AN IMPROVEMENT OR IMPROVEMENTS IN SURGICAL INSTRUMENTS FOR REMOVING THE STONE IN THE BLADDER, AND ENABLING THE PATIENT TO PASS IT OFF THROUGH THE URETHRA
Year: 1834

page_text: TO ALL TO WHOM THESE PRESENTS SHALL COME, I, JAMES
LEE HANNAH, Doctor of Medicine, of the Town of Brighton, in the County of
Sussex, send greeting.
WHEREAS His most Excellent Majesty King William the Fourth, by His
Letters Patent under the Great Seal of Great Britain, bearing date at West-
minster, the Sixteenth day of June, in the fourth year of His reign, did, for
Himself, His heirs and successors, give and grant unto me, the said James
Lee Hannah, Doctor of Medicine, His especial licence that I, the said James
Lee Hannah, Doctor of Medicine, my exors, adiiors, and assigns, or such
others as I, the said James Lee Hannah, Doctor of Medicine, my exors,
adiiors, and assigns, should at any time agree with, and no others, from time
to time and at all times during the term of years therein expressed, should
and lawfully might make, use, exercise, and vend, within England, Wales,
and the Town of Berwick-upon-Tweed, and also within all His Majesty's
Colonics and Plantations abroad, my Invention of "AN IMPROVEMENT OR
IMPROVEMENTS IN SURGICAL INSTRUMENTS FOR REMOVING THE STONE IN THE
BLADDER, AND ENABLING THE PATIENT TO PASS IT OFF THROUGH THE URETHRA;
in which said Letters Patent there is contained a proviso obliging me, the said
James Lec Hannah, Doctor of Medicine, by an instrument in writing under
my hand and seal, particularly to describe and ascertain the nature of my said
Invention, and in what manner the same is to be performed, and to cause
the same to be enrolled in His Majesty's High Court of Chancery within six

page_text: calendar months next and immediately after the date of the said recited
Letters Patent, as in and by the same, reference being thereunto had, will
more fully and at large appear.
NOW KNOW YE, that in compliance with the said proviso, I, the said
James Lee Hannah, Doctor of Medicine, do hereby declare that the nature
of my said Invention, and the manner in which the same is to be used, is
described and ascertained as follows, that is to say::-
An Improvement or Improvements in Surgical Instruments for Removing
the Stone in the Bladder and enabling the Patient to pass it off through the
Urethra. The apparatus which constitutes the improvements may be divided,
for distinct comprehension, into two divisions, namely, the one which enters
the bladder, and the other that remains without.
The parts entering the bladder have a general resemblance of form to the
instruments denominated a sound and a catheter, as seen in Figure 1 of
Plate A. These parts entering the bladder are of three different kinds, as
seen closed in Figures 1, 8, and 10, of Plate A. Figure 1 is for cutting or
dividing the stone in the bladder, and therefore denominated a cutter;
Figure 8, for crumbling or crushing it there; Figure 10, for crumbling or
crushing it also. Both of these may therefore be called crumblers or crushers.
The cutter is formed of the best wrought steel, by making the curved portions
of the instrument of two nearly equal and similar parts, as seen in Figure 2,
Plate A (where the instrument is represented as open in the bladder), and
placing them in lateral contact with each other. At the point of the instru
ment which enters the bladder these two parts are secured to each other by
means of a screw or a rivet (as seen in Figure 2 of Plate A), and form a joint
of very easy motion. One of these parts of the curve (that one which the
other appears as if it had been cut from) is a continuity of the handle or shaft
of the instrument, as seen in Figure 2. This shaft or handle is from the
curve about nine inches long, more or less, according to the size of the instru-
ment suitable to a man or to a boy. These two sections of the curve of the
instrument have each an edge similar to the two blades of a pair of shears, one
section with its edge below, and the other with its edge above, as they close
on each other and divide the intermediate substance. At the extremity of the
less section, opposite the extremity which is secured by a rivet or a screw.
there is a little transverse portion that perhaps might be called an arm, which,
when the instrument is closed, rests across the shaft, where it lodges into a
little notch or recess cut to receive it (as seen in Figure 2, Plate A), so that
all the parts may be properly smooth to pass through the urethra and into
the bladder. The purpose of this little arm is for attaching or securing to it,

page_text: by means of a screw or a rivet, a flexible steel spring similar to what is called
the main spring of a watch, which steel spring is of sufficient length, say,
fifteen or sixteen inches (more or less) to allow of its being pushed into the
bladder far enough to separate the two curved parts of the instrument
sufficiently from each other (as is seen in Figure 2 of Plate A) to enable
the surgeon to inclose the stone between them. To the outer extremity of
this flexible steel spring a steel or other metallic plate, about an inch long,
half an inch broad, and an eighth of an inch thick, is secured by a removable
screw. At the other end of this little metallic plate is a hole or eye (as seen
in Figure 2 of Plate A) about a quarter of an inch diameter, to receive a
hook through the whole length of the handle or shaft before-mentioned, and
immediately under the flexible spring there is a groove or canal, about an
eighth of an inch deep and as broad. It is for the purpose of injecting
and discharging the bladder through it at about two inches and a half (more
or less according to circumstances of fitness to the patient's size, whether boy
or man). From the outer extremity of the shaft or handle an oblique cut is
made into this canal towards the curve, and at an angle of about forty-five
degrees, equal in breadth and depth to the principal canal; into this obliquo
cut or short groove a pipe or tube reflected or bent downwards from a syringe
or a bag is inserted, and the bladder thus injected. The flexible steel spring
is, with the shaft or handle of the instrument, inclosed in a thin silver or
other metallic tube or case, which goes down quite into the bladder, fits
closely on its contents and slides easily on them by applying the fingers to the
rim that surrounds its outer extremity from the curve of the instrument, as is
seen in Figure 2, of Plate A. In the silver tube there is a lateral orifice corre-
sponding with the little transverse canal or groove in the shaft when the tube
is in its place. After this silver case or tube is drawn over the shaft and the
steel spring, then the little metallic plate before described is to be screwed on
to the extremity of the steel spring, as it is seen in Figure 2, of Plate A.
Of the second kind of the parts of the apparatus which enter the bladder,
Figure 8, in Plate A, represents the crumbler or crusher with two ranges of
teeth, as is more distinctly seen in Figure 9, of Plate A, where the instrument
is represented open or having its ranges of teeth separated from each other.
This crumbler (made also of the best of wrought steel) Figure 9, Plate A,
has the convex part of the shaft portion of the curve serrated or cut into
three or four rows of teeth in the whole direction of the curve from about
half an inch from its inner extremity or joint to the termination of the curve
on the shaft, as seen in Figure 9, referred to; the other row of teeth on the
moveable section of the curve, (and which may be designated the moveable

