Greek, σταφυλάγρα.
In Aetius (II. iv. 12) we have an interesting description of the amputation of the uvula by first crushing it in a forceps so as to prevent haemorrhage and then cutting it off:
‘Then inserting a vulsellum and making traction on it, the uvula crusher (τὴν σταφυλάγραν) is fitted on about the middle of the uvula or a little below it, and then it is pulled and twisted (by the vulsellum). By the torsion it becomes lifeless and, as it were, snared off; it curls up, becomes livid and comes off without much effusion of blood. Wherefore it is well to wait some time and hold it till the patient can stand it no longer, and then cut it off—the cut being made close to the vulsellum but nearer the tip than to it.’
The σταφυλάγρα therefore corresponds in its action to a pile-crusher. This instrument I believe to be represented by the type of forceps shown in [Pl. XXX, fig. 1]. It is in the British Museum. The two branches of the forceps cross like scissor blades, and at their ends the jaws are formed in such a way as to project forwards and enclose a cavity 1 cm. deep and 18 mm. long. Over all the forceps is 18 cm. long. The jaws are finely toothed. There is in the same museum another instrument similar in all respects except that it is 1 cm. shorter, and that in each blade, which is 16 mm. long ([Pl. XXX, fig. 2]), there is a small hole near the proximal end. A posterior view of a similar instrument is seen in [Pl. XXXI, fig. 1]. It is from the find of the surgeon of Paris. A similar specimen is in the Mainz Museum.
[Pl. XXXII, fig. 3] shows a smaller specimen from the Naples Museum. It is 11 cm. in length. A large powerful variety with a different arrangement of the handles is seen in [Pl. XXXI, fig. 2] from a specimen in the Antiquarian Museum at Basle. It is 20 cm. long.
A forceps which I take to be a staphylagra occurs on the coins of Atrax in Thessaly (circa 400 B. C.). The forceps stands alongside a bleeding cup.
The object of the holes in several of the specimens is to permit the insertion of a cord to bind the jaws firmly together, and thus keep up the strangulation of the part for some time, as Aetius directs. The application of a ligature in this way would, of course, not be possible while the instrument was applied to the uvula, but the following passage from Leonidas (Paul, vi. 79) shows that the uvula crusher was also used to clamp piles in the same way:
‘Having seized the haemorrhoids and held them there for some time with the uvula crusher (σταφυλάγρᾳ) he cuts them off with a scalpel.’
In such a case the application of a cord to clamp the jaws together would be a distinct convenience. The short variety is more suitable for external operations, as for haemorrhoids; the long variety for manipulations in the throat.
Hippocrates mentions the uvula crusher as one of the instruments necessary for the outfit of the physician (i. 63).