‘Having placed the patient on a seat either before us or on the left hand, we turn the upper eyelid outwards, and if it has long hairs we take hold of them between the index finger and thumb of the left hand; but if they are very short we push a needle having a thread through the middle of the tarsus from within outwards. Then stretching the eyelid with the left hand by means of this thread, with the point of the scalpel held in the right hand, having everted the eyelid, behind the thread we make the inferior incision inside the hairs which irritate the eye, extending from the larger canthus to the smaller along the tarsus. After the inferior incision, having extracted the thread and having put a small compress under the thumb of the left hand, we stretch the eyelid upwards. Then arranging other small compresses on the canthi at their extremities we direct the assistant, who stands behind, to stretch the eyelid by means of them. Then by means of the ‘scalpel for the plastic operation’ (ἀναρραφικοῦ σμιλίου) we make the first incision called the ‘arrow-shaped’ a little above the hairs which are normal, extending from canthus to canthus and penetrating only the depth of the skin. Afterwards we make the incision called the crescent-shaped, beginning at the same place as the former and carrying it upwards to such a height as to enclose the whole superabundant skin and ending in like manner as it did. Thus the whole skin within the incision will have the shape of a myrtle leaf. Having perforated the angle of this portion with a hook we dissect away the whole skin. Then washing away the clots with a sponge we unite the lips of the incision with three or four sutures’ (VII. viii).
The use of the scalpel for the plastic operation, therefore, was to make an incision in the eyelid in such a way as to enclose a leaf-shaped area and to dissect off the skin surrounded by the incision. Albucasis figures it as a small but fairly broad blade with a rounded cutting tip ([Pl. IX, fig. 3]).
It must have been a small scalpel to suit the operation described, and to make the dissection indicated it must have been sharp-pointed. It is contrasted to some extent with the pterygotome by Paul, and we saw that the pterygotome was narrow and sharp-pointed. These various references to its use are in agreement with the supposition that it was of the shape figured by Albucasis. I have considered it here because the question of its shape is rather hypothetical, and therefore it seemed best to consider it close by its confrere the pterygotome. We may recall the fact that in the grave of the third-century oculist Severus several tiny scalpel handles were found. These were probably handles for these two ophthalmic scalpels, but unfortunately only a trace of the steel remains. Védrènes, in his edition of Celsus, figures an instrument from Pompeii of a shape which we are accustomed to associate with eye work ([Pl. IX, fig. 6]).
Uvula Knife.
Greek, σταφυλοτόμον.
This is a special scalpel for throat work, of whose shape we know nothing. It is mentioned by Paul as a special scalpel for excision of the uvula:
‘Wherefore, having seated the patient in the sunlight and directed him to gape wide, we seize with the uvula forceps or a common tenaculum upon the elongated part and drag it downwards and excise it with the instrument called the uvula knife (σταφυλοτόμῳ), or the scalpel used for the plastic operation on the eyelid’ (VI. xxxi).
The knife figured by Albucasis as used for the purpose is a small curved bistoury ([Pl. IX, fig. 4]). We have no other means of determining its shape. I have placed it here because it was mentioned along with the ‘scalpel for the operation on the eyelid’.
Blade curved on the flat.—Tonsil Knife.
Greek, ἀγκυλοτόμον (ἀγκύλη, ‘bend of elbow,’ or ἀγκύλος, ‘crooked’).