Mr. Higginson’s Transfusion Instrument
Although some of the early experiments on blood transfusion had been done in England, and although its revival in the nineteenth century was initiated in England, yet it is to be noticed that most of the references to it up to 1874 are to be found in the works of Continental writers. Nevertheless, an important modification was introduced into the technique of the operation in 1857 by Higginson, who applied the principle of a rubber syringe with ball-valves for transferring the blood from the receptacle into which it was drawn, to the vein of the recipient. This apparatus is illustrated here, as it is of some interest in the history of medicine.
A is a metallic cup, of 6-oz. capacity, to receive the supply of blood. B an outer casing, which will hold 5 oz. of hot water, introduced through an aperture at C. D is a passage leading into an elastic barrel, composed of vulcanized india-rubber, E, of which the capacity is 1 oz. F′ the exit for the blood into the injection-pipe G. At D and F there are ball-valves, capable of closing the upper openings when thrown up against them, but leaving the lower openings always free. The blood, or other fluid, poured into the cup A, has free power to run unobstructed through D, E, F; a small plug H is therefore provided to close the lower aperture F when necessary. The tube G is of vulcanized india-rubber, and terminates in a metal tube O for insertion into the vein.
Whole Blood Transfusion with Kimpton’s Tube.
The principle of this method depends upon the use of paraffin wax as a coating for the vessel into which the blood is drawn, so that clotting is prevented or greatly delayed. The form of the vessel has been modified by different workers, but the essentials are the same in each. One form of the apparatus, known as the Kimpton-Brown tube, is illustrated in the accompanying diagram. It consists of a graduated glass cylinder, of about 700 cc. capacity, the lower end of which is drawn out into a cannula point at an acute angle with the body of the cylinder; the point is of a size convenient for introducing into a vein and its bore large enough to allow of a free flow of blood through it. Near the upper end is a side tube to which a rubber tube can be attached, and an opening at the top is closed by a rubber bung. An ordinary rubber double-bulb bellows is the only other apparatus that is needed.
When the donor’s arm has been congested by gripping it above the elbow, or better by the application of a tourniquet drawn to the requisite degree of tightness, a suitable vein, usually the median basilic, is chosen. The area of puncture is washed with ether and a very small quantity, 2 to 3 minims, of 2 per cent. novocain is introduced over the vein with a hypodermic syringe. If a larger quantity is used, the vein may become obscured, but this small amount may be dispersed by a few moments’ pressure with the finger, and is usually enough to anæsthetize the very small area of skin that is to be operated upon. A tiny cut in the skin is then made with the point of a scalpel, and the needle is pushed through into the vein.
A more general interest in the subject was revived in England by the work of James Blundell, lecturer on physiology and midwifery at St. Thomas’s and Guy’s Hospitals. He published in 1818 his earliest paper on experimental transfusion with a special form of syringe invented by himself. His first apparatus consisted of a funnel-shaped receptacle for the blood, connected by a two-way tap with a syringe from which the blood was injected through a tube and cannula into the recipient. His experiments were performed upon dogs, and he began by drawing blood from the femoral artery and re-injecting it into the same animal through the femoral vein. He then conducted a long series of investigations into the properties of blood, the effects of its withdrawal, and the resuscitation of an exsanguinated animal. Soon he had opportunities of transfusing patients with human blood, and the results are recorded in his paper of 1824. His apparatus had by then been elaborated, and an engraving of his Impellor, as he termed it, is reproduced here. It consisted as before of a funnel-shaped receptacle for the blood, but the syringe was now incorporated in one side of the funnel, and contained a complicated system of spring valves, which caused the blood to travel along the delivery tube when the piston was pushed down. The Impellor was fixed to the back of a chair in order to give it stability.
TOOTHACHE is an universal plague. Every country has a special " nostrum " for its cure. China knows the plague, and China has a nostrum, which may well challenge all others for originality and efficacy. The quacks who in this case advance their specific are all women. I speak of them and their doings as I have seen and known them in the province of Chekeang. Whether they are found elsewhere in China I know not. The remedy they employ has never yet, to my knowledge, been published to the world ; and we must not feel sur-prised if, after this paper has once got abroad, a shipload of these charlatans should be sent for, and make their appearance " one fine morning," in the Thames.
These female quacks maintain that the usual cause of toothache is a little worm or maggot, which has its nest in the gum under the root, and if this little offender can be driven or coaxed out, the gnawing pain will immediately cease. But how he is to be driven or coaxed out is the secret of their trade, the knowledge of which they confine most rigidly to those of their own profession. We had not been resident many years in the country before we heard talk of these women and their wonderful performances, and as my friend and I took our customary walks together, our con-versation not unfrequently turned their way. My friend stoutly maintained that it was all impos-ture ; it was impossible, he said, that maggots in the gums or teeth should have escaped the obser-vation of our dentists, who had examined hundreds of thousands, not merely of teeth, but of mouths for so many years.
