Medical instrument

“ The surgical operations are performed on what are considered auspicious days. The patient is made to sit or stand with his face to the east, the surgeon before him with his face to the west. The surgeon should be cautious that no vital part, artery, vein, joint, or bone is carelessly injured in the course of the operation, and that the instrument does not go deeper than the requirements of the case actually demand. In serious surgical operations, and in diseases of a painful nature, the patient was made insensible by the administration of anaesthetics. ”

“ It is an excellent plan for the student to purchase his microscope when entering the medical school and to use his own instrument throughout his course. It is the one instrument without which no physician can afford to enter practice; and the student who uses his own microscope before graduation will continue to use it afterward. The microscope obtained, the remaining expenditure necessary for the fitting-up of a practical working laboratory of clinical and pathologic diagnosis need not be very great if one’s financial condition does not warrant spending with a free hand. ”

“ The physician is required to note the patient's appearance, eye, tongue, skin, pulse, voice, urine, and faeces. The examination of the pulse is, however, considered the most important of all, as furnishing the best criterion of the phenomena and progress of disease, and it is the one usually depended upon by the native doctors. In order to know the precise character of the pulse, the radial artery at the wrist is usually chosen. In case of a male patient, his right pulse is generally felt, and in case of a female the left. ”

“ He laid out his large Quain’s Dictionary of Medicine in the forefront of the table so as to impress the casual patient that he had ever the best authorities at his elbow. Then he cleared all the little instruments out of his pocket-case—the scissors, the forceps, the bistouries, the lancets—and he laid them all out beside the stethoscope, to make as good a show as possible. ”

“ Many surgeons of great and deserved repute have invented each a single instrument, such as Beer’s knife or Tyrrell’s hook; and some have invented more than one, chiefly because they have struck out some new procedure for which new appliances were indispensable. ”

“ But you may now ask what all this physiology and chemistry of the plasma has to do with a report on surgery. I propose to use it for the purpose of explaining some peculiarities in the process of repair in surgical cases.
A few months ago I had a case of delayed union in a fracture of the tibia, at the hospital, and spent more time in waiting for nature, unassisted, to accomplish a cure, than I should ever spend again. One week after putting the patient on the use of ten grain doses of hypophosphite of lime, I had the pleasure of seeing bony union commencing. And why? ”

“ Bloodletting instruments, perhaps the most common type of surgical instrument little more than a century ago, are now unfamiliar to the average person. When one sees them for the first time, one is often amazed at their petite size, careful construction, beautiful materials, and elegant design. ”

“ A big sheet is thrown over the lower part of his body, another over the upper part, a third, with an oval opening in the centre of it, thrown over the region to be operated upon. The instrument nurse takes a boiled knife out of a sterilized dish of distilled water, hands it to the surgeon, who takes it in his gloved hand, and the operation begins. ”

“ It is self-evident that no clear conception of a surgical operation, ancient or modern, can be formed from a written description without some previous knowledge of the instruments intended to be used. ”

“ It is our pride that medicine, from an art, and a pretty black one at that, originally, is becoming a science. And the most powerful factor in this development, its indispensable basis, in fact, has been the invention of instruments of precision—the microscope, the fever thermometer, the stethoscope, the ophthalmoscope, the test-tube, the culture medium, the triumphs of the bacteriologist and of the chemist. Any man who makes a final diagnosis in a serious case without resorting to some or all of these means is regarded—and justly—as careless and derelict in his duty to his patient. ”

“ These manual movements upon the surface of the body will often excite muscular sensibility, similar to that awakened by a weak Faradic current. The internal medicines should be such as to regulate the general functions of the system. The use of these remedies must be directed by the skill and experience of those who are professionally qualified to administer hem. ”

“ In the past seventy-five years medicine has progressed from an art to a science. The doctor today has diagnostic aids which would have seemed fabulous to the physician of a hundred years ago. Exact laboratory tests and the X ray enable the physician to base his treatment on definite knowledge. These are as available to the surgeon and doctor aboard ship as to the man working in the most modern and extensive medical center. ”

“ Such demonstration is a thrilling spectacle to inexperienced students. It appeals to that love of excitement which makes them rush to a surgical operation, or to an extraordinary medical case which may have no bearing whatever on their future practice, whilst the commonplace but all-important bedside observation seems dull in comparison. Yet patient work in the anatomical and microscopic rooms, and in the chemical laboratory for general and animal chemistry, and close clinical study, all of which involve no form of suffering, are of primary importance. ”

“ Besides the instruments of precision referred to above, more careful percussion, more careful auscultation, more careful measurements, roentgenoscopy and fluoroscopic examination of the heart, and a study of the circulation with the patient standing, sitting, lying and after exercise make the determination of circulatory ability a specialty, and the physician who becomes an expert a specialist. It is a specialization needed today almost more than in any other line of medical science. ”

“ The facilities of the Sanitarium for the treatment of disease are the best known to modern medical science. In addition to baths of every description, including Turkish, Russian, vapor, electro-vapor, thermal, etc., the employment of massage, Swedish movements, and the various forms of electrical treatment, are provided for by costly appliances, some of which were designed expressly for this institution. ”

“ This union of that grand vitalizing and restorative agent, Electricity, in a gentle and continuous current, with a highly Medicated Plaster composed of the choicest medicinal gums and balsams known to modern pharmacy, each in itself a curative marvel, is the grandest medical triumph of this century. It is instantly soothing, healing and strengthening. ”

