locking the jaws and
was quite probably used for both operations performed with the staphylagra. A passage
from Muscio would tend to confirm this:53
47
op. cit. (note 37), VI, xxiv.
eg. the pointed-jawed forceps/needle holder in the Milos set: V Deneffe, Etude sur la Trousse d'un
48
Chirurgien Gallo-Romain du III siacle (Anvers, 1893), pl. 5, no. I.

49
op. cit. (note 6), vii, 7, 8.
so op. cit. (note 37), VI, xiii; Milne, op. cit. (note 13), 91.
51
Milne, op. cit. (note 13), 97; Paulus Aegineta, op. cit. (note 37), VI, viii.
52 op. cit. (note 6), vii, 30, 2.
53 Muscio II, xxx, I 10 v.3; V. Moller-Christensen, The History of the Forceps (London, 1938), 135. In the fifth
century A.D. Muscio translated into Latin part of the important works of Soranus of Ephesus (first century A.D.).

'Hold the haemorrhoids firmly with a myzon or sarcolabum, in such a manner that the
roots drawn somewhat forward are first cut with a scalpel.. .
The coud6e fixation forceps is found less often than the normal toothed fixation forceps, but
examples are known both from occupation sites and from graves. Of the two which most
closely resemble No. I I, one is of first-century A.D. date from Pompeii/Herculaneum.54 It
has jaws of the same form and width, the same number of teeth, and the same simple
locking ring. The other example, from a tomb of probable third-century A.D. date, near
Ohrid, Yugoslavia,55 also has jaws of identical form and size. It is of particular interest in
the present context because it comprises one end of a double-ended instrument, sharing a
central disc-and-baluster moulding with a smooth-jawed fixation forceps of very similar
form and size to No. io. Like the Ohrid double forceps the two present fixation forceps are
each one end of a combination instrument.
Although infrequently so, forceps combined with other instruments do occur. They
include pointed-jawed forceps/elevators from Paris,56 from Gauting, near Miunich,57and
from Aschersleben, E. Germany,58 a pointed-jawed forceps/needle-holder from Milos,59 a
smooth-jawed fixation forceps/sharp hook and a smooth-jawed fixation forceps/probe from
Cologne.60 In all these cases, as with that from Ohrid, the instrument is dual-purpose but
made from a single piece of bronze. However, a smooth-jawed fixation forceps from Asia
Minor61 originally held an iron instrument at the other end, though only traces of iron
corrosion now remain in the region of the small circular socket. Each of the present forceps
is also the bronze component of a bronze and iron combination instrument, the stub of an
iron tang secured with soft solder surviving in the simple slot socket within the disc
mouldings.
Iron/steel was selected primarily for two purposes in Roman surgery, for blades and for
cauteries. Of these two possibilities the more probable combination is that of forceps and
blade, and the presence of similar simple slot blade fastenings (also employing soft solder as
a bonding-agent) on the Type II scalpel handles (Nos. 7-9 above) may be seen to lend
support to this suggestion. Furthermore, most cauteries would have had wooden or bone
handles and are unlikely to have been combined with another instrument.
Sharp Hooks (Latin: hamus, hamulus acutus.) (Nos. 13-15; FIG.2, 13-15; PL. XI)
Sharp hooks were an indispensable part of the Roman surgeon's instrumentarium. They
were used primarily to retract and fix the edges of incisions and wounds, and for that reason
several examples are often found together, as in the present case. However, like most
Roman surgical instruments they also served other functions, notably, in conjunction with a
scalpel, in the raising and excision of small pieces of tissue, as in the operation for
contraction of the vulva.62 Celsus describes the use of a hook in tonsilectomy and again in a
delicate eye operation:63
54 Vulpes, op. cit. (note 31), pl. V, fig. IV; Meller-Christensen, op. cit. (note 53), I29-130, fig. 197.
55 Kunzl, op. cit. (note 2), fig. 86, 4.
56 Milne, op. cit. (note 13), 94, pl. XXVII, I. Recent examination of this instrument has confirmed the terminal
as an elevator, not a rugine as Milne believed.
57 Prihistorische Staatssammlung, Minchen, Inv. no. 1951
8 440o.
Kiinzl, op. cit. (note 2), fig. 80, 2.
59 ibid., fig. IO, i; Deneffe, op. cit. (note 48), pl. 5, no. I.
60 Romisch-Germanisches Museum, K1oln, Inv. nos. Li 194, and 762.
" Romisch-Germanisches
Zentralmuseum, Mainz, Inv. no. 0.38310.
62 Paulus Aegineta, op. cit. (note
37), VI, xxx.
63 op. cit. (note
6), vii, 12, 2; vii, 7, 5.

140 RALPH JACKSON
'Sometimes, when the pterygium has not been quite cut away or from some other cause, a
small tumour, called by the Greeks encanthis, forms at the angle and this does not allow
the eyelids to be completely drawn down. It should be caught up with a hook (hamulo)
and cut round, but with so delicate a touch that nothing is cut away from the angle itself.'
Reflecting the different degrees of delicacy of treatment a range of types and sizes is
found. Identifiable hooks are invariably of copper-alloy and variation is normally restricted
to the length and decoration of the stem and upper terminal. A secure grip was necessary,
especially for retraction, and many, like Nos. 13 and 14, have elaborate mouldings or
exquisitely cut facets which were both decorative and functional. For this reason too the
hook was seldom combined with another instrument, although examples do occur, as for
example one in combination with a fixation forceps,64 and another with a fine cautery/
needle-holder.65
In retracting wound edges it was also important that the hook itself was as small as
possible to avoid inflammation and its potentially dangerous consequences. In fact,
wherever the hook has survived in good condition it can be seen to have been extremely
carefully made from polished tapered wire ending in the finest of points. It may well have
been in a further attempt to avoid the hazards of inflammation, rather than pure
ostentation, that a pair of bronze retractors from Cologne had the very tip of their hook
made of silver.66 They are part of a finely inlaid set of instruments from a surgeon's tomb in
the Luxemburgerstrasse cemetery.67
The sharp hook is one of the most commonly found of Roman surgical instruments and
examples occur widely throughout the Empire. The three hooks of the present set illustrate
the main types, from the simplicity of No. 15 to the elegant ring-and-baluster mouldings of
No. 14 and the strikingly faceted grip and button terminal of No. 13. Close parallels to the
latter include those from Pompeii/Herculaneum,68 Bingen,69 and South Shields.71
Blunt Hook (Latin: hamulus retusus) (No. I6; FIG. 2, 16; PLS. xi, xIIB)
Blunt hooks are mentioned not infrequently by Greek and Roman medical writers, but
unfortunately their appearance is not described. They performed a similar role to sharp
hooks (retracting, raising, stretching and fixing) but in operations in which puncturing had
to be avoided. To judge by the varying operations in which they were used they must have
existed in a number of different forms. Thus in the freeing of a lower eyelid adhering to the
eye,7' the hook used for stretching is likely to have been a comparatively small and slender
one. An instrument which could have been used for such work was found at Springhead,
Kent.72 It is 13-2 cm long with slender, finely-drawn stem and a small, narrow, carefully
rounded hook. Amongst other things it could also have been used in the manner described
by Celsus73 for the removal of foreign bodies from the ear.
In another passage of Celsus74 the operation for excising a fold of a lax or drooping eyelid
is described. Similar surgery undertaken in the mid-19th century utilized special eyelid
64
Koln, Romisch-Germanisches Museum, Inv. no. Li. 194.
15 London, Museum of London, 19887.
66
Koln, Romisch-Germanisches Museum, Inv. nos. 1076-7.
67 Kunzl, op. cit. (note 2), 89-go, fig. 68, 5.
"` Tabanelli, op. cit. (note 7), pl. LVII.
69
Como, op. cit. (note 4), fig. 3, 15-17.
71 L. Allason-Jones, Arch. Ael.i vii (1979), 239-241, fig. I.
71 Aetius, Tet. III lib.i, 13; Milne, op. cit. (note
13), 87.
72 SF 2487. Miss D. French kindly allowed me to examine this instrument.
73 op. cit. (note 6), vi, 7, 9.

74 ibid., vii, 7, 8.

retractors,7", and two examples of almost identical form were found at Pompeii.76 They
have a short slender stem and broad, flat, acute hook with blunt crescentic edge.
However, the majority of references to the blunt hook record its use in the raising of
blood vessels, either to isolate them or as a preliminary to excision. Milne77 summarised a
passage from Aetius detailing one such operation:
'We transfix the lips of the incisions with two hooks and gradually dissecting with the
scalpel we free the vessel from the underlying fascia. Then with a blunt hook placed
under the vessel we raise it up from the depth, and beneath it when raised we place a two
ply thread by means of a needle, and doubly tie and cut between.'
Again, for treatment of varicose veins where the veins were deemed too involuted for
cauterization, Celsus recommended careful excision using hooks and scalpel:78
'The skin is similarly incised over the vein, and the margins held apart by hooks
(hamulo); with a scalpel the vein is separated from surrounding tissue, avoiding a cut into
the vein itself; underneath the vein is passed a blunt hook (retusus hamulus); the same
procedure is repeated at the intervals noted above throughout the course of the vein
which is easily traced by pulling on the hook. When the same thing has been done
wherever there are swellings, at one place the vein is drawn forward by the hook and cut
away; then where the next hook is, the vein is drawn forwards and again cut away.
It is possible to envisage Z-shaped double blunt hooks like No. I6 being used in this way.
The blunt sides, rounded blunt tip and convex outer face of each spatulate hook would
protect vessels and tissue alike, while the flat inner face might be utilised as a small platform
for intricate dissection. In addition, the broad front edge of the hook would have minimised
the possibility of injury in passing beneath the vessel, and the smooth tapered sides would
have guided the vessel back to engage in the slender, rounded looped neck to be gently
raised.
The fact that there is no mention of a double blunt hook in the medical writings poses no
great problem. Many things were self-evident and did not require specific comment as, for
instance, in the above passage the word hamulo (hook) to describe the instrument used to
retract the incision edges. These were undoubtedly sharp hooks (hamulus acutus) and
would have been understood as such. Similarly, so many ancient surgical instruments were
double-ended that this, too, was not normally worthy of comment.
Only three other Z-shaped double blunt hooks of the same form as No. I6 are known to
the present writer. They are listed in Table I together with a further five related
instruments. It is to be noted that seven of these are definitely or probably from surgeons'
tombs ranging in date from the first to early third century A.D.All four double blunt hooks
(Table i, Nos. 1-4) bear one angular and one rounded leaf-shaped hook, and all have or
once had a pronounced 'swans-neck' loop behind each hook. Table i, Nos. 5-8 combine
either an angular or a leaf-shaped blunt hook with a sharp hook of normal form. Table
I,
No. 9 has a sharp hook combined with a serpentine or crozier-shaped blunt hook of rather
different form to the others. However, its moulded multiple-disc-and-foliate decorated
7' E. Bennion, Antique Medical Instruments (London, 1979), 147, fig. 17.
76 Milne, op. cit. (note 13), pl. XLVI, 2; Pompeii Antiquarium, Inv. no. 6955B.
77 ibid., 87.
78 op. cit. (note 6), vii, 31, 2--3.