Reducing Dislocated Shoulder
Reducing Dislocated Jaw
The basic principle of life, in the Galenic physiology, is a spirit, anima or pneuma, drawn from the general world-soul in the act of respiration. It enters the body through the rough artery (τραχεῖα ἀρτηρία, arteria aspera of mediaeval notation), the organ known to our nomenclature as the trachea. From this trachea the pneuma passes to the lung and then, through the vein-like artery (ἀρτηρία φλεβώδης, arteria venalis of mediaeval writers, the pulmonary vein of our nomenclature), to the left ventricle. Here it will be best to leave it for a moment and trace the vascular system along a different route.
A kylix from the Berlin Museum of about 490 b. c. It bears the inscription ΣΟΣΙΑΣ ΕΠΟΙΗΣΕΝ, Sosias made (me), and represents Achilles bandaging Patroclus, the names of the two heroes being written round the margin. The painter is Euphronios, and the work is regarded as the masterpiece of that great artist. The left upper arm of Patroclus is injured, and Achilles is bandaging it with a two-rolled bandage, which he is trying to bring down to extend over the elbow. The treatment of the hands, a department in which Euphronios excelled, is particularly fine. Achilles was not a trained surgeon, and it will be observed, from the position of the two tails of the bandage, that he will have some difficulty when it comes to its final fastening!
A Greek Clinic of 400 BC
In the centre sits a physician holding a lancet and bleeding a patient from the median vein at the bend of the right elbow into a large open basin. Above and behind the physician are suspended three cupping vessels. To the right sits another patient awaiting his turn; his left arm is bandaged in the region of the biceps. The figure beyond him smells a flower, perhaps as a preservative against infection. Behind the physician stands a man leaning on a staff; he is wounded in the left leg, which is bandaged. By his side stands a dwarfish figure with disproportionately large head, whose body exhibits deformities typical of the developmental disease now known as Achondroplasia; in addition to these deformities we note that his body is hairy and the bridge of his nose sunken; on his back he carries a hare which is almost as tall as himself. Talking to the dwarf is a man leaning on a long staff, who has the remains of a bandage round his chest.
A U-tube contains mercury, on which floats a rod supporting a scratching point, which makes a “tracing” on blackened paper wrapped round a revolving drum. Between the manometer and the cannula which is introduced into the central end of a cut artery is a three-way cock, which leads to a pressure-bottle containing a half saturated solution of sodic sulphate. This solution prevents blood from clotting. Before it is connected with the artery the apparatus is filled from the pressure-bottle. The cock is then turned into the second position, and the bottle raised until the mercury in the manometer stands at a level somewhat higher than that which it may be expected to attain under the influence of blood-pressure. The cannula being then inserted into an artery, the cock is turned into the third position, which places the manometer in connection with the blood, and excludes the pressure-bottle. As the mercury is a little higher than blood-pressure, some of the sodic sulphate solution enters the artery, but no blood enters the cannula. The scratching point, rising and falling with every variation in blood-pressure, makes a record on the soot-blackened paper, which is subsequently removed from the drum, and varnished.
A, An ivory button which is pressed on the skin over the radial artery by a metal spring.
B, A continuous screw which works against the cogwheel
C. By rotating B, the lever
D is raised to a position in which its point scratches the travelling-plate
E (covered with blackened paper).
F, A box containing clockwork which moves E.
G, A screw by means of which the pressure of the spring is adjusted to the force of the pulse.
Thirteenth-Century Hospital Interior (Tonerre)
From “The Thirteenth: Greatest of Centuries,” by J. J. Walsh
This was built by the sister of Louis IX of France, Marguerite of Bourgogne, who retired to it herself to spend her life caring for the ailing poor.
Surgical instruments of the Arabs, according to Abulcasim
After plates in Gurlt’s “Geschichte der Chirurgie”
1. A pincher for extracting foreign bodies from the ear
2. An ear syringe for injections
3. A tongue depressor
4. Concave scissors for the removal of tonsils
5. Curved pinchers for foreign bodies in the throat
6 to 29. Instruments for the treatment of the teeth
19 and 20. Forceps
21 to 25. Levers and hooks for the removal of roots
26. Strong pinchers for the same
27. A tooth saw 28 and 29. Files for the teeth
Surgical instruments of Guy de Chauliac, nos. 1, 2, 3, and 4 (fourteenth century);
and surgical apparatus of Hans von Gerssdorff, nos. 5, 6 and 7 (fifteenth century)
After plates in Gurlt’s “Geschichte der Chirurgie”
2. Balista used for extraction of arrows
3. Cauterizing shears with cannula for cauterization of the uvula
5. Extension arrangement for reducing upper arm dislocations, called “The Fool”
6. Screwpiece for extending a knee contracture
7. Extension apparatus in the form of armour-arm and armour-leg plates
(“harness instruments”) for contractures of the elbow and knee joints
From Gurlt’s “Geschichte der Chirurgie”
Hans von Gerssdorff and Hieronymus Brunschwig, who flourished in the latter half of the fifteenth century in Germany, have both left early printed treatises on Surgery which give excellent woodcuts showing pictures of instruments, operations, and costumes, at the end of the medieval period.
This is the first picture of an amputation known
From Gerssdorff’s woodcut, reproduced in Gurlt’s “Geschichte der Chirurgie”
Wet cupping for a headache. (From Frederik Dekkers, Exercitationes Practicae Circa Medendi Methodum, Leyden, 1694.)
