Chirurgie


A book (1) to start: Johannes SCULTETUS

 

 

Johannes SCULTETUS aka Schultes resp. Schultheiss (born 12.10.1595 in Ulm, died 1.12.1645 in Stuttgart). The father, a poor skipper, died when the boy was 5 years old. In an inn, the orphan's surgical talent was discovered by Adriaan van der SPIEGHEL (1578-1625), who immediately took him to Padua.


In Padua SCULTETUS was a pupil of SPIEGHEL and Fabricio d'AQUAPENDENTE. Prosector from 1616-1623, doctorate 1623. Practice in Padua and Venice, 1625 return to Ulm, where from 1623 he was in negotiations with the city council to get the position of a "city surgeon" awarded. From 1625-45 Stadtphysikus there. He died of a stroke that surprised him near Stuttgart - on the way to a (noble) patient ...

He left a single manuscript (in Latin) that was edited 15 times in Latin, and translated several times into living languages ​​(English, Dutch, German and French) - in total more than 18 editions:
1653 Latin (folio) First edition of his "Armamentarium chirurgicum"; posthumously with Balthasar Kühnen in Ulm (only 65 pages, 43 plates) published at the instigation of his nephew.
1655 Latin edition in Leiden.
1656 Latin (octavo) edition; with Adrian Vlacq in The Hague (44 plates). Since this issue a title page with surgical scene.
1662 Latin edition; with Adrian Vlacq in The Hague (328 pages).
1666 German first edition, translated by Amadeus MEGERLIN, city doctor in Haydenheim; at (Daniel) Johann Gerlin's widow in Frankfurt a.M. (263 pages, 56 plates).
1671 Latin edition; with John v. Someren in Amsterdam.
1679 German edition "Wund-Arzneyliches Zeughaus".
1692/93 with 288 pages and 86 plates lat. at Boutestyn in Leiden.
1741 Dutch edition; at J.C. de Sprögel in Amsterdam.
1741 Dutch edition "Het vermeerderde wapenhuis of the heel-meesters" (in 't Neerduitsch vert. Door Gerardus DICTEN) in Amsterdam with Jansoons van Waesberge.


The French editions all appeared in Lyon:
1672 Antoine Galien (48 plates, two of them with monster child)
1674 with Antoine Cellier (385 pages, 48 ​​plates, two of them with monster child)
1675
1712 at Léonard de la Roche (49 tablets - copy of the lux doctor COLLART in the Luxembourg National Library.).

Surgery


Amputation case

Stodart
Stodart
Stodart
Stodart
Amputationskasten von Stodart, frühes 19. Jahrhundert 

 

Antique battles were decided by means of deck, hiest, stitch and cuts in cuddles. At the latest since the introduction of the push-pile of fires in the 14th century, the desert of rubble and disorder injuries was the sad picture on the battlefields - was the settlement of limbs to the most important interventions in the war surgery. As a top table, a door fed up from the fishing. Two wizards were needed to fix the patient - the anesthesia was invented only in 1847. Operational was often "mother nature" because it was bright and ventilated before ... He beside the table burned a fire in which the chew glowed! Box (mahogany wood) with red fabric (rare blue). Brass fittings. Manufacturer: Fa. Stodart, a family business for the production of razor blades and surgical instruments, which was founded by J Stodart (1760-1823) in 1787 and will be demanded in 1839, with its son David Stodart (1779-1840) (Cit. Bennion). Fitness of the company 401 The beach in London. Interestingly, the cooperation of Michael Faraday (1791-1867) is in the time of 1818 to 1822 with James Stod (D) type in improving steel quality. By mixing silver, they produced a breakduler steel.

 

Lit.: James Stodart and Michael Faraday, on the Alloys of Steel, Philosophical Transactions, 112 (1822). After Paul and John-Henry Savigny he was the leading manufacturer of instruments in the UK.

 

***

 

The surgeon comes to the knife mercy and puts its box together, after its taste, his preferences. One discusses the arrangement of the instruments in the future box, a contract is signed, the surgeon comes back after 4 weeks, pays and makes on the journey ... so it is that no two boxes are really identical.

