These writers, then, all take note of the possibility of wounding the vein, but give no clue that they knew of the utility of a cloven plate in preventing the accident. Further, the Arabs, timid operators all and fond of describing safeguards such as this, give no mention of it, although Albucasis, Rhases, Avicenna, and Haly Abbas all describe the operation. I can find no reference to the use of a guard for this purpose until quite recent times.

_Ear specillum._

Greek, ???t??, -?d??, ???t???, ?p??????, t? p????a ? ????s? t??test? t?

???t??d? (Galen, Lexicon); ?t????f??, ???? ???t?da (Galen, Lexicon); Latin, _oricularium specillum_ (Celsus); _auriscalpium_ (Scrib. Largus); German, _Ohrloffel_.

Of all the specilla this is one of the most frequently mentioned by name.

It consists of a small narrow scoop at one end and a simple probe without olivary enlargement at the other. We shall discuss the scoop first. The following pa.s.sage from Archigenes describes it (Galen, xii. 652):

'If a bean, stone, &c., fall into the ear remove it with the small narrow scoop of the ear specillum' (??a??s?? ste?? ???? ???t??d??).

Again Galen (loc. cit.) and Paul (VI. xxiv) say that in cases where foreign bodies cannot be got out of the ear by more simple methods, we must incise behind the ear and remove them by means of the ear scoop. The removal of foreign bodies from the ear by means of this instrument is very frequently referred to and shows that the scoop was small. Celsus says (VI. vii):

'When a person begins to experience a dullness of hearing, which very often happens after long continued headaches, first of all we must examine the ear itself, for there will appear either a scab such as occurs upon ulcers, or a collection of sordes. If there is a scab it ought to be fomented with warm oil or with verdigris in honey, or leek juice or a little nitre in hydromel, and when the scabs have been detached from the part, the ear is to be washed out with tepid water, in order that being spontaneously separated it may be the more easily extracted with the ear specillum (_oriculario specillo_). If there is cerumen and it is soft, it is to be extracted with the same specillum, or if it is hard vinegar with a little water is to be put in, and when it is softened the ear is to be washed out and evacuated in the same way.'

In VI. vii he says:

Ubi vero vermes orti sunt, protrahendi oriculario specillo sunt.

'Where worms have arisen they are to be extracted with an ear specillum.'

Celsus also recommends it for extracting a calculus from the meatus urinarius (VII. xxvi):

Eum, si fieri potest, oportet evellere vel oriculario specillo, vel eo ferramento quo in sectione calculus protrahitur.

'It, if possible, is to be extracted with the specillum or the instrument for extracting the calculus in lithotomy.'

Aetius (III. v) also describes removal of urethral calculus in this way.

The following pa.s.sage from Paul (VI. xl) on venesection shows that in cases where the band of Antyllus could not be applied, the back of the ear scoop was pressed on the proximal end of the vein, in order to obstruct the flow of blood and cause it to discharge by the opening made with the phlebotome:

'Tie a ligature round the neck, and when the frontal vein is properly filled divide it with the point of a phlebotome or a scalpel. In the same way we open the external jugulars for chronic ophthalmia, producing a discharge of blood with the scoop of a probe' (??a??s???

Adams evidently misunderstood this pa.s.sage. He translates it 'with the concave part of a scalpel', which is meaningless. This use of the scoop will also explain an otherwise obscure pa.s.sage in Hippocrates (iii. 678).

He says:

'In letting blood avoid pressing hard with the specillum (?a? ?ta?

?fa???? t? a?a t? ??? ? ???ta p???e?? ?? ? f??s?? p??s????ta?) lest injury be caused.'

Of the use of the ear scoop as a curette we have several instances. Thus Aetius (II. iii. 81) recommends it for curetting the interior of a chalazion, and again (II. iii. 84), cf. Galen, _Comp. Med._ vii. 2. The scoop was also used for applying medicaments, especially to the eye.

Liquid applications were poured from it, semi-solid were applied with the back of it (_averso specillo_). This use of the back of the scoop has often been misunderstood. The natural translation of the phrase _averso specillo_ is 'with the probe turned away', i. e. the back of the probe.

