Greek, λιθουλκός; Latin, uncus, ferramentum quo in sectione calculus protrahitur.
Celsus thus describes the extraction of calculus through a perineal incision by means of a lithotomy scoop:
Quum vero ea patefacta est, in conspectum calculus venit; in cuius colore nullum discrimen est. Ipse si exiguus est, digitis ab altera parte propelli, ab altera protrahi potest; si maior, iniiciendus a superiore parte uncus est, eius rei causa factus. Is est ad extremum tenuis, in semicirculi speciem retusae latitudinis; ab exteriore parte laevis, qua corpori iungitur; ab interiore asper, qua calculum attingit. Isque longior potius esse debet; nam brevis extrahendi vim non habet. Ubi iniectus est in utrumque latus inclinandus est, ut appareat an calculus teneatur; quia si apprehensus est, ille simul inclinatur.
‘When it is opened there comes into view the calculus, the colour of which is unmistakeable. If it is small it is to be pushed by the fingers from one side and pulled from the other. If too large the hook for the purpose is to be put in above it. The hook is slender at the end and flattened out in the shape of a semicircle, smooth externally where it comes in contact with the tissues, rough internally where it meets the calculus. The hook should be pretty long, for a short one has no power of extraction. When it has been inserted it should be inclined to either side, so that it may be seen whether the calculus is caught, because if it is held it also is inclined to the side’ (VII. xxvii).
The above passage gives a very complete account of the lithotomy scoop. The only thing it leaves undecided is the breadth. Was it a broad, spoon-like scoop, or was it a hook-like instrument? That the latter was the case is proved by the following passage also from Celsus (VII. xxvi):
Nonnunquam etiam prolapsus in ipsam fistulam calculus: quia subinde ea extenuatur non longe ab exitu inhaerescit. Eum, si fieri potest, oportet evellere vel oriculario specillo, vel eo ferramento quo in sectione calculus protrahitur.
‘Sometimes also a stone slips into the urethra itself and lodges near the meatus, because at that part there is a constriction. It should if possible be extracted either with an ear probe, or with the instrument for the extraction of calculus in lithotomy.’
This shows that the scoop must have been quite a narrow instrument, or it could not have passed into the urethra. It must have had very much the same appearance as the modern ‘Ferguson’s Scoop’. We have two extant specimens of the ancient lithotomy scoop in the Naples Museum, one of which is shown in [Pl. IV]; and in the marble ex voto tablet in the Athens Museum, to which I have already referred, there is a representation of a manubriolus curved so as to serve as a lithotomy scoop ([Pl. XLVI, fig. 2]). Rufus of Ephesus mentions this form of scalpel handle.
Lithotomy Forceps.
Was there a forceps for extracting calculus from the bladder? The sixteenth-century translation of Aetius (IV. iv. 94) by Cornarius has the following passage, under the treatment of calculus in the female: