Tum idem medicus hamulum acutum, paulum mucrone intus recurvato, subiicere extremo ungui debet eumque infigere; atque eam quoque palpebram tradere alteri; ipse, hamulo apprehenso, levare unguem eumque acu traiicere linum trahente (VII. vii).

Aetius also mentions this use of the sharp hook:

'And, transfixing the pterygium with a hook (?a? ????st??

?atape????te? pe?? t? ?sa t? pte??????), we gently make traction on it' (_Tet._ II. iii. 60).

Paul also says:

'Seizing the pterygium with a hook with a small curve, (????st??

?????ape? ??ade???e???) we stretch it' (VI. xviii).

The method of excision of the tonsil described by Celsus, Aetius, and Paul is to bring the tonsil into view by dragging on it with a sharp hook and then amputating it. Thus Paul says:

'Wherefore seating the person in the light of the sun, and, directing him to open his mouth, while one a.s.sistant holds his head and another presses down the tongue to the lower jaw with a tongue depressor we take a hook (????st???) and transfix the tonsil with it and draw it outwards as much as we can without drawing the capsule along with it, and then we cut it out by the root with the tonsil knife suited to that hand' (VI. x.x.x).

In contraction of the v.u.l.v.a, Paul says:

'Having transfixed the connecting body, whether flesh or membrane, with hooks, we stretch it and divide it with the fistula knife' (VI.

lxxii).

Similarly Celsus (VII. xxviii) says:

At si caro increvit, necessaria est recta linea patefacere; tum ab ora, vel vulsella vel hamo apprehensa, tamquam habenulam excidere.

In dissection, many of the manipulations which we perform with the dissecting forceps were performed by the ancients with sharp hooks. Pl.

XXIV, figs. 1-5 represent specimens from various sources; some simple, others combined with another implement.

_Blunt Hooks._

Greek, t?f?????st???; Latin, _hamus retusus_.

Aetius (_Tet._ III. i. 13) says:

'Whatever adhesions there are of the lower border of the lids to the tunics of the eye, we must put them on the stretch with a blunt hook (t?f?a???st??) and with a pterygotome free the adhesion.'

In Aetius (_Tet._ II. iii) we see the blunt hook used in the same way as we use an aneurism needle, except that the ligature is not introduced with it, but with another needle. He says we transfix the lips of the incisions with two hooks and gradually dissecting with the scalpel we free the vessel from the underlying fascia. Then with a blunt hook (t?f?????st???) placed under the vessel we raise it up from the depth, and beneath it when raised we place a two ply thread by means of a needle, and doubly tie and cut between.

Paul says:

'Exposing the vessel with dissectors we must raise it up when it is separated all round. If it be small, having stretched and twisted it with a blunt hook, we may divide it through in such a way as to remove part of it. But if it be large we must apply a double ligature under it with a needle, either a piece of raw flax or some other strong thing' (VI. v).

The 'eyed hook' is mentioned by Galen in describing the dissection of the spinal cord:

??d??eta? d? ?a? ????? e????? ????st?? d?at??t? ?e??s?a? t??

???e???s??, ?? ?p? t?? pe?? t?? ?a??t?da? ??t???a? ?e???? e???e p??e?s?a? (ii. 669).

'It is advisable that the manipulation be performed not with a needle but with an eyed hook, as is usually done in the case of the tendons in the neighbourhood of the carotid arteries.'

A small variety of the blunt hook is mentioned by Celsus, Galen, and Paul.

Of the extraction of foreign bodies from the ear Celsus says:

Sin aliquid exanime est, specillo oriculario protrahendum est, aut hamulo retuso paulum recurvato (VI. vii).

Paul says that if stones of fruits, &c. fall into the ear they must be extracted with an ear scoop, a hook, or a forceps.

Both types of blunt hook are represented by extant specimens; see Pl.

XXIII, figs. 3, 4. These remind us of our aneurism needles, and it is interesting to note that Galen (_ut supra_) speaks of an 'eyed hook'. The instruments shown in Pl. XXIII, figs. 2, 4 we might look on either as curved retractors or dissectors as they are half sharp. Pl. XXV, fig. 2 shows a hook of crotchet-hook type combined with a scoop. It is from Herculaneum.

_The Strigil._

Greek, ??st?a. Latin, _strigil_.

It seems to have been a common method of applying remedies to the auditory ca.n.a.l to warm them in a strigil and pour them in with it. Galen frequently mentions this. In _Med. Sec. Loc._ (xii. 622) he says:

Having warmed the fat of a squirrel in a strigil, instil it.

Celsus (VI. vii. l) says:

In aurem vero infundere aliquod alimentum oportet quod semper ante tepefieri convenit; commodissimeque per strigilem instillatur.

Marcellus (IX. l) says:

Conteres et in strigili calefacies, et infundes, et lana occludes aurem.

Scribonius Largus (x.x.xix) says:

Ad auriculae dolorem et tumorem sine ulcere prodest herbae urceolaris aut cucurbitae ramentorum sucus tepens per strigilem in foramen auris dolentis infusus.

The strigil varied much in size and shape. A common form was a sickle-shaped instrument, the circular part being hollow and semicircular on section, and admirably adapted for warming and pouring oil and other medicaments into the ear as above described. Pl. XXV, fig. 1 shows a small strigil from my collection.

_Spoon for applying astringent liquids to the uvula._

Greek, staf??ep??t??.

In his description of the medical treatment of diseases of the mouth Paul (III. xxvi) says:

'When the uvula is inflamed we must use the gargles recommended for inflammation of the tonsils, and those of a moderately astringent nature, such as the juice of pomegranate, applied by means of a spoon or the instrument called the "uvula medicator"' (staf??ep??t??).

It is evident that it is quite a different instrument from the staphylocaustus (_q. v._), which we are specially told had more than one hollow and was a grasping instrument like a forceps. The present instrument is for applying liquids, and was apparently of the form of a spoon. Fabricius describes and figures such an instrument. It is a small round spoon with a long handle.

CHAPTER V