Tuesday, December 15, 2015

2015.12.14

Lawrence J. Bliquez, The Tools of Asclepius: Surgical Instruments in Greek and Roman Times. Studies in ancient medicine, 43. Leiden; Boston: Brill, 2014. Pp. xxxv, 439. ISBN 9789004279070. $194.00.

Reviewed by Lesley Bolton, University of Calgary (labolton@ucalgary.ca)

Version at BMCR home site

Preview

For over a century, John Stewart Milne's Surgical Instruments in Greek and Roman Times has been the definitive handbook on the topic.1 In this new offering, an addition to Brill's series 'Studies in Ancient Medicine', Bliquez has drawn on his extensive experience to present a thoroughly up-to-date treatment of the field, yet not without giving due respect to his predecessor, as reflected in the subtitle of this present volume.

A brief introductory chapter addresses previous scholarship, the taxing problem of nomenclature, and the design and manufacture of the tools, along with some speculation as to the span of surgeons' training and the success, or not, of their surgeries. The bulk of the work then falls into three chronologically arranged chapters that examine the Hippocratic, Hellenistic and Imperial evidence. This is, in itself, a departure from Milne's approach, which was to "bundle together all literary testimonia to a particular category of instrument from the Hippocratics to Imperial times" (p. 5).

Material survival from the period of the Hippocratic texts is scarce. Bliquez notes that the only reliably 'Hippocratic' remains are a number of cupping vessels recovered as grave goods; the emphasis, then, of chapter two is chiefly on the literary sources, bolstered by some inscriptional evidence from the healing sanctuaries. The instruments are presented by category with sections on, for example, cupping vessels, probes, forceps and cutting instruments. Each discussion brings together the relevant references from the Corpus, progressing from the instrument in its simplest manifestation ("a knife", for example, p. 28) to special purpose types marked out by modifying adjectives (so, "a knife that is curved and not too narrow at the tip", p. 28). The majority of citations are either paraphrased or translated in full, the more important passages include the Greek alongside the text itself, or in a footnote. Where a number of passages exist relating to one procedure or theme, they are gathered together in useful summaries, clearly marked out from the surrounding prose. Parallels in later testimonia and material remains are collected in the footnotes.

The topic of the third chapter is the Hellenistic contribution. With physical evidence seemingly absent, and literary testimony fragmentary at best, this is a very short discussion, scarcely five pages. Bliquez here calls upon the evidence of Celsus' De Medicina, a generation or so later than the Hellenistic age, to make good the gaps. Where surgical tools are mentioned both in the Hippocratic texts and by Celsus, Bliquez argues for a continuation of type and usage; where Celsus introduces types not mentioned in the earlier works, Bliquez suggests this represents considerable developments that should be attributed to the Hellenistic surgeons.2

The meat of the work comes in the fourth chapter, which is devoted to the tools of the empire. The format is almost identical to the earlier chapter on the Hippocratic instruments, but with some additional tool categories, namely, needles, vessels and containers, and some miscellaneous surgery-related items. Here, Bliquez has amassed a huge quantity of testimonia from Greek and Latin sources, so much so that the tool categories are further broken down into subcategories such as simple probe, eyed probe, spatula probe and so on. Equally extensive is Bliquez' treatment of the material remains. A sizeable appendix deals with natural products such as wool, linen, and sponge, which surely played a significant part in the surgeon's practice. The volume concludes with an extensive bibliography, appropriate Greek, Latin and English indices, and ninety-five black and white/halftone illustrations.3

Bliquez accepts that searchable databases have given him an advantage over Milne, but, even so, the range of written testimonia he addresses is extensive and impressive. Selections from poets, grammarians, historians, philosophers and veterinary texts supplement a complete survey of the medical writings; a good number of less well-known Byzantine and mediaeval sources round off the list. The author makes appropriate use of use of modern translations where available, but has himself translated or paraphrased many of the Greek and Latin passages in a clear, concise fashion, yet one that does not pass over any difficulties of interpretation. Unlike Milne, he has opted to at least acknowledge as many relevant references as he has come across, even if they advance little new knowledge, since they can allow speculation as to who invented a particular tool, and may give some indication of the route of information through the witnesses.4 As a testament to Bliquez' engagement with the sources, he can, for example, elicit the following information about a seemingly humble instrument like the eyed needle: its alternate names, both Greek and Latin, as well as several Greek terms for the actual eye of the needle, its numerous forms, where it is variously 'sharp', 'fine', 'extremely fine', 'large', 'stout', 'dull', 'bent', 'slightly bent' or 'fine with a blunt part', and the stitching materials, including wool, sinew, dried gut, silk and hair (both human and animal), that it might employ. He also summarizes, according to author, no less than sixty five individual instances in which the needle is used surgically. This reader finds these summaries, some categorized by procedure, some by implement, some by author, particularly useful and very effective in bringing both tool and surgery 'to life'.

There have been many finds of surgical instruments since Milne's day. Bliquez notes there have been smaller recoveries from graves particularly, but also houses, bathing and military instillations, and shipwrecks, while sites at Rimini and, most recently, Allianoi in Turkey, have yielded collections numbering in the hundreds. New categories of tools have emerged, and using a more stringent typology than previously, existing museum collections that lacked context have also been reassessed. The author quite rightly credits K├╝nzl and Jackson (amongst others) for their pioneering work in this field, but somewhat underplays his own contributions, which have been considerable. In this present volume, he brings his substantial knowledge to bear upon the material evidence, proposing potential candidates amongst the survivals to match the literary descriptions he has collected. As with the written testimonia, his treatment is most thorough, with due attention to construction, mechanical function and decoration of the instruments. Sometimes he supports Milne's position on an artefact, sometimes not, but all assertions are convincingly argued; where he is unsure, or at a loss, he says so.

There are a few niggling problems with this volume. It seems not to have benefitted from a rigorous editorial process, since there are more typographic errors than one would expect, along with some mistakes in punctuation and the occasional factual slip-up. Furthermore, while the quality of illustrations is generally adequate, with the line drawings being particularly effective, sometimes it is just too difficult to make out in the photographic reproductions the fine detail that Bliquez describes in the text.5 The sheer volume of medical terminology, both ancient and modern, is also problematic, and most readers would have been well served by an extensive glossary.

The strengths of this volume, however, far outweigh any weaknesses, and it should indeed replace Milne's outdated and sometimes inaccurate treatment. It is an important resource, particularly for those interested in the history of medicine; anyone working on medical texts, whether in translation or not, knows the difficulties any mention of the tools inevitably throws up. Those more interested in the archaeological artefacts and their associated technologies should also find much of interest, and may be amazed at the variety and the complexity of surgeries carried out in the ancient world.



Notes:


1.   Milne, John Stewart, Surgical Instruments in Greek and Roman Times. Oxford: Clarendon Press, 1907 (reprinted New York: Augustus M. Kelley, 1970). This work is now easily accessible online at archive.org.
2.   Bliquez includes new forms of dissectors, retractors, forceps, needles and catheters in this group.
3.   Roughly one fifth of the illustrations are reproduced in colour in the e-text format; unfortunately, figures 20 and 29 seem to have been carelessly cropped in this version.
4.   This practice is not extended to the appendix, where references to items such as wool and sponge are numerous and extend beyond the medical sphere.
5.   The scalpel handles in the form of Hercules, for example (pp. 74-75 and Figure 2) are impossible to make out. The figures which feature collections of instruments would also have benefitted from some numbering of the individual items, since having to search, for example, for 'middle row, 12th from the left' soon becomes tedious and subject to error.

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