Instruments: A-Z

At the very start of his popular course on surgery, Cours d’operations de chirurgie, demonstre’es au Jardin Royal … (Paris, 1714), the French surgeon Pierre Dionis (1643-1718), introduces us to ‘Instruments useful in almost all Operations’. As you will see, Dionis, writing with his students in mind, presents a very useful introduction to the basic instruments.

Pierre Dionis, Cours d’operations de chirurgie, demonstre’es au Jardin Royal … (Paris, 1714), p. 18.

A Scissars are the Chirurgeons most common Instruments; the first Pair, lark’d A, which I represent to you, is stronger than the rest, and are those used to cut Bands, Bolsters, Plaisters, and other grosser things, to which Services they are also proportion’d.

B The second Pair, B, are finer, the Blades, or cutting Parts of them, are thinner and longer ; and they are called Incision-Scissars: The Chirurgeon ought to keep one Pair for that Operation only; they have a small Button at the end of the Blade, which is thrust into the Wound, to prevent its pricking, irritating or hurting the Part affected. The steel’d edges of these Scissars ought to be fine and very sharp, that they may cut true and quick, and consequently put the Patient to the less pain.

C The third Pair, C, are called bent or crooked Scissars; and the two Blades are bent in order to fit them for Incisions, where the straight ones cannot be used ; they have also a Button at their external point, which is always that which is thrust into the Wound which is to be dilated. ‘Tis proper to hint, that Chirurgeons ought not to make use of the same Scissars which are used by Women and Taylors, who thrust their Thumb into one of the Rings and their fore-Finger into the other, but they should clap the annular or ring Finger into the second Ring, instead of the fore-Finger, which renders them more dextrous, and gives them more strength, by reason that the fore and middle Fingers rest on the Branches or Handle of the Scissars, which they accordingly guide.

D The Razor, D, is one of the most ancient Chirurgical Instruments. It was formerly made use of in several Operations to make Incision and Cut, but not being firmly fix’d in its handle, and there being other more convenient Instruments, ‘tis now grown out of any other use than that of shaving hairy places.

E Tho’ the Amphismela, or Dissecting Knife, E, serves particularly in Dissections, it may yet be useful in many Operations; as in Amputation, where we are oblig’d to cut the Flesh and Membranes betwixt the two Bones of an Arm or Leg, before Sawing it. This Instrument cuts both sides, and hath a Haft of Ebony or Ivory, which, being thin and flat to its extremity, serves to separate the membranous and fibrous Parts in anatomical Preparations.

F The other Dissecting Knife, F, has a back, and is not sharp on both sides; its blade is curve, and it is very proper to separate Flesh from Bones, in embalming or preparing of Skeletons.

G The Spider, G, is another necessary dissecting Instrument, so call’d because at its end it had two crooked Points like a Spider’s Foot ; but one of them being found useless, ‘its now made with no more than one, which serves for a Servant to hold a Vessel or Ligament to be anatomis’d; and on occasion, in some Operations, as in that of the Bubonocele or Rupture, a flatted or blunt one is used, for fear lest by pricking some of the sensible Parts, it should excit Pain or Convulsions.

H The Lancet, H, is of all Instruments the most necessary to a Chirurgeon, because without it he cannot perform the most common Operation in Chirurgery, I would say Phlebotomy; and using it every hour he is obliged to be provided with several. Some will have them very narrow pointed, others a little broad ; the former assert, that the first sort may be better guided in the Vein, and that by raising them more or less they can made the Orifice ad they please ; and the other affirm, that with a broader Lancet they make the Orifice large enough at first, without being oblig’d to raise their Instrument, by advancing it farther into the Vessel, and that they avoid giving the Patient the pain which is not so much caused by the Punction as that Elevation. Those I make use of are a midling sort betwixt both, and require but a small Elevation, and the pain they give is very light; they are call’d Lancets with a Barley-corn point. Its handle is generally of Tortoise Shell, and ought to be very thin, and separated into two Parts, for the most commodious cleaning of it : Tipping them with Silver is a mistake, which renders them too clumsy for a Chirurgeon to guide them with that nicety which Bleeding requires.

I The other Lancet, I, is much larger than the former, and is design’d for long and deep Dilations, which cannot be made with a bleeding Lancet ; the Point ought not to be too fine, nor the Edge too keen, lest they should be blunted when used in cutting either Flesh or Skin which proves somewhat hard. Formerly these Lancets were sharp at the end, and broad in the belly, resembly an Olive Leaf ; but at present they are made of the same breadth from the Belly to the Haft ; the convenience of which for mis, that we can hold them faster, and they are more steady when we use them. As for their other Qualifications they ought to be very flat and very well polish’d, that in the Vein they may make the smallest Orifice possible, and the easiest to be clos’d.

K The little Instrument, K, is called a Probe. ‘Tis round and even all over, except at one end where it has a small Head, which prevents its pricking the Wound which it searches. There are several lengths and breadths. ‘Tis by the Probe that we discover the course and depth of a Wound; ‘tis the Probe what assures us of the Existence of exotick Bodies, whether the thrust penetrated, or the Bone is discover’d: To conclude, ‘tis the Prodbe which gives us the first light which we want in order to proceed to the Cure of the Wound.

L The other, mark’d L, is call’d the flat Probe, and is of great use in places where the round one cannot enter; discovering to use when there are Clefts or Cracks in the Bones, and the Pericranium is separated, whence ‘tis not less useful than the former.

M The third, M, is a Probe channel’d and hollow’d like a gutter ; having for almost its whole length a Cavity like a Channel to guide points of the Instruments in Incisions ; for which end ‘tis larger and stronger than the other two, and the two Ears at the end enable the Chirurgeon to hold it fast in his left Hand when he uses it. These Probes are commonly made of Iron, but ‘twould be better they were Silver.

