‘Separate off the membranes adhering to the bone, which being properly done, divide the bone of the rib by means of two chisels placed in opposition to each other secundum artem’ (ἀντιβαλλομένων δυοῖν ἀλλήλοις ἐκκοπέων ὡς ἔθος).
The following passage from Paul shows the chisel used for a similar purpose:
‘If part of the clavicle is broken off and unconnected, and if we find it irritating the parts, we must make a straight incision with a scalpel and remove the broken portion and smooth it with chisels (δι' ἐκκοπέων), taking care that the instrument called ‘meningophylax’ (q. v.), or another chisel, be put under the clavicle (μηνιγγοφύλακος ἢ ἑτέρου ἐκκοπέως) to steady it’ (VI. xciii).
The phrase δι' ἐκκοπέων ἀντιθέτων, which Paul uses in describing the treatment of a fistula leading to carious bone, is translated by Briau—‘à l’aide de tenailles tranchantes’. It does seem here, and occasionally in other passages, as if the phrase might suggest ‘cutting forceps’, but we have no knowledge of such an instrument being used by surgeons in classical times, and the passages from Paul and Galen show that only two chisels are meant. We may compare the passage on extraction of the foetus in Paul (VI. lxxiv), where he directs a second hook to be fixed on opposite the first (καὶ ἀντίθετον τούτῳ δεύτερον).
Gouge.
Greek, κυκλίσκος, κοιλισκωτὸς ἐκκοπεύς, κυκλισκωτὸς ἐκκοπεύς, σκυλισκωτὸς ἐκκοπεύς; Latin, scalper excisorius.
The Greek writers frequently refer to the gouge. Celsus never does so by any special name, although it is evident that many of the manipulations he describes as being performed by the ‘scalper’, his general term for chisels of all kinds, could only be performed with gouges and not with flat chisels. The gouge was a favourite instrument of Galen’s, especially in injury to the skull. With it he removed pieces of fractured bone from the skull. He also used it to groove a path for the vertical cutting instrument called the lenticular (q. v.). He calls it a ‘hollow chisel’ (τῶν κοίλων ἐκκοπέων οὓς καὶ κυκλίσκους ὀνομάζουσιν, x. 445).
Paul (VI. xc) says:
‘And if the bone be weak, naturally, or from the fracture, we cut it out with gouges (σκυλισκωτοῖς), beginning first with the broader ones, and changing to the narrower, and then using those which are probe-like, striking gently with the mallet to prevent concussion of the head.’
The gouge is still familiar to us.