142 RALPH JACKSON
central grip mirrors that of the present example79 (Table i, No. i) and of Table I, Nos. 8
and 3, although on the latter the decoration is inlaid not moulded. The grip of Table i, Nos.
4,80 5-6 and 7 has elegant multiple-disc-and-baluster mouldings, while that of No. 2 consists
of a central multi-faceted zone flanked by discs.81
TABLE I: ROMAN DOUBLE HOOKS
provenance terminal I terminal 2 length date reference

cm A.D.
I. Italy, prob. blunt, leaf- blunt, kite- prob. Ist-2nd present paper No. i6
from a tomb shaped shaped 15.9 century
2. Bingen, from blunt, leaf- blunt, kite- c.I8-o late ist-mid 2nd Como, op. cit. (note 4),
a tomb shaped shaped century fig. 2, 17.
3. Nea Paphos, blunt, leaf- blunt, kite- 17-8 mid 2nd-early 3rd Michaelides, op. cit. (note
from a tomb shaped shaped century 158), fig 1,20.
4. *Italy, prob. blunt, leaf- blunt, kite- 20.5 prob. Ist-2nd Kunzl, op. cit. (note o107), pl.
from a tomb shaped shaped century 65, 4. Museum of Classical
Archaeology, Cambridge, Inv.
no. 176.
5. Rheims, from blunt, leaf- sharp i7-i
late 2nd-mid 3rd Kunzl, op. cit. (note 107), pl.
a tomb shaped century 66, 3.
6. Rheims, from blunt, leaf- sharp 17-I late 2nd-mid 3rd Kiinzl, op. cit. (note 107), pl.
a tomb shaped century 66, 4.
-
7. (?) Asia blunt, leaf- sharp 17.5 Rimisch-Germanisches Zen-
Minor shaped tralmuseum, Mainz, Inv. no.
0-38217.
8. ? Italy blunt, kite- sharp c. i6o - City Museum and Art Gallery,
shaped Bristol. Fawcett Coll., FT
1450.
9. Aschersleben, blunt, sharp 17?7 ?3rd century, or Kuinzl,op. cit. (note 2), fig. 8o,
from a tomb serpentine earlier i.
* for provenance details see footnote 8o.
Although most of the double hooks are between 17-18 cm in length, the present example
measures just 15.9 cm while Table i, No. 4 is 20-5 cm long. Additionally there is some
variation in the stem thickness and hook size. Table I, Nos. 4-8 are slender and
small-hooked while the present example has both a stout stem and large robust hooks. To
an extent this may be presumed to reflect slightly different usage.
79 Elaborate moulded foliate decoration of a similar kind is to be seen on several instruments from Pompeii - a
small spoon, a spatula, and one of the trivalve specula (Vulpes, op. cit. (note 31), pl. VI, figs. I-II; pl. IV, figs.
I-III) - and on the MWridatrivalve speculum (Kiinzl, op. cit. (note 2), fig. 8i) indicating a first- to second-century
A.D. date for the present hook.
Classical
8o The set of surgical instruments, of which the double hook is a part, was donated to the Museum of
Archaeology, Cambridge in 1921/22. Found in Italy in the late nineteenth century, it is believed to have come from
a tomb either in the Campania or in the vicinity of Rome. Information kindly supplied by Mr W. Thompson.
81 Subsequent to its original manufacture the Bingen double hook was modified, apparently to suit a changed
role. A small hole was punched through each of the hooks and one hook was turned back on itself changing the
bow
shape of the instrument from an elongated Z to an elongated U. It may have been used as a small makeshift
for a simple drill or the crown trephines found in the set.

Finally, an interesting point of association emerges when the companion instruments of

those hooks from sets are compared. Predictably sharp hooks are present in most cases,
though not with Table I, Nos. 3 and 4. That is not, of course, to say that they were not
present when these instrumentaria were in use. More strikingly bone levers or elevators, a
comparatively rarely found class of surgical instrument, were found with Nos. 4 (two
examples), 3 (at least two examples), 9, and 2 (four examples, as well as two crown
trephines and a rasp), while two bone chisels occur in the present set.
Even with this small sample a link with bone surgery seems assured though in what
capacity the hooks were used, if different to that in the operations described above, is
uncertain. The manipulation of tendons, ligaments and skeletal muscle in addition to the
raising of blood vessels is conceivable, but it is also possible that the double blunt hook is a
variant of the instrument which Celsus terms82 '* . a guard of the membrane (membranae
custos) . . which the Greeks call meningophylax.' He continues with a brief description of
the instrument and recommends its use, together with the drill and chisel, in the excision of
diseased cranial bone:83
'this is so inserted that the smooth side is next the brain and is gradually pushed in under
the part where the bone is being cut through by the chisel: and if it is knocked by the
corner of the chisel it stops the chisel going further in: and so the surgeon goes on striking
the chisel with the mallet more boldly and more safely, until the bone, having been
divided all round is lifted by the same plate, and can be removed without any injury to the
brain'.
The same approach is advocated for treating depressed skull fracture:84
'. the plate which I suggested as a guard of this membrane is to be passed underneath
in order that all pointed fragments which project inwards may be cut away over the plate,
and any depressed bone is to be raised by means of the same plate'.
Certainly the present example and that from Nea Paphos are no less sturdy than some
elevators, and their Z-shape would not have been ill-suited to such use, whilst the potential
of the inner flat face of the hooks as small treatment platforms has already been noted.
Bone Chisels (Latin: scalper) (Nos. 17-I8; FIG. 2, I8--8; PLS. XI, XIIB)
The chisel is frequently referred to in Greek and Roman treatises on bone surgery. Celsus"
records its use in the excision of diseased or fractured bone, in particular that of the
cranium. Where small areas were to be removed the crown trephine (modiolus) was used,
and the small locating hole for its centre pin was made with the corner of the chisel blade.
After removal of the disc of bone the edges of the perforation were cut back with the chisel
until healthy bone was reached. For larger areas the chisel was used in conjunction with a
strap drill:86
'With this a hole is made exactly at the margin of the diseased and sound bone, then not
very far off a second, and a third, until the whole area to be excised is ringed round by
82 op. cit. (note 6), viii, 3, 8.

83 ibid., viii, 3, 8-9.
84 ibid., viii, 4, 17.
85 ibid., viii, 3.
86
ibid., viii, 3, 3-4.

144 RALPH JACKSON
these holes;. .. Next the excising chisel (excissorius scalper) is driven through from one
hole to the other by striking it with a mallet, and cuts out the intervening bone, and so a
ring is made like the smaller one cut by the modiolus.'
In this operation Celsus recommended the use of a third instrument, the meningophylax"7
to protect the brain and cerebral membrane from a misplaced chisel stroke. Indeed he
underlined the inherent risks of this form of surgery and advised against the automatic
excision of bone fragments in cranial fracture, preferring first to try plasters and only if
these were ineffective, '. . . then at length we must resort to surgery with the chisel.'x
The drill and chisel were also used to free a weapon point or other missile embedded in a
bone. Again the role of the chisel was to divide the bone, here between the cavity of the
entry wound and an adjacent hole drilled by the surgeon. The removal of this small
wedge-shaped piece of bone loosened the embedded object and permitted its subsequent
removal.
Apart from cutting and dividing, the chisel was also employed for scraping, smoothing or
paring the bone. Where a cranial fracture was suspected but could not be confirmed either
by probing or by initial visual inspection, the bone was laid open and the following
procedure adopted:89
. ink is to be applied over the bone, then it is to be scraped with a chisel; for a fissure
will retain the blackness.'
Sharp projecting bone in compound fractures was cut off or filed down and then smoothed
with chisels,90"while for levelling the elevated section of a depressed cranial fracture, where
the minimum of bone was to be removed, Celsus91specified a flat chisel (scalprum planum),
whose blade was probably thinner and cutting edge wider than that of the ordinary chisel.
The third major role of the bone chisel was that of an osteotome, as in the removal of
supernumerary digits."2Sometimes a pair of chisels was used, one either side of the bone to
be divided, a technique described on more than one occasion by Greek writers. It was
recommended by Paul for treatment of a fragmented clavicle93 and earlier by Galen in the
operation for division of ribs:94
'Separate off the membranes adhering to the bone, which being properly done, divide the
bone of the rib by means of two chisels placed in opposition to one another secundum
artem.
For most of the operations described a chisel rather smaller than the normal woodworking
firmer chisel would be preferable, but otherwise the two were interchangeable. Carpenters'
chisels were of iron with wood, bone or iron handles, and many surgeons' chisels may have
been made of the same materials. An iron blade from Pompeii/Herculaneum,'95 though
rather large, may have been the cutting edge of a bone chisel. Certainly the chisels, gouge
87 referred to above, p. 143.

" Celsus,
op. cit. (note 6), viii, 4, I2.
`9 ibid., viii, 4, 6.
99 ibid., viii, io, 7.

9' ibid., viii. 4, 14.
92 Paulus
Aegineta, op. cit. (note 37), VI, xliii.
93 ibid., VI, xciii.
14 Galen, ii, 687, transcribed by Milne, op. cit. (note 13), 123.
95 Vulpes, op. cit. (note 31), pl. VII, fig. VIII.

A SFE ()F RO()MAN MEDI)('A INTS FROM 145
INSTRtME ITAIY
and drill-bit in the Bingen instrumentariumiw are essentially carpenters' tools. Their
presence in the large set of surgical and medical instruments is enigmatic: it is equally
possible to view them as carpentry tools, perhaps for the manufacture of medical apparatus
(splints, traction equipment etc), or as instruments of bone surgery in their own right.
Although their size might favour the former identification, they might also be seen to
complement the crown trephines and elevators of the set. Suffice it to note that tools,
implements and apparatus of primarily non-medical function (styli, shears, strigils, spoons,
vessels etc.) are often included in grave groups of medical and surgical instruments, and the
surgical use of many is specified in the contemporary medical literature.
A small iron chisel with organic handle can survive intact only under optimum conditions.
Normally corrosion, if not totally destructive, obscures the object and hinders or prevents
identification. This is doubtless a partial explanation of the rarity of bone chisels. Those few
that have been identified in medical contexts are of a sufficiently characteristic form to allow
future recognition in less certain contexts. They have a narrow blade and slender
copper-alloy handle with lightly domed head. One in a grave group from Kallion, Greece,97
slightly smaller than the pair in the present set, has a particularly slender blade with splayed
cutting edge. A rather larger example from Pompeii/Herculaneum is figured by Vulpes,9"
but the drawing is not sufficiently detailed to permit a certain identification. Milne"
identified as a bone chisel a diminutive example all of bronze from Cologne.
The closest parallels to the present chisels are two of near identical form found with two
scalpels and an (?) elevator in a room in the baths at Xanten.""' They have slender, slightly
waisted, octagonal-sectioned handles with narrow blades in good enough condition to
discern a slight bevel on one face of the cutting edge. They are a pair, of almost identical
size, like Nos. 17 and 18, and also display a lightly burred head, the product of use with a
mallet. In view of the manipulation for osteotomy involving the use of a pair of chisels, the
presence of two chisels in each of these sets is of some interest.
Speculum (Latin: speculum ani) (No. 19; FI(;. 2, I9; PLS.xi., XIA)
In Greek and Roman medical texts the anal speculum, a simple bivalve dilator, was
distinguished from the vaginal speculum, a larger trivalve or quadrivalve dilator, (speculum
magnum matricis). Galen,"" for instance, refers to 'the catopter, which is called the anal
dilator, in the same way as the diopter is called the female dilator'. While such a distinction
might be made, and while the screw mechanism of the trivalve and quadrivalve dilators
particularly suited them to gynaecological work, there is no reason why the bivalve dilator
should not have been used also as a vaginal speculum. However, its primary role was to
allow visual examination of the anus and rectum, and to simplify access for treatment.
There is no doubt that in the absence of anaesthesia this would have occasioned
considerable discomfort and pain. Yet the success of the instrument may be gauged by its
longevity: specula, both anal and vaginal, remained almost unchanged until the 18th
century.1
"• Como, op. cit. (note 4), fig. 6, nos. 6, 7, 12, 13.
97 Kiinzl, op. cit. (note 2), fig. II , 4.
98 op. cit. (note 31), pl. VII, fig. VII.
" op. cit. (note 13). pl. XLI, 2.
"o Rheinisches Landesmuseum, Bonn.
(ii Galen, transcribed in Milne,
op. cit. (note 13), 150.
102 See,
for instance, Scultetus' illustration of seventeenth-century anal and vaginal specula in Tabanelli, op. cit.
(note 7), pl. CXVI.

146 RALPHJACKSON
Milne points to the earliest recorded use of the anal speculum in the Hippocratic treatise
on fistula and in the treatment of piles.'03 Paul also refers to its use in the operation for
piles:104
'with regard to blind fistulae Leonidas says: "We dilate the anus as we do the female
vagina, with the anal or small speculum".'
The combination of frequent horseback riding and generally poor personal hygiene must
have made fistula in ano, haemorrhoids, and other linked complaints a common occurrence
in the ancient world. To combat this were such things as the specially soft padded saddle,
the subject of one of Martial's epigrams:'05
'Take, hunter, the housing of a nimble steed, for from a bare-backed horse piles are wont
to spring'.
Somewhat earlier the inimitable Cato recommended a less orthodox preventive measure:106
'To prevent chafing: when you set out on a journey, keep a small branch of pontic
wormwood under the anus'.
The present example is only the seventh Roman bivalve speculum to come to light and is
closely similar to four of these (see Table 2). Each has two stout handles which pivot on a
strong hinge and terminate in powerful jaws, each with an out-turned, blunt, prong-like
blade or valve. The hinge, braced in all but one case (Table 2, No. 4) by a pair of
disc-washers, is positioned close to the blades in order to achieve the considerable leverage
required in such an instrument, while the solidity of jaws and hinge provided the necessary
strength. The plain handles have a flat inner face but are carefully rounded on the exterior
surface and at the tip. Their lack of decoration is notable and in marked contrast to the fine
cast mouldings on the screw-handle terminals of the trivalve dilators.
The priapiscus, formed by the two solid out-turned blades, varies slightly in shape from
one example to another. Each blade has a flat inner face with a smooth and carefully
rounded outer surface and rounded blunt tip to minimise the discomfort in use. A common
characteristic is a slight swelling near the tip of the priapiscus which may have been
designed to counter any tendency of the instrument to slip out of position when in use. This
feature is lacking only on the present example on which the priapiscus is both very slender
and simply tapered.
Two of the specula (Table 2, Nos. 5-6) are markedly smaller and slighter than the others
and have a maximum span between the blade tips of only c. I cm. Their use as anal specula is
questionable and they should perhaps be regarded as nasal specula.
103 op. cit. (note 13), 149-

104 op. cit. (note 37), VI, lxxviii; an amended reading by Milne, op. cit. (note 13), 149.
o05Martial, Epigrams, English translation by W.C.A. Ker, Loeb Classical Library, XIV,
lxxvi.
"'"Cato, De Agricultura, English translation by W. Davis Hooper, rev. by H. Boyd Ash, Loeb Classical
Library, CLIX.

A SET OF ROMAN MEDICAL INSTRUMENTS FROM ITALY I47
TABLE 2: ROMAN BIVALVE SPECULA
provenance overall priapiscus priapiscus date reference

length length opening A.D).
cm cm cm
I. Italy 15-6 7-6 large prob. Ist-2nd present paper, No. 16.
(c.5-o) century
2. Pompeii I) 15-0 c.7-o large 79 or earlier Milne, op. cit. (note 13), pl.XLVI,
(c.7-o) cit. (note
I; Vulpes, op. 3I), pl.
IV, fig. IV. Naples, Museo
Nazionale, Inv no. 78,03I.
3. Pompeii 2) 18-4 8-9 large 79 or earlier Tabanelli, op. cit. (note 7),
(5.2) pl.CXI. Naples, Museo
Nazionale, Inv. no. I16436.
4. ? -
16-8 large LJ Bliquez, Bull. Hist. Medicine,
9"5 Ivi (1982), 195-217, fig 8. Balti-
more, Welch Medical Library.
? 6-2 small - E. Kiinzl, Der Wormsgau, xiii
13.9
5-
(c. I.O) (1979-81), 49-63, pl.3, no. 5.
Worms Sttidt. Mus.
6. ? 6-o small - London, Wellcome Museum, Inv.
14-o
(c. I1-) no. A645719.
-
7. River Tiber ? ? ? Tabanelli, op. cit. (note 7), 151.
Rome, Museo Nazionale delle
Terme.
The rarity of specula, unlike small or slender instruments, cannot be attributed to

corrosion. They are large instruments made from solid, bar-like pieces of bronze and should
have a comparatively good chance of survival. Yet only seven bivalve specula are known.
With the possible exception of the present example none of them comes from a tomb,
though the provenance of three is unknown. Two of the remaining examples come from
Pompeii, a moderate sized town, but in a particularly properous part of Italy. They may be
compared to the numerous scalpels, retractors, forceps, probes, bleeding-cups etc. from
that town. The 'frozen' nature of the Pompeii assemblage, albeit still partial, should give
some impression of the currency and relative frequency of specific instruments within the
spectrum of medical equipment in first-century Italy. Such indications as exist, therefore,
are that specula were never common in the Roman period. They were likely to have been
used only by specialists and the better-equipped surgeons, the majority of whom will have
been centred in the larger towns and more prosperous parts of the Empire.
Catheters (Latin: fistula aenea) (Nos. 20-22; FIG.3, 20-22; PL. XI)
A slender instrument designed to reach the bladder via the urethra, the Roman catheter
served a number of differing roles (manipulation, injection and extraction) related to
urinary diseases and disorders. Such conditions, no doubt in large part due to low levels of
hygiene and dietary deficiencies, seem to have been very prevalent in the ancient world.
Urethral calculus (bladder stone) is mentioned by most Greek and Roman medical writers
and its treatment formed one of the few areas of specialisation in early surgery. "'7 Although
107
E. Kiinzl, Archiiologisches Korrespondenzblatt xiii (1983), 487-493.

148 RALPHJACKSON
clearly a very unpleasant and painful operation, lithotomy was nonetheless often preferred
to the continuing agony of the condition. Pliny the Elder'"" noted that '. .. the experience
of time has concluded that the disease causing the sharpest agony is strangury from stone in
the bladder', and the relief which a patient felt on being cured was, as in later times,
doubtless expressed in the form of a high fee for the surgeon.
An alternative or a preliminary to lithotomy, when the stone was impacted in the urethra
or lodged at the neck of the bladder, was to use a catheter to push the stone back into the
bladder, a procedure advocated both by Rufus of Ephesus and Soranus. "' In another role,
this time as an injector, the catheter might be used as a clyster for the irrigation of an
ulcerated bladder:'"•
'But since we often have occasion to wash out an ulcerated bladder, . . . we must tie a
skin, or the bladder of an ox, to a catheter and throw in the injection through its lumen.
However, the primary role of the catheter seems to have been in treatment for retention
of urine:"l
'When urine is not passed on account of excessive dilation of the bladder so that it cannot
contract, we draw off the urine with a catheter. Therefore an instrument like the Roman
letter S is let down into the bladder by the urethra.'
By their very nature (slender, flexible, thin-walled tubes) catheters are particularly delicate
instruments, easily damaged, destroyed or corroded beyond recognition. It is hardly
surprising that few ancient examples have been identified. When broken, for instance,
unless the tip with characteristic eye is present, they are almost indistinguishable from the
upper stem of a broken split-nib pen.
Those few Roman catheters that do remain can be seen to be closely similar to their
modern counterparts. There are two types, a long S-shaped instrument and a shorter
straight or lightly J-shaped instrument, corresponding respectively to our male and female
catheters. A passage in Celsus makes it clear that the differing position of male and female
bladder was known, and he describes the use of differing catheters accordingly:12
'For this purpose bronze tubes (aenaefistulae) are made, and the surgeon must have three
ready for males and two for females in order that they may be suitable for everybody
large and small: those for males should be the longest, fifteen finger-breadths (digiti) in
length, the medium twelve, the shortest nine; for females, the longer nine, the shorter
six. They ought to be a little curved but more so for men, and they should be very smooth
and neither too large nor too small.'
Celsus' specific reference to the use of 'tubes of bronze' finds confirmation in the surviving
examples, all of which are of bronze, or copper-alloy. In post-Renaissance Europe a variety
of metals was used for catheters (lead and pewter as well as silver, copper and brass) and
this may have influenced Tabanelli'13 in his description of the Pompeii example as made of
lead. Close examination, however, confirms that it is of copper-alloy, its greyish appearance
10s Pliny, Naturalis Historia, English translation by H. Rackham et al.,

Loeb Classical Library, XXV, vii, 23.
"09 Milne, op. cit. (note 13), 145.
110 Paulus
Aegineta, op. cit. (note 37), VI, lix; an amended reading by Milne, op. cit. (note 13), io8.
111 Galen, xiv, 787, transcribed by Milne, op. cit. (note 13), 143.
112
113 op. cit. (note 7), pl. LXII.

probably the result of post-depositional surface enrichment. The present three examples
are all of sheet bronze (see Table 5 and scientific report below).
In all other respects the catheter changed hardly at all from the Ist century to the 20oth
century. Both male and female instruments were provided with an eye a short distance back
from the lower end to ensure a completely smooth tip, and to prevent any blockage of the
eye occurring before the neck of the bladder was reached. The tip itself was tapered,
round-ended and very smooth like the rest of the instrument and, in common with many
sounds, in particular those most slender ones used for especially sensitive probing, the
handle region was also completely smooth enabling great delicacy of touch. A variety of
lubricants may have been pressed into service, but undoubtedly the most usual would have
been olive oil, and Paul" describes the immersion of the catheter in oil before insertion
into the urethra.
Of particular interest in the present context is Celsus' stipulation that the surgeon should
possess a graded set of catheters, a requirement also implicit in a passage in Paul: 15
'Wherefore, taking a catheter proportionate to the age and sex we prepare the instrument
for use'.
It would appear that the single female and two male catheters of the present instrumentar-
ium formed such a set, albeit of a limited range. There is certainly a difference both in
degree of curvature and overall length, as well as a slight difference in gauge, between the
two male catheters, so that they complement rather than duplicate each other; and, as
Celsus reveals, there was seen to be less of a need for variation in size of female catheters.
Indeed, as recently as the 18th century a single size was deemed sufficient for all female
patients."
The three present examples comprise the largest single find of Roman catheters (see
Table 3), and they substantially increase the total now known (from 9 to 12). Most of these
are site or loose-finds, only the male catheter from the Ephesus instrumentariumapparently
deriving from a grave.117 Milne' 18 knew of three male catheters, two fragmentary examples
from Baden and the well-known complete instrument from Pompeii, House of the Surgeon.
The latter he equated with a modern 'no. II English', one of the former to a 'no. io
English'. The two present male catheters compare closely in shape and length to that from
Pompeii and the larger example from Colophon"9 though they are of slightly narrower
gauge. Surprisingly, in comparison to the wide range in length measurements, the gauge of
the surviving Roman catheters varies very little. For instance, the short Ephesus catheter is
no more slender than the three long examples from Pompeii and Italy, and the gauge of the
two female catheters is also much the same. Only the smaller of the two Colophon
instruments is of markedly narrower gauge, and it is proportionately short. Although
Caton1?"was of the opinion that it was incomplete, it may have been intended for boy
patients.
14 op. cit. (note 37), VI, lix.

1" ibid., VI, lix.
"' Bennion, op. cit. (note 75), 78.
17 Th. Meyer-Steineg,Jenaer
118 medizin-historischeBeitriigei (1912), 42-3, pl. VII, 1.
op. cit. (note 13), 143-5.
"9 Caton, op. cit. (note 35), pl. XI, 20.
120
ibid., Ii6.

