Part 5 (1/2)

An instrument in the Louvre has two blades of this shape at either end of a round handle ornamented with rolling grooves (Pl. VIII, fig. 8).

_Polypus Knife._

Greek, p???p???? spa????, p???p?d???? spa????; Latin, _ferramentum acutum modo spathae factum_.

Paulus Aegineta (VI. xxv) thus describes the excision of nasal polypus:

'Holding in his right hand the polypus scalpel, which is shaped like a myrtle leaf and sharp pointed (p???p??? spa??? t? ??s???e?de?

??a??), we cut round the polypus or fleshy tumour, applying the point of the steel blade (t?? ???? t?? s?d????) to the part where it adheres to the nose. Afterwards turning the instrument end for end (??t?st???a?te?) we bring out the separated fleshy body with the scoop' (t? ??a??s??).

This description reminds us very forcibly of Celsus's account of the operation:

Ferramento acuto modo spathae facto, resolvere ab osse oportet. Ubi abscissus est unco ferramento extrahendus est (VII. x).

These pa.s.sages, especially that from Paul, show that like the majority of Roman instruments the polypus scalpel was a double instrument, with a sharp-pointed leaf-shaped blade at one end and a scoop at the other. The fact that it was able to work inside the nose shows that it could not have been of any great breadth. Paul says it was able to be used in the auditory ca.n.a.l.

'If there be a fleshy excrescence it may be excised with a pterygium knife or the polypus scalpel' (VI. xxiv).

This shows that it was less than a quarter of an inch broad at the most.

It was used for several other purposes. Sora.n.u.s refers to it for opening the foetal head in cranioclasis:--

?? d? e?????? t?? ?efa???? ?p?????t?? ? sf???s?? ?p?te???t?, d?? t??

????t??? ? t?? p???p???? spa???? ???pt????? eta?? ???a??? ?a? t??

a???? da?t???? ?at? t?? ???es?? (xviii. 63).

Paul copies this (VI. lxxiv). Sora.n.u.s also says it may be used for dividing the membranes where they delay in rupturing.

There are two instruments of steel which are of the form indicated above.

One is in the Museum of Montauban (Tarne-et-Garonne). The other was found at Vieille-Toulouse and is shown in Pl. VIII, fig. 1.

_Lithotomy Knife._

Greek, ????t??? (t?); Latin, _scalpellus_.

In describing lithotomy Paul says:

'We take the instrument called the lithotomy knife (t? ?a???e???

????t???), and between the a.n.u.s and the t.e.s.t.i.c.l.es, not however in the middle of the perinaeum, but on one side, towards the left b.u.t.tock, we make an oblique incision cutting down straight on the stone where it projects' (VI. lx).

Celsus, whose description of the operation is famous, gives us no more hint of the shape of the lithotomy knife than Paul does. He only says 'multi hic scalpello usi sunt', and as he uses 'scalpellus' to denote all sorts of different knives, we can draw no information from that term. We may note, however, that both Celsus and Paul describe the operation as being performed by fixing the stone by means of the left index finger inserted in the a.n.u.s, and cutting down directly upon it with one stroke as in opening an abscess. Now this sort of incision was always performed by early surgeons with a two-edged scalpel sharp at the point, and a knife of this sort was used for lithotomy by the Arabian surgeons, and after them by European surgeons down to comparatively recent times. Heister, for instance, shows as a lithotomy knife a large knife, like a phlebotome in shape. It is most likely, therefore, that the Greeks and Romans used a knife of this shape also.

A pa.s.sage in Rufus of Ephesus shows that in his time the lithotomy knife had the handle shaped like a hook to extract the stone after the perineal incision was made:

?a? e? ?? p???e???? e??, t? ?a? t?? a?a????? ?????e??, pep?es????

d? t? ?a? t?a?e?? te ?a? ?ap??? ?? ?????, ?? ?? ???sta s?f???? t?

'And if it (the stone) be at hand we must eject it with the handle of the knife, made with the handle roughened and curved at the tip, as best suited for the operation' (ed. cit. p. 52).