Spirit of Jefferson. [volume] (Charles Town, Va. [W. Va.]) 1844-1948, 1906-09-25
THE SURGEON'S TOOLS
AS FEW AS POSSIBLE Used BY THE
MODERN PRACTITIONER.

To Remove an Appendix, For In
stance, He Can Carry Everything
Necessary In One of His Pockets.
Hand Forged Instruments the Best.
"A surgeon used to carry bag of in
gtruments weighing often as much as
twenty-five pounds when he was called
10 operate" said member of the staff
pf the New York Postgraduate Med
cal School and Hospital the other day.
+" To-day an average operation, such as
the removal of an appendix, calls for no
more instruments than can be carried
in the pockets.
Il have just come" continued the doc
| tor, "from removing an appendix, and
here in this small package are all the
| instruments / used--a scissors, two ar
terry clamps, two forceps and needle
Many operations, of course CASTRO
enteric, genealogical and those that
have to do with bones-require more
instruments, but modern science de-
mands the use Of as few as possible In
order that time may be saved. Skill
and haste are prime factors in an OPP
Grafton. In the old days, before anaes-
| thesia was known. this was to shorten
the patients agony as much as possible.
After ether was discovered surgeons
for awhile operated more leisureIy, but
soon finding out that the shock to the
patient remaining under ether so long
was always dangerous and often fatal
| they again recognized the Importance
of swiftness. Diminishing the number
| of instruments was one Of the methods
| for saving time. In the operating room
| in the old days there was always, no
| matter what the operation, good sized
table laid out with ten or fifteen score
of instruments, fifty artery clamps,
scissors, forceps and. lancets by the
| dozen. 1t used to take over an hour to
remove an appendix; today the average
| is about twelve minutes
1.-THE variety of instruments increases
every year as surgeons meet with new
needs or solve old problems. In our
school here, as in others, many instru-
ments have been devised. Especially
to those having to do with the eye, ear,
nose and throat have we made valua-
BILE additions as well as In the field of
| orthopedic appliances. The Hippocrat-
ic oath precludes the patenting of any
such inventions; consequently all in
struments are free to be made by all
and every surgical mandatory"
The making of surgical instruments
| in the United States Is nearly contem-
poraneous with the beginning of the
republic, and one or two Of the promi-
nent firms today date from long before
the civil war. In no country are finer
instruments made than in the United
States. Though the number of men
employed Is small, every man Is a
skilled laborer and an artist, with an
adroitness often as fine as that Of a
journeyman jeweler, capable of max
ing even the most delicate OF the great
variety of instruments, amounting to
about 10000, which surgical house
must keep in stock or be ready to pro-
duce upon order.
Cast and drop forged instruments
have no lasting value, and once the
edge is worn off they can never be sat
isfactorily resharpened. The process
which they undergo demands that they
be brought three times to white
heat. The first time the steel becomes
tempered; the second and third time it
becomes decarbonized and loses its
temper, the result being an instru-
ment with q shell of hard steel, capa-
BILE of taking fair edge, but beneath
which the metal is soft and unfit to
stand honing.
"All good instruments are hand
forged Thus prices are doubled and
trebled over the prices Of cast instru-
ments because Of the skilled labor and
time necessary to their construction.
The workman In a careful factory
must make study of his work and
learn the physical qualities OF the
steel or metal he works with, Its
strength and cutting and tension quail
tiles. General operating instruments
are made Of steel, silver. platinum,
gold and aluminium. German steel,
| owing to its tenacity, is used for for
ceps and blunt instruments; English
cast steel for edged tools. as it receives
a high temper, fine polish and re-
tains its edge. Silver when pure is
very flexible and is useful for cathe-
tiers, which require frequent change of
curve When mixed with other metals.
as coin silver, 1t makes firm catheters,
caustic holders and -cannulated work
| Seamless silver instruments are least
liable to corrode- Platinum resIsts the
action Of acids and ordinary heat and
Is useful for caustic holders, actual
cauteries and the electrodes Of the
galvano cautery. Gold, owing to its
ductility. is adapted for fine tubes,
such as eye syringes and SO forth,
while aluminium is by its extreme
lightness suitable for probes, styles
and tracheotomy tubes.
Handles are made of ebony, ivory,
pearl or hard rubber. Ebony and rub
Der are used for large instruments.
| though these at times have handles Of
steel. Ivory makes durable and
beautiful handle, though 1t and ebony
are not entirely aseptic. because 1t Is
| impossible to boil them for the purpose
of sterilization without their cracking.
Ivory and pearl are used for scalpels
and for small instruments like those
used in operating on the eye. On the
whole. the best material for handles
is hard rubber. since it may be vulcan
lied on the instrument, thus making 1t
practically one piece. with no possible
seam for the lodging Of germs and
hence perfectly safe.
Next to the materials the mode OF
making determines the Instruments
| quality. Steel overheated In the forge
is brittle or rotten In shaping with
the file the form may be destroyed.
| In hardening and tempering the steel
may be spoiled. In every stage the
value OF the instrument depends upon