St. Paul daily globe. [volume] (Saint Paul, Minn.) 1884-1896, 1884-07-05
SURGICAL SCRAPS.
Instruments for Use in Critical Gases, and
Ho,c They Are Handled.

SURGICAL SCRAPS.
Instruments for Use in Critical Gases, and
HO,c They Dire Handled.
There is a curious instrument in the ar
mamentarium of the surgeon called a pro-
bang, employed for removing foreign bodies
which have become fixed in the aophagus or
gullet. 1t consists of flexible stem, at one
end of which is an arrangement of catgut
fibers, and at the other end a small handle.
By moving the handle slightly, these threads
of catgut-which are stretched all round
and parallel to the stem at its lower end
can be bent outward in a radiating manner,
which gives the instrument the appearance
Of chimney sweeps broom in miniature.
When person is so unfortunate as to get q
piece of bone stuck in his throat beyond the
reach of the surgeons hand, the probang is
sometimes found very useful 1t can be pass
ed down the gullet in closed condition, be-
yond the obstruction, then opened, some
what like an umbrella, and drawn upward,
carrying with tiff all goes well-the foreign
body. The passing of such an instrument
is far from being pleasant to the patient; but
if it be done with ordinary care and judg-
ment, it will not be attended with any harm.
Every one who has known the misery at
tendant upon getting a good sized piece of
bone impacted in the food passage will I'M
derstand that when the operation has proved
successful the patient is likely to consider
the pleasure of seeing the offending frag-
ment caught in the meshes of the probang
cheaply purchased by the discomfort attend
ant upon the passage of the instrument
Another instrument employed for passing
down the asophagus is used for a different
purpose. When the gullet has been severely
burned intern all -as, for instance, from
the accidental swallowing of corrosive acids
after the ulcer produced has healed, there
is great tendency to contraction in the
scar, and consequent structure of the 9so-
phagus. This may threaten life, by tending
to close the passage altogether. To prevent
this, instruments called bougies are passed
through the construction from time to time.
These bougies are simply firm, smooth,
dignity flexible rods with rounded ends, and
are various in size as regards their diameters.
An instance of the passing of these instru-
ments being turned to account in very GU
rious way occurred some years ago in one of
the London hospitals. A patient was suffer-
ing from structure of the asophagus, brought
the tendency to contraction was in this case
so great that it was only by the frequent
passing of instruments that it could be pre-
vented from becoming to the last degree
dangerous Now, it was impossible that the
man could remain in the hospital permanent
ly; it was therefore decided to teach him to
pass the instrument for himself. He proved
capable of this, after a certain amount of in
struction: and it then occurred to some one
about the hospital that the daily performance
of this operation might be made the means
by which the man could earn livelihood.
Accordingly, the patient was advised TO
get a bouge made as much as possible to re-
semble sword. This he did and for long
time afierward was to be seen about the
streets of London making money by what
looked like the swallowing of a sword. In
his case there was really no deception as re-
CARDS the passing of long instrument down
toward his stomach was concerned, the only
deception being that the instrument was not
the weapon it represented His daily street
performance thus served him in two ways, it
supplied him with food, and also kept open
the passage by which that food could be con-
Yeyed to his timer man."
The contraction about which we have spok-
en- as taking place in scars formed after
burns of the gullet and which is so danger
GUS there, also occurs in burns on the sur
face of the body, and often leads to a good
deal of deformity. Burns, indeed, are a
great source of trouble to the surgeon
in many ways. For instance if
instance, if burn is very extensive there
may be great trouble in getting cicatrice
to form over the whole of it. Cicatrization
only begins in the immediate neighborhood
of living epidermis, and therefore burn or
ulcer must heal from the circumference to
the centre. But the further that the cica-
tricial tissue extends from the margin of the
burn, the more slowly and the more imper-
fectly is it formed; and indeed it may fail
altogether to reach the center. This diff
Guilty is often met by small operation called
skin grating. A piece of sound skin about
the size OF split pea is pinched up, say on
the outside OF the arm, and the epidermis
shipped off with pair Of curved scissors,
the scissors going deep enough to cut slight
IL into the second layer of the skin and
draw a little blood. special kind of scis-
sors has been invented for the purpose that
viii only take up just the right amount Of
skin, so that the operation is thus made sim
pier still; and if it is skillfully performed it
causes only very trifing pain. The little
fragment OF skin thus separated is then
placed gently, with its raw surface downward
on the healed surface of the burn. The
same thing is repeated again and again till
there are many gratis, if the burn is a large
one. Isinglass plaster, or some other SINH
lar material, is employed TO keep the CRAFTS
in position and preserve them from injury.
In about four days they should have taken
root, and then the covering can be removed.
There is now number of foci from which
cicatrization can start; for, as before said,
it viii begin from where there is an epider-
NAL covering and thence alone. After a
time number of little islands Of scar tissue
nav be seen, which go ON increasing until
at length they coalesce with one another,
and also join that extending from the mar
gin of the burn. This is what happens If
all goes well; but unfortunately, there is
yery great tendency for cicatrice formed
from gratis to break down and disappear, so
that the result is not by any means always SO
satisfactory as it at first promises to be-
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