Instruments

‘We have two sorts of Chirurgical Instruments, some are Natural, and others Artificial. The natural Instruments of a Surgeon are his Hands … Artificial Instruments are used by a Surgeon when his Hands are not sufficient. They consist of different matters; but generally of Iron and Steel, some are made of Gold, Silver, Lead, and other Matters’.

René Jacques Croissant de Garengeot, ‘A Short Description of the Instruments that are used in Chyrurgical Operations’ in A Treatise of Chirurgical Operations (London, 1723), pp 528-9.

Guido Guidi, Ars medicinalis, in qua cuncta quae ad humani corporis valetudinem praesentem tuendam, & absentem reuocandam pertinent, methodo exactissima explicantur. Quae per Vidum Vidium juniorem diligentissime recognita … (Venice, 1611), p. 106.

The Florentine Guido Guidi (1509-69), who became the first Professor of Medicine at the Collège de France, is, in many ways, representative of a host of medical writers in the early modern period who, in discussing anatomy and surgery in their works, included a section on surgical instruments. This image, from Worth’s copy of Guido Guidi’s Ars medicinalis (Venice, 1611), concentrates on forceps, an instrument which the eighteenth-century French surgeon René Jacques Croissant de Garengeot (1688-1759), advocated should be used to dress the inside of a wound ‘to take or place some Things which could not be taken or placed so easily with the Fingers’.[1]

Forceps were also considered to be a vital surgical instrument by the seventeenth-century English surgeon, Thomas Brugis, whose Vade Mecum: or, a Companion for a Surgeon. Fitted for Sea, or Land; Peace or War (London, 1681), Worth bought in its seventh edition. For Brugis, forceps were an ‘Instrument of continual and very necessary use in Chyurgery’, and should be an item in any basic seventeenth-century surgical kit which should also include the following: ‘Incision Knife; Uvula Spoon; Scissers; Stitching Quill, with three Chyrurgions Needles, of several sizes; Plain Spathula; Spathula, or Speculum Linguae; Director, with Speculum Oculi; Single, and Screw Probe’ and, finally, a ‘Fleme’.[2]

Helpfully, he provides us with a brief introduction to their possible uses:

Incision Knife: ‘The use of this Instrument, is to cut the Skin or Flesh upon needful occasions, in paring away the putrid part of a Gangrenous Member, in making Fontanella’s, or Issues, in opening Apostemes, in Scarifications, etc. Let this Instrument be alwayes kept clean and bright, by being rubbed dry, after it hath been used, and sharp as any Razor. Let the Artist ever hide it from the Patients sight with a Cloth, and also all other sharp Instruments, for divers Reasons’.

Uvula Spoon: ‘This serveth to put Pepper, Salt, and fine Bole in, by putting it under the Uvula, or Palate of the Mouth … It also serveth … to pour hot Oil or Liquor into a Wound, whereto I do constantly use it in green Wounds’.

Scissors: ‘The Scissers be very useful to cut Cloth for Roulers, Lint, and Emplasters; to cut, and clip off loose Skin, putrid or superfluous Flesh, etc.’

Stitching Quill: ‘These are Instruments that cannot be missed in your Plaster-box: you shall therefore have in your Stitching Quill at least three Needles of several sizes or bigness, with square points, well set, and ready armed with green or red Silk oyled, your Needles alwayes kept oyled, and clean from rust …’

Spatula: ‘The Spathula is used to mingle your Unguents on your palm of your hand to cover your Plegets, etc.’

Spatula Linguae: ‘The Spathula Linguae, or Speculum Linguae, is much like an ordinary Spathula at one end, only it is perforated and cut through, the better to hold the tongue down without slipping off; the other end is made to scrape the tongue that is furred in Fevers, Cankers, or other affects of the mouth …’

Director: ‘The Director is an Instrument to guide and direct the Incision Knife, in Dilation, or inlarging a Wound, when you are near any Vessels. They are also used in cutting for the Stone’ [Lithotomy].

Single and Screw Probe: ‘The Probe cannot be missing in the Chryurgions Plaister-Box, for without it can nothing be done artificially. The use of it, is to arm the Eye with soft Lints, and with the other end to make probation of the depth of a Wound; sometimes the small end armed with Lint, is dipped into some Oil, or Liquor, and conveyed into the bottom of an Ulcer, or Fistula, thereby to mundifie, or heal … [The screw probe] is as long again as an ordinary Probe, made to unscrue in the middle, and is used where the small Probe is too short to make sufficient probation’.

Fleme: ‘[It] is an Instrument used to open Gums, and separate them from the tooth you intend to pull out, compassing the tooth with the round sharp end thereof close to the tooth, piercing deeper by little and little, until you feel it as low as the jaw-bone: Some use to open a vein with this Instrument, but for mine own part, I do disallow it as very uncertain, and dangerous, for touching the Nerves, or great vessels’.[3]

Johannes Scultetus, Armamentarium chirurgicum olim auctum triginta novem tabulis … (Leiden, 1693), plate XIX.

Many of these basic instruments were also mentioned by one of the most famous seventeenth-century professors of anatomy and surgery at the University of Leiden, Johannes van Horne (1621-70), whose views on surgery had been influenced by the teaching of Marco Aurelio Severino (1580-1656). Van Horne lists the instruments ‘which are carry’d about by every Surgeon in a proper Case; as an Incision-Knife, Forceps, Probe, Spatula, Scissars etc.’[4] However, he was well aware that this set of instruments was only the tip of an ever-increasing iceberg and therefore advised his readers to look at the illustrations of images of instruments in works by Ambroise Paré (1510-1590), Fabricius Hildanus (1560-1634) and Johannes Scultetus (1595-1645) (all authors whose works were collected by Worth).

Scultetus in particular was famous for his work on surgical instruments and provides us with an in-depth description of a large array of objects. However, perhaps the clearest introduction to basic instrumentation is provided by the French surgeon, Pierre Dionis (1643-1718), whose ‘Instruments A-Z’ is replicated here.

Jean Jacques Manget, Bibliotheca chirurgica, sive Rerum ad artem Machaonicam quoquô modô spectantium thesaurus absolutissimus; … (Geneva, 1721), plate XVIII./p>

Sources

Brugis, Thomas, Vade Mecum: or, a Companion for a Surgeon. Fitted for Sea, or Land; Peace or War (London, 1681).

De Garengeot, Rene Jacques Croissant, A Treatise of Chirurgical Operations (London, 1723). Worth had the 1720 Parisian French edition: Traité des operations de chirurgie (Paris, 1720).

Van Horne, Johannes, Micro-Techne; or, a methodical introduction to the art of Chirurgery (London, 1717).

Velenciuc, I. et al. ‘A Renaissance Promoter of Modern Surgery’, Rev. Med, Chir. Soc. Med. Nat. Iaşi, vol. 120, no. 1 (2016), 201-8.

Text: Dr Elizabethanne Boran, Librarian of the Edward Worth Library, Dublin.

[1] De Garengeot, René Jacques Croissant, ‘A Short Description of the Instruments that are used in Chyrurgical Operations’ in A Treatise of Chirurgical Operations (London, 1723), p. 535.

[2] Thomas Brugis, Vade Mecum: or, a Companion for a Surgeon. Fitted for Sea, or Land; Peace or War (London, 1681), p. 1.

[3] Ibid., pp 1-7.

[4] Van Horne, Johannes, Micro-Techne; or, a methodical introduction to the art of Chirurgery (London, 1717), p. 19.