 

***

 

In our box, a combination of amputation and trepanization box, we find the classic content - unlike the "big boxes", which were rather on board of wars, we find no tools for the tooth and ophthaltic care:

1. Ball pitch "Bullet Extractor" to grab foreign bodies in the depth of the "wound), which was spoken. Could the found (noisy mini-globe was not found in 1840) was not ampuated. The ball was considered as high-incorporated foreign body, which would inevitably lead to deadly infection. The balls were used to rubbed with narrow or bee-wax, in the mistake of faith, that this would be the target accuracy. This resulted in a contamination of the wound through the gamble track. Only the amputation gained the real cleaning of the wound. Also bone splinters and clothes watches had to be pulled out of the wound, since weaken unwound are not sufficient enough to clean a wound (https://www.youtube.com/watch?v=9mxeyxca6sq).

2. Tourniquet (supplement) - in principle introduced in 1674. A targeted finger pressure on the main vessels made the same service and probably led to less nerve damage ...

3. Knife with one-sided cutting "LISTON KNIFE", especially in the "circular" method (applied). The first knives were half-mid-fear, after Loston and Syme preferred to knife by 1825, they became increasingly.

4. Knife with double-sided cutting edge ("CATLIN") were used in the space between two bones and in the "Flap" method. (Supplement). Average length of these knives 6-8 inches.

5. Large saw, "Capital saw"

6. Small saw "Metakarpal saw"

7. Tenaculum, a hook, with which the large vessels were preferred for ligature, also used as wound hooks.

8. Timer Roll.

9. Rongeur to defuse the bone edges (complement)

10. Scalpel

11. Trephine (2), Handle Separated

12. Lever with wood handle (bone liver?)

13. Brush "Bone-Brush", for removing bone dust.

14. Long metal catheter

15. tweezers (2): a width, a top.

16. Troicars (2)

 

Not to be used for draining abscesses was a bone saw for William Hey (1736-1819). Also provided not were clamps - which of Péan was only in 1862, which invented by Koker, the first end of the 19th century.

There are no combustion tracks on the instruments: Our surgeon used his iron cold. Others preferred to bring their knives and saws to the red gut, not to sterilize them (this term did not exist then at the time), but to reach a quick blood hold of small banners.

Surgery


Amputation knife (1), straight

 

In ancient Greece, it was amputated only in gangrene. Later, at CELSUS, we find the amputation "healthy".



Robert LISTON (1794-1847), a surgeon from Ecclesmachan, Scotland, worked at the Royal Infirmary, where he also performed sections. In 1818 he became a lecturer in anatomy and surgery at the Edinburgh School of Medicine, 1827 surgeon at the Royal Infirmary and in 1835 (until his death in 1847) Professor of Clinical Surgery at University College in London.

 


LISTON was famous for his speed of operation. He removed the accidentally smashed-up and eventually - not surprisingly in the clinics at that time - wounded leg of a butler called Frederick Churchill in a record-breaking time of 25 seconds - the unflattering star surgeon usually had an assistant at his side, who measured the time. 25 seconds at that time represented a normal operation time; it was reported about Dominique-Jean LARREY (1766-1842), the personal physician of Napoleon, that he could make over 200 amputations in one day. Today, a lower leg amputation from the skin incision to the end of the suture usually takes between 25-60 minutes (depending on the surgeon's practice). "Fastest Knife in the West End" - 2 ½ minutes from the first cut to the last suture for the amputation of a leg. A speed that took its toll:


He took it for an abscess and cut in - it was an aneurysm and the patient bleed to death.
He was supposed to amputate only the leg and castrated so casually the man.

 

He managed to kill three people in a single operation:
the patient who died of sepsis two weeks after the procedure,
- his assistant, to whom he cut several fingers - as a result of the injury, the assistant died of sepsis,
- a helper, whom he accidentally cut with the amputation knife in the body - this died in terror, it is said.


Fast, yes. But also with the introduction of anesthesia his name is connected: on December 21, 1846 he applied in London in the operating room for the first time the ether anesthesia. The real progress was not in the development of the xth knife, but in the improvement of the operating conditions, the introduction of sterility! This development, however, took place only a generation after LISTON ...


Around 1861-65, 50% of the amputations performed by the surgeon Joseph Lister (1827-1912) ended in death. When PASTEUR proved in 1865 that bacteria were the cause of these catastrophic results, LISTER immediately became one of the most enthusiastic advocates of antisepsis ... In 1867, he was proud to report that in the past 9 months nobody in his clinic had died of sepsis.



Two LISTON amputation knives are presented with a cutting blade that continues on the back of the knife.
Stamp: "Hilliard", a manufacturer from Edinburgh, Nicolsonstreet 7 - the home of LISTON. Harvey Hilliard (who had previously worked in Glasgow) remained at this address from 1850 to 1885, before the operation was relocated by his sons and the engraving changed. Ebony handle with grid pattern (called "some guilloché" in French).
Origin of Knives: Northallerton, North Yorkshire, United Kingdom.

Messer
Gravur

Surgery


Amputation knife (2), curved

Messer 1
 

 

This curved amputation knife dates back to times when there was no general anesthetic worthy of the name and speed was trumps.



The amputation was performed with as few cuts as possible without discarding the knife:
- with the "coup de main" the skin was
- in a second rotation, the muscles, tendons and vessels (arteries, nerves) were severed: the so-called "tour de force"

 


This technique required a top knife, with an optimally cut blade. As the blade rattled regularly over the bone during the "tour de force", it became dull with every amputation. It is said that 20 minutes have passed to restore the blade: the knives were considered the sharpest in the world ...

Since there was no time for such a grind on the battlefield, the surgeons sometimes carried around 6 to 10 knives with them. The curved knives come from the times of Ambroise PARE and SCULTETUS. Then, in the 19th century, straight knives were gradually pulled out, making it easier to make the V-shaped cut and forming meat flaps that made a nicer stump.

 


About the knife:
Brass ferrule (brass fret), ebony handle. Length of the blade tapped over the bend 20 cm, length of the handle 11 cm.

 

About the manufacturer
One knows of this monier in Pouvourville a series of knives - and nothing else. When asked by local historians to get the information, there have never been any manufacturer of knives or scissors in this village, probably a family Monier. So the engraving "Monier Pouvourville" could refer not to a manufacturer, but a user (surgeon?). The following HG probably means Haute Garonne: Pouvourville is located in this department, not far from Toulouse.

Surgery


Amputation saw (1)

Signierte Säge, um 1770 

 

Wounded and ill soldiers died a miserable death: at the beginning of the 18th century, cripples were often hanged by their own people so that they would not fall into the hands of the enemy. But the nightmare of every soldier was amputation on the battlefield.

 


Handling
With this instrument it went "to the point": with him, after the dissection of the diseased limb "in healthy" by amputation knife ("tour de bras", then "tour de force"), the bone sawn through. The freshly cut soft tissue had to be pushed several cm to the proximal side to expose the bone. For this purpose, special muscle hooks or semicircular metal discs were used with a notch in the base into which the bone to be sawn was fitted (see PERCY).
The size of the saw was proportional to the limb to be amputated: specimens for the finger surgery were daintily small, for the amputation of a thigh instruments were available with lengths up to 60 cm!
Of course, the instrument is not missing in the specialist literature of the time, in the "Armamentarium chirurgiae" or "L'Arsenal de Chirurgie" by Johannes SCULTETUS (1599-1645), in the "Opera chirurgico-anatomicae" by Paul BARBETTE (1672), etc. One Illustrated surgical instructions in several stages can be found in the "Institutiones chirurgicae" by Lorentz HEISTER (1683-1758). But the first pictorial representation of such a saw can be found on an oil painting from 1517. Again and again, the eerie elegance of the instrument inspired the artists to depict it on "still life": Jan Brueghel the Elder. formed a saw with a turned handle on the oil painting "The Feeling" - a monkey plays next to it (Prado / Madrid).



The "capital saw" (engl.) Experienced a considerable development over the centuries: according to the zeitgeist, the instruments were richly decorated in the Renaissance, a fashion that disappeared during the Enlightenment, emerged as instruments whose design only from the pure necessity was dictated.
"Saw handles were large, and circular in cross-section until about 1770, when a hexagonal shape was invented to improve grip" - "Iron-framed eighteenth-century saws often have highly decorative features and an elaborate tensioning screw".
The small pages are "bent", the Frenchman speaks of "petits côtés incurvés en accolade". Also typical of the 18th century are the different lengths of "petits côtés".
Typical of an instrument from the 18th century: the octagonal, slightly curved handle made of unyielding thuja wood. The Occidental "Tree of Life" came to Europe in 1596, the Oriental "Tree of Life" in 1752.

 

About the manufacturer
Iron surgeon saw, "poinçon trèfle couronné" [Langres 18th century], handle walnut wood. Langres is one of the oldest cities in Gaul. In the 15th century there were numerous knife manufacturers, 1418 of them lived in the r. Vernelle and the r. de la Coutellerie. Reason for the increased emergence of this industry was probably the proximity of iron warehouses and a particularly hard and fine sandstone. In a list of "maîtres coutelliers de Langres" from 1768 we find "our" manufacturer: Vinnebault VIEILLIOT, whose mark was the crowned cloverleaf, "trèfle couronné" (Camille Pagé, La Coutellerie Depuis L'Origine Jusqu'À Nos Jours : La Fabrication Ancienne & Moderne, Edition H. Riviere, Paris 1896. Les Couteliers de Province, p.82). He was settled in Langres in the rue Sainte-Barbe (Bulletin de la Société historique et archéologique de Langres, Vol.5, 1907 p.380.) Nota: in Langres came in 1713 as the son of a knife manufacturer (!) Denis DIDEROT to the world, the later co-editors of the famous encyclopedia ...

link
www.gesch.med.uni-erlangen.de/messer/ausstell/amput/t_amp18.htm

 


The saw shown here was purchased in Paris at the Théorème Gallery, "Antiquités du Louvre", 2 Place du Palais (Clignancourt branch). She comes from a doctor's office in Toulouse and was bought the same day Lady Di died. In the trade, such old saws seldom appear, but younger ones are relatively common on "the collector can find themselves from the last two hundred years without difficulty" (D.J. Warren) - so the collector is reasonably protected against counterfeiting. Rarely do you find the right brushes to remove bone meal between the teeth of the saw ...

Surgery


Amputation saw (2) by CHARRIERE

um 1850 

 

 

In the treatment of fractures, adventurous practices have been tried, and complicated splinter or multiple fractures and fracture injuries to or in joints have usually been treated simply by generous amputations.



Dominique-Jean LARREY (1766-1842) was embroiled in a barrage of amputation around 1809/12 - he operated countless Frenchmen on the battlefields of his master Napoleon, bringing it to 100 amputations a day, each lasting no more than 2 to 3 minutes: 300 amputations in Wagram, 200 on the eastern front in Borodino ...



The amputation was in the 18th century with great risks for all concerned:
- For the patient who had to undergo a very painful procedure
- for the surgeon, for whom the amputation could have a fatal aftermath: the patient died, he was blamed; when he recovered, he was accused of having miserably maimed the patient. Heister therefore advised every surgeon to consult more and more colleagues and to attend the surgery.

 

Nothing changed in the 19th century in terms of these fundamental risks. Anesthesia became known only in the second half of the century, and antibiotics were not available until recently. Neither had the prosthetics improved significantly, nor was there something significantly new for the disabled patient. Only the 20th century will invent the invalidity pension!

 

If the patient did not die of blood loss during or immediately after the amputation, death often threatened him with severe infection of the wound. Not a few examples bear witness to unprecedented torments. For example, after such severe amputation infections, they attempted to treat them with further partial amputations. That may have started with the amputation of one foot and ended, after another six partial amputations, with the last high on the hip, after which the patient so maltreated finally died miserably at the infection of the last operation.



There were technical advances, but also signs of stubbornness: in the 19th century, despite warnings from hygienists, the handles of the instruments were still made of wood. A 38 cm long, 9.5 cm high saw with wooden handle and replaceable blade, from the workshop of the famous Parisian instrument maker CHARRIERE, will be presented. This type of saw, both as regards the blade and the GriffForm, continued to be used unchanged after 1900. Only the material changed by the handle, was worked in a cast with the leaf frame, made of steel.

Surgery


Amputation saw (3) by COLLIN

COLLIN saw, about 1900 

 

 

We are happy to talk about famous amputations, such as that of the Fimdiva Zsa Zsa Gabors, or the one of the Austrian ski racer Matthias Lanzinger, who had his right lower leg dropped off and forgot the "not performed" interventions. We gladly forget that the great impresario, dancer and musician of King Louis XIV, Jean-Baptiste LULLY (1632-1687), refused when his doctor, dr. Jean-Baptiste ALLIOT (1640-1721), son of the court physician Pierre ALLIOT (1610-1685), advised to have the right small toe amputated, which he had pierced with his baton. LULLY preferred to die with his toe ...



Until the 19th century, epidemics such as leprosy and tuberculosis, as well as war injuries, frostbites, animal bites and gangrene led to amputation. In the course of the last century, the improvement in living conditions caused a shift in causes. Infectious diseases, work and everyday accidents were replaced by diabetes as the main cause of amputation.
In the era of sterility metal instruments became common.



In order to store the device better and to be able to change the knives faster, the handle could be opened on some models (WINDLER, COLLIN, FARABEUF, MATHIEU). For this purpose, the handle was opened by means of a Arrêtierung, the knife was then stretched out with a single handle.
Slightly angled model of the manufacturer COLLIN (at the FARABEUF the saw blade is parallel) was purchased in Metz on 16.4.2005, no manufacturer's information.

Surgery


Anatomical tweezer

Kornzange
 

 

 

Small tweezers, on the inside an industry number 23. 

 

Such tweezers are represented in all catalogs and are offered in very different lengths, ranging from 11 to 33 cm. Our tweezer measures 14.5 cm.

Surgery


Anatomy model (1), by AUZOUX

 

 

In the 19th century, an industry developed for the growing medical teaching supplies. Anatomical wax models were sensitive; therefore the anatomists experimented with other materials.

The French surgeon Jean François AMELINE (1763-1835), professor of anatomy in his native city of Caen from 1808 onwards, was the first to produce articulated models of paper clay. His compatriot Louis Thomas Jérôme AUZOUX (1797-1880), who began his medical studies in 1818, was deterred by the formalin corpses presented to him for dissection. He therefore devoted himself to the development of an odorless technique of modeling, and invented the so-called "anatomy clastique" [from the Greek clastos, broken, disassembled - since his models could be disassembled into individual parts]. Inspired by dolls made of papier mâché (Italian carta pesta), which were then offered for sale in the streets of Paris, he developed a modeling compound that was initially soft and malleable, but then solidified to a resistant mass. Initially, he used plaster molds commonly found in housewares, but later developed more resistant forms of lead. He poured the pieces in pieces before joining them with wire threads into larger, hollow, ensembles, which were then smoothed and coated with cover paper and were supplemented with fine neural networks of silk [and license plates]. The solidified paste could be stained, allowing the modeling of the soft tissues with amazing naturalness. Already in 1822, he presented a model to the Académie de médecine in Paris, consisting of original bones, which were held together with a paste developed by him. An encouragement of the academy in 1824 and a public contract of the Ministry of the Interior then determined his further career, by devoting himself entirely to modeling from now on. In 1825 he presented a model of 139 parts. The success made him a factory for teaching models of humans and animals: in 1827 he founded in his birthplace Saint- Aubin-d'Ecrosville a factory with 50 workers who made models on the assembly line, popularly called "bonhommes d'Auzoux". The workers were highly paid, the most gifted were moved several times by AUZOUX to study medicine ... After 5 years of preliminary work, the company presented in 1830 a life-size model "Le Grand Ecorché", consisting of 129 (130) parts, which was noted on the 1500 details - priceless! From 1845 onwards, therefore, a cheaper 2: 1 whole body model was produced, along with models of the eye, the inner ear, the brain. His clients included universities, royal houses - even the Vatican ordered a full-body model for his collections.



Compared to anatomical wax models, papier-mâché artifacts are easier to manufacture, cheaper and more robust. In addition, individual sections of the models can be moved, which replaces the opening of real bodies and thus facilitates the teaching of anatomy. AUZOUX died high in Paris, a bust and a 1995 opened "Musée de l'Ecorché d'Anatomie" in Le Neubourg in Normandy are reminiscent of his work. Numerous international collections contain models from his hand. For more than 150 years, the AUZOUX factory supplied thousands of schools at home and abroad with human, animal and botanical figures.



The model presented here comes from the Pfaffenthal'er midwifery school and found itself one day in the dumpster of a municipal clinic. It is signed and dated on the top of the right diaphragm dome "Anatomie clastique du dr. Auzoux, 1887 ".

https://www.seton.at/D95586000/Lageretiketten-aus-Papier-nummeriert.html

Surgery


Anatomy model (2), hight 28 cm

Kunststoff 28 cm
 

 

Man darf sich die Frage stellen, was Kinder an Hand solcher Modelle lernen sollen. Möglicherweise ist der einzige Nutzen das Ablegen der Scheu vor dem "innenleben" unseres Körpers, das Ablegen eines natürlichen (?) Ekelgefühls.

 

Anatomisches Modell, 28 cm hoch, aus Kunststoff. Erworben 9/2016 in Innsbruck "am alten Hafen".

 

Surgery


Anatomy model (3), 24 cm

Kunststoff 24 cm CLEMENTONI

 

24 cm high torso, no manufacturer specified. Probably part of the toy box "Galileo" of the company CLEMENTONI. What should a child do with such a figure? Neither the function, nor the real situation in the body is clear to him - at best, the dexterity is trained during assembly: but for that pupose other construction kits are certainly better suitable and more varied ...

 

 

Surgery


Anatomy, model (4) picture

frz. "planches anatomiques à découpis mobiles en superposition 

 

The two-dimensional representation of the human anatomy remained unsatisfactory. This circumstance tried to remedy the "layered folding pictures" of the 16th century.


From simple "before-after" images of the early sixteenth century, in which the transience of human endeavor was portrayed in a blatantly vivid manner, resourceful publishers developed the genre of the anatomical layered image. In pseudo-three-dimensional fashion, they reproduced the different stages of the situs in different, small printed sheets, as they presented one after the other for the preparing anatomist, and could be unfolded in the manner of a "thumb cinema". Presumably, the publishers reacted to the development of anatomy at universities, which had begun to make autopsies on humans.


The anatomical folding pictures were extremely successful. Since they were printed on loose paper, they felt like many early skeletal figures or Aderlasstafeln: they were worn and ended up sooner or later in the wastebasket. Accordingly, the number of surviving copies is very low. The situation improved when the folding method was added to books. Folding pictures, movable Pictures in books probably first appeared in anatomical works. Thus, the method was adopted in the anatomical textbook "Ophthalmologia, Das ist Augenendienst" by Georg Bartisch (Dresden 1583): from the apex perspective, the reader was able to contrast the stacked woodcuts from the scalp, skull and layers of the brain to the eyeballs.


The folding pictures were not accessible to a broad public until the Belle Époque, with the folk - healing books by Friedrich Eduard Bilz (1842-1922) "The New Natural Remedies" of 1888 and "The New Healing Method" by his pupil Moritz Platen, the teacher and director of the Bilz's hospital in Dresden-Radebeul was as well as director of the Naturheilanstalt Bad Ottenstein to Schwarzenberg in Saxony. The first two-volume edition was a single folding figure of the human body attached, late editions of the now four-volume work contained 10 models, including 1 model of the male body in 8 partially folded and hinged panels, 1 model of the female body also in 8 partially folded and foldable panels, (this also with representation of the pregnancy), as well as 8 hinged colored anatomical models of nose, ear, oral cavity and larynx, heart, eye, stomach, lung and head in color pressure (Chromolithographie).


Already the first publication of Bilz "The human happiness" of 1882 contained a naturopathic attachment. Later, Bilz published only natural history books. The books of Bilz with their fold-out panels achieved dreamlike editions - until 1938, about 3.5 million copies were sold. Last (stripped down) edition 1956!.


The four-volume showpiece of 1910 reached a volume of more than 4,000 pages and was richly illustrated with 1,400 text images, 58 color plates and 16 demountable models.


The work has been translated into 12 languages ​​- the flip picture shown here was imported from the USA, so it should be taken from an American Bilz edition. You can see the three main layers folded into a triangle. Each of these layers has more or less lush further folding options. The most detailed is the intestinal tract, where the figure readily shows us her pregnant uterus ... a bloodless autopsy for home use!
Similar tomograms can be found in a popular health book published by a doctor: med Anna Fischer-Dückelmann, The wife as a family doctor, a book that appeared from 1901 to 1979 in countless issues (and pirated prints).