page_text: teeth), are cut only transversely on the corresponding concave surface of the
curve, as seen in Figure 9, Plate A, and fit in smoothly between those with
which they come in contact, as is seen in Figure 8, of Plate A. This portion
of the instrument forming the moving range or row of teeth has about half an
inch of its extremity filed laterally, and drilled to form a tongue to be let in
at the extremity of the movable row of teeth, so as to be screwed or riveted
together (as seen in Figure 9, of Plate A), and thus form a joint of casy
motion, which joint serves as a fulcrum in the use of the instrument and
renders it very powerful in its effect. To the other extremity of the moving
range of teeth the same kind of flexible steel spring as used with the cutter is
secured by a screw or a rivet and made perfectly smooth. The shaft or
handle of this crumbler is grooved like that of the cutter before described, and
is in all respects similar to it, except that it is without the little transverse
notch which the other must have. The flexible steel spring is let in (equal to
its thickness) to the extremity of the moving range of teeth, as seen in
Figure 9, Plate A. It is then nicely screwed or riveted on to its place, and
no roughness or pointedness perceptible.
-
The third kind of the parts of the apparatus which enter the bladder is
this second kind of crumbler or crusher (made of the same material as the
other) shewn by Figures 10 and 11, Plate A. It differs from the other
crumbler, Figure 9, in having but one range of teeth, and the flexible steel
spring extending over them from the joint, as seen in Figure 10, Plate A,
about eight inches beyond the extremity of the shaft or handle. This steel
spring is over the curve of much greater breadth than those before-mentioned.
It is the main spring of a chronometer, and just sufficiently covers the teeth
to prevent their wounding the urethra, being filed or ground down from the
point where it leaves the curve.
It is to be of the same breadth as the others
when it enters the silver tube or sheath, and that breadth about three six-
teenths of an inch resting on the flat surface of the shaft, which surface is
about the same breadth, the sides of the shaft rounding out beyond the flat
surface. The joint of this instrument, as seen in Figure 11, Plate A, is made
by filing a piece of steel to the exact shape to suit the form of the part into
which it is to go as a tongue for the joint. Being thus filed or formed, there
is to be about three eighths of an inch left at the end opposite the end of
the tongue, and of double the thickness of the chronometer spring before men-
tioned, (but of the same breadth that the spring may be let down as far as its
own thickness in it, and thus riveted, a contiuued smooth surface is formed,
as if the whole thing had been made from one steel bar. This tongue riveted
to its place completes the joint. All the parts entering the urethra and

page_text: bladder are to be spring tempered, the manner of doing which is known to all
surgical instrument makers.
Now for a Specification of that division of the apparatus which does not
enter the bladder. It is composed of the following parts seen in Plate A,
namely, Figures 3, 4, 5, 6, and 7. Figure 5 is not essential to the operation,
as will be shewn, it is merely convenient.
Figure 3 is a frame of wood from twelve to twenty inches long more or
less according to circumstances, which shall be mentioned. It is an inch and
a half broad, (more or less), and about an inch thick. At one extremity of this
frame or body of the apparatus, and in the middle of that extremity on its
broadest surface, a little groove, about an inch and a half long, is cut (as seen
in Figure 3 of Plate A), just sufficient in breadth and depth to lodge an equal
length of one of the shafts of either of the three instruments before mentioned.
Across this little groove, near its outer extremity, is a little flat piece of
steel, about three quarters of an inch long, a quarter of an inch broad, and
about a sixteenth of an inch thick. One end of it is screwed down to the
wood with a screw that has not its worm or thread quite up to its head,, but
sufficiently far from it to allow the little flat piece of steel or button .to be
moved round across the groove to keep down the shaft in its place there, but
not to cover the steel spring. This little steel plate or button, after being
moved over the shaft lodged in the groove, passes under a small flat steel arm
that projects from a small screw, by which it is secured into the wood, as seen
in Figure 3 of Plate A). This arm is about as long as the little button or
plate is broad. The screw part of this arm (which is at a right angle to the
arm) goes about half an inch into the wood and allows the button to come
under the arm in contact with it; the arm keeps down the button and secures
the shaft of the instrument in the groove. At the extremity of the little
groove which receives the shaft of the instrument, a small iron wedge, a little
broader than the groove and about half an inch long, is driven down even
with the surface of the wood. It serves for better resistance to the extremity
of the shaft. At about three eighths of an inch from this wedge, a semi-
circular trough, about half an inch deep and an inch wide, extends through
the length of the frame, as is seen in Figure 3 of Plate A. At the opposite
extremity of this trough an arm or cross piece projects, (as seen in Figure 3
of Plate A), through which the trough is continued; this arm and the frame
of the trough are made of the same kind of wood, sickamore. The trough is
let into the arm or cross piece and they are secured together by little screws,
as the Figure shews.
Figure 4, of Plate A, shews a screw of the same kind of wood as the

