In treating of polypus naris Hippocrates directs us to take a sponge and tie it into a hard ball, and attach a four ply thread to it. Next to pass the end of this thread by means of an eyed probe of tin till it is caught at the back of the mouth, and drawing it out of the mouth to place a bifurcated probe under the palate, and using this as a fulcrum pull until the polypus is extracted (De Morbis, ii. 243: ἔπειτα χηλὴν ὑποθεὶς ὑπὸ τὸν γαργαρεῶνα ἀντερείδων ἕλκειν ἔστ' ἂν ἐξειρύσῃς τὸν πώλυπον). In Galen’s Lexicon we find χηλή explained as meaning a notched probe, split like a hoof at the point (μήλην δικροῦν, κατὰ τὸ ἀκρὸν ἐκτετμημένην ἐμφερῶς χηλῇ). And again under the heading δικροῦν he gives τὸ οἷον δίκρανον, ὅπερ καὶ δισχιδὲς ὀνομάζουσι τὸ δὲ αὐτὸ καὶ δηλοῖ, ‘what they call cloven and also cleft.’ The same word also means the notch of an arrow. In De Morbis (ii. 245), Hippocrates describes another method of extracting polypus with the same instrument. Taking a piece of stringy gut (χορδήν) and making a loop on it pass the end through the loop, thus making a second larger one, i. e. a noose. Pass the end of the gut through the nose into the mouth with a tin probe. Pull the loop into the nose and adjust it round the polypus with a notched probe (μήλῃ τῇ ἐντετμημένῃ), and when this is done pull on the gut, using the notched probe as a fulcrum.
There must have been one form of bifurcated probe with a rounded end bearing a notch like an arrow. This is the only form of cleft probe which it would be safe to use in the back of the throat in the manner described by Hippocrates. We know, however, of other forms of bifurcated probes. Celsus describes a bifurcated retractor used for the extraction of weapons buried in the flesh:
Saepius itaque ab altera parte quam ex qua venit recipienda est; praecipueque quia fere spiculis cingitur; quae magis laniant si retrorsus quam si contra eximatur. Sed inde aperta via caro diduci debet ferramento facto ad similitudinem Graecae litterae Y; deinde, ubi apparuit mucro, si arundo inhaeret propellenda est donec ab altera parte apprehendi et extrahi possit (VII. v).
Variant readings are V and Λ. The Aldine edition has ψ. The reading I have adopted is Daremberg’s; but whichever is correct matters little, as all indicate a bifurcated instrument, except the Aldine, which would indicate a three-pronged one. There are several bifurcated specilla in the British Museum ([Pl. XXII]). One in the Orfila Museum, Paris, of slender construction, carries a hook at the other end. It is from Herculaneum ([Pl. XXI, fig. 1]). A plain variety is shown in [Pl. XXI, fig. 6]. The specimen shown in [Pl. XXI, fig. 3] is interesting as showing a possible fallacy. It has considerable affinity to the Roman netting-needle, and may not be a probe at all. The typical netting-needle has, however, blunt points, and the planes in which the forks lie are at right angles to each other.
Blunt Dissectors.
In his chapter on Angiology (or Division of the Temporal Blood Vessels) for headache and ophthalmia (VI. v), Paul mentions the use of dissectors:
‘Having therefore first shaven the hairs of the temples we make an examination by palpation, applying warm fomentations or even a fillet round the neck, and mapping out the vessels with ink as they become apparent, we stretch the skin to either side with the fingers of our own left hand and those of an assistant, and make a superficial incision along the vessel. Then cutting down and retracting with hooks and exposing the vessel with dissectors (δι' ἐξυμενιστήρων) we must raise it up completely isolated. If it be small, having stretched it and applied torsion we may divide it through in such a way as to remove a piece of it at one stroke.’
The typical scalpel handle ends in a leaf-shaped dissector, and Celsus always describes blunt dissection as being performed with the manubriolus of the scalpel. We have, however, a few dissecting manubrioli as separate instruments not designed to carry scalpel blades. Three were found together in the grave of the surgeon of Paris. There are also two in the museum of St-Germain-en-Laye, and one in the Museum at Mainz. We may take as types two from the find of the oculist Severus in the St-Germain-en-Laye Museum ([Pl. XX, figs. 3, 4]). They consist of elongated leaf-shaped blades carried on hexagonal handles, and are exactly similar in appearance to a scalpel handle, except that they do not carry a slot for the insertion of a blade.
Curved Dissectors.
Greek, ὑδροκηλικὸν κοπάριον.