I50 RALPH JACKSON
TABLE 3: ROMAN CATHETERS
male catheters female catheters gauge date reference

provenance digiti* :15 12 9 9 6 cm A.D.
cm :27-75 22-2 16-65 16-65 11-1
I. Italy 30-25 0-51- prob. Ist- present paper, No.

0o52 2nd century 21
2. Italy 28-o0 049- prob. Ist- present paper, No.
o05I 2nd century 20
3. Italy 0-5I- prob. Ist- present paper, No.
14"4 2nd century 22
0o59
4. Pompeii, 27-2 0-51- 79 or Vulpes, op. cit.
House earlier (note 31) pl. III,
of the o'55 fig.I; Milne, op.cit.
Physician (note 13), pl. XLV,
1; Tabanelli, op. cit.
(note 7), pl.LXII
5. Pompeii/ c.o.5o- 79 or Milne, op.cit. (note

Herculaneum 20o0 earlier 13), pl. XLV, 2.
o090
6. Colophon c.o.6 Caton, op.cit. (note
32"2 35), pl. XI, 20.
7. Colophon I6-5 c.o-3 Caton, op.cit. (note
35), pl. XI, 21.
8. Ephesus -
15.4 c.o50- Meyer-Steineg,
0o'55 op.cit. (note 117),
pl.VII, 1.
9. Neuss 29-o c.o-5 Tiberian G Simpson, Bonner
Jahrbiicher xxxviii,
(1977), 562-564,
fig.I, 11.
Io. Baden fragmentary ? - Milne, op.cit. (note
13), 144
I . Baden, 1893 fragment ? ? Ist-2nd Milne, op.cit. (note
excavation century 13), 144-5
12. (?) Rome fragment ? - Tabanelli, op. cit.
(note 7), 143
* conversion: 16 digiti = I Roman Foot = 29-6 cm
I digitus = 1-85 cm.
With such a restricted sample it is not possible to make close comparisons between the
length of these catheters and the scale of sizes mentioned by Celsus.121 Nonetheless, as
Table 3 illustrates, the two present male catheters (Table 3, Nos. 1-2), and Table 3, Nos. 4,
6 and 9 would appear to be at the upper end of this scale, and Table 3, Nos. 7-8 at the lower
end, while of the two female catheters, Table 3, No. 5 is at the top end of the scale, the
present example (Table 3, No. 3) almost exactly midway between Celsus' two suggested
sizes. Presumably a catheter which was strictly rather too long could nonetheless be used on
121 cf. note 112.

occasion in place of a smaller one, whereas the reverse situation would not be feasible; a
catheter that was too short simply would not suffice. One might therefore expect, in a
restricted set, a tendency towards longer examples. Alternatively the catheters of the
present set may simply be part of a once more extensive range, since there is some evidence
elsewhere that sometimes only a selection of instruments might be interred in a surgeon's
tomb.122
Handled Needles (Latin: acus) (Nos. 23-24; FIG. 3, 23-24; PLS.XI. XIII)
Until the introduction of spectacles in the I8th century defective eyesight must have been a
common affliction for which little could be done. Cataract was the one impediment to vision
which early proved susceptible of correction. There is some literary evidence and, recently,
some archaeological evidence'23 for the extraction of cataract at least by the time of Galen,
but the earliest operation was that for the moving away (couching) of cataract. One of the
most famous passages of Celsus describes the careful procedures involved:124
'. the patient . . is to be seated opposite the surgeon in a light room facing the light,
while the surgeon sits on a slightly higher seat; the assistant from behind holds the head
so that the patient does not move: for vision can be destroyed permanently by a slight
movement . . . Thereupon a needle (acus) is to be taken pointed enough to penetrate,
yet not too fine; and this is to be inserted straight through the two outer tunics at a spot
intermediate between the pupil of the eye and the angle adjacent to the temple, away
from the middle of the cataract, in such a way that no vein is wounded. The needle should
not be, however, entered timidly ... When the spot is reached, the needle is to be sloped
against the suffusion itself and should gently rotate there and little by little guide it below
the region of the pupil; . . . If it sticks there the cure is accomplished; if it returns to some
extent it is to be cut up with the same needle and separated into several pieces, which can
be the more easily stowed away singly and form smaller obstacles to vision. After this the
needle is drawn straight out.'
Clearly the operation required considerable care, and the surgeon needed a light but steady
and precise touch. Nonetheless it was a comparatively straightforward if delicate piece of
surgery requiring little specialist equipment, and it was this simplicity together with the low
incidence of septicaemia consequent on it that ensured the operation a good chance of
success.125 For these reasons the method continued in use almost unchanged for centuries,
in some parts of the world until recent times.
From Paul's account of the same operation, based in part on Celsus, there emerges a
clearer picture of the couching needle itself:'12
'. then mark with the olivary end of the couching needle the place to be perforated ...
Bringing round the pointed end of the perforator which is round at the tip we push it
firmly through ... Then raising the needle to the apex of the cataract (the bronze of it is
plainly visible through the transparent part of the cornea) we depress the cataract to the
underlying parts. After . . . we gently extract the needle with a rotatory movement.'
122
Kunzl, op. cit. (note 2), IO-II.
23 E. Kiinzl, Jahrbuch RGZM xxxii (1985), 436-508.
124
125
However it was not without risk. Within two years in the mid-eighteenth century Handel lost his vision and
J.S. Bach his life as a result of the operation for cataract: Bennion, op. cit. (note 75), 136.
126 Paulus Aegineta, op. cit. (note 37),
VI, xxi; an amended reading by Milne, op. cit. (note 13), 70.

152 RALPH JACKSON
Pooling the informationfrom both writers, it may be seen that the cataractneedle was a
double-endedinstrumentwith an olivaryterminalat one end and a round-pointedneedle at
the other. The needle was of bronze, was slender but not excessively so, and may
occasionally have had a tiny expansion at the tip. Kiinz1'27has recognised such an
instrumentin a bronzehandledneedle fromthe palaestra,Pompeii,128in one from the Asia
Minorinstrumentarium'29 and in anotherfromthe Milos set.'13The presentneedle (No. 23)
is undoubtedlya further example, and there are at least two more from Pompeii.131
Althoughthe gripof the Pompeiipalaestraneedle is rathershorterthe form is otherwise
very close to that of the present one, with a slender grip, long olivaryterminalat one end
and round pointed needle at the other. The Milos needle also has one olivary and one
needle terminal,and Milne132illustrateda similarinstrument,though with broken needle
tip, fromhis own collection, apparentlyfound in Bedfordshire.The Asia Minorinstrument
has, in place of an olivaryterminal,a second needle, with tiny spatulateexpansionnearthe
tip. All of these needles closely fit the descriptiongleaned from the accountsof Celsus and
Paul and could have been used successfully in their operation for cataract. It seems
legitimate to regard them as couching needles.
It is interestingto note that four of these couchingor cataractneedles (Milos; Pompeii,
palaestra;Pompeii (II16444A);and the present example) were found in association with
anotherform of handledneedle, a slendersocketedvariety.This type has been found more
commonlythan the cataractneedles and in a greatervariety of forms (see Table 4). It is
invariablya double-endedinstrument,normallya slender grip with a small socket at each
end (Table 4, Nos. 1-6), but sometimes with a single socket combined with another
instrument,e.g. with a pointed-jawedforceps (Table 4, No. ii), with a slender pointed
probe (Table 4, No. io), or with a sharp hook (Table 4, Nos. 8-9).
The double socketed form compriseseither two straightsockets or one straightand one
angled socket, as in the case of the present example (Table 4, No. I). Similarly,those
combinedwith anotherinstrumentmay have either a straightsocket (Table 4, No. 8) or an
angled socket (Table 4, Nos. 9-11). That they were grips for fine instrumentsis beyond
doubt, and from their occasionalassociationwith cataractneedles, their slender stem and
tiny socket, and the presenceof iron corrosionin the socket of at least one (Table4 No. 8),
it may be inferredthat they held very slenderiron needles. Indeed the examplefrom Milos
(Table4, No. II) had, at the time when Deneffe's plate was made,133what appearsto have
been a short, fine needle projectingfrom the end of the socket. At present there is no
evidence for the precise form of the needle, nor as to whether it was permanent or
removable.
cit. (note 123).

127 op.
128 Kunzl, op. cit. (note 2), 26-7, fig. 4, second from right. This needle is from a set of instruments found in the
palaestra with the skeletons of a number of victims of the A.D. 79 catastrophe.
129
Hassel and Kunzl, op. cit. (note 28), pl. III, io.
13 Kiinzl, op. cit.
(note 2), fig. 10, 4.
131 e.g. Naples, Mus. Naz., Inv. no. I16444A, found in a cylindrical probe box with six other probes and
needles; and Pompeii Antiquarium, Inv. no. 10123, from Pompeii, Region II, Insula II, 'vicino al tempietto, 1953'.
132
op. cit. (note 13), pl. XVI, 7.
33
op. cit. (note 48), pl. 5, I.

TABLE 4: ROMAN SOCKETEDNEEDLE-HOLDERS
provenance terminal I terminal 2 length date reference

cm A.D.
i. Italy straight socket angled socket 14-0 late Ist/early present paper No. 24.
2nd century
2. Colophon straight socket angled socket 13*75 Caton, op.cit (note 35), pl.
XI, 28
3. Bingen straight socket angled socket 13.5 late Ist/early Como, op.cit. (note 4),
2nd fig.3, 20.
4. Pompeii, Casa straight socket angled socket 12-6 pre-79 Pompeii Antiquarium
di Giulia Felice Inv.no. 9040.52
5. Savaria straight socket straight socket 13-2 3rd century Kuinzl, op.cit. (note 2,
fig.92, 5
6. Nijmegen straight socket straight socket ? 3rd century Kiinzl, op.cit. (note 2), fig.
75, I3
7. Pompeii, straight socket broken prob. 79 Kiinzl, op.cit. (note 2), fig.
palaestra 4, far right; Pompeii Anti-
C.12"5 quarium, Inv. no. 6128F
8. Pompeii straight socket sharp hook pre-79 Naples, Mus. Naz. Inv. no.
14"4 116444 c.
9. London sharp hook angled socket 144 - Museum of London, Acc.
no. 19887
io. Pompeii, pointed probe angled socket 13-o pre-79 Pompeii Antiquarium Inv.
Reg. I, Ins. no. I11530
13, N.2.
I1. Milos pointed-jawed angled socket c.15-o prob. Ist-2nd Deneffe, op.cit. (note 48),
forceps century pl.5,I
It seems probable that these needle-holders held both dissecting needles and needle
cauteries of the kinds frequently mentioned, in particular in ophthalmic surgery. A very fine
needle would have been required in Celsus' operation for the removal of small tumours on
the eyeball: 134
*' . small hard tumours in the

white of the eyeball are called clavi, from a resemblance in
shape to nailheads. These it is best to transfix with a needle (acu) at their base, and to cut
away underneath the needle.'
The same author specified a slender iron needle cautery for the treatment of trichiasis
(abnormal inturned eyelashes which irritate and abrade the eye):'35
'If eyelashes have grown where they ought not, a fine iron needle (tenuis acus ferrea)
flattened like a spear point is put into the fire; then when the eyelid is turned up, so that
the offending eyelashes can be seen by the operator, the red hot needle is passed along
their roots
.
134 op. cit. (note 6), vii, 7, 12.

'13 ibid., vii, 7, 8B.