page_text: Figure 3. It is about three quarters of an inch diameter and nine or ten
inches long, inore or less, according to the necessary dimensions of the frame
and trough, as will be mentioned. At one extremity of this screw, Figure 4,
Plate A, a steel hook is screwed into the depth of about three quarters of an inch.
The point of the hook stands perpendicularly to the body of the wooden screw.
The cylindrical metallic tube, Figure 5 of Plate A, is about nine inches
long and three quarters of an inch diameter. It is the cylinder in common
use for weighing, having within a spiral metallic spring attached to a
graduated scale, that indicates the weight or power of a body acting against
the spiral spring, by removing its ordinary movable hook that was used in
hooking up meat to be weighed, and applying the present fixed hook screwed
in (as seen in Figure 5), and removing the former ring from the other
extremity, by which ring the cylinder was suspended in weighing anything.
This cylindrical tube is made available in my apparatus for ascertaining the
quantum of power exerted on the stone in the bladder for cutting or crumbling
it. At the extremity of this cylindrical tube, opposite to where the hook is
fixed, there is seen the eye through which the former ring (before mentioned)
passed. This eye is the extremity of the graduated scale of power or weight,
acting against the spiral spring within the cylinder, and proportionately to the
power applied does this scale come out to shew how much that power is.
Figure 6, Plate A, is a nut or fly for the purpose of acting on the wooden
screw, Figure 4, when that screw is laid in the trough of Figure 2, and
projects beyond the arm or cross piece of that Figure. This nut or fly is
about four inches and a half long, two inches and a half broad, and half an
inch thick, having a hole bored through the centre of it, with a tap to receive
the screw, Figure 4 of Plate A. It is made of the same kind of wood as the
other pieces.
Figure 7, Plate A, is to act as a rider over the frame, Figure 3 of Plate A,
and as such to receive the hook of the screw, Figure 4, through the little
holo in it as the rider straddles the trough in Figure 3. The removeable screw
that passes through the legs of the rider (as seen in the Figure) serves to
keep the rider secure as a slide on the frame. The rider is made of iron or
steel; its use is to keep the hook of the wooden screw drawing in a straight
line, by preventing it from turning round when it is through the eye of the
steel plate that is at the extremity of the flexible steel spring Figure 12.
Plate A shows all the parts of the apparatus in appropriate combination for
operating on the stone in the bladder. The part that opens in the bladder is
represented as if about to close on the stone. In this Figure it is seen that
by turning the nut or fly, (Figure 6), it draws up the screw through the arm

page_text: or cross piece. This screw having its hook passing through the eye of
the cylindrical metallic tube (Figure 5), and also through the eye or hole of
the sliding rider (Figure 7), and the hook of the cylindrical metallic tube
passing through the eye of the little metallic plate at the extremity of
the flexible steel spring (as mentioned before and seen in Figures 1
and 2 of Plate A), the turning of the nut or fly draws up the steel spring
and closes the instrument on the stone. The power thus applied to cutting
or crumbling the stone in the bladder may be very great. The metallic
cylindrical tube, Figure 5, Plate A, indicates the power applied, as is seen by
the graduated scale within it coming out at the eye of the tube when the
instrument is in use. This index indication of power is evidently not
essential to the operation, for if the cylinder (or power gage, as it may bo
denominated), were dispensed with, as in the Figures of Plate B, and the hook
of the screw be passed immediately through the hole in the rider and the
steel plate at the extremity of the steel spring, the power applied will be.
equally efficient, but unknown.
Directions for using the apparatus.-The directions for using one instru-
ment of the apparatus, say Figure 1 of Plate A, will be equally appli-
cable to the others. The surgeon is to introduce Figure 1 of Plate A
into the bladder precisely as he would a catheter or a sound. Being in,
he touches the upper part of the stone with the convex part of the curve
of the instrument; this done, he slides the instrument on the stone laterally
to the patient until he perceives it to be on the verge of the stone's
convexity, he then keeps the instrument there in contact with the stone;
with his left hand he pushes down the flexible steel spring into the bladder
sufficiently far to enable him to feel that the moveable portion of the curve
has passed below the stone, then by a kind of scooping action with the
instrument he incloses the stone between its parts or jaws; feeling that the
stone is thus inclosed, he secures the hold of the instrument on it by drawing
up the steel spring tightly with his left hand, then with the thumb, the fore
and the middle fingers of the left hand (the thumb below them) he holds
securely together the shaft and the flexible spring; with the right hand
he takes up or receives from the patient (the only assistant necessary, perhaps)
the apparatus as arranged in its parts in Figure 12, Plate A, of course
exclusive of the part in use, and with that hand he applies the little groove in
the extremity of the frame, (Figure 3, Plate A), to the extremity of the shaft;
then, carefully pressing the shaft into it with his fore and middle fingers, he
turns the little steel button over it, and under the little flat steel arm, but not
over the steel spring, which must move freely. The shaft being lodged in the