Scultetus, however (_Tab._ VIII. vii), considers that it refers to a spatula probe, and says it means the probe turned end for end. Other translators adopt this meaning. Deneffe (_Les Oculistes Gallo Romains_, p.

108), e. g., says:

Il faut entendre par _averso specillo_ la partie de la spatule opposee a celle qui sert comme sonde, c'est-a-dire son extremite large, l'autre bout etant le plus souvent olivaire.

Scribonius Largus puts the true meaning of the phrase beyond doubt. He directs us, after the application of caustic to haemorrhoids, to endeavour to get them to fall off by the back of an ear scoop, which part the Greeks called the spoon ('auriscalpio averso quam partem ??a??s??? Graeci vocant').

Marcellus copies this pa.s.sage from Scribonius, but alters it. He says: 'de specilli lat.i.tudine illinendae sunt' (x.x.xi. 6, p. 329).

I shall now proceed to give a few instances of this use of the back of the scoop in minor surgical manipulations.

In ancyloblepharon Celsus says the eyelids are to be separated with the back of the scoop.

Igitur aversum specillum inserendum, diducendaeque eo palpebrae sunt (VII.

vii. 6).

The back of the scoop was used as a retractor for delicate structures. In radical cure of hernia Celsus directs us to keep the bowel from prolapsing by means of it:

'For if the piece be small it is to be pushed back over the groin into the abdomen, either with the finger or the back of the specillum.'

Nam quod parvulum est super inguen in uterum vel digito vel averso specillo repellendum est (VII. xxi).

In the cure of varicocele it is used to replace the veins in position:

Tum venae, quaecunque protractae sunt, in ipsum inguen averso specillo compelli debent (VII. xxii).

'Then the veins which have been drawn upon ought to be replaced with the back of a specillum.'

In sloughing ulcer of the bladder it is used to separate the lips of the perineal wound:

Quod si antequam vesica purgata est orae se glutinarunt, dolorque et inflammatio redierunt, vulnus digitis vel averso specillo diducendum est (VII. xxvii).

'But, if before the bladder has become cleansed the lips unite and pain and inflammation have returned, the wound is to be separated with the fingers or the back of a specillum.'

We shall next proceed to discuss the other end of the ear specillum. This was a simple probe. It had no nucleus. In his Lexicon Galen defines it thus:

?p??????? t? p????a ? ????s? t??test? t? ???t??d?.

'Probe without olivary enlargement--that is to say "the ear specillum".'

Not only was its tip not expanded into a nucleus, it was actually sharp.

Galen (xiv. 787) treating of fistula in ano, says in non-perforating fistulae we perforate all the sound flesh with the sharp end of an ear probe (t? ??e? t?? ???t?d??). The chief use of an ear probe in aural work was to instil liquids into the ear. A large ball of wool saturated with the liquid was wrapped round the middle of the probe, and on squeezing this the liquid ran down and dropped into the meatus. There are many mediaeval ill.u.s.trations showing the ear probe used in this fashion.

Sometimes, however, we read of the tip of the probe being wrapped in a small ball of wool, which was dipped in some sticky substance to extract foreign bodies from the ear. Galen (xii. 689) says foreign bodies may be removed thus by a probe dipped in resin.

The ear probe seems to have been much used for probing wounds and fistulae when a very slender instrument was required. Galen (ii. 581), in describing the torcular Herophili, says:

'And in the double pa.s.sage you may be able to insert some of the slender instruments you have at hand, a double ended probe--a 'double-olivary' if you prefer to call it so--or if something smaller be necessary even an ear specillum' (?a? ???t??da).

In his chapter on the extraction of weapons (VI. lx.x.xviii) Paul says:

'If the weapon has a tang, which is ascertained by examination with an ear probe' (?? t?? ???t??).

As a cautery it was used to destroy the roots of hairs, which had been removed for trichiasis. Paul says:

'We may apply a double olive or an ear probe (???t?da) or some such fine instrument heated' (VI. xiii).