N The Incision Knife, N, is an Instrument very much in use, and of which there are several sorts : This here describ’d cuts all on one side ; but on the other, which is call’d its Back, it cuts no farther than the middle ; it may be folded backwards and forwards like an abcesse Lancet, instead of which ‘tis sometimes used: ‘Tis proper for several sorts of Incisions, particularly those to be made in the Head. Every Body knows, in the Use of these Instruments, that by the Fingers of the Right Hand they must be held by the Blades which turn on their Handles, which serve as a Counterpoint to the Hand during its Operation, and as Sheaths to the Blades at other Times.

O The Incision Kinfe, O, is call’d Straight, becuse it does not fold backwards like the other, and the Blade remains rectilineal with the Halt like a knife ; it also cuts on one side only, being flatted on the other : Sometimes a small knob of Wax is fixed on the Point, to prevent its hurting the Patient, when the Operator is oblig’d to thrust it into a Wound: This Instrument is very useful to the Military Chirurgeons who are very Moment obliged to make Incisions in all Parts.

P The other, P, is a curve, crooked or bent Incision Knife, shap’d like a Crescent, its Edge innermost, and Back on the Outside : There are small, middling and very strong Knives of this sort ; the last of these three are called crooked Knives, and are designed for great Operations ; the crooked are never chosen but where the straight will not serve, as when in the Operation of Bubonocele, we are oblig’d to dilate the Rings of the oblique descending Muscle, when we guide the point of the Incision Knife thro’ the Channel of the hollow Probe, when ‘tis needless to put a Button at the End of the Blade.

Q The Spatula, Q, is a necessary Chirurgical Instrument for the spreading of Plaisters, and extending of Unguents or Plegets : It ought to be strong, broader at one End than the other, flat on one Side, and half round on the other: Those Chirurgeons who are somewhat nice, have them always of Silver rather than Iron, which is never so perfectly clean, and which foulds their Hands more than the other.

R The Instrument R is called the Myrtle Leaf, or Myrtle Leaf pointed Knife, from its Resemblance of that Leaf; others have named it the Demy or Half-Spatula, because its Shape is very near that of a Spatula; but yet is pointed, not so straight, and larger. Its Use is to cleanse the Outside of a Wound; ‘tis shaped like an Ear-picker at its Extremeity, which serves to extract exotic Bodies got into the Ears, or small Stones remaining in the Ureter.

S The other Myrtle Leaf, S, much thinner than the precendent, is half-edg’d; it is somewhat bent at the end like a Tooth-pick. Besides its use in common with the first, it also serves in Dissections to separate the Membrances from the Fibres. I have always successfully used it in the Operation of Bubonocele, where I prefer it to cutting Instruments, for fear they should wound the Intestine.

T The Elevator, or Levator, T, is an Instrument which derives its Name from its use : You will see several sorts of it in pursuit of these Operations, but this is crooked at both ends, one of which is square, and the other round, that the former may enter into long and broad Orifices, and the latter into round ones: They are both tooth’d or jagged within side, that they may not slide under the Bone which they are to raise. This Instrument sometimes serves for the Extraction of Bodies, as Balls, or Splinters of Granadoes; but it is chiefly proper to raise up a piece of Bone fallen on the dura mater.

V There are several sorts of Forceps, which derives their Names from the Parts which they resemble, as Ducks-bills, Crows or Cranes’bills, and each of them have their different uses, as we shall shew: But I shall here trouble you with no more than a pair of Forceps, V, which is the commonest of them all, and which Chirurgeons ought to carry with them in a Case where-ever they go: They are better of Silver than Steel, because not so apt to rust. The upper end of this pair is to take out a Splinter or Bone, or pull up Hair: They have a Spring which keeps them continually open, and the inferior Branches being longer than the superior, are very convenient to raise the Plegets above the Sore, or put them on.

X The Needle, X, is very much used by Chirurgeons, and that on so many different Occasions, that they are obliged to be provided with all its serveral Sorts, of which I shall treat more at large in my Demonstrations of Sutures: This here express’d is a straight sharp-pointed Needle, whose two sides do a little increase in breadth, and are sharp to the middle, the rest round, and its Head provided with a large Eye to run the String through. Its use is to sew up a Body in publick Anatomical Preparation or Embalmings.

Y The crooked Needle, Y, is course and strong, for it frequently bends or breaks, especially when used to sew the Skin of a dead Body, which is much harder to pierce than that of a living. Its use is the same with the straight one; besides which ‘tis absolutely necessary in the Gastrorhaphia, or Suture of Wounds of the Belly.

Z The Saw, Z, is an Instrument common to Chirurgeons with other Artists ; but the Chirurgical one being always made by very good Cutlers, had the advantage above all others, on account of its neatness, niceness, and the quick and exact separation which it makes of the Parts to which ‘tis applied. It ought to be small and light, that it may be handled with more freedom, and hath a handle to hold it the firmer : The Blade must be exquisite, and the Teeth very sharp, that they may saw with the greater ease, and in the least Time possible to divide the Bone of an Arm or Leg, when an Amputation is to be made. We cannot dispense with the use of the Saw in Opening of a Scull, the Embalming of a Head, or Demonstrating the Brain.

The small number of Instruments which you have just seen, comprehends properly only those which are called General; besides which there are a great many Particular …

Sources

Pierre Dionis, A Course of Chirurgical Operations, Demonstrated in the Royal Garden at Paris (London, 1733). This is an English translation of Dionis’ Cours d’operations de chirurgie, demonstre’es au Jardin Royal … (Paris, 1707). Worth had the 1714 Parisian edition.

Text: Dr Elizabethanne Boran, Librarian, the Edward Worth Library, Dublin.