154 RALPH JACKSON
Again as a cautery, a fine needle was recommended for a piece of cosmetic surgery on the
ear:136
'Where the ears . . have been pierced and have become offensive, it is enough to pass a
red hot needle (candente acu) quickly through the hole in order to blister its margins
superficially . . . afterwards to put on applications . . . and induce a scar.'
Iron/steel was the preferred metal for cauteries, but could also provide the hardest and
sharpest needle points and it is conceivable that socketed needle-holders held the
instruments which performed all of the above operations and many more. Some may even
have been used for cataract, although this seems inherently unlikely in view of the existence
of a specific couching needle, and those needle-holders with an angled socket would
certainly not have been suitable for that operation. On the other hand, in use as a small
cautery or dissecting needle, an angled socket, especially in combination with a straight
one, would have proved a distinct advantage allowing a far wider range of manipulations.
The length of the needle-holders, without the needles themselves, is similar to, though a
little more constant than, that of the cataract needles, varying from c. 12-5-15 cm. Like the
cataract needles too they are widely but thinly scattered, with examples from Greece to
Britain, and they range in date from the Ist to the 3rd century A.D.
Cautery (Latin: ferrum candens) (No. 25; FIG. 3, 25; PLS.XI, XIIC)
To judge from Greek and Roman medical literature the cautery was almost as important a
surgical instrument as the scalpel. It had a seemingly endless list of uses, and in Celsus'37
alone the following are attested: to check haemorrhage in a wound (v, 26, 21); to cauterize
varicose veins (vii, 31), scrotal varices (vii, 22, I) and blood-vessels and bone on the temple
and scalp to stop eye discharge (vii, 7, 15 E-K); to check gangrene (v, 26, 33-4); to disperse
pus over a fractured rib (viii, 9, I) and in liver abscess (iv, 15,4); to treat an ulcerated nostril
(vii, Ii); to destroy diseased bone (vii, 7, 7C; viii, 2, 2; viii, 3, lo); to kill the root of
abnormal eyelashes (vii, 7, 8B); to remove a carbuncle (v, 28, I) and a whitlow (vi, 19, 3);
to promote discharge in dropsy (iii, 21, IO); to heal split lips (vii, 12, 6) and infected pierced
ears (vii, 8, 3); to alleviate painful joints (iv, 29, 3; iv, 30), treat the bite of a mad dog (v,27,
2) and create a saline drip over a diseased limb (ii, 17, io).
Most of these in fact fall into
three broad categories: the staunching of a flow of blood (haemostasis); the removal by in
situ destruction of unhealthy tissue; and the removal of living tissue by the same means to
give access to underlying structures etc. The sobriquet 'bloodless knife' may thus be seen to
be particularly appropriate, and the cautery later prospered at the expense of the scalpel in
Arabian surgery in which Islamic religion forbade the cutting of human flesh and spilling of
blood. It remained popular with surgeons throughout the medieval period and beyond, and
not until the i8th century did it gradually give way to cauterizing styptics.138
Although usage was also wide in Greek and Roman medicine it was certainly not
indiscriminate. From Hippocrates onward the cautery was generally regarded very much as
a last resort. Burnt tissue heals more slowly than cleanly cut tissue and cauterization was
therefore employed only when other methods had been tried without success or were seen
to be inappropriate. In Celsus, for instance, the use of the cautery is frequently preceded by
such phrases as 'the ultimate measure' (iv, 29, 2), 'If even these are not effective .. .' (v,
26, 33c), 'If the malady is still not checked . . .' (v, 26, 34C), 'when circumstances do not
136
ibid., vii, 8, 3.
137op. cit. (note 6).
13 Bennion, op. cit. (note 75), I85.

even admit of this . . .' (v, 26, 21C). Celsus' sparing use of the cautery is most strikingly
seen in his description of the various methods available to stop haemorrhage in a wound (v,
26, 21). There the cautery is placed at the end of a long list of increasingly drastic measures
(dry lint, cold damp sponge, sponge soaked in vinegar, caustics or corrosives, ligature,
cautery). However, such reluctance was normally confined to its use on large diseased or
wounded areas. In many other instances the cautery, far from being used in desperation,
was carefully adapted to a specific form of treatment. This particularly applies to the range
of small cauteries frequently used in ophthalmic work and in fine surgery in other parts of
the body (cf. No. 24 above). That it is also true of a large number of other cauteries is
apparent from the numerous different types referred to in the classical medical literature.139
Despite the large number that must have existed very few Greek or Roman cauteries
have been identified. It is ironic that of the best known Roman cauteries, three tile-shaped
examples from Pompeii/Herculaneum,140 only one is of iron, the other two of bronze. For
already by the time of Hippocrates iron had become established as the most appropriate
metal. So universal did it become that both in Greek and Latin cauteries were termed
'irons'.
In view of the poor preservation qualities of iron it is easy to understand why so few
cauteries are known. It is also the case that other instruments (knives, probes, spatulae,
styli etc.) could be and were used as cauteries. In the present set an obvious candidate for
such secondary use is the stylus (No. 26). Were it simply a writing-instrument, the richness of
the instrumentarium might lead one to expect a finely decorated example of bronze or
silver. That it is of iron, simple and plain, might, therefore, suggest that it had been
intentionally selected for use, amongst other things, as a cautery. With a temporary
wrapped handle either end could be put into service, and both pointed and wedge-shaped
cauteries are referred to in the classical medical literature.141 Two iron styloid objects in the
instrumentarium from a grave at Luzzi142are almost certainly to be identified as cauteries,
as are, doubtless, many of the other styli found with sets of surgical instruments.143
The word cautery in ancient medical literature, therefore, must often have described
rather the function than a specific instrument. Indeed the lack of detailed description is a
further impediment to identification. Only rarely is there even so much as a two or three
word summary of the appearance of particular varients - 'sword-shaped cautery', 'gamma-
shaped cautery' (Paul vi, lxii), 'a fine iron needle flattened like a spear point' (Celsus vi, 7,
7B), 'cauteries which are not thick nor much rounded but of an elongated shape'
(Hippocrates iii, 15I).
With such tantalisingly incomplete information it has proved difficult to identify loose
finds, and the identification as a cautery of a small iron spatulate object from
Verulamium144has little to recommend it. Sealed groups of surgical instruments provide
safer ground and, although the four bronze spatulae of the Cramond set are not fully
convincing as cauteries,1450ne from Colophon is more so,146 while the identification of a
cautery in the Bingen instrumentarium seems secure.147 It is a stout example of iron, some
9-5 cm long, with a rectangular-sectioned tang and broad, stepped lunate end. A tang is one
139 See Milne, op. cit. (note 13), 117-120.

140
Vulpes, op. cit. (note 31), pl. VII, figs. X-XIII; Tabanelli, op. cit. (note 7), pl. LXII.
141 See Milne, op. cit. (note 13),
142
119.
Guzzo, op. cit. (note 3), fig. 32, 101-2.
143
Kiinzl, op. cit. (note 2), fig. 2.
144
A Gilson, Britannia xiii (1982), 303-4.
145 A Gilson, Medizinhistorisches Journal xviii (1983), 384-393.
146 Caton, op. cit.
(note 35), pl. XI, 27.
147 L.J. Bliquez, Amer.
Journ. Arch. lxxxv (1981), 187.

156 RALPH JACKSON
of the features that should be sought in prospective cauteries as a separate, normally

organic handle would have been required to counter the effects of heat conduction. It was,
therefore, one of the few ancient surgical instruments which could not normally have two
functional ends.
The present cautery (No. 25) is a small example whose slender tang still retains traces of
its wooden handle. Beneath the corrosion radiography reveals a finely made instrument
with elegantly forged mouldings. The working end is either complete or very substantially
so and comprises a small leaf-shaped spatula whose edges appear to have been blunt.
However, the possibility cannot be excluded that one edge was originally sharp, and a
sharp-edged cautery is alluded to by more than one ancient writer.148
One of the few known cauteries, that from the Asia Minor instrumentarium,149 may have
been functionally similar to No. 25. Although the handle arrangement differs, the small
leaf-shaped spatula is of similar size and shape. A much closer parallel lies in an
unpublished instrument said to have been found 'on the battlefield of Lake Trasimene'.'150
Made of iron, apparently coated with tin at the functional end, it is 7-5 cm long with slender
tang and forged mouldings of almost identical form to those of the present example. The
elongated spear-head shaped spatula, in a rather better state of preservation than No. 25, is
of similar overall shape but has one flat and one ridged face giving a low triangular
cross-section. This may be the type of cautery advocated by Celsus for treating a chronic
split lip:151
. if the fissures have penetrated deeper, it is necessary to burn them with a fine
cautery (tenui ferramento), spearhead shaped, which should as it were skim over them
without being pressed down'.
Certainly the modest size of both the Lake Trasimene and present cautery would suit them
to such 'medium-range' work.
Probes, Scoops, Spoons and Spatulae (Nos. 26-35; FIG. 3, 26; FIG. 4, 27-35; PL. xi)
The study of anatomy in Roman medicine was severely hindered by the many constraints on
human dissection. It was rarely encouraged (even Celsus152was ambivalent on the subject)
and it was frequently the cause of vehement attacks on surgeons.153 While sporadic
observation of internal structure and organs would have occurred in the treatment of
wounds suffered in accidents, in battle, or in the arena, knowledge was still defective. In
compensation the tactile sense became very highly developed, and detailed exploratory
work using a wide range of probes preceded many operations. Celsus' instructions for
sounding fistulae testify to the high level of proficiency reached by some practitioners:154
'first of all, however, it is proper to pass a probe (specillum) into the fistula that we may
learn both its direction and depth, and at the same time whether it is moist or rather dry
... if what is touched by the end of the probe is soft, the disease is still limited to the
flesh; if it meets with more resistance, the fistula has reached the bone. But when the
1'• Paulus Aegineta, op. cit. (note 37), VI, lxii; Galen xiv, 786.
'1 Hassel and Ktinzl, op. cit. (note 28), pl. III, I2.
British Museum GR 1932, 11-I2, 7.
15""
15
152
ibid., Prooemium, 73-5.
153
See J. Scarborough, Roman Medicine (London, 1969), 168-170.
154
op. cit. (note 6), v, 28, I2C-D.

probe slides smoothly, there is not yet decay; if it does not so slide, but meets with an
even surface, there is some decay although still slight; if what underlies is uneven also and
rough, the bone has become more seriously eaten away
For such sensitive work Paul155 specified 'a double-headed specillum of a very flexible
nature, such as those made of tin, and the smallest of those made of copper'. The fine,
slender probe, No. 27, is an example of this instrument. It has a tiny olivary expansion at
each end and the stem still retains some of its former flexibility. Termed dipyrene by Greek
writers it also served a number of other roles including that of a fine cautery for destroying
the roots of hairs after epilation.156 Surviving instruments include one each from the
third-century A.D.Asia Minor instrumentarium,57 the second-third century A.D. surgeon's
tomb at Nea Paphos,158 and the first-century A.D. Luzzi set,159 as well as one from
London160 and at least one from Pompeii.6'1 A variant with a small circular eye in the olive
is also known both from the classical medical literature'62 and from surviving examples
which include two from Caerwent,'63 one from Asia Minor,'164 and one from a late first- to
mid second-century context in London.'65 But for the vulnerability of such slight instru-
ments many more would be known, for it may safely be assumed that the Roman surgeon's
probe case was seldom without at least one fine dipyrene.
Although unusual variants or modified instruments are occasionally found the assortment
of other probes and sounds would normally have comprised a number of common types. It
is interesting to note that the present set, in addition to the fine dipyrene, includes at least
one example of each of these types - ligula (No. 28), ear probe (oricularium specillum) (No.
29), scoop probe (cyathiscomele) (No. 30), three spatula probes'66 (spathomele) (Nos.
33-35), as well as a stylus (No. 26), a spoon (No. 32), and what is probably a modified scoop
probe (No. 31). There is little doubt that they were carefully selected as a set to cover all
eventualities. An almost identical range of probes, still held in their cylindrical copper-alloy
box, was found amongst the large set of instruments in the second/third-century A.D.
surgeon's tomb at Nea Paphos, Cyprus.167 They comprised a fine dipyrene, a fine olivary
probe, a ligula, a scoop probe, and a spatula probe. The Pompeii palaestra find included a
similar though slightly more restricted set of probes within a cylindrical box,'68 and many
similar boxed sets, normally comprising 2-6 probes, exist in the collections of the Pompeii
Antiquarium and the Naples National Museum.
These were all multi-purpose instruments serving many different functions. The ligula
was primarily used to extract ointments and powdered medicaments from their containers,
but it could also be used to apply these substances. Additionally it could have served as a
155 op. cit. (note 37), VI, lxxvii.

