Surgery


Spring lancet (2)

Snapper, around 1919 

 

 

    

The bloodletting became the panacea of ​​the medical profession: the doctors prescribed it, the surgeons carried it out, the patient had to endure it and pay - some even with there life ...

 

     In the United States, the physician Benjamin RUSH favored extensive phlebotomy. George Washington was taken from a riding accident more than 1.5 liters of blood; this loss may have contributed to his death. Also in the death of Emperor Leopold II accelerated, so the criticism of Samuel Hahnemanns, a fourfold bloodletting within 24 hours by his personal physician Lagusius the demise of the ruler.

 

The handy square Schnepper with cocking lever let rip 12 to 20 knives at the bottom. Advantage of this method: standardized cuts with uniform length and depth. Disadvantage: the Scarificatoren could not be cleaned.

 

Exhibit

The two snappers presented here belonged to gynecologist Dr. med. Joseph PRIM (1891-1974).

Surgery


Spring lancet (3)

 

 

Soon it was said: the more knives, the better - lots of stuff!

 

 

Exhibit
From the estate of the doctor Guillaume KOERNER (1882-1953) established in Clerf from 1913 comes this Lancet with 12 knives.

Surgery


Spring lancet (4)

around 1920 

 

Bloodletting was anything but a banal, harmless intervention; there were, though rarely, injuries to tendons and nerves, there was phlebitis with subsequent thrombosis, yes embolism and sepsis.

 

After evaluating numerous medical histories, the French physician Pierre Charles Alexandre LOUIS (1787-1872), the founder of clinical statistics, was able to prove that bloodletting is useless and sometimes even harmful. Hardly anyone listened to him.

 

19th century lancets - owned by the Diekircher practitioner dr. Paul HETTO (1895 - 1979) - a lancet  with 8 knives still common in the 20th century: the lever for clamping and the rotary knob for cutting depth adjustment at the top, the trigger at the front.

Surgery

Spring lancet (5)

 

 

    

Scarificator, invented in Germany, to make suddenly several small superficial incisions in the skin, on which then the cupping head is set. The S. consists of a capsule of steel, on the lower surface of which are as many elongated openings as small lancets (4-12-20) are hidden inside the capsule. These are attached to two or three shafts, by means of which they can make a quarter-circle movement out of the openings. These waves are, as in a shotgun lock the cock, determined by a thumbwheel u. then by a spring, which one relaxes by a pusher, around its axis moves.

 

Exhibit

The round scarificator, which comes mostly from France, is rather rare - in the Anglo-Saxon area, the model with 4- resp. 8 corners is the most frequent .

Surgery


Lancet (8)

Fliete aus Laufen
 

 

 

The surgeon held the instrument between the thumb and middle finger of the left hand - the spiraling "heel" to "handle" facilitated this access and prevented the flies from twisting the moment the finger (or razor comb) hit , With the right index finger, the surgeon tapped the iron - for cutting into the skin and vein - to pierce the rough cow / horse skin it required a special hammer (see previous article).

Surgery


Stapler, set

Klammerungsset n. MICHEL, um 1930 

 

Even "primitive peoples" had developed techniques of wound care. Brazilian Indians used ants with strong pliers to clasp a wound: the heads are torn off the animals as soon as they have bitten the wound edges.


Modern surgery rediscovered this stapling technique and developed it into "serre-fine" and "Kölner Sparklammern". In an emergency, they could cling to wounds without numbing the skin.
a) Presented is a cutlery for suture, free according to Dr. med. Paul MICHEL (Congrès international de médecine 1900, section of surgery) -
The original device was a "pince-revolver", an automaton from which one could shoot 50 agraffes without dropping off.


Most surgeons, however, were more used to working with normal tweezers and therefore preferred to put the MICHEL staples with tweezers; however, you needed a special pair of tweezers with 3 teeth on each side. The box presented here, a metal case supplied by the instrument maker Moitzheim in Luxembourg, originally contained:
a narrow forceps for lifting the adapted wound edges,
a wide tweezers for applying the brackets,
25 wound clips made of pure nickel and
2 check marks to remove the clips.
With special agraffenhebern (after MICHEL or JOLY) the MICHEL'schen Wundspangen were opened and "dug".
b) The single combined tweezers / pliers of the French company DRAPIER presented here are used to set the clamps (right part) and to remove them (left part). In the SIMAL catalog of 1936 we find it as "pince à double usage for poser et retirer les agrafes"
c) Right next to it, a modern, American staple removal forceps of a company "A". Light metal, solid riveting.

 



In the Luxembourg daily press we occasionally find evidence of the use of these (or similar) brackets:
"Schieren, June 3. At the Beer Table A small discussion in a local inn led to quarrels between two guests in the evening, with the farmer Joh. Metz vom Schierenerhof beating his opponent so relentlessly that he needed the doctor Apply some staples to wounds "(Escher Tageblatt, 3.6.1935).


"Dudelange, 14 Nov. When playing in the schoolyard two children collided with such force with their heads that both bore a centimeter-long wound over the eye, which had to be clamped by the doctor" (Obermoselzeitung, 14.11.1936).


"Wiltz 9 May The 12 - year - old son of the inn owner, Mr. Wilmes von der Lann in Niederwiltz, suffered a serious hand injury while chopping up wood and wanted to hold a piece of wood, which another boy was to split The doctor had to use braces "(Luxemburger Wort, 9.5.1940)


"Petingen, fall from the stairs." The pension inspector Mich. D. of the Neustastrasse crashed down the stairs in an inn so unhappily that he suffered a sore wound at the back of his head and lost consciousness Two hours later, the maid found the injured woman and was immediately taken to the hospital for treatment, and the doctor had to use D. several surgical clips "(Escher Tageblatt, 19.12.1941).

Surgery


Staples (1) by MORIZ

Hautklammer_1.jpg
 

 

When Anton MORIZ founded his factory of surgical instruments in Cologne in 1969 he was in possession of the patent for the famous "Köln Sparklammern" - staples known for their economic usage. You could use and remove them without a specialized Instrument and you could reuse them after sterilisation.

 

Unfortunately the sterilisation standards got that hard, that the staples were condemned to disappear in human surgery - they survive in veterinary medicine.

 

Surgery


Staples (2) by v. HERFF

Hautklammer_2.jpg

1915

 

 

In 1914 the Basle (Switzerland) gynecologist Otto v. HERFF (1856-1916) designed a new kind of staples he had patented in the USA on 5th of January 1915

 

You applied and removed them without any instrument, just with your fingers, and threw them away after use ...

Surgery


Sterile container (1)

 

 

The surgeon needed, for sterile storage of instruments and bandages, boxes that could be steam-sterilized in an autoclave. In this sense, the company ADNET after the First World War brought boxes of tinplate (z.T. nickel plated) in the sales with a lid that sealed by means of bayonet closure. There was a ring of closable openings in the lid. Illustration by Rehm p. 167.

 

Lit .: P.L. REHM, Nouvelle Encyclopédie Pratique de Médecine et d'Hygiène, Quillet Paris 1922.

Surgery


Sterile container (2) by KONRICH

Schimmelbusch Trommel

Trommel n. KONRICH, 1938

 

 

In the second half of the 19th century, it came through the first disinfection of the suture, the English surgeon Joseph Lister (1827-1912) using carbolic acid (1867) and later the German surgeon Curt Schimmelbusch (1860-1895) with steam sterilization (1889 ), leading to a significant improvement in the surgical suturing technique - for the first time wound infections could now be prevented.

 

   The containers developed by Schimmelbusch 1889 (inserts of the Schimmelbusch steam sterilizer) for instruments and surgical underwear are still called "mold bush drums" worldwide. From these containers, the containers and container systems used today have developed.

 

   The contributions made by Schimmelbusch under Ernst von Bergmann in Berlin to the development and scientific justification of mechanical sterilization methods make the young Prussians world-famous. Its steam-sterilized containers and "mold bush drums" named after it are used for instruments, dressings and surgical underwear, and the principle of mold bush drums is still valid today, and continues to be the basis for the development of containers and container systems. The introduction of the autoclave for sterilization is considered to be a milestone in aseptic surgery .. For the use of sterilized products, Schimmelbusch gives concrete instructions: "the once so popular rinsing and washing out with sublimate or carbolic solutions should also be avoided as far as possible (surgical wounds) and to be replaced by a swab and swab with sterilized gauze ".

 

The presented round drum (diameter 20 cm, height 11 cm) comes from the outpatient department of the Innsbruck University Hospital, acquired 8/2016 at the "Old Port". A peculiarity of this drum is the fact that the openings coated with gauze can not be closed off, so sterility does not last long. In fact, it is NOT the classical drum n. Schimmelbusch, but a model according to KONRICH, which has a filter both in the bottom and in the lid.

 

The hygienist Friedrich KONRICH was born in Hooksiel (Oldenburg) in 1878, he was admitted to the Military Medical Academy in 1935, and from 1937 he was appointed head of the Institute for Hygiene and Infectious Diseases in Saarbrücken. From 1942 to 1945 he was President of the Reich Water Institute. and air quality in Berlin, field medical officer of the army medical inspection. He participated in "detoxification experiments" in the Neuengamme concentration camp. He died in 1945 in Berlin.

 

He wrote:

Mrs. Konrich, The bacterial germ killing by heat; Disinfection and sterilization by heat. For use in hospitals and bacteriological laboratories, for physicians, pharmacists and health engineers, Ferdinand Enke publishing house, 1938. Review in: Umschau in science and technology issue 44, November 1940.

Ms. Konrich, About the rehabilitation centers of the German POW camp, Health Engineer 64 (29) (1941) p. 399-404.

Mrs. Konrich, introduction to the military hygiene, publishing house F. Enke, Stuttgart 1943.

 

Lit .:

Curt Schimmelbusch: Instructions for aseptic wound treatment. Berlin 1892 (reprint Saarbrücken 2007).

Marion Ruisinger, Prof. Dr., The steam sterilizer, in: Object stories, German Museum of Medical History, object January / February 2015.

Surgery


Sterilizer (1)

 

 

The enforcement of asepsis is closely linked to the name Josef Lister. His principle was to purify the air, the surgeon's hands and the instruments of pathogenic germs before they came into contact with open wounds. LISTER decided to favor the effect of chemical antiseptics on the physical mechanisms (heat, filtration). Who is not familiar with the term carbolic acid, especially in the context of the nickname for nurses derived from it.


The procedure was very successful worldwide, although it was not completely safe for the surgeon and the patient. In Germany, it was the Leipzig surgeon Carl TIERSCH and the Berlin doctor James ISRAEL, who introduced asepsis at the Jewish Hospital in Berlin. It is exciting that the aseptic principle prevailed at a time when one hardly knew the pathogens of the infections to be prevented. Their research was Robert KOCH's task.

 

In his further research Robert KOCH discovered in the seventies of the penultimate century that some now known pathogens could by no means be completely killed by mere wetting with varying percent carbolic acid. Even other more aggressive disinfectants did not produce the desired result. So he turned to the heat disinfection, which was already used in some hospitals at that time. However, he had recognized by his research that it is not enough to destroy only the living forms of bacteria, but especially their reproductive, the viable spores. However, spores were not destroyed by the simple heat disinfection. The use of heat combined with steam followed after KOCH discovered that anthrax spores did not survive two minutes in boiling water, but needed dry heat for an approximate effect but a time of 3 hours at 140 ° C.


Another well-known physician from Berlin earned the application of the theoretical results - Kurt SCHIMMELBUSCH. In the 1892 for the first time published "instructions for the aseptic wound treatment" he entered definitely for the results of research KOCH's and documented already excellent results. Hospitalbrand was almost completely suppressed under consideration of aseptic wound treatment. Technological progress allowed the design of sterilizers. The surgeon was no longer the sufferer of fate, he could even influence the positive course of wound healing. To this date, the basic features of Schimmelbusch's aseptic have not changed much. Added to this was only the use of surgical gowns and gloves and the disinfection of the surgical field by iodine.

 

We present a small table unit by the Parisian company THENOT, collapsible. Firing with gasoline resp. Spirit. Such devices allowed a reasonably reliable kill of the living forms of common bacteria - often in the presence of the patient, in the apartment. Thus, they had, if not a real disinfection effect at least an educational, that is advertising effect on the clientele ...

Surgery


Sterilizer (2)

 

 

With the electrification of our practices in the thirties, the alcohol firing was replaced by electricity.

 

 

We present a small desktop device with 220 volt plug on the side and charming porcelain handles on the lid. Purchased in 2004 on an antique market in Echternach.

 

Nota: Sterilization by boiling alone is now considered a malpractice and is to be used at most for disinfection or emergency sterilization in case of disaster. In modern practice small autoclaves are used today, steam sterilizers in which the sterilized material is subjected to particularly high temperatures (> 121 ° C) as well as a high atmospheric pressure (> 2 atm). Only then can spores and dangerous germs really be killed


Lit.:
Herbert Dräger, Werner Gill, Instrumentenkunde, Materialien und Aufbau, Pflege und Umgang, 1990 Georg Thieme Verlag, Stuttgart.