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Moments in Surgical History |

On Scalpels and Bistouries

Ira M. Rutkow, MD, MPH, DrPH
Arch Surg. 2000;135(3):360. doi:10.1001/archsurg.135.3.360.
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SCALPEL, AS DEFINED IN Stedman's Medical Dictionary is: "A pointed knife with convex edge." Amongst the oldest known instruments in a surgeon's armamentarium, early representations of scalpels are found on a sculptured ex-voto stone tablet located on the site of the temple of Aesculapius at Athens' Acropolis, dating from about 300 BC. Since Greece had passed into the Iron Age, it is probable that their cutting instruments were made of steel and often double ended, containing a blade and spatula. Moving ahead several centuries, Roman scalpels were mostly bronze and, although the actual blade sometimes had double cutting edges, whenever possible, the combination of 2 instruments in 1 was also used. Thus, knives frequently had a spoon or even a raspatory at its opposite end. Known to Romans as "scalpellus," in more technologically advanced forms the metal of the blade could be found continuing down between 2 metal plates that were screwed on either side of it to form a holder. These rudimentary forms of handles in certain Roman scalpels were often finely worked and not uncommonly embellished or gilded with silver.

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For scalpels and bistouries, 19th-century surgical etiquette strictly dictated the manner in which they should be held. In this plate from Joseph Pancoast's (1805-1882) A Treatise on Operative Surgery (1844), the "positions of the bistoury and scissors" are demonstrated. In making a science out of "hand-positions," 19th-century surgeons varied in regard to the total number of these positions but, at least, one surgeon described 8 of them, ranging from holding the instrument as a " knife . . . writing pen . . . and like the bow of a violin."

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