“ Eye-pieces and Objectives.—The usual equipment consists of one- and two-inch eye-pieces, and two-thirds, one-sixth, and one-twelfth inch objectives. These are very satisfactory for clinical work. It is an advantage to add a one-half-inch eye-piece for occasional use with the two-thirds objective. The one-sixth should have an especially long working distance, otherwise it cannot be used satisfactorily with the Thoma-Zeiss blood-counting [p. 21] instrument, which has a very thick cover-glass. Such a "special one-sixth for blood work" is made by most of the microscope manufacturers. ”

“ Its size indicates that it contains an enormous quantity of material on the gross and fine anatomy, but excursions are also made into the domain of medicine to illustrate the application of the anatomical knowledge to the explanation of symptoms in disease; and quite frequently physiology and pathology are dealt with. ”

“ It is a case of elegant surgical instruments for the work of dissecting the living human heart;—every instrument wrought with exactest temper and polish and adapted with exquisite care, and labelled with the name of the nerve or artery or muscle which it is designed to sever. ”

“ That is, after all, what chirurgy, the old form of our word surgery, means. Medical problems are more complex and involve both art and science, so that solutions of them are often merely temporary and lack finality. During the Middle Ages, however, and especially towards the end of them, the most important branches of medicine, diagnosis and therapeutics, took definite shape on the foundations that lie at the basis of our modern medical science. We hear of percussion for abdominal conditions, and of the most careful study of the pulse and the respiration. ”

“ On the first floor the Tissue Pathologists sit at their microscopes and study the pretty blue and red stained slides of human and animal tissues which come from the batteries of Technicon machines and the skillful microtomes of the laboratory technicians. Here too are the Medical Library and the Hematology Section, where blood from thousands of patients is smeared on slides, stained, and examined for signs of disease. ”

“ The advances in general medical science and practice have also necessitated great elaboration of the resources for the study and treatment of the physical condition of the patients. Instruments of precision, laboratories, x-ray departments, dental and surgical operating rooms, massage and hydrotherapy departments, facilities for eye, throat, nose, and ear examinations and treatment, and all the other means of determining disease processes and applying proper treatment have been supplied and the methods and standards of modern clinical medicine and surgery are utilized. ”

“ The clinical laboratories in the combat support, field, and general hospitals have the ability to perform a general, but limited, array of analytical procedures in hematology, urinalysis, chemistry, microbiology, serology, and blood bank. Patient specimens of suspected biological or chemical agent exposures are forwarded through technical channels to the supporting medical laboratory. See Appendix B for sample/specimen collection, packaging, chain of custody, processing, and transporting requirements. ”

“ Your patient has no more right to all the truth you know than he has to all the medicine in your saddlebags, if you carry that kind of cartridge-box for the ammunition that slays disease. He should get only just so much as is good for him. I have seen a physician examining a patient's chest stop all at once, as he brought out a particular sound with a tap on the collarbone, in the attitude of a pointer who has just come on the scent or sight of a woodcock. ”

“ At the Invalids' Hotel and Surgical Institute these measurements are all taken by the surgeon in person, and each appliance is constructed under his immediate supervision. It is utterly impossible for physicians who have but a limited experience in the treatment of such cases to take correct measurements and send off for an apparatus which fulfills the requirements of the case. ”

“ The good surgeon is careful to use the right sort and pattern of instrument, and the chief fact about the surgery of the present day, that it is aseptic or antiseptic, is recorded in the make of surgical instruments and in all the installation of an operating-theatre. ”

“ The surgeon, before commencing an operation, is enjoined to equip himself with all the requisites, such as the instruments, salts, bandages, honey, oil, water, etc. He should have practical experience of his art, and should have seen many surgical operations performed by others. He should be intelligent, steady, skilful, and should execute his work with a light hand. He should have by his side steady and strong attendants to assist him. The patient should be allowed to take light food before any operation is performed upon him. ”

“ The hospital and drug store hold all that is wanted by modern medical science. There is an operating-room containing every known appliance useful in surgery; the whole room is finished in marble tiling, while all the metal work is shining nickel. Here is the electric apparatus necessary to operations, a Roentgen ray apparatus, batteries for treatment of certain diseases, and, in fact, all the devices and mechanisms used in a city hospital. ”

“ Report on Surgery.
In presenting this report I will not attempt to give any historical data connected with the subject of surgery, since that has been ably done in the report of last year.
I shall assume, and that without hesitation, that surgery is a science, properly so-called. That it is an art, is also true. But what is science? What is art? Science is knowledge. Art the application of that knowledge. To be more explicit, science is the knowledge we possess of nature and her laws ”

“ The doctor is tapping upon the abdomen of this man, and listening to the sounds. You will find this the weirdest part of the whole procedure, for you will naturally assume that this young man is being examined, and will be dazed when some one explains that the patient is in Toronto or Boston or New Orleans, and that this young man's body is the instrument which the doctor uses in the determining of the vibration rates of the patient's blood. Dr. Abrams tried numerous instruments, but has been able to find nothing so sensitive to electronic activity as a human body. ”

“ When thou wishest to introduce the needle, the eye must be turned towards the light and looking straight at thee; also, I should make the patient turn his eye a little towards his nose, so that thou canst use the instrument better and that thou wilt not injure the small veins of the eye, but respect them. Direct the needle straight and with attention over the membrane called the conjunctiva, straight towards the pupil and uvea, at the distance of two blades of a knife from the membrane called cornea or from the grey that is in the eye. ”

“ Instead of depleting, we, by proper constitutional treatment, strengthen and fortify the system. We do not confine the patient in bed, but permit him to go around and take all necessary exercise. We adjust an ingeniously devised and perfectly fitting appliance or apparatus, by which a gentle extension of the limb is maintained, thereby relieving the tension of the muscles, and preventing the friction and wearing of the inflamed surfaces of the joint, which, without the use of our new and improved appliance, are a source of constant irritation. ”