A "flexible saw", consisting of a fine serrated link chain held between two wooden handles, was pioneered in the late 18th century (c. 1783–1785) by two Scottish doctors, John Aitken and James Jeffray, for symphysiotomy and excision of diseased bone, respectively. ... Park and Moreau described successful excision of diseased joints, particularly the knee and elbow, and Jeffray explained that the chainsaw would allow a smaller wound and protect the adjacent muscles, nerves, and veins. ... For much of the 19th century the chainsaw was a useful surgical instrument, but it was superseded in 1894 by the Gigli twisted-wire saw, which was substantially cheaper to manufacture, and gave a quicker, narrower cut, without risk of breaking and being entrapped in the bone. ... A precursor of the chainsaw familiar today in the timber industry was another medical instrument developed around 1830, by German precision mechanic and orthopaedist Bernhard Heine. This instrument, the osteotome, had links of a chain carrying small cutting teeth with the edges set at an angle; the chain was moved around a guiding blade by turning the handle of a sprocket wheel. As the name implies, this was used to cut bone.

One of the earliest patents for a "chain sawing machine" comprising a chain of links carrying saw teeth was granted to Frederick L. Magaw of Flatlands, New York, in 1883, apparently for the purpose of producing boards by stretching the chain between grooved drums.