This shows that it was less than a quarter of an inch broad at the most. It was used for several other purposes. Soranus refers to it for opening the foetal head in cranioclasis:—
Εἰ δὲ μείζονος τοῦ κεφαλίου ὑπάρχοντος ἡ σφήνωσις ἀποτελοῖτο, διὰ τοῦ ἐμβρυοτόμου ἢ τοῦ πολυπικοῦ σπαθίου κρυπτομένου μεταξὺ λιχανοῦ καὶ τοῦ μακροῦ δακτύλου κατὰ τὴν ἔνθεσιν (xviii. 63).
Paul copies this (VI. lxxiv). Soranus 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, λιθοτόμον (τό); Latin, scalpellus.
In describing lithotomy Paul says:
‘We take the instrument called the lithotomy knife (τὸ καλούμενον λιθοτόμον), and between the anus and the testicles, not however in the middle of the perinaeum, but on one side, towards the left buttock, 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 anus, 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 passage 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: