Surgery

Leg splint (1)

VOLKMANN leg splint, about 1930

Already the antique knew greaves of metal. In the Middle Ages, the leg was wrapped after repositioning of the bone [with a screw clamp] with strips of linen, were glued to the wood chips in the longitudinal axis of the leg. These chips were then lashed together with knitting to hold the bone fragments.
The sheet metal rail presented here for immobilizing a leg fracture - a somewhat disturbing collection object for a gynecologist - was named after the great surgeon Richard von VOLKMANN (1830-1889). Born in Leipzig, he became a student of John Lister (1827-1912). From 1867 he was professor of surgery in Halle and could venture thanks to the learned antisepsis to the surgery of the joints. He was a great friend of the US surgeon HALLSTEDT, after the mastectomy is named - so there is a connection with gynecology!

His lower limb metal sheet (allegedly) of stainless zinc sheet was used worldwide - during the First World War it was often made from rain gutter sheets in need (cit., Léon Binet, Le guide du médecin aux tranchées ou Petit arsenal chirurgical à l'usage the infirmier, Paris 1916)!

The model presented here belonged to the practical inventory of the 1979 deceased physician Paul HETTO from Diekirch. It consisted of two halves and could be lengthened or shortened by superimposing the two halves to fit the patient's leg.

Nota: The Belgian military doctor Antonius MATTHIJSEN (1805-1878) invented in 1851 the plaster cast, which quickly displaced all other types of permanent bandage. Not everyone found plaster a good solution. In 1890, for example, the British prosthetist George BEACOCK patented a leather bandage which, moistened and breathable by means of many perforations, was tied around the injured limb like a corset. Sure, which Englishman would have liked a treatment with "Plâtre de Paris", the historical archenemy ...

Surgery

MAYOR leg splint (2)

MAYOR-ESMARCH leg splint

"An advancement in the field of flexible splints was the wire mesh introduced in 1836 by the Swiss surgeon Mathias Louis MAYOR (1775-1847) as well as the telegraph wire splint by ESMARCH, which is the archetype of our" empty splint.

"The Cramer rail was developed in the 1980s by the Wiesbadener surgeon CRAMER (died 1903) stated "(Mrs. Härtel, Mrs. Loeffler The Association: Textbook of Surgical and Orthopedic Association Treatment, Berlin 1922 P. 74).

The MAYOR splint presented here, like the previous one, comes from the estate of the physician Paul HETTO, who was established in Diekirch in 1925.

Surgery

Leg splint (3), wooden

Wooden leg splint

When a Tyrolean mountaineer had broken his foot - the Tyroleans say "to Hax åkrissn" - he had to be carried on the hump of a helper or in the basket to the valley. Even today, a foot or a leg must be immobilized if the transport does not degenerate into nightmare and the damage to tapes and vessels should be even greater than they are anyway.

From the fund of the practicing in Mayrhofen / Zillertal doctor Armin ZUMTOBEL comes here presented wooden rail, which was light enough (190 g) to be taken on or in the backpack to the scene of an accident - a real Tyrolean product: economical, in the village, Timber workshop at any time to recreate from local wood.

Surgery

Lenticular

This  instrument is doubtless a lenticular (originally I took it for a tartar remover), comes from an antique shop in Innsbruck.

Here the description of the instrument in the "Dictionnaire des sciences médicales, Paris 1818":
"Lenticulaire: petit couteau fixe, immobile sur son some, et dont la lame, tranchante seulement d'un côté, est garnie à son extrémité d'un petit bouton de forme triangulaire. On se sert de ce couteau pour détruire les inégalités qui se rentrétrent quelquefois aux bords osseux formé par l'application d'une couronne de trépan. Le bouton lenticulaire, dans ce cas, sert à protéger les membranes qui recouvrent le cerveau pendant qu'on fait usage du couteau; It is also part of the faciliter l'usage, en se plaçant entre le cerveau et la boîte osseuse qui le recouvre".

... a rasp used in ancient neurosurgery. Therefore, you will find similar devices under the name "raspartoire" or "râpe". In France they were later called "rugine". The "lenticular", as the English call it, was round-headed, but also, as in the present case, a pentagonal head, the tip of which was turned towards the surgeon, but whose rounded lower edge was pressed against the meninges, an injury the same while the 4 side edges smoothly rasped the bony edges of the trephination site.

The lenticulars were found in trepanning utensils until around 1920, when they gradually disappeared from the company's offer. The "Berlin Waarenhaus" offered around 1910 none more, but the Fa. Esculape, 1910 by P.J. Mountain, Grossstrasse 17.

Surgery

Military helmet

In 1914, the armies went over to the war of position, from the beginning of 1915, they began to prepare for infantry attacks by hours of artillery fire. It was mainly used shrapnel and shrapnel projectiles, which unfolded a devastating effect on humans. Within a short time, the proportion of wounds increased massively. About a quarter of these wounds were head injuries and thus almost always fatal. So it was hurry to protect the heads of the soldiers.

The German helmets M1916 / M1917
1915, was at the XVIII. Army Corps conducted an investigation, which revealed that 83 percent of the head injuries were caused by splinters, which were mostly tiny. Only 17 percent were caused by infantry shells. This raised the question of a special head protection. In November 1915, the new helmet with a metal thickness of 1 mm had been subjected to bombardment attempts on the artillery shooting range Kummersdorf, which ran to the fullest satisfaction. Even shrapnel balls from a distance could not pierce this helmet.
In December first copies of the helmet were tested at the front. It was followed by the arrangement of mass production, end of January 1916 delivered the ironworks Thale / Harz first helmets to the troops. In February 1916, the introduction of a "steel safety helmet", as the official name, by the Chief of the General Staff of the Field Army, General von Falkenhayn, has.

The inventors were three people. Since both technical and anatomical problems were to be solved, the cooperation of several people was required - Friedrich Schwerd (1872-1953), who was a professor at the Technical University of Hannover, in the war captain of the Landwehr;
- Professor August BEER (1861-1949), marine general physician and consultant surgeon of the XVIII. Army Corps; the simple turning of a night pot made of sheet metal should have inspired him to invent the steel helmet. On August 15, 1915, he encouraged the development of the protective helmet.
The helmet was given the typical and probably unique shape by the wife of Professor Schwerd.
During World War II, the paramedics carried white M35 helmets with a red cross in front, sometimes in the back.

The typical American helmet M1

At the beginning of the Second World War efforts were made on the Allied side to design improved steel helmets. The US War Department refused to sign a contract for the production of two million other M1917 helmets and commissioned the development of a new helmet type. A first draft was rejected because of its too close resemblance to the German steel helmet - one feared fatal confusions in the fight. The issue of the finally retained model, the M1 helmet, was ordered on June 9, 1941. The paramedics also wore M1 helmets, with a red cross: three, four or more crosses were sprayed on. Presented is a helmet with 5 fields. The inlay shows that it is in fact an overmilled MP (Military Police) helmet ... Yes, the helmets varied very much from unit to unit. Often the chief surgeon determined about the appearance of the painting. One author has identified 20 different paintings!

Surgery

Needle box (1)

Needle box, about 1900

Needle boxes (square) for sterilizing and storing sewing needles. Sliding lid / hinged lid.                                                    

Surgery

Needle holder (1)

Needle holder of DESCHAMPS, about 1930

Even today, the needle iinvented by the urologist Joseph-François-Louis DESCHAMPS (1740-1824) from Chartres, who worked in Paris is used:  it is available for the stitch to the right, and for the stitch to the left.

Surgery

Needle holder (2)

Needle holder with a pedal, about 1910

Three men have made a special contribution to seam technology:

- Jacques-Louis REVERDIN (1842-1929) from Geneva, who had been trained in Paris - who in 1879 published a paper on a modification of the needle of the tub BRUNNS: the pedicled needle "à chat mobile" was born.

- Auguste REVERDIN (1848-1908), cousin of the former, had been trained in Strasbourg, in 1887 he gave a needle holder "à pédale" with interchangeable needle. His son

- Albert REVERDIN / 1881-1929) improved the instrument even further. Since he worked at the hospital in Lausanne for a while, we tend to see Georges-Louis GAUDIN co-inventing the needle holder.

Jacques-Louis Reverdin (1842-1929) Cette aiguille est modifiée par la suite par son cousin le sur les Auguste Reverdin (1848-1908) et son neveu le Surgeons Albert Reverdin (1881-1929) ".

***

I could not find out anything reliable about GAUDIN.

- Dr. Georges Louis GAUDIN (1821-1875) was from 1866 established as a surgeon in Lausanne.

- Dr. Célestin Philippe GAUDIN (1818-1879) .Maire de Saint-Georges-de-Didonne de 1871-1874. Il est né en 1818 à Marennes et il est mort le 9 avril 1879 à SGD. Il était alors Surgery Major de Marine en retraite et consultant à VICHY. Il était chevalier de la Legion d'Honneur le 16 septembre 1860 et chevalier de l'Ordre Suédois de Wasa de 1869. Il a écrit de nombreux ouvrages de médecine, e.a. "Traité d'hygiène navale". Célestin-Philippe-Baptiste Gaudin, soutint à Montpellier en 1861 une thèse intitulée «De l'heureuse influence du climat de l'île de la Réunion et des eaux thermales de Salazie sur la guérison de la cachexie paludéenne». Il écrivit avec Louis Alexandre Petit, Médecin de la Marine en poste à la Réunion de 1855 à 1861 en tant que directeur de Service de santé, un guide intitulé «Guide to the medical and technical services of Salazie, île de la Réunion. Saint-Denis (Réunion), 1857, Vilal Delval, 1 vol. in-8, avec 6 lithographies ».

Surgery

Oesophagus, dilatator by  SENGSTAKEN-BLAKEMORE

Oesophagus, dilatator, about 1950

Patients with cirrhosis of the liver are interned patients for years, so even in case of emergency, they primarily turn to their internists: they even come to the Internist Outpatient Clinic, even with massive bleeding from esophageal varices (a classic result of liver cirrhosis), and the first measures have to be taken by internists.

The initial supply of esophageal variceal bleeding involves filling the circulation, followed in a hurry
 - An electro-coagulation of the source of bleeding. In case of failure
- Tamonade of bleeding varices by means of balloon catheter. For years the Tampnade with the so-called SENGSTAKEN BLAKEMORE probe has proven itself in the clinic.

 
Robert William SENGSTAKEN, American neurosurgeon (* 1923)
Arthur H. BLAKEMORE, American Surgeon (1897-1970).

 
The Sengstaken-Blakemore Probe is a three-lumen probe that is used in the most massive bleeding of esophageal varices. The lumens are on the one hand for the stomach and the esophageal balloon and others as a gastric tube with lateral openings in the stomach. The length for adults is 100cm, the maximum filling volume of the gastric balloon is 250ml and that of the esophageal balloon 150ml.
- The small round balloon is advanced into the stomach, expanded and then pulled forward until it lies distally to the cardia. Then the oblong esophageal balloon is inflated to compress the bleeding. To prevent pressure necrosis of the esophageal mucosa, however, this probe may only remain for a few hours under maximum pressure (35-45 mmHg), then the blood clotting must be corrected - the probe is carefully unblocked ... Some authors even recommend the oesophageal balloon not to inflate, to prevent rupture of the esophagus. So first fill the gastric balloon and pull it firmly up so that it blocks the venous blood flow from the stomach into the esophagus. Only in case of failure of this compression, the esophageal compression is indicated.

Recently, the probe is also recommended for massive obstetric bleeding:
- M. Kastesmark, R. Brown, KS. Raju, Successful use of a Sengstaken-Blakemore tube to control massive postpartum haemorrhage. British Journal of Obstetrics and Gynecology, March 1994, vol.101.pp259-260.
- D. Frenzel, G.S. Condous, A.T. Papageorghiou, N.A. McWhinney, The use of the 'tamponade test' to stop massive obstetric haemorrhage in placenta accreta, BJOG: An International Journal of Obstetrics & Gynecology, Volume 112 Issue 5 Page 676 - May 2005.

Surgery

Oesophagus, probe 2

Probe from the "Metzer Kiste"

Long flexible metal probe, with a screw-on ivory olive on top, with holes in the esophagus (tumor lining, obstruction due to scarring) boughened.
 

Armand TROUSSEAU (1801-1861) studied in Tours, where he was a pupil of BRETONNEAU. "Agrégé de la Faculté de Médecine de Paris" in 1827, "Médecin des Hôpitaux" in 1830, he was first assistant to RECAMIER (see Speculum) before he got in 1852 the chair of "Clinique Médicale" at the Hôtel-Dieu.
 In 1834 he was able to prove that placebo tablets (cornstarch) had the same therapeutic effect as homeopathic remedies ...
- In 1837 he performed the first tracheostomy.
- In 1843 he performed a first thoracozentesis,
- In 1864 he coined the term "aphasia".
 

 
Two hospitals are named after him:
- CHU TROUSSEAU in his hometown Tours (municipality of Saint Avertin, Indre-et-Loire),

- Hôpital TROUSSEAU in Paris XIIe arrondissement; 26, avenue du Docteur Arnold-Netter.

Surgery

Oesophagus probe (part 1)

about 1900

"Foreign bodies in the esophagus are often the opportunity for surgical intervention, one must try to extract them with suitable instruments," coin catcher ", etc., or push them down into the stomach, only in desperate cases do they proceed to the opening of the esophagus Esophagotomy (Greek: esophagotomy) by opening the esophagus from the outside through the skin and muscles of the neck.This operation is difficult and not dangerous, it is also performed if, after sulfuric acid or alkali poisoning or following cancerous destruction, such narrowing of the esophagus that even fluid food does not even get into the stomach and death threatens by starvation "(Meyers Konversationslexikon, 4th ed. 1892).

Armand TROUSSEAU (1801-1867) was once considered the greatest clinician in France. In Paris he performed the first tracheostomy for Krupp. While suffering from asthma, in 1844 he developed cigarettes whose active ingredients were used to treat the seizures - the method was practiced until 1995.

TROUSSEAU proposed a set of extension olives to cure narrowing of the esophagus. Interesting is next to the ivory olives the coin catcher "crochet à bascule de GRAEFE", a kind of small parachute, with the swallowed coins could be pulled up ...
It lacks the sponge respectively. the 6th "egg".

"Ulflingen, Sept. 28 (Rescued) The 5-year-old son of a station assistant stationed there recently played with a coin.As usual for the children, the little one took the coin in his mouth and suddenly swallowed it in the esophagus, where it was swallowed During this time the child was unable to eat solid food and suffered great pain, until the medical art and skilful treatment of Mr. Delvaux of Luxembourg succeeded in taking out the coin now happy and cheerful again "(Bürger- und Bürgertenzeitung of 1.10.1903).

Illustrations of the coin catcher can be found p. 212/213 in the edited in 1910 (1987 re-published) Catalog of "Medicinisches Waarenhaus Action Society Berlin".

Surgery

Patient transport (1914/18)

Ambulance done by the Nürnberg "Spielzeugfabrik Georg Fischer in the 1930th years