Deinde eam ferramento, quod a similitudine corvum vocant, incidere sic ut intrare duo digiti, index et medius, possint (VII. xix).
Vulpes (Tav. VII, 3 and 4) figures two curved bistouries from the Naples Museum. They have lost their tips. Both are of the same shape, but one has the blade slightly larger than the other. The handles are of bronze, the blades of steel. A good example is seen in the Athens scalpel box ([Pl. IV]).
A powerful variety so strongly curved as to resemble a small billhook was found in the Roman hospital at Baden ([Pl. IX, fig. 5]). The handle is of ivory, the blade is of steel, and there is a mounting of bronze.
Pterygium Knife.
Greek, πτερυγοτόμος, ὁ; Latin, scalpellus.
Paul (VI. xviii), quoting Aetius, II. iii. 60, says that there were two methods of curing pterygium. In the first the pterygium was raised by a small sharp hook, and a needle carrying a horsehair and a strong flaxen thread was passed under it. Tension being made on the thread by an assistant, the operator sawed off the pterygium towards the apex by means of the horsehair. The base of the pterygium was then severed with the scalpel for the plastic operation on entropion. The second method consisted in dissecting away the pterygium (stretched as aforesaid with a thread) with the instrument called the pterygotome (πτερυγοτόμῳ) care being taken not to injure the lids.
Aetius (II. iii. 74) says that adhesion of the sclerotic to the lid may be separated by means of the pterygotome. Paul (VI. xxii) in empyema of the lachrymal sac dissects out the part between the sac and the canthus with the pterygotome, and again in excision of polypus aurium he says it may be employed. These uses of the pterygotome point to its having been a sharp-pointed knife of a small size. Albucasis, who conveys entire the passage on pterygium from Paul, gives figures of both these instruments. The pterygotome which Albucasis depicts is a small, narrow, sharp-pointed scalpel ([Pl. IX, fig. 2]).
Knife for plastic operation on the eyelid.
Greek, ἀναρραφικὸν σμιλίον.
I have in describing the pterygotome given one instance of the use of the ‘scalpel for the plastic operation’, viz. to dissect away the base of a pterygium the rest of which had been separated off by means of sawing with a horsehair. The plastic operation for entropion seems to have been one which was very frequently required. We know that granular ophthalmia with trichiasis as a sequela was very rife. Aetius (quoting from Leonidas) and Paul give very nearly the same account of the operation to remedy the trichiasis. Paul says: