Chirurgie

HEY's Säge

Trepanationssäge, (laut Verkäufer 1840-90), erworben 1/2017. Von allen HEY-Sägen, die ich kenne, ist sie die hässlichste: weder Holz- noch Perlmuttgriff, keine Taille. Und dennoch: ich liebe meine Rostlaube aus Romford in der Grafschaft Essex, weil ihr letzter Besitzer mich so unwiderstehlich anknurrte "ja ich verkaufe ins Ausland, aber wie so viele, werden Sie ja doch nicht kaufen ".

Mit der HEY'schen Säge wurde trepaniert, wurden das Schlüsselbein und die Fingerknochen durchtrennt, Exostosen abgetragen, das Wangenbein durchtrennt, Nasen abgeschnitten, Zähne mitsamt Kiefersegment ausgeschnitten ...

HEY hatte alle erdenklichen Formen ausprobiert, Sägen mit einem Blatt, mit 2 Blättern und jedem Krümmungsgrad. Unser doppelblättriges Modell hat eine Länge von 16.7 mm. Sägeblatt 3.2 x 4.7 mm. Gerade Säge 22 mm, gewölbte 25 mm (ab Stielmitte gemessen). Sägeblatt durch 2 Nieten gehalten. Geriffelter Teil des Griffes 89 mm lang, max. Breite des Griffes 16 mm.

Eine größere historische Übersicht über die Geschichte der Trepanation findet sich in folgender Würzburger Dissertation: "Aug. Friedr. Leisnig, Über Trepanation nebst Beschreibung der zu dieser Operation von mir erfundenen Messer-Krone, die sich vorzüglich für feldärztliche Etui's eignet, Würzburg 1844".

Zum Hersteller

Am Übergang zum geriffelten Griff findet sich die Markierung YOUNG, offenbar einer der zahlreichen Archibald YOUNG's "de père en fils" aus der Princes Street n°79, South Bridge n°40, Forrest Road n°61 usw. aus Edinburgh. Schon für John AITKEN (1770–1790) hatte ein Archibald Young aus Edinburgh eine Geburtszange geschmiedet (Elisabeth Bennion, Antique Medical Instruents 1979 S.120). 

Lit.:

- Archibald Young, surgical instrument maker, in: Nurs Mirror Midwives J. 1973 Feb 2;136(5):14-7.

- Ruth Pollitt, in 2005, she completed a Museum Studies, Master of Arts Degree at Newcastle University and undertook a historical research dissertation on the surgical instrument maker Archibald Young & Son of Edinburgh.

Zur Person von HEY

1803 gab der Chirurg William HEY (1736-1819) seine Knochensäge an, als er an der Leeds General Infirmary arbeitete und gedachte, damit Schädelöffnungen zu erleichtern. Erhalten ist von ihm ein Ölgemälde, das ihn sitzend zeigt, wie er ein Kind an der linken Schulter berührt - HEY war Kinderarzt und behandelte das Kind mit einer Claviculafraktur.

"Hidden from public view in many of our hospitals are works of art that reflect a rich medical and social history. From an era long before paediatrics became a specialty in its own right, there are few representations of the care of children. One exception is this painting of Leeds surgeon William Hey (1736–1819), remembered for the eponymous Hey’s saw and Hey’s ligament, together with his original descriptions of internal derangement of the knee. Hey worked for nearly 60 years, not only as apothecary-surgeon but also as a man-midwife and “paediatrician”, describing both infantile hernia and congenital syphilis. This portrait by William Allen was commissioned in 1816 as a testimony to Hey’s humanitarianism. He is shown examining a child with a fractured clavicle from the estate village of Harewood just outside Leeds. Incognito and observing the consultation is Lady Harewood, bent on testing Hey’s reputation for indifference to social circumstances and class when it came to medical duty. This charming image portrays both compassion and tenderness, a fitting example to those of us caring for children today. Hey’s outlook was no doubt moulded by his religious upbringing, personal experience of sickness and loss among his own children, and his desire that new discoveries in science and medicine should lessen the suffering of mankind. Hey’s marked squint can be readily appreciated; it resulted from a childhood penknife injury to his right eye. However, monocular vision proved no barrier to him becoming a famous surgeon, his writings recognised throughout Europe. He maintained perfect vision in his left eye until his death from a perforated colon at the age of 83. The portrait hangs in the Boardroom of the General Infirmary at Leeds, a hospital that originated through the endeavours of its eighteenth century founders, prominent among whom was Hey himself" (N Leadbetter, J W L Puntis, William Hey (1736–1819) and child patient, in: Arch Dis Child 2004;89:901).

An HEY wurden alle gemessen: "When Cheselden died.” says Benjamin Bell, “ Hey was fifteen years of age. John Hunter was born eight years before him. and died when Mr. Hey was fifty-five; Samuel Sharp died when Hey was forty-two; and Percivall Pott ten years later. Desault was his junior by eight years, and he predeceased Hey by twenty-three. He was contemporary with John Abernethy, Astley Cooper, John Bell, Charles Bell, Sir Benjamin Brodie and William Lawrence” - the great provincial surgeon, whose long life bridged the gulf between empirical and scientific surgery …

Hier ein Artikel aus JAMA: "William Hey was born at Pudsey near Leeds, Yorkshire, England, the son of a respectable tradesman noted for his overbearing honesty and ramrod integrity. His maternal grandfather and great-grandfather were surgeon and physician respectively. His mother, whose good judgment usually prevailed, held the greater influence in building the character of the large family. At the age of four young Hey had an accident with a penknife and lost the sight of his right eye; however, he retained excellent acuity in the left eye, even late in life performing the details of surgical practice without the aid of a corrective lens. Before he reached the age of eight, he was enrolled in an academy near Wakefield where he was instructed in the classics, natural philosophy, and the French language. At the age of 14 he complied with the wishes of his parents and was apprenticed to surgeon-apothecary Dawson in Leeds; he remained there until 1757, when he went to London to complete his medical education. During the first winter Hey spent long hours in the dissecting room and subsequently became a pupil of Bromfield in surgery, Donald Monro in medicine, and MacKenzie in midwifery at St. George's Hospital. Having completed his formal training, Hey returned to Leeds, set up practice, and without delay acquired a reputation as a surgeon. Leeds at that time lacked facilities for hospital care which prompted him to promote a program to correct the deficiency. In 1771, he witnessed the opening of Leeds Infirmary for the admission of patients. Hey was appointed senior surgeon at the Infirmary, a position held from 1773 to 1812. In the meantime he established a close friendship with Joseph Priestly, who then lived at Leeds and who sponsored his Fellowship in the Royal Society of London which was approved in 1775. Hey was president of Leeds Literary and Philosophical Society in 1783, and was twice mayor of the city. He loved music, was a profoundly religious man, and a strong Methodist until 1781, when he joined the Church of England and wrote Tracts and Essays, Moral and Theological, including a Defence of the Doctrines of the Divinity of Christ, and of the Atonement. During his mayoralty his severe denouncement of profanity and vice led the population to burn him ineffigy. Hey suffered a series of family tragedies; three sons, two daughters, and a daughter-in-law died from pulmonary tuberculosis. Hey was an excellent surgical operator and, as a member of the Royal College of Surgeons of London, late in life gave courses in anatomy on the bodies of executed criminals at Leeds Infirmary. He introduced significant improvements in the treatment of hernia, cataract, and dislocations; suggested amputation of the foot distal to the tarso-metatarsal joint; described and named the growth, and offered evidence of the transmission of venereal disease to the fetus in utero. In addition to Hey's religious tracts he contributed several manuscripts on structural anomalies to the Philosophical Transactions and wrote a monograph, Practical Observations in Surgery, first published in 1803. His two most important contributions to clinical surgery appeared in this volume. The of the of scrotal hernia description types in infants began with deductions from the autopsy findings of an 18-month-old child. I found that the tunica vaginalis was continued up to the abdominal ring, and inclosed the hernial sac, adhering to that sac by a loose cellular substance, from the ring to within half an inch of its inferior extremity. The fibres of the cremaster muscle were evident upon the outside of the exterior sac, or tunica vaginalis. The interior or true hernial sac was a production of the peritoneum as usual, and contained only the caecum or head of the colon... Having removed the proper hernial sac, I examined the posterior part of the exterior sac, and found it connected with the spermatic vessels in the same manner as the tunica vaginalis is, when the testis has descended into the scrotum. An additional proof, that the exterior sac was the tunica vaginalis. From all these circumstances it is evident, that this hernia differed both from the common scrotal rupture, in which the hernial sac lies on the outside of the tunica vaginalis; and also from the hernia congenita, where the prolapsed part comes into contact with the testicle, having no other hernial sac besides the tunica vaginalis. To understand the cause of the hernial sac being in contact with the testicle, and surrounded by the tunica vaginalis, it is necessary to consider the manner in which this coat of the testicle is originally formed. In the foetus a process of the peritoneum is brought down, through the ring of the external oblique muscle of the abdomen, by the testicle as it descends into the scrotum; which process forms an oblong bag communicating with the cavity of the abdomen, by an aperture in its upper part. This aperture is intirely closed at, or soon after, birth. The upper part of the bag then gradually contracts itself, till the communication between that portion of it which includes the superior and greater part of the spermatic chord, and the lower part of the bag, which includes the testicle and a small share of the chord, is obliterated. The lower part of the process or bag retains its membranous appearance, and is called tunica vaginalis testis propria; while the upper becomes an irregular cellular substance, without any sensible cavity, diffusedamongst the spermatic vessels, and connecting them together. In the hernia which I am describing, the intestine was protruded after the aperture in the abdomen was closed; and therefore the peritoneum was carried down along with the intestine, and formed the hernial sac. It is evident also, that the hernia must have been produced while the original tunica vaginalis remained in the form of a bag as high as the abdominal ring; on which account that tunic would receive the hernial sac with its included intestine, and permit the sac to come into contact with the testicle. The proper hernial sac, remaining constantly in its prolapsed state, contracted an adhesion to the original process of the peritoneum which surrounded it, except at its inferior extremity: there the external surface of the hernial sac was smooth and shining, as the interior surface of the tunica vaginalis is in its natural state. This kind of scrotal hernia may, therefore, not improperly be called hernia infantilis, as it can only exist when the rupture is formed while the parts retain the state peculiar to early infancy. The scrotal hernia may be divided into three species, the specific difference of which arises from the state of the tunica vaginalis at the time of the descent. If the abdominal aperture of this process is open when the intestine or omentum is protruded, the rupture is then called hernia congenita. If the upper part of the process remains open, but the abdominal aperture is closed, and is capable of resisting the force of the protruding part, the hernia then becomes of that species which I have now described, the hernia infantilis. If the cavity of the upper part of the process is obliterated, and the septum is formed a little above the testicle, as in the adult state; the hernial sac then descends on the outside of the tunica vaginalis, and forms the most common species of scrotal rupture, which may with propriety be called hernia virilis. In the same treatise Hey discussed the factors involved in internal derangement of the knee that follows minor trauma. The disease is, indeed, now and then removed, as suddenly as it is produced, by the natural motions of the joint, without surgical assistance: but it may remain for weeks or months, and will then become a serious misfortune, as it causes a considerable degree of lameness. I am not acquainted with any author who has described either the disease or the remedy; I shall, therefore, give such a description as my own experience has furnished me. The leg is readily bent or extended by the hands of the surgeon, and without pain to the patient; at most, the degree of uneasiness caused by this flexion and extension is trifling. But the patient himself cannot freely bend, nor perfectly extend the limb in walking; but is compelled to walk with an invariable and small degree of flexion. Though the patient is obliged to keep the leg thus stiff in walking; yet in sitting down the affected joint will move like the other. The complaint which I have described may be brought on, I apprehend, by any such alteration in the state of the joint, as will prevent the condyles of the os femoris from moving truly in the hollow formed by the semilunar cartilages and articular depressions of the tibia. An unequal tension of the lateral, or cross ligaments of the joint, or some slight derangement of the semilunar cartilages, may probably be sufficient to bring on the complaint. When the disorder is the effect of contusion, it is most likely that the lateral ligament on one side of the joint may be rendered somewhat more rigid than usual, and hereby prevent that equable motion of the condyles of the os femoris, which is necessary for walking with firmness".