W. D. Hooper’s patent cupping apparatus with tubular blades. (From patent specifications, U.S. patent no. 68985.)
Scarification without cupping in Egypt in the 16th century. To obtain sufficient blood, 20 to 40 gashes were made in the legs and the patient was made to stand in a basin of warm water. (From Prosper Alpinus, Medicina Aegyptorum, Leyden, 1719.
R. J. Dodd’s patent cupping apparatus. Figs. 4 and 5 are the tubes for cupping the uterus. Fig. 3 is the flexible match scarifier. (From patent specifications, U.S. patent no. 3537.)
Patent for a complex cupping pump, J. A. Maxam, 1916. (From patent specifications, U.S. patent 1179129.)
Paré’s scarificator, 16th century. (From The Workes of that Famous Chirurgeon, Ambrose Parey, translated by Thomas Johnson, London, 1649.)
Junod’s boot applied to a baby in the cradle. (From Victor Theodore Junod, A Theoretical and Practical Treatise on Maemespasia. London, 1879.
Instruments for bleeding from the arm, 1708: a, a serviette to cover the patient’s clothing; b, a cloth ligature to place around the arm; c, a lancet case; d, a lancet; e and f, candles to give light for the operation; g, a baton or staff for the patient to hold; h, i, and k, basins for collecting blood; l and m, compresses; n, a bandage to be placed over the compress; p, eau de la Reine d’Hongrie that can be used instead of vinegar to revive the patient if he faints; q, a glass of urine and water for the patient to drink when he revives; r, s, t, implements for washing the hands and the lancets after the operation. (From Pierre Dionis, Cours d’opérations de chirurgie demontrées au Jardin Royal, Paris, 1708.
Instruments and technique of phlebotomy: Fig. 1 shows an arm about to be bled. A ligature has been applied to make the veins swell. The common veins bled—cephalic, basilic, and median—are illustrated. Fig. 2 shows several types of incisions. Fig. 3 is a fleam, Fig. 4 a spring lancet, and Fig. 5 a “French lancet.” (From Laurence Heister, A General System of Surgery, London, 1759.
Dry cupping for sciatica. (From Frederik Dekkers, Exercitationes Practicae Circa Medendi Methodum, Leyden, 1694.
Depurator patented by A. F. Jones, 1866.
(From patent specifications)
Demours’ device for combining cup, scarifier and exhausting apparatus. (From Samuel Bayfield, A Treatise on Practical Cupping, London, 1823.)
Damoiseau’s terabdella. (From Damoiseau, La Terabdelle ou machine pneumatique, Paris, 1862.
Cupping instruments illustrated by Dionis, 1708: a, cups made of horn; b, lamp for exhausting air; c, fleam for making scarifications; d, horns with holes at the tip for mouth suction; e, balls of wax to close the holes in the horn cups; f, g, glass cups; h, candle to light the tow or the small candles; i, tow; k, small candles on a card which is placed over the scarifications and lit in order to exhaust the cup; l, lancet for making scarifications; m, scarifications; n, plaster to place on the wound. (From Pierre Dionis, Cours d’opérations de chirurgie demontrées au Jardin Royal, Paris, 1708.)
An early illustration of the octagonal scarificator, 1801. This plate also includes one of the earliest illustrations of the syringe applied to cupping cups. (From Benjamin Bell, A System of Surgery, 7th edition, volume 3, Edinburgh, 1801.)
Advertisement for phlebotomy and cupping instruments. Note the rubber cups. (From George Tiemann & Co., American Armamentarium Chirurgicum, New York, 1889.)
A man employing leeches to reduce his weight, 16th century. (From P. Boaistuau, Histoire Podigieuses, Paris, 1567. )
Woman using leeches, 17th century. (From Guillaume van den Bossche, Historica Medica, Brussels, 1639.)
Chair to assist in straightening of the spine
Where frequent lying down on a sofa in the day-time, and swinging frequently for a short time by the hands or head, with loose dress, do not relieve a beginning distortion of the back; recourse may be had to a chair with stuffed moveable arms for the purpose of suspending the weight of the body by cushions under the arm-pits, like resting on crutches, or like the leading strings of infants. From the top of the back of the same chair a curved steel bar may also project to suspend the body occasionally, or in part by the head, like the swing above mentioned. The use of this chair is more efficacious in straightening the spine, than simply lying down horizontally; as it not only takes off the pressure of the head and shoulders from the spine, but at the same time the inferior parts of the body contribute to draw the spine straight by their weight.
Steel Bow to diminish curvature of the spine
I have made a steel bow which receives the head longitudinally from the forehead to the occiput; having a fork furnished with a web to sustain the chin, and another to sustain the occiput. The summit of the bow is fixed by a swivel to the board going behind the head of the bed above the pillow. The bed is to be inclined from the head to the feet about twelve or sixteen inches. Hence the patient would be constantly sliding down during sleep, unless supported by this bow, with webbed forks, covered also with fur, placed beneath the chin, and beneath the occiput.