page_text: groove, and the button secured over it, the surgeon-or his assistant, the patient
is to put the eye of the steel plate at the extremity of the spring upon the
hook of the cylindrical tube or power gage if that instrument be used, or if
not, the eye is to be put upon the hook of the wooden screw, Figuro 4,
Plate A, after the rider had been secured over that hook, as seen in the two
Figures of Plate B, where the cylindrical tube is omitted. All this being done
whilst the patient lies on his right side for greater convenience to the surgeon,
the apparatus is to be held steadily in the bladder by the patient himself,
or any other assistant, whilst the operator turns the nut or fly. For every
subsequent cut or crumbling the nut or fly is to be turned back, that the steel
spring may be slackened and removed from the hook to allow of its being
again pushed into the bladder as at first. The stone is divided or crumbled
or grated by turning the nut or fly before mentioned from left to right. If the
instrument, Figure 9, Plate A, with the moveable range of teeth, seizes the
stone at the verge of its circumference, its grating or biting the stone will
be strikingly analogous to a dog's biting the end of a large bone. The two
ranges of teeth act as a double grater when the instrument thus seises a stone.
The bladder is to be injected through the shaft of the instrument in the
manner before stated. After the stone has been cut its new surfaces will
absorb the injection more readily than the old one, the stone will thereby
become softer, and every subsequent cut of it require the exercise of less power
to divide or crumble it. After the cutter bas divided a stone into several
portions, say six or eight, the crumbler or crusher may be used with very little
power to pulverize them for the casy passage of their substance through the
urethra. A silver wire is to be used occasionally to keep the canal or groove of
tho shaft free of obstruction.
What I claim as new in the apparatus, and as my Inventions, and for
which I have prayed Letters Patent, arc,-
First, the curve of the cutter and of the crumbler, being each of them
formed of two entire sections, one section moving on a joint formed by a
screw or a rivet fixed into the other section.
Second, those sections of the instruments being formed with edges to cut or
teeth to crumble and pulverize the stone.
Third, the groove in the handle or shaft of the instruments for injecting
the bladder.
Fourth, the application of the elastic steel spring, by means of which the
instruments are opened and closed in the bladder.
Fifth, the application of the silver or other metallic tube to keep that
olastic steel spring acting properly in its place.

page_text: Sixth, the application of a flexible steel spring, forming a joint, as described
n the foregoing Specification, extending over the whole of the convex
range of teeth, and then narrowing off to pass through the tube.
Seventh, the application (as described in the Specification) of the wooden
rough, screw and nut, as means of applying power.
Eighth, the application of the rider to keep the hook of the wooden screw
acting properly in its place.
This is the Specification of my Invention.
In witness whereof, I, the said James Lee Hannah, Doctor of Medicine,
have hereunto set my hand and seal, this Twentieth day of November,
in the year of our Lord One thousand eight hundred and thirty-
JAMES LEE (L.S.) HANNAH, M.D.