The Coconino sun., 1906-12-15
THESURGEON'S TOOLS
AS FEW AS POSSIBLE USED BY THE
 MODERN PRACTITIONER.


 "A surgeon used to carry bag of in struments weighing often as much as twenty-five pounds when he was called to operate" said a member of the staff of the New York Postgraduate Med lcal 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.
 q have just come" continued the doe tor. 'from removing an appendix, and here in this small package are all the instruments 1 used-a scissors, two ar tery clamps, two forceps and a needle. Many operations, of course-gastro- 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 op- eration. 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 lelsurely. but 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. It used to take over an hour to remove an appendix; today the average is about twelve minutes.
 ''The variety of instruments increases needs or solve old problems. In our school here. as in others. many lnstru- ments have been devised. Especially 10 those having to do with the eye, ear, nose and throat have we made valua- ble 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 manufactory."
 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 mak. ing even the most delicate of the great variety of instruments. amounting to about 10000. which a surgical house must keep in stock or be ready 10 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 1t | becomes decarbonized and loses its | temper, the result being an instru ment with a shell of hard steel. capa- ble of taking a 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, it's | strength and cutting and tension qual- ities. General operating instruments are made of steel. silver platinum, gold and aluminium. German steel, owing to It's 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- ters, 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 reslsts 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 It's 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