156 ibid., VI, xiv.
157 Hassel and Kiinzl, op. cit. (note 28), pl. IV, 36.
158
D. Michaelides, 'A Roman surgeon's tomb from Nea Paphos', Report of the Dept. of Antiquities Cyprus,
1984 (Nicosia 1984), 315-332; see fig. I, 9.
159 Guzzo, op. cit. (note 3), fig. 39, 97.
16) British
Museum PRB 1896, 5-1, 15.
161 Naples, Museo Nazionale, Inv. no.
78145 B.
162 eg. Paulus Aegineta,
op. cit. (note 37), VI, xxv.
163 Newport Museum, D2 832,
164
840.
Mainz, R6misch-Germanisches Zentralmuseum, Inv. no. 0.38226.
165 British Museum PRB DR 1-63.
'~' Scientific examination (see p.164 below) has revealed that spatula probe No. 33 may have become
incorporated in the set after its discovery.
167 Michaelides, op. cit. (note
168 158), fig. I, 7-13.
Kunzl, op. cit. (note 2), fig. 3.

158 RALPHI JACKSON
dental scaler, while its small angled plate might be used as a fine cautery or as a blunt hook.
The slender pointed stem of the present example is essentially a fine simple probe
(specillum) and is likely to have been used as such, and also perhaps, as a perforator.
The ear probe is very frequently mentioned in the extraction of wax and foreign bodies
from the ear, and the instilling of liquid applications into the ear by squeezing them from a
twist of wool wrapped around the stem of the ear probe so that it ran down and fell in
droplets from the simple pointed end. Beyond its aural role the ear probe was recom-
mended for removing urethral calculus, for pouring liquid applications, especially to the
eye, for curetting tiny cavities and for a host of delicate surgical manipulations.
The spatula probe and scoop probe, like the ligula, served both as toilet implements and
medical instruments. They vary considerably in size and shape'69 according to the specific
usage or range of functions intended. In medicine they were used primarily in pharmacy, in
the preparation of medicaments (extracting, crushing, stirring, mixing) and in their
application (dabbing, pouring, spreading). Additionally the spatula probe might be used
as a tongue depressor, a cautery, a blunt dissector or a substitute for the meningophylax,
while the scoop probe could be employed in the removal of foreign bodies, as a curette, and
as a director. The olivary terminal was recommended as a small cautery, as a probe for
exploring large cavities, and, wrapped in wool, as a plug for occluding the nostrils.
In addition to the tiny spoon of the ear probe and the scoop probe larger spoons have
occasionally been found in medical instrumentaria. They may be specialised types designed
for medical use, as for example the large-bowled spoon with pouring lip in the 'Paris
surgeon' instrumentarium,'70 but they are often normal domestic utensils, like the fiddle-
shaped spoon of the Asia Minor set71 or the simple round-bowled spoon in the present set.
They were used in pharmacy for dispensing, measuring, heating and pouring medicaments,
but the slender pointed handle of the present type of spoon would have permitted its use as
a simple surgical probe in its own right.
Another household utensil, the stylus, is often found together with medical instruments.
Its medical uses included that of a perforator, a cautery (see above, p. 155), a simple probe
and tooth extractor.
It might be expected that all of the probes as well, perhaps, as some of the other slender
instruments of this set would have been held in the two cylindrical copper- alloy boxes (Nos.
36-37). That this was not so is indicated not by the manner of burial, which is unknown, but
by an examination of the two boxes, both of which are too short to have held instruments
and were undoubtedly medicine boxes. From the presence of iron corrosion on several of
the probes it may be inferred either that they were held in cases, boxes or pouches made
partially of iron, or that they were held in containers alongside iron instruments.
Cylindrical Boxes (Nos. 36-37; FIG. 5, 36-37; PLS.XI, XIV)

Of the containers which held Roman surgical instruments and medicaments only a
comparatively small number from a restricted range has survived. Not a single wooden
scalpel box has yet been found even though they must have been very common and are
known from depictions on stone reliefs and from traces of wood on the scalpels themselves.
It is only under exceptional soil conditions that a glimpse may be gained at the appearance
of those containers made of organic materials. Traces of a leather pouch, with instruments
within, were found in the mid third-century A.D.tomb at Wehringen,'72 while at Nijmegen
169
see eg. Milne, op. cit. (note 13), pls. XII-XV.
17'Deneffe, op. cit. (note 48), pl. 4, 14.
17' Hassel and Kuinzl, op. cit. (note 28), pl. II, 3.
172
Kiinzl, op. cit. (note 2), figs. 95-6.

the third-centuryA.D.surgeon'stomb included a small rectangularwooden box with four

compartmentsand slidinglid.173This type of rectangularbox has also been found in ivory,
but is much more frequentlyof copper-alloy.'74When found in a medicalcontext (and it
was not exclusivelya medicaltype) the compartmentshave on severaloccasionsbeen found
to containremainsof materiamedica.175Suchremainshave also been found in containersof
the second main type, a slender, copper-alloytube with closed ends comprisingbody and
lid. However some of the longer examples of these cylindricalboxes have been found to
contain slender surgicalinstruments,notably probes, 76 and they are often referredto as
portableprobe cases. Unless medicamentsor instrumentsare found within, it is preferable
to refer to them as cylindricalboxes.
Of the present two boxes No. 37 is a characteristicexample, made of thin sheet simply
decoratedwith lightlyengravedgirthlines. It is now empty, althoughdifferentialcorrosion
showsthat on burialthe lid was extendedto its greatestlength, some 14cm, as thoughit had
then containedsomethingsince gone. With the lid pushed rightdown the length of the box
is just Io-5 cm. Even at its greatest extent the box could have held none but the broken
stylus and probes (Nos. 26, 29, 31), all of which in any case appearto have broken after
burial.From this it must be concludedthat the box was not intended for instruments,but
was very probablya medicinebox for pills, powders, or collyrium-sticks.Four examplesof
identicalsize andtype, completewith pills and powderedmedicament,were includedin the
Nea Paphosinstrumentarium.177 The basic appearanceof the second box, No. 36, is much
the same as No. 37, but the dimensionsand constructionare less usual and set it apartfrom
other cylindricalboxes. Althoughit is comparativelylong its diameteris disproportionately
great (almost twice as wide as normal) giving it an unusuallylarge capacity. Even more
atypicalis the construction,four joining segments instead of the normaltwo-piece lid and
base. The purposeof this, at firstunclear,was revealedby scientificexaminationand radio-
graphy(PL.XIV).Each segment is a small box in its own rightwith one open and one closed
end. The provisionof accuratelyrebatedends on the centralsegmentspermitsthese boxes to
be stacked one upon another, each with a close-fittingoverlap. In this way three separate
compartmentsare formed each closed by the base of the segment above, the upper one
being sealed by the lid, Segment I. The practical result was that several different
medicamentscould be stored convenientlytogether each easily accessiblebut withoutfear
of contamination.In its presentform there are three closed units, but the systemwas easily
extendable by introducingfurther rebated segments. The base segment (IV) though of
suitable size is of slightly different form and different composition to the upper three
segments.
In the top two segments are remains of a solidified powdery substance, buff-coloured
tingedwith light green stainingfrom the corrosionproductsof the box walls. In SegmentII
a central tapering hollow in this substance indicates the manner in which it had been
scooped out for use. It is hardlyto be doubted that this was a medicament,and the first
stage of analysis(see p. 163-4) has revealed the presence both of lead, a common Roman
medical ingredient, and of wax, probably beeswax, which was often used as a base for
ointments and salves.
173 ibid., fig. 76.

174 F. Beck, Antiqu. Nationales ix (I977), 50-65.
175
eg. Milne, op. cit. (note I3), pl. LIV; Tabanelli, op. cit. (note 7), pl. CXXI; Beck, op. cit. (note 174), pl.
VIII, i, pl. VII, 6.
176eg. Milne, op. cit. (note 13), pl. LIll; Tabanelli, op. cit. (note 7), pls. CXVIII, CXIX.
177 Michaelides, op. cit. (note 158), fig. I, I-3, 5.

60o RALPH JACKSON
Stone Palette (No. 38; FIG. 5, 38; PL. XI)

One of the standard pieces of Roman pharmaceutical equipment was the mixing palette,
usually a small rectangular tablet of marble or other fine-grained stone.17" These have
frequently been found in association with medical instruments, but as they had a number of
alternative uses, for example in the preparation of cosmetics and artists' colours, a medical
use cannot be assumed for loose finds. In medicine, although some appear to have been
used to whet scalpel blades, they were primarily for the preparation of medicaments
(mixing ointments, grinding powders and rolling pills). The plain side was the working face
and it often bears a distinct hollow attesting to heavy and prolonged use of this kind.
The spatula probe was the instrument regularly used in conjunction with the palette, and
it is often found in association, as also are rectangular and cylindrical boxes and remains of
materia medica.'79 A stripe of copper corrosion on the underside of the present palette may
have derived from one of the spatula probes (Nos. 33-35). Indeed some palettes were held
in a metal slide which incorporated a tubular grip to hold one or more probes. A palette
from Cologne'so and another from Andernach'1 have such a slide made of copper-alloy
sheet with a hemispherical projection for mixing preparations, and a small compartment for
storing materia medica. The slide protected the palette from damage, and the palette in turn
comprised the lid of the container. The presence of iron corrosion on the long lateral facets
of the underside of the present palette strongly suggest that when buried it was held in a
similar way in a slide of thin iron sheet which has since corroded away.
Folding-Knife (No. 39; FIG. 5, 39; PL. XI)

In every respect this object appears out of place alongside the other instruments of the set.
The most immediate visual difference is in the colour and texture of the patina. This
difference has been confirmed by scientific examination which has revealed that the knife is
made of brass and has basic copper chloride in the corrosion products, not the basic copper
carbonate found on almost every other instrument. Additionally, by comparison with the
other instruments, it is of comparatively poor workmanship. The butted suspension-ring is
simply made and quite crudely finished, while the decorative mouldings lack the precision
and crispness of their counterparts on the other pieces.182 Furthermore, the instrument
itself has no medical parallel known to the writer. Certainly the ring-and-baluster decor-
ation is common enough on Roman medical instruments, but it is not restricted to them,
and the suspension-ring, although it might favour identification as a toilet implement or
personal utensil, is not a feature to be found on medical instruments.
The blade, apparently heavily whetted, now hangs loose on its securing rivet, the length
of which suggests there was originally some sort of organic filling material, bone plates
perhaps, within the slot socket, and even, perhaps, a second blade. This is unlike the
arrangement of known Roman folding knives. These, whether with bone or metal handles,
almost invariably comprise a single-sided blade, hinged on a rivet, with a cutting edge
protected within a grooved handle not an open slot.
Such indications as exist, therefore, are that the knife is almost certainly neither Roman
nor a medical instrument. There is little doubt that it became incorporated in the set of medi-
cal instruments, whether by accident or design, some time after the discovery of the latter.
178 eg. Tabanelli, op. cit. (note 7), pl. CXXIII.

