IMPROVEMENTS IN SURGICAL INSTRUMENTS FOR THE INCISION OF STRICTURES AND FOR SIMILAR OPERATIONS
Year: 1881

page_text: PROVISIONAL SPECIFICATION left by Edwin Ambrose Brydges at the
Office of the Commissioners of Patents on the 2nd May 1881. A com-
munication by M. V. Schiltz, of the City of Cologne, in the German Empire,
Doctor of Medicine.
EDWIN AMBROSE BRYDGES, of the Firm of Brydges & Co., Engineers & Patent
Solicitors, of 73, Koeniggraetzer Str., in the City of Berlin and German Empire,
and 6, St. Leonard's Terrace, Upton, in the County of Middlesex. "IMPROVEMENTS
IN SURGICAL INSTRUMENTS FOR THE INCISION OF STRICTURES AND FOR SIMILAR
OPERATIONS." [A communication by M. V. Schiltz, of the City of Cologne, in
the German Empire aforesaid, Doctor of Medicine.]
My Invention relates to improvements in surgical instruments, which instruments,
as made according to the said Invention, are peculiarly well adapted for employment
for the incision of strictures in various parts of the human body, and for other
surgical operations where internal cutting or operation is requisite.
Although the said improved surgical instruments are all constructed on the same
main principle, it will be necessary to adapt them to the special operations to be
executed therewith.
For operating on the urethra I employ either an urethrotome, which acts in being
advanced or pushed forward, or one which acts in being drawn back.
An urethrotome made according to my Invention, and which operates in being
advanced or pushed forward, consists:
(1.) Of a nearly semi lunar blade, the entire upper surface of which is rendered
sharp or cutting, whereas the back is almost straight, or only slightly curved.
This blade slides by means of a projecting flange or guide piece in a small drawn
tube which is slit up for its entire length, and serves as a guide for a projecting
flange of the blade, and prevents the blade from leaving the guide when protruded
from the sheath for operating or making an incision.
(2.) Of a scabbard or sheath to cover the blade from the rear. The cutting blade
or knife has on its rear end near its basis a round eye or perforation, with a small
slot for easily attaching the blade to and disengaging it from a small blade rod or
wire, which blade rod or wire is at its forward end divided or slit for a short.
distance so as to form a fork. The extremities of this forked end of the rod or.
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wire are united by means of solder or in other suitable manner.
The blade or
incision instrument is inserted in the so formed slot in rectangular position to the
rod or wire, and is fixed by turning the same in the direction of the rod or wire.
The blade rod is at intervals fitted with small projecting flanges which slide like
the blade flange in the cavity of the guide tube; these flanges serve to guide the
projections to the blade rod or wire, and prevent the same from leaving the split
.tube.
The covering scabbard or sheath consists of two plates, between which the
cutting blade enters. These two plates are soldered together at the rear upper
end so as to form a stop for the backward movement of the incision instrument or
blade. The scabbard or sheath is bored out for its entire length near to and
parallel with its base line for receiving the rod or wire, which rod or wire can be
pushed forward and the blade or incision instrument made to protrude from the
said sheath. This boring in the sheath serves to guide and support the rod or
wire of the blade or incision instrument when the latter is made to protrude from
the said sheath for the purpose of making an incision.
The sheath or scabbard is provided at its rear end with a round eye or perforation
and a small slot in order that the said sheath or scabbard may be readily attached
to its rod or wire in like manner as described above with reference to the incision
instrument or blade and its rod or wire.
Or the rod or wire to the scabbard or sheath can be attached to the same by
inserting a small cylindrical knob or button in the perforation or boring afore
mentioned. This knob or button is soldered on to the extreme end of the sheath
rod, and is hollowed out so as to correspond with the boring in the scabbard or
sheath, so that when the blade or incision instrument rod is passed into the boring
of the scabbard and the knob or button, it is held correctly on its rod or wire.
The grooved steel scabbard, or sheath wire or rod, is soldered to a tube which is
slit up its entire length, and in which the blade rod may be placed in such manner
that the small guide flanges protrude.
In order to operate the blade rod sliding in the scabbard rod tube, both are fitted
with a knob or button.. The blade rod can be introduced for its entire length in
the scabbard rod tube and runs through the scabbard rod button.
The probe, which also acts as a guide for the operating blade, is fitted with a
handle ring opposite to the slit in the same, and ends in a small short screw to
which a very small round button or a flexible probe of india rubber can be
attached. This probe can also be employed in the instruments hereinafter
described:
For making more or less deep incisions another cutting blado or incision
instrument is requisite.
The urethrotoine made according to my Invention, and operating-in being drawn
back, consists principally of a cutting blade which turns or moves on a pivot.
The blade is brought into operation when the blade rod or wire is. pushed
forward by means of an inclined stop, which operates on the back of the knife or
blade and causes the same to protrude from the catheter or sheath. The said blade
is withdrawn into the sheath by means of another inclined stop which presses on
the tongue or rear end of the blade, that is, the part of the blade behind the pivot.
point. The action of the cutting blade can be produced by pushing the blade with
its rod forward against the inclined stop, or by making the stop adjustable and:
drawing the same by means of a suitable rod or wire so to the rear that the knife
or. blade is made to protrude from the catheter or sheath, but I prefer the first
described method. . The forward end of the knife rod is cut away so as to leave
the same of semi-circular section, and the extreme forward end is further-more split
into two like halves, each of which said halves forms one fourth of a circle in
section. One of these halves or split arms to the knife rod is provided with a pin,
whilst the other half is provided with a small boring to receive the pin attached to
the other arm. This pin serves as pivot for the operating blade or incision-instru-
ment, which is, so inserted between the two.arms that the pin passes through a

