Cutting instruments — The scalpel handle — Typical form rectangular, with blunt dissector — Round — Octagonal — Mounting the blade — Varieties of blade — Classification — Straight blades with one cutting edge — Scalpel — Bistoury — Scarificator single or multiple — Razor type — Blunt-pointed bistoury — Ring knife for dismembering the foetus — Straight two-edged knives — Galen’s long dissecting knife — Phlebotome — Fleams — Katias — Spathion — Hemispathion — Polypus knife — Lithotomy knife — Knife for lithotomy invented by Meges — Perforator for foetal cranium — Probe-pointed bistoury with two edges — Curved bistoury — Crow-bill — Pterygium knife — Knife for plastic operation for entropion — Uvula knife — Tonsil knife — Fistula knife — Curved two-edged blades — Galen’s cartilage knife — Curved myrtle-leaf-shaped blade — Shears.

   THE surgical knife had, as a rule, the blade of steel and the handle of bronze. We find specimens all of steel or all of bronze but these are exceptional forms; and hence it happens that many more handles than blades have been preserved to us, as usually the blade has oxidized away leaving no trace of its shape. It will be well, therefore, to commence with the study of the handle.

   The scalpel handle consists, as a rule, of a bar of bronze, which may be round, square, hexagonal, or trapezoidal in section. At one end there is a slot to receive the steel blade, varying in depth from 2 cm. in the larger, to 1 cm. in the smaller, instruments. The other end of the handle carried a leaf-shaped spatula to act as a blunt dissector. A groove is often formed near the end of the handle, or the end is raised into a cylindrical roll on each side, and this roll again is sometimes perforated with a hole.

   It is generally believed that the blades were fixed in the handle by a binding thread or wire, and that the rolls and perforations were to give security to the mounting used. This detachable arrangement would allow of removal for cleaning, and also permit one handle to be used with several varieties of blade. A consideration of the slots in a large number of handles leads me to believe, however, that this was, to say the least, not the usual arrangement. The proportion of the depth of the slot to the size of the blade to be supported is in most cases not large enough to allow of a temporary mounting to fix the blade firmly, and I believe that most blades were either luted or brazed in permanently. These processes were well known to the ancients, and in fact we have them in evidence in other surgical instruments. Those bleeding-cups from Pompeii which carry rings on their summits have the top part brazed or soldered on. Galen (ii. 717) alludes to the blowpipe which goldsmiths used, and Paulus Aegineta has a chapter on the fluxes used by these artists. We frequently meet with ornaments fixed on boxes by means of solder.

   On the other hand, the slot in some handles expands at its termination into a wider portion which would carry a cylindrical expansion on the other end of the blade. This form of blade could not be pulled outwards, and might well be fixed with a temporary mounting.

   Different varieties of handles are shown in Plates I-III. Some are beautifully damascened with silver. These are mostly of the third century, but Sambon reports some damascened handles of the first century. A rare form is seen in a specimen in the Museum at Le Puy-en-Velay, where the handle is round and decorated with a spiral band of silver inlaid round it. It is from the find of the oculist Sollemnis (Pl. II, fig. 6).

   A few variations from the characteristic combination of handle and spatula-shaped dissector occur. Thus we have a handle ending in a conical point (Pl. II, fig. 7), which Deneffe regards as a drill for perforating the nasal septum in cases of fistula lachrymalis. Archigenes describes this operation, and the handle was found in the grave of the oculist Severus. Along with it were found two other handles, which, instead of a spatula, had carried a steel needle (Pl. II, figs. 1,2). The needles have disappeared of course, but there are the holes to receive them. In other cases the handle was round, and either quite plain or ornamented with raised rings. Some of these ended in a small round knob (Pl. V, fig. 2). Others carry the head of Minerva Medica like the spoon in Pl. XX, fig. 5. There are three of these handles in the Naples Museum. Rufus of Ephesus describes a lithotomy knife which had a scoop at the end of the handle with which to extract the stone. An example of this is seen in the box of scalpels from Athens (Pl. IV).

   For the study of the different varieties of blade we have at our disposal first of all the specimens that have actually survived. Of these the largest number are to be seen in the Naples Museum, but a considerable number are to be found scattered over various museums. An ex voto tablet found on the site of the temple of Aesculapius on the Acropolis at Athens shows a box of scalpels, among which are some interesting forms (Pl. IV). The scalpels, it will be noted, are arranged head and tail alternately. A few varieties are actually described in detail in the classical authors, and, by piecing together other references to parti¬cular instruments and drawing inferences from the various uses to which we find them put, we are able to describe a surprisingly large number of forms. The sixteenth-century writers, such as Paré, and seventeenth-century writers, such as Scultetus, illustrate with great confidence many of the cutting instruments mentioned by ancient writers, but it is easy to show that in several instances they are wrong, and, therefore, I have drawn on them as little as possible.

   As a basis of classification we may select the following points about the blade. The form may be straight or curved. There may be only one cutting edge or there may be two, and the point may be sharp or blunt. We shall examine combinations of these in the following order:

   I. Blade straight—

(A) Cutting on one side only (a) sharp-pointed, (b) blunt-pointed.

(B) Cutting on two edges (a) sharp-pointed, (b) blunt-pointed.

   The ordinary scalpel had apparently a straight, sharp-pointed blade. The word which Galen, Aetius, and Paulus use to denote scalpel is σμίλη. Latin authors use scalpellus, the diminutive of scalper. From the etymology of these terms we can learn nothing as to the shape of the blade; they are merely general terms denoting a cutting blade of any kind—chisel, graving tool, knife, &c. The word Hippocrates uses, μάχαιρα or μαχαίριον, has a more definite meaning. It is from μάχαιρα, the old Lacedaemonian sword, a broad blade cutting on one edge, sharp-pointed, and straight or with the tip turned slightly backwards. Thus, even in Hippocratic times the scalpel was apparently much of the same shape as it is now. Good examples of the ordinary scalpel may be seen in Pl. V, figs. 1 and 2 from the British Museum. They are all of steel. A variety with the point turned back at the tip is seen in one of the scalpels in the scalpel box from the Acropolis (Pl. IV).