Et tunc paululum supra pudendi alas, quo loco calculus occurrit sectionem facito et per calcularium forcipem extrahito.
The original Greek of this part of Aetius has not yet been published, but from a pretty intimate knowledge of Cornarius’s methods I have a strong suspicion that ‘calcularium forcipem’ may be a free translation of λιθουλκός, as in the following passage in Paul:
‘Sometimes from the pressure of the finger or fingers at the anus the stone starts out readily at the same time as the incision is made, without requiring extraction. But if it does not of itself start out we must extract it with the instrument called the stone extractor’ (τοῦ λιθουλκοῦ) (VI. lx).
Adams translates λιθουλκός by ‘forceps for extracting stone’, but this is not quite a justifiable translation. The instruments whose names end in -ουλκός, and which are derived from ἕλκω, are certainly in many instances forceps, e. g. βελουλκός, a forceps for extracting weapons, but in other cases they are as certainly not. I need only refer to ἐμβρυουλκός, which is conclusively described as a hook for extracting the dead foetus. Thus while it is possible that the λιθουλκός may have been a forceps, the etymology of the word does not entitle us to translate by any term more definite than ‘stone extractor’. Galen (xiv. 787) uses the word λιθολάβος, which has a more definite meaning. The majority of words compounded of -λάβος means some variety of forceps, e. g. σαρκολάβος, tumour vulsellum. The etymological evidence thus leaves the matter open, with a slight balance in favour of there having been a forceps. I should have had no hesitation in translating λιθολάβος to mean a forceps, had it not been that Celsus evidently had no cognizance of a stone forceps. Galen, however, lived after Celsus, and we may note that the Arabians used such an instrument. Albucasis says that if the stone does not start out it must be seized with a forceps or a hook, and failing removal by these means it is to be broken up with forceps. One forceps in the Naples Museum, from the house of the physician, seems to be suited for the operation ([Pl. XLVI, fig. 3]). The handles are short in proportion to the blades, and it seems better suited to grasp some substance inside the bow than between the jaws. The unfinished condition of the tips of the handles indicates that they had been inserted into handles of wood.
Lithotrite.
Latin, ferramentum.
A sort of chisel by which a calculus was split is thus described by Celsus:
Si quando autem is maior non videtur nisi rupta cervice extrahi posse, findendus est; cuius repertor Ammonius ob id λιθοτόμος cognominatus est. Id hoc modo fit: uncus iniicitur calculo sic ut facile eum concussum quoque teneat, ne is retro revolvatur; tum ferramentum adhibetur crassitudinis modicae, prima parte tenui, sed retusa, quod admotum calculo, et ex altera parte ictum, eum findit.
‘If at any time it seems too large and impossible to be extracted without splitting the cervix, it is to be split. The originator of this is Ammonius, hence called the lithotomist. It is performed in this manner. A scoop is put over the calculus in such a way that it easily holds it even when struck from sliding back; then there is applied an instrument of moderate thickness, slender at the tip, but blunt, which being placed against the calculus and struck on the other end splits it’ (VII. xxvi).
The above paragraph really gives us all the information we possess about the instrument. It is evidently a slender chisel. A passage in Aretaeus (Morb. Chron. ii. 9) is held by some to refer to lithotripsy (digital). The reading, however, is dubious.