179 eg. Kunzl, op. cit. (note 2), fig. 43 (Vermand), fig. 85 (Luzzi), fig. 95 (Wehringen), p. 102 (MWrida).
s18 Bonn, Rheinisches Landesmuseum, Inv. no. 13122.
'•l E. Kiinzl, Trierer Zeitschrift
xlvii (1984), 153-237; see pl. 16, II.
'" Decoration of similar style and workmanship is to be seen on Byzantine medical and toilet implements from
Corinth and Coptic Egypt: L.J. Bliquez, Dumbarton Oaks Papers xxxviii (1984), 187-204, nos. 5, 6, I1, etc.

A SET OF ROMAN MEDICAL INSTRUMENTS FROM ITALY I61
SCIENTIFIC EXAMINATION
By Susan La Niece
The instruments were examined to determine how they were made and whether, on the
grounds of composition of the metal and corrosion products, any could be excluded from
the group. All of the metal objects were examined for joins and constructional information
by radiography and optical microscopy. Metal corrosion products and the stone palette
(No. 38) were identified by Debye-Scherrer powder X-ray diffraction analysis.1" All the
copper-alloy objects were analysed by X-ray fluorescence spectrometry using an energy
dispersive system.184 The corrosion products were polished away to reveal the area of
analysis and copper, zinc, lead and tin were quantified. Some of the pieces have no flat
surface suitable for quantitative analysis so for these it was only possible to obtain
semi-quantitative results. These are not noted in Table 5 but are discussed in the text.
Scalpels (Nos. I-9)

Nos. 1-6 form a clear group: they all have a smooth patina of copper carbonates with no
trace of the rough calcareous matter which is found on so many of the other instruments.
Fragments of wood embedded in the corrosion suggest that they were almost certainly
buried together in a wooden box. However, analytically, the metal of every one is different.
2, 3 and 6 are of brass, though the level of zinc is quite low in 2 and 6 (see Table and
with tin contents from to These 5).- , 4 in
differences
5 are bronze, ranging 10'4% 14-8%.
composition can serve no obvious practical purpose in this case and are clear evidence that
the group was not cast together. It was not possible to polish a section through the metal in
order to examine the structure and ascertain how the instruments were made. These
scalpels could have been cast or they could have been worked from a square-sectioned
rod. In any case, they have been carefully finished: several still show clear marks of a file
used on the tapered neck. All six were double-ended tools with a socket for a now-corroded
iron blade at the end. The blades were secured with a soft solder of tin and lead. This melts
at a low temperature (250 'C or less) so a broken blade could easily be replaced.
Scalpels 7-9 are stylistically different from the first group, and there is no evidence that
they were buried in the box with Nos. 1-6. There are no traces of wood on them and their
patina is rough. Stylistically and analytically these three are very similar to each other and
clearly form a group, graded in increasing size of dissector and thickness of grip. They are
all made of brass with circa 12% zinc, tin and i% lead. They were probably worked
from a rod of brass rather than cast.2"5% The longitudinal striations along the seven-sided
handles (eight in the case of No. 7) are the result of scraping to accentuate the faceting. The
corroded iron blades were secured in the manner described above, with tin-lead solder.
Forceps (Nos. IO-12)

Nos. Io and I I are of brass of virtually identical composition to each other and to scalpels 7,
8 and 9. Like the scalpels, they are double-ended instruments with the remains of an iron
component at one end, again secured with tin-lead solder. The forceps appear to have been
made in one piece, from rod cut down the centre and forged to shape. The metal
composition and the decorative details of Nos. 7-1I are virtually identical so they can be
confidently grouped as a set made together.
No. I2, however, is not only different in type but also in metal composition to the two
discussed above. It is bronze, rather than brass, and was plainly designed to have a springy
13
L.V. Azaroff and M.J. Buerger, The Powder Method in X-ray Crystallography (London, 1958).
114 M. Cowell, 'Energy dispersive X-ray fluorescence analysis of ancient gold alloys', PACT
i, (1977), 76-88.

162 RALPH JACKSON
action; the metal still retains its resilience. The technique of manufacture is probably similar
to that used to make Nos. Io and II. The tips have been sharpened to fine points which are
still perfectly aligned. The ring now with No. 12 does not belong: its metal composition is
completely different and there is no evidence in the patina that the ring was buried with the
forceps. There is some organic material, probably wood, adhering to the inside of the ring.
Sharp hooks (Nos. 13-15)

No. 13 has a shiny black patina which is different in appearance to most of the other
instruments but where nodules of green corrosion do survive they are of the same, albeit
common, type (basic copper carbonate), as is found on other items. Its metal composition
does not stand out as unusual (1-5% zinc, 3% lead, 9-7% tin) so it may simply have been
cleaned since excavation.
No. 14 is a bronze, containing 8-13% tin and a little lead (lack of a suitable surface
prevented more accurate analysis). No. 15 is a brass similar in composition to the group of
Nos. 7-1 I. Both of these hooks have a green patina with some blue (copper carbonates).
No. 15 is stained with iron, like so many other instruments from this set.
Nos. 13 and 14 have decorated tops which may have been cast but the hooks have been
worked. No. 15 is a tapering faceted rod most easily made by forging.
Blunt hook (No. 16)

This is a bronze double-ended instrument with heavily decorated central grip. Radiography
reveals a clear crack in the metal running along the grip, the main part of which is likely to
have been cast. However, some of the detailed decoration may have been added after
casting when the ends were hammered flat and bent at 90 degrees to the grip.
Bone chisels (Nos. 17-18)
These are a virtually identical pair with brass handles of the same composition. No. 18 is
splayed at the top of the handle where it has been struck repeatedly with a hammer. No
traces of solder were found at the junction between handle and blade. It is possible that the
brass handle was cast on the iron. Radiography indicated that the iron is embedded in the
handle to a depth of 1-5 cm.
Speculum (No. 19)

The speculum works on a hinge, not a scissor, action. The two sides were cast separately
and joined by a rivet with a washer on each side. It is made of bronze and the rivet and
washers are of virtually identical composition to the rest of the instrument.
Catheters (Nos. 20-22)

All three are made of sheet bronze, but with small differences in composition, and have a
single, butted seam running lengthwise, slightly twisted off-centre. There appears to be no
overlap on this seam but it is still close-fitting, and is probably joined with solder, although
no proof of this was found. Tin-lead solder was found around the open necks of Nos. 20 and
22, probably for attaching a collar like that on No. 20. Draw-plates are not generally
considered to have existed in the Roman period.'85 If not drawn these tubes could have
been formed over a mandrel. Whatever the method used, they have been made with great
care to produce the smoothest possible finish.
115
W.A. Oddy, Gold Bulletin Vol. io, no. 3, (1977), 79-87.

Handled needles (Nos. 23-24)
No. 23 appears to have been made in a single piece. The metal is brass with zinc in the range
10-15% and between 2 and 5% of lead and tin. Its patina is different in appearance from
the rest of the set. The decoration is very crisp and would appear to have been cut not cast.
There is no evidence for inlay in the spiral grooves.
No. 24 was made up of 3 pieces: two hollow tubes forming sockets for the needles, now
missing, and a decorated section joining the two sockets. The tubes are made, like the
catheters, of sheet bronze with a single, butted seam running lengthwise. Again there
appears to be no overlap and the join is very neat. The central decorated section appears
from the radiograph to be solid but may be filled with solder. The sockets are empty right
down to the central section and it is not clear how the needles were secured. Again there is
no evidence of inlay in the decoration.
Cautery and stylus (Nos. 25-26)

Both are of iron, forged to shape from a rod.
Probes, scoops, spoons and spatulae (Nos. 27-35)

No. 27 (dipyrene) is hammered from a fine rod with a zinc content in the range of 1-5%, tin
of 5-1o% and a trace of lead. There is a mark in the patina where it rested against another
object during burial. The ligula (No. 28) was made in the same manner but in bronze, with
no zinc.
No. 29, the ear probe, has been heavily cleaned clearly revealing the creases in the
hammered shaft. The metal is brass with a little lead and arsenic but no tin. At the broken
end are traces of tin-lead solder which look very fresh and bright.
No. 30 is of bronze and shows evidence of working. No. 31 is brass (15-20% zinc, 2-5%
tin, trace of lead) with a higher zinc content than any other item in the set. Spoon No. 32 is
bronze and is the only item in the set which has evidence of tinning. The bowl and part of
the handle are tinned. Creases from hammering are present on the handle and its tip is
broken.
Spatula probe No. 33 has a smooth dark patina which stands out from that of the rest of
the set, and the green corrosion was identified as a basic chloride, not a carbonate. The
spatula itself is made of bronze and a sheet of decorated copper has been wrapped around
the grip. The sheet does not seem to serve any practical purpose; for example, there is no
break in the grip. It appears to be purely decorative, indeed the reddish copper would have
contrasted well with the bronze.
The two spatula probes, 34 and 35, are very similar in their manufacture; both were
hammered from a rod. Their metal composition differs only in that No. 34 has a little zinc,
as well as tin and lead, in the copper. Radiography indicated longitudinal creases in the
metal of No. 35 caused by the hammering. There is a mark in its corrosion where it rested
next to a long thin object during burial.
Cylindrical boxes (Nos. 36-37)

Both boxes are made of bronze but one of the end sections of No. 36 is made of brass and
would have looked very different in colour. It was probably added later. No. 36 is in fact
made up of three small boxes end to end, capped with a lid. Radiography clearly shows the
hammer impressions in the metal. Surprisingly no joins were found except for the obvious
ones between the sections. It appears that each section, including the deep and narrow main
section of No. 37, was raised, i.e. hammered, in a single piece.
The material found inside the top two sections of Box 36 was analysed by XRF which
indicated that traces of copper, calcium, silicon and iron are present, all of which are

164 RALPH JACKSON
probably contamination from the metal box and its burial environment. However, a little
lead was also present, which is not found in any significant quantity (c. 0-03%) in the metal
of the box. This may well be an ingredient, though apparently a minor one, of the
medication. A wax, probably beeswax, was identified by XRD.186
Stone palette (No. 38)

The palette is made from a dull, green, fine-grained stone."'87 X-ray diffraction indicates
that the mineralogy is predominantly chlorite with some quartz. Thus it is a low-grade
metamorphic rock of a type which is fairly widespread, and may even occur as erratic
pebbles. Without examination in thin/polished section, which would require removal of a
small fragment, it is not possible to be more precise. The surface is much stained from
contact with iron during burial.
Folding-knife (No. 39)

This implement stands out from the rest of the set for its comparatively poor workmanship
and also its black and green patina. The green was identified as basic copper chloride, not
the carbonate found on most other instruments. This suggests that it was buried in different
soil conditions. The blade and the handle are made of brass of similar composition. The
blade is much worn by sharpening, and something appears to be missing which held the
blade in position in the handle.
GENERAL SCIENTIFICCONCLUSIONS
Most of the instruments in this set have a very similar patina. Many of the objects are
stained with iron and have a calcareous deposit which has been identified by XRD as calcite
(CaCO3) and dolomite (CaMg(C03)2), indicating burial in a region of limestone, rich in
magnesium. The items on which no traces of such a deposit were found are the scalpels,
1-6, which appear to have been protected by a box, and also sharp hook 13, ear probe 29,
spatula probe 33, and cataract needle 23, all of which appear to have suffered cleaning since
excavation, and folding-knife 39. Nos. 33 and 39 both have basic copper chlorides in their
surfaces, whereas all the other items in the set have blue and green basic copper carbonate
corrosion. This indicates different burial conditions for 33 and 39, suggesting that they do
not belong to the set. The evidence for needle No. 23 was not conclusive as it was not
possible to identify the green corrosion products present, but it is possible that cleaning
since excavation has confused the evidence.
The metal composition of the set is surprisingly varied. Both brass and bronze, which
were in everyday use in the Roman period,188 are present. In contrast 21 Roman needles
analysed by Riederer189produced only I brass, I mixed alloy, 13 bronzes and 6 of copper.
The scalpels (Nos. 1-6) which seem such a clear group, linked by their form, patination and
the evidence of contact with wood are particularly surprising in their differences. It may be
that the tools were in use over a long time and breakages were replaced or special
requirements were filled by adding new instruments over the years. The clearest groups by
metal composition within the set are firstly, the pair of bone chisels (Nos. 17 and 18);
"' Professor G.
Eglinton of the Organic Geochemistry Unit at the University of Bristol has kindly agreed to
carry out further analysis of the material.
187 Examination by Dr Ian Freestone and Mavis Bimson, British Museum Research Laboratory.
88
P.T. Craddock, Journ. of Arch. Science, v (1978), 1-16.
89
J. Riederer, 'Romische Nihnadeln', Technikgeschichte xli (1974), 153-172.

secondly, Scalpels 7-9, together with Forceps Io and I I; and thirdly, the Catheters 20-22
and Needle-holder No. 24.
Most of the metal items in the set show evidence of working and the standard of finish is
high for all except knife No. 39.
TABLE 5: RESULTSOF QUANTITATIVEANALYSIS
Catalogue % copper % zinc % lead % tin

No.
I scalpel 83-7 <0-2

2 81.9
1"5
2-9 14"8
scalpel 13-3
2.I
3 scalpel 9.2 1-7 3-8
4 scalpel 85"3 <02
90o2 1I9
5 scalpel <0-2 7-I 7"9
10-4
6 scalpel/spoon 82"5
84 1.4 37 10-9
7 scalpel 12.7 II 2-9
8 scalpel 83.2I 12 o08 2 2
85" 11
9 scalpel 85-9 0-7
IO forceps 12-3 o-6 2"3
2
85"I
86 11 0-9
II forceps
10 2"2
12 forceps 79'5 <0-2 IO
ring now with the above 82 17 0-4 0O2
13 sharp hook I5 3
15 sharp hook 85"9
86-5 11 4 0o6 9"7
1-5
16 blunt hook I 9'4
17 bone chisel: handle 89"5 <0"2
13 10-9
bone chisel: handle 78"6 9"2 I-I
I8 9"3 11.9
19 speculum
77"7 11 7
87"5 <0"2 o08
20 catheter 90-6 <0 2 0-4 9 I
21 catheter 87.6 0-2 12 I
22 catheter <0"22
<0
84-2 I I 14-8
24 needle holder 87.6 I 115
<0"2
<0-2
30 scoop probe 91 I 2-4 6-4
33 spatula probe 86.8 <0-2 0-4 12-7
spatula probe grip 97.9 <0-2 0-3 I-6 Arsenic
34 spatula probe II 0"3 9
35 spatula probe 87"3
86-6 <0-2 2.5
21 113
I
36 cylindrical box
sections I-II <O I
<0.2
section IV 92.5
c c 15 trace 7"5
trace
85
37 cylindrical box <0-2
0O2 9
39 folding knife 90o9 3.3
8.8 2-4
85"5
CONCLUSIONS
Apart from the intrusive folding-knife (no. 39) the instruments have in common a high
level of craftsmanship. Like most Roman surgical instruments they are made primarily of
copper-alloy or iron/steel or a combination of the two. The surface of the metal, as far as
can be seen, is unflawed and where decoration exists it is regular and crisply cut or cast.
Some of the probes have a particularly finely swaged stem, while the workmanship of the
catheters is of the highest calibre. Few of the iron/steel components survive intact but there
is no reason to doubt that they were of equally high quality. Like the copper-alloy
instruments variation may have occurred in the metal, although how far this may be viewed

166 RALPHJACKSON
as a deliberate choice and how much as a consequence of the use of recycled metal is
difficult to assess.
If careful and specific choice did not enter into the matter of metal alloys then it certainly
did so in the selection of types and groups of instruments. Immediately apparent is the lack
of repetition. The probes and sounds complement rather than duplicate one another, as do
the forceps, while the scalpels, hooks and catheters form graded sets within the main
instrumentarium. Scalpels 1-5, though of a standard and simple type, have a distinct 'air de
famille' and, while differing widely in metal composition, they may yet have had a common
source. Scalpels 7-9 are so similar, both in form and in composition, that they must have
been acquired as a set, together, almost certainly, with the combination forceps Nos. io-i I.
By the same token both the bone chisels and the catheters may be regarded as sets acquired
together. Other instruments, the hooks and the probes, for example, bear no such close
similarity and may well have been added individually or in small groups, while at least one
piece (No. 31) appears to have been used in a modified form.
In short, the set gives every appearance of having been built up gradually, though
perhaps over no very great period of time. Such processes as inheritance, purchase,
damage, repair, commission, replacement and reconditioning may all be envisaged, the
changing size of the set, which would perhaps have reflected the fluctuating fortunes of its
owner, terminating only with its burial.
In the absence of contextual evidence dating of the set has perforce to be based on the
form of the instruments themselves. The scalpels are of the form characteristic of the
Roman Imperial period, a type which has as yet no certain dated context prior to the first
century A.D.;like the other instruments of the set the scalpels bear no inlaid decoration, a
fashion which seems to have flourished in the second and third centuries A.D.In a set of such
size and quality this absence argues for a first- or early second-century date. This is also
implied by the similarity of several instruments and their style of decoration, in particular
the fine foliate moulding of the blunt hook, to examples from Pompeii/Herculaneum as well
as to several other independently dated grave groups of that period.
In its present form the instrumentariumwould have enabled a wide range of surgical and
medical treatment. It comprises three groups:
I) A large number of 'basic' surgical instruments: - scalpels, hooks, forceps and probes.
2) A group of pharmaceutical pieces: - cylindrical medicine boxes, scoop probes, palette,
spatula probes and spoon.
3) A number of specialist or rarely found instruments: - bone chisels, sharp spoon, blunt
hook, catheters, speculum, cataract needle, cautery.
With the equipment belonging to the first two categories the surgeon could have operated
on and prescribed for many of the more common diseases and afflictions, but the
instruments of the third category would have permitted more specialised operations. Eye
surgery, including the operation for couching cataract, is represented by the fixation forceps
and the handled needles; the chisels and sharp spoon as well, perhaps, as the blunt hook
were instruments of bone surgery; the catheters would have permitted treatment of patients
with urinary disorders, especially strangury, though not those with urethral calculus, while
anal lesion, fistula in ano and internal haemorrhoids could have been operated upon
through use of the speculum.
The skill and success of a surgeon may by no means be gauged by the quality and quantity
of his instruments, a point made by several classical authors, but if used effectively the
present set could clearly have embraced an impressive list of operations. The surgeon who

used it was not a specialist in the modern sense, nor did he specialise in a single type of
operation like a very small number of his contemporaries.'" Rather he appears to have
been a well-equipped 'general practitioner' who could turn his hand to a number of specific
operations as well as to the day-to-day range of fractures and minor surgery.
ACKNOWLEDGEMENTS
I have received help and advice from many colleagues, in particular from Mr Brian Cook,
Mr Donald Bailey, Mr Ian Jenkins, Miss Judith Swaddling, Miss Catherine Johns and
Professor Larry Bliquez. I am grateful to them and to many others who have provided
details of instruments. Above all I have benefitted from Dr Ernst Kinzl's extensive know-
ledge of Roman surgical instruments. It is a pleasure to record my thanks to him for
stimulating and friendly discussion on both specific instruments and Roman medicine in
general.
Dept. of Prehistoric and Romano-British Antiquities, British Museum
19o Kiinzl, op. cit. (note 107).

PLATE XI
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PLATE XII
. . . . . . .
(Photo Copyright: British Museum)
A. Roman medical instruments from Italy. The anal speculum, No. 19. Actual size 15-6 cm. (p. 124).
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B. The blunt hook and bone chisels, Nos. 16-18. Scale C. The iron cautery, No. 25. Scale 2:I. (p. 128).
I:2. (p. 124).

PLATE XIII
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Roman medical instruments from Italy. The handled needle and needle-holder, Nos. 23-24. Scale I:I. (p. 126).

PLATE XIV
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Roman medical instruments from Italy. The 'stacking' medicament box, No. 36, with radiograph to show
construction. Scale 1:1. (p. 130).


A Set of Roman Medical Instruments From Italy

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A Set of Roman Medical Instruments From Italy

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A Set of Roman Medical Instruments from Italy

Author(s): Ralph Jackson and Susan La Niece

This content downloaded from 81.49.165.213 on Sun, 16 Mar 2014 14:36:03 PM

This content downloaded from 81.49.165.213 on Sun, 16 Mar 2014 14:36:03 PM

P.G. Guzzo, Not. Scavi xxviii (1974), 449ff.

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I. Scalpel/blunt dissector, Type I (FIG. I)

2. Scalpel/blunt dissector, Type I (FIG. I)

4. Scalpel/blunt dissector, Type I (FIG. I)

5. Scalpel/blunt dissector, Type I (FIG. I)

6. Scalpel/sharp spoon (FIG. I)

This content downloaded from 81.49.165.213 on Sun, 16 Mar 2014 14:36:03 PM

This content downloaded from 81.49.165.213 on Sun, 16 Mar 2014 14:36:03 PM

7. Scalpel/blunt dissector, Type II (FIG. I)

8. Scalpel/blunt dissector, Type II (FIG. I)

io. Smooth-jawed fixation forceps/(?)scalpel (FIG I)

Ii. Toothed fixation forceps/ (?)scalpel (FIG.I)

12. Pointed-jawed forceps (FIG. I)

I3. Sharp hook (FIG. 2)

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14. Sharp hook (FIG. 2)

15. Sharp hook (FIG. 2)

16. Double blunt hook (FIG. 2, PL. XIIB)

17. Bone chisel (FIG. 2, PL. XIIB)

18. Bone chisel (FIG. 2, PL. XIIB)

I9. Anal speculum (FIG. 2, PL. XIIA)

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This content downloaded from 81.49.165.213 on Sun, 16 Mar 2014 14:36:03 PM

21. Male catheter (FIG. 3)

22. Female catheter (FIG. 3)

23. C -ract needle (FIG. 3, PL. XIII)

24. Needle-/cautery-holder (FIG. 3, PL. XIII)

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This content downloaded from 81.49.165.213 on Sun, 16 Mar 2014 14:36:03 PM

25. Iron cautery (?) (FIG.3, PL.XIIC)

27. Dipyrene (FIG. 4)

28. Ligula (FIG. 4)

29. Ear probe (FIG. 4)

30. Scoop probe (FIG. 4)

31. (Scoop) probe (FIG. 4)

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This content downloaded from 81.49.165.213 on Sun, 16 Mar 2014 14:36:03 PM

32. Spoon (FIG.4)

33. Spatula probe (FIG.4)

34. Spatula probe (FIG.4)

35. Spatula probe (FIG.4)

38. Stone palette (FIG. 5)

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This content downloaded from 81.49.165.213 on Sun, 16 Mar 2014 14:36:03 PM

39. Folding knife (FIG. 5)

7 M. Tabanelli, Lo strumento chirurgico e la sua storia (Milan, 1958), pls. 10-15.

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This content downloaded from 81.49.165.213 on Sun, 16 Mar 2014 14:36:03 PM

18 R. Meiggs, Roman Ostia (Oxford, I960), pl. XXVII, a.

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sharp-pointed blade which accompanied Albucasis' translation of Paul's description of the

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34 Tabanelli, op. cit. (note 7), pls. XII and XIII-XIV.

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Forceps (Latin: vulsella, myzon.) (Nos. 10-12; FIG. I, PL. XI)

41 Como, op. cit. (note 4), fig. 2, 14.

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Chirurgien Gallo-Romain du III siacle (Anvers, 1893), pl. 5, no. I.

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