Bone Lever.
Greek, μοχλίσκος, ἀναβολεύς.
Instruments for levering fractured bones into position are described in several places. Hippocrates (iii. 117) says:
‘In those cases of fracture in which the bones protrude and cannot be restored to their place, the following mode of reduction may be practised: pieces of steel (σιδήρια) are to be prepared like the levers (οἱ μοχλοί) which the cutters of stone make use of, one being rather broader and the other narrower, and there should be at least three, or even more, so that you may use those that suit best, and then along with extension we must use these as levers, applying the under surface of the piece of iron to the under fragment of bone, and the upper surface to the upper bone, and in a word we must operate powerfully with the lever as we would do upon a stone or a log. The pieces of steel should be as strong as possible so that they may not bend.’
In a note to this passage Galen (xviii. 593) says:
‘It is evident that the instruments described resemble those of stone cutters, not in size but in principle. For the instruments prepared by us for levering bone are similar in size to those used for levering out teeth. But for levering bones several ought to be prepared, differing from each other in length as well as breadth and thickness at the point, by which means they may afford their greatest effect.’
Paul (VI. cvi) gives us some additional information:
‘Of whatever bones therefore we endeavour to replace the protruded ends, we must not meddle with them when in a state of inflammation. But on the first day before inflammation has come on, or about the ninth day after inflammation has gone off, we may set them with an instrument called the lever (τῷ λεγομένῳ μοχλίσκῳ). It is an instrument of steel about seven or eight fingers’ breadth in length, of moderate thickness that it may not bend during the operation, with its extremity sharp, broad, and somewhat curved.’
There are two bone levers in the Naples Museum, both of bronze. [Pl. XLI, fig. 1] shows one of them (No. 78,012). It is 15·5 cm. in length, and with its ends flattened, and curved, and pointed, as described by Paul. The other instrument is of similar shape, but is somewhat less in size. The concave surface at one end is smooth, at the other ridged like a file.
It may be remarked, that though the similarity in form to the instruments figured by Paré as in use in his time for levering up depressed bones shows that these are undoubtedly bone levers, it is quite possible, from what Galen says, that they may also have been used for levering out teeth. The smooth end also corresponds to the description of the meningophylax, so that it is possible it may have been used in that capacity also.