Here, at last, is a comprehensive monograph on Graeco-Roman surgical instruments, to replace J.S. Milne's Surgical Instruments in Greek and Roman Times of 1907, which even by the time of its 1970 reprint was beginning to look decidedly out of date. B. is one of the triumvirate of internationally renowned scholars specialising in Graeco-Roman surgical instruments, along with E. Künzl and R. Jackson. Together with the latter he had already made an important contribution to this field in 1994, with a large tome describing the collections of the Museo Archeologico at Naples.
Although B. self-deprecatingly points out his lack of medical expertise compared with Milne, as he himself says, this is not an insurmountable obstacle to research on this subject, based as it is on archaeological finds and texts. B. has some considerable advantage over Milne. Not only is there a larger number of instruments available with the addition of finds made since 1907, but he can also avail himself of the work done by Künzl and Jackson (and of course by B. himself) on the typology of authenticated instruments. When it comes to looking for specific terms or names of instruments in Greek or Roman texts, electronic searches in TLG and TLL have made the task quick and easy in ways unimaginable in the past (if perhaps at the price of a thorough familiarity with entire works).
The ‘tools’ of the title covers more than bona fide surgical instruments. B. also includes what he calls ‘parasurgical equipment’, that is, the various paraphernalia necessary in the surgery – among them mortars and pestles, whetstones or vessels, but not mechanical devices like the ‘Hippocratic bench’. In the appendix, B. also deals with ephemeral items such as bandages, sutures or plugs. (It is not quite clear why this also contains the ‘kephalike of Philotas’, a specific plaster rather than a paramedical item.)
After a list of primary sources, the book opens with the introduction, discussing the state of research, nomenclature, the training of surgeons, the manufacture of instruments, and their material and characteristics. At first glance one issue with the identification of instruments is that we have more names than authenticated types of instruments, but to a large extent this divergence can be explained by the fact that some instruments have more than one name. The opposite problem can arise in Celsus, who sometimes uses vague terms like ferramentum.
The section about medical training gives a brief overview of how one would have become a doctor in antiquity – and although the heading calls them ‘surgeons’, the majority would have had training in nearly all fields of medicine. While most historians of medicine will be familiar with these matters, the explanation will help to make the volume accessible to those who are not.
In the next two sections, B. describes how surgeons would acquire their instruments, by either buying ready-made ones, commissioning them from a blacksmith (as we know Galen did), or even making them themselves. He then applies his archaeological expertise to a discussion of the different materials used, which influence material survival (e.g. iron or steel rusting away), as well as different levels of workmanship or creativity.
In a brief section at the end of the introduction, B. addresses the risky and unanswerable question of how successful ancient surgery was in real life. He wisely refrains from any attempt at statistics, merely citing examples. The section also touches upon the use, or non-use, of drugs that might have functioned as anaesthetics, a topic on which most historians of ancient medicine have their own take, with no view being entirely provable. B. suggests occasional (and not necessarily effective) usage for major operations, but the overwhelming textual evidence seems to suggest that, while strong narcotics were well known, they would have been considered too dangerous and unpredictable by most.
In the course of this discussion, B. also suggests (p. 22) that Galen may have been reluctant to be considered a surgeon because of the bad reputation of surgery as painful and risky. Although Galen certainly would not have wished to be identified solely as a surgeon (but rather to be seen as a physician excelling in all fields of medicine as well as a philosopher), he speaks of his surgical achievements with pride, and the low status of surgery is a later phenomenon. The reference to τοῖς χειρουργοῖς καλουμένοις in n. 100 need not be taken as any more than the highlighting of a technical term.
The main body of the book is divided chronologically into two chapters, one on ‘Hippocratic Surgeries and Surgical Tools’ and the much longer ‘Tools of the Empire’, separated by a very short one on ‘The Hellenistic Contribution’. For the ‘Hippocratic’ chapter, B. notes the discrepancy between the considerable number of instruments mentioned in the writings on the one hand and the extreme scarcity of material survivals from the same period on the other. He explains this by a difference in burial practices: only during the Roman Empire was there a widespread custom of burying doctors with the tools of their profession. In the very rare instances dating back to the centuries in which the Hippocratic Corpus was written, the object of choice for grave goods appears to have been the cupping vessel as a symbol of medical activity. As B. states, though, the difference between Hippocratic instruments and their Roman successors will not have been enormous, so one can assume that they would have resembled later specimens.
Within the chronological chapters, the instruments are listed by their functions, for example ‘cutting and puncturing instruments’ or ‘bone and tooth instruments’. Under these headings, the Greek (or sometimes Latin) names provide a further subdivision, accompanied by references to textual passages in which these items are named. In the main text, the relevant passages are often summarised, with just a few Greek or Latin words, or the original sentence is quoted in a footnote. In the case of the Hippocratics, readers who want to look up these passages will find it disorientating that only certain quotes are cited in the standard way, i.e. by volume and page number of the Littré edition, while others refer to various other editions. (With Galen, B. adheres to conventions by always citing the Kühn edition, at times together with a more recent one.)
Before launching into the description of instruments used by Celsus, Galen and later physicians, B. gives a brief survey of what had been added in the centuries since the Hippocratics. Most of these appliances appear to go back to Hellenistic surgery, alongside technical innovations such as arterial ligature (which made major amputations possible). The influence of Alexandrian mechanics, too, is evident in screw- or piston-driven devices like specula or syringes.
In discussing the large number of post-Hellenistic instruments in the ‘Empire’ chapter, B. supports his findings with numerous quotations from Galen and quite a range of other authors, including ones not cited by Milne. Some entries come with useful, and typographically attractive, lists of references (usually alphabetically, by author) in small-print summaries.
The black-and-white illustrations are another great improvement on Milne, both in quality (although Brill could have allowed a few glossy pages) and in content: apart from containing fewer samples, Milne's illustrations included a number of items mistakenly identified as instruments, in reality cutlery or household gadgets.
It only remains to say that we can perhaps keep our Milne as an antiquarian curiosity, but need never use it again. This excellent volume is likely to become the standard reference work for the next hundred years for scholars, students and lay readers with an interest in ancient medicine.
