The nature of the cranioclast is pretty well indicated by this passage, and in Galen’s Lexicon we find πιέστρῳ defined as τῷ ἐμβρυοθλάστῃ καλουμένῳ. I give drawings from Albucasis of a ‘forceps to crush the child’s head’ ([Pl. LI, fig. 3]).
Cephalotribe.
Whether or not the instrument last described was used also for the operation of cephalotripsy, or whether there was a special instrument, we cannot say, but it is certain that the operation of crushing the head and delivering the child without removing the bones was practised. In Aetius (IV. iv. 23) cephalotripsy is thus described:
‘But if the foetus be doubled on itself and cannot be straightened, if the head is presenting, break up the bones of it without cutting the skin. Then to some part of it fix on a traction hook and make traction, and the legs becoming straightened out we get it away.’
Though there is an essential difference between the operations of cephalotripsy and cranioclasie there is no essential difference between the instruments necessary for carrying out the same, and it is possible that the instrument used may be the same as the last. The cephalotribe figured by Albucasis is not essentially different from his cranioclast (see [Pl. LI, fig. 4]).
Midwifery Forceps.
Had the Greeks and Romans a forceps for extracting the child alive? Probably not. We have no mention of any such instrument by Soranus or Paul, both accomplished obstetricians, nor can any description of such an instrument be found in the voluminous pseudo-Hippocratic works on women. Adams, in a note to Paul, III. lxxvi, says that though the Roman and Greek writers do not mention the forceps, Avicenna does so, and he says that a forceps was dug up in the house of an obstetrix at Pompeii bearing a considerable resemblance to the modern forceps. The only passage I have met with in the slightest degree supporting the notion that the ancients ever delivered the child alive with instruments is one in the pseudo-Hippocratic treatise De Superfoetatione, where we are told that:
‘If the woman has a difficult labour, and the child delay long in the passage and be born not easily but with difficulty and with the mechanical aids (μηχαναῖς) of the physician, such children are of weak vitality, and the umbilical cord should not be cut till they make water or sneeze or cry’ (i. 465).
We are not entitled to translate μηχαναῖς by ‘instruments’, because it may mean any mechanical aid such as a fillet, or even assistance with the fingers of the accoucheur; but, even granting that it refers to instruments, it might mean no more than, e. g., the embryo hooks already described. With them, terrible as they were, the child must frequently have been born alive, though mutilated. A child would have had a far better chance of being born alive with them than with the murderously toothed forceps of Albucasis ([Pl. XLI, figs. 3, 4]), with which probably no child could have been born alive. As regards the statement that Avicenna knew of the forceps, his directions are that the fillet is to be applied, and, if that fail, the forceps is to be put on and the child extracted with it. If that fail, the child is to be extracted by incision, as in the case of a dead foetus. This passage, says Adams, puts it beyond doubt that the Arabians were acquainted with the method of extracting the child alive with the forceps.