344

INSTRUMENTS FOR SURGICAL OPERATIONS ; IMPROVEMENTS IN. [Class Xc.

this mild plan of treatment may be superseded, in manycases, by the simpler method of a merely graduated com-pression on the exterior of the limb.

It might seem, then, that the skill of the instrument-maker is destined to be less and less required in the pro-gress of the healing art; but if his ingenuity may be thusbalked of its fruit, sometimes it would appear to be evokedby the very improvements which are the pledge of theadvance of surgery. A remarkable instance in point isthe comparatively recent operation of lithotrity, the prin-cipal merit of which will be cheerfully accorded to theFrench surgeons. The only method of effectually relievinga sufferer from the torture and health-destroying conse-quence of stone in the bladder had been by cutting intothe part, and by extracting the stone through the wound,which, in such cases, extends deeply, and involves partswhich it would be dangerous, or even fatal, to injure.But by the novel process entitled lithotrity, instru-ments, ingeniously contrived for the purpose, are in-troduced into the bladder, and, in the hands of a skilfuloperator, are made to break, crush, and pulverize thestone, without the necessity of any incisions, and withoutthose dangers to the patient which attended the operationof lithotomy. Here the aid of the mechanist was calledin to contribute to the success of one of the greatesttriumphs of modern operative surgery; and though thevarious modifications of the apparatus may have beensuggested by surgeons, it may be safely said that the in-struments would not have reached the perfection theyhave attained, as shown in the present Exhibition, withoutthe skill and ingenuity of the instrument-maker. Itshould be remembered also, in connection with this sub-ject, that Sir Astley Cooper devised a plan of extractingstones from the bladder whole and entire, when of smallsize, and that it was successfully carried out by means ofan instrument constructed by the late Mr. Weiss, whowill ever be regarded more as an artist than as a mere arti-ficer, in the line in which he earned his desen edly highreputation.

If, then, the improvements in the apparatus and instru-ments of surgeons, during the last half-century, be con-sidered in the spirit here vindicated, they will be foundto depend on simplification, and if on novel appliances,yet on inventions, which have afforded new means ofrelief to the sufferer, or have tended to introduce thegentler and less formidable methods of operation, whichare ever the characteristic of the enlargement of surgicalknowledge. Among these, besides the capital instancesadduced of modes of instrumentation of proved efficacyfor relieving the sufferings of stone in the bladder, theremay be mentioned—the stethoscope, invented by thecelebrated Laennec , for aiding the ear in examining themorbid sounds of the chest, and which is not without itsuse to the surgeon; the stomach-pump, the valuableauxiliary in the treatment of poisons ; Weiss’s dilator ofthe female urethra, for the purpose of facilitating theextraction of foreign bodies from the bladder; the water-bed of Dr. Arnott, calculated, in all cases, to afford equalpressure in lying, and to prevent or remove the sufferingand danger of bed-sores; various apparatus for facilitatingand improving the treatment of fractures, especially thebed invented by Mr. Ilarrold for fractures of the spine,and the useful appliance of the gummed roller; the in-struments for the cure of aneurism, by the graduatedcompression of the artery leading to the sac; the mecha-nical contrivances in aid of orthopaedic processes; andthe different forms to which caoutchouc has been madeavailable in air and water-cushions, and in a variety ofbandages and similar surgical appliances.

With these premonitions the Jury now proceed to givea brief synopsis of the contents of the present Exhibition.

Instruments deserving notice.

In looking over the assortment of instruments, whichdisplay not only all the ordinary contrivances required bythe surgeon, but many novelties and ingenious adaptationsand combinations, we may notice—in the instruments foroperations on the eye —specula, knives, needles, scissors,hooks, which are admirably calculated for the delicacy ofthe requisite manipulations. In those for operations on

the car, some novelties for the exploration of the meatusauditorius and Eustachian tube, and for the removal ofpolypi and foreign bodies from the external passage; aninstrument for perforating the membrana tympaui; and wemay add to these a variety of acoustic contrivances for aidsto imperfect hearing, many of which are so contrived as tobe disguised as articles of furniture or personal attire. Inthose for operations on the nose , mouth , and pharynx, somemodifications of the forceps for the extraction of polypi;syringes for injecting the nares and antrum; a variety oftonsillar guillotines; staphyloraphic instruments, and newaids to dental surgery, especially Gilbert’s chair, with afulcrum, and instruments adapted to the forms of theseveral kinds of teeth, for their more easy extraction.In those for operations on the air-passages and thorax ,various instruments for tracheotomy, and amongst thema novel tracheotome, and a valvular canula. We mayinclude with these various forms of inhalers for the ad-ministration of medicinal vapours, stethoscopes of novelconstruction, and instruments for measuring tire capacityof the chest, amongst which will be found Dr. Hutchinson’sspirometer, Coxeter’s portable spirometer, and Quain’sstethometer. Iu those for operations, or other surgicalministrations, on the abdominal u-alls or alimentary canal ,we may mention some improvements in the gullet forcepsand in oesophageal tubes; modifications of the stomach-pump, which are calculated to facilitate its use: enemafountains ; specula of different kinds for the examinationof the rectum, or subservient to operations on the part;and a large assortment of trusses and herniary bandages,including most of those in use, and others of novel con-struction, especially such as those by which the wearercan vary at pleasure the force of the spring and the di-rection of the pad.

In those for operations on the genitourinary system inthe male , we find all the recent modifications of the in-struments for lithotomy; lithotrites, of various novelty,including contrivances for the use of the screw and lever,as mechanical forces for breaking calculi, and one instru-ment for the purpose of pulverizing calculous fragments;syringes for injecting the bladder, together with con-trivances for maintaining a double current of the injectedfluid; dilators and various instruments to remove calculifrom the bladder and urethra without cutting; trocliarsfor puncturing the bladder, together with a form ofcanula so contrived as to prevent its slipping from theopening in which it is intended to remain; and, lastly,varieties of bougies, catheters, sounds, and instrumentsfor applying caustic and for dividing strictures; and wemay here notice the invention, patented by Chavriere, offlexible ivory, as a novel material in their make. Wemay also draw attention to the speculum and lamp ofMr. Avery (No. 631a, p. 478) for exploring the urethraand other lengthened canals; and the same gentlemanexhibits a new instrument for lithotomy.

In those for operations on the genitourinary systemin the female , we have a large assortment of specula,dilators, syringes, forceps for removing polypi, instru-ments for applying ligatures, pessaries, and artificialsupports of various kinds; an instrument for the cure ofvesico-vaginal fistula; and different instruments for ob-stetrical purposes.

In those for operations on the extremities, we find, inconnexion with some varieties in the knives and sawsused for amputations, several noticeable modifications iuthe form and adaptation of tourniquets ;—for the adjust-ment and co-aptation of fractures, numerous contrivancesclaim attention in the way of fracture-beds, inclinedplanes, splints of various form and materials, a cradlewith a moveable sling to enable the patient to sit up inbed, an apparatus for a fractured clavicle, together withpads and bandages in different materials;—for the re-duction of dislocations several contrivances, in one ofwhich the extending force is produced by a lever, and aneat apparatus for the reduction of the thumb or othersmall extremity.

In those for operations on the osseous system , the osteo-tomes claim attention, especially the revolving saw ofHeine, the circular saw of Macuell, and, in addition tovarious instruments for the resection of bone, one will be