page_text: suitable.boring in the said blade. The blade is, when not in use, fully protected by
the split tube or catheter, which acts as sheath to the same. A second half round
rod or wire, which is also split at the forward end to receive two small thin pieces
of sheet steel, which are provided with an inclined surface, serve as stops for the
movement of the knife, and also to cause the knife or blade to protrude or
to withdraw the same into the split tube or catheter. Both of these inclined stops
project somewhat above the surface of the fork so as to be guided in the slit in the
catheter, and thus prevent the instrument from being turned in the said split tube
or catheter, and the blade from coming in contact with the metal of the same and
becoming blunt.
When both half round rods, the one containing the blade, the other the steel stops
with inclined surfaces, are adjusted on each other, they form a perfectly round rod
or wire, so that the blade is enclosed in its fork, having one stop at each end, the
entire apparatus being enclosed in the slit catheter.
A longitudinal movement of the two half round rods or wires in opposite
direction to each other produces the action of the inclined surfaces of the arrests
or stops on the blade, as before described.
In order to be able to operate the instrument, one of the half round rods, that is,
the rod which carries the arrests or stops, is soldered to a suitable tube, which tube
is provided with a knob or button.
The rear end of the blade or knife rod is soldered or otherwise firmly attached to
a round rod or wire, or made of one piece with the same, on to the extreme rear end
of which said rod a button is screwed. This button acts as a nut, and is provided
with a female screw threading, whereas the extreme rear end of the rod like
prolongation of the half round blade or knife rod is provided with corresponding
male threads.
When the blade shaft is pushed forward the cutting blade protrudes from the
instrument; the contrary action brings the blade back into its covered position.
The degree of the protusion of the blade, that is to say, the depth of the incision,
can be adjusted by screwing the knob or button forward or backward on the thread
of the rod carrying the incision instrument.
The slit catheter can be adapted at its extremity (as the former instrument) with
a small round button or a flexible india rubber probe, which probe is ordinarily
employed, as will be readily understood by all professional men. In order to
predetermine at what point the incision is to be made in the urethra, I employ
small slit rings which can be moved back and forwards on the hollow catheter.
The tip, by means of which an elastic probe can be attached to the instrument,
consists of two small cylindrical pieces of metal and a screw.
Both of these cylindrical pieces are provided with female screw threads at
each end.
The piece of metal is provided with a like thread throughout, whereas the other
is bored to allow the said screw to pass, and the other end is provided with a
tapering thread to receive the probe.
This arrangement enables me to screw the caoutchouc probe in without turning
the same in case the probe should be firmly embraced by the urethra.
The instrument made according to my Invention for internal incision of
strictures of the lachrymal duct is based on the same principle as the former
instrument, but must be made so as to adapt the instrument to the narrow duct.
The anterior or forward incline consists of a small steel plate, by means of which
a cutting blade is made to protrude on its being pushed forward.
This piece of steel is soldered in the extremity of a small slit sheath itself, which
is provided with a small screw onto which a small silver or elastic probe can be
screwed. The rear inclined surface is soldered to a round steel wire. This wire is
encased in a hollow blade rod, whereas a rod or wire is arranged to slide in the
outer sheath to which the probe is attached. This hollow wire or fine tube is split
at the forward end, and the cutting blade attached between the two parts by
means of a pin or small screw. The wires or tubes are provided with buttons or

page_text: knobs attached to the same. These instruments I prefer to make of gold or nickel
alloy on account of their non corrosive properties.
The instrument made according to my Invention for internal incision of the
aesophagus, denominated aesophagotome, is a modification of the two instruments
described above. The mechanism is based on the principle above described, and is
enclosed in a short metallic tube.
A flexible aesophagus probe is inserted into the upper part of the said short
metallic tube, and an elastic aesophagus tube of required length into the rear end
of the said tube, which is provided with a slit or slot for the incision instrument or
blade. The aesophagus tube or pipe can be strengthened by inserting small
metallic rings in the same, which also acts as guides for the blade rod or wire.
The blade, rod is split or forked at the forward end to receive the blade, which is
attached to the same by means of a suitable pin or pivot, and so that the rear
inclined surface can slide in the said slit or slot or fork. The inclined surfaces are
in this case attached to a shuttle-like piece of metal, one incline at each end of this
said piece of metal of semi-cylindrical form. This shuttle-like part of the apparatus
can be made of one piece or composed of two pieces; in any case a slot or slit is
made in the same of about equal length with the incision blade, to allow the same
to pass through to make the desired incision. The forward end of this said shuttle-
like piece of metal is so formed that when rivetted together (that is, when made of
two pieces), the forward end forms a perfect circle of like diameter with the
interior surface of the short metallic tube, the point where the knife is attached to
the blade rod or wire is also so enlarged that the said joint has a semicircular form,
thus forming in combination with the semicircular shuttle-like knife or blade
receiver, a circle of like diameter with the said piece of metallic tube. The rear
end of the knife or blade rod or wire is provided with screw-threads, onto which a
knob or button is screwed. I also employ a small disc with milled edge, which is
screwed onto the said blade rod or wire in front of the knob. This small disc can
be screwed forwards and backwards on the blade rod or wire, and serves to limit
the movement of the incision instrument according to the depth of incision
required. The said forked end of the blade wire or rod is attached to the blade as
near to the back surface and consequently as far from the cutting edge of the same
as possible. A small screw is provided which serves to connect the shuttle like
blade receiver and the inclined stops to the small metallic tube, and there is a
boring in the small metallic tube, so as to permit the pivot pin or pivot screw
which connects the knife to the fork of the knife rod or wire being reinoved, and
the knife or blade also removed for sharpening without taking the other pieces
apart. The rear inclined surface can in some instances be dispensed with, where
the resistance made by the flesh proves sufficient to force the knife back into the
sheath, although I prefer to employ both inclined surfaces.