Licence: Public Domain Mark
Credit: Surgical scraps. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
1/2 page 383
![Chambers's Journal, June 14, 1884.] IICAL SCRAPS. c.n 383 in its cooling spray, instantly ilispeMnf illusions ; and in another moment lam {kcompletely in the midst of the living present as lSw»ibefOre in the dead past. jus 30 m SURGIQA L.JgLC R 4 P S. There is a curious instrument in. the armamen- tarium of the surgeon calledn ^rhbang, employed for removing foreign bodies~wliich have become fixed in the esophagus or gullet. It consists of a flexible stem, at one end of which is an arrange- ment of catgut fibres, and at the other end a small handle. By moving the handle slightly, these threads of catgut—which are stretched all round and parallel to the stem at its lower end can be bent outwards in a radiating manner, which gives the instrument the appearance of a chimney-sweep’s broom in miniature. When a person is so unfortunate as to get a piece of bone stuck in his throat beyond the reach of the surgeon’s hand, the probang is sometimes found very useful. It can be passed down the gullet, in a closed condition, beyond the obstruction, then opened somewhat like an umbrella, and drawn upwards, carrying with it—if all goes well—the foreign body. The passing of such an instrument is far from being pleasant to the patient; but if it be done with ordinary care and judgment, it will not be attended with any harm. Every one who has known the misery attendant upon getting a good-sized piece of bone impacted in the food- passage, will understand that when the operation nas proved successful, the patient is likely to consider the pleasure of seeing the offending fragment caught in the meshes of the probang cheaply purchased by the discomfort attendant upon the passage of the instrument. Another instrument employed for passing down the esophagus is used for a different purpose. When the gullet has been severely burned inter- nally—as, for instance, from the accidental swallowing of corrosive acids—after the ulcer produced has healed, there is a great tendency to contraction in the scar, and consequent stricture of the esophagus. This may threaten life, by tending to close the passage altogether. To prevent this, instruments called bougies are passed through the constriction from time to time. These bougies are simply firm, smooth, slightly flexible rods with rounded ends, and are various in size as regards their diameters. An instance of the passing of these instruments being turned to account in a very curious way, occurred some years ago in one of the London hospitals. A patient was suffering from stricture of the esophagus, brought about in the manner above described ; and the tendency to contraction was in this case.so great, that it was only by the frequent passing of instruments that it could be prevented lrom becoming to the last degree dangerous. Now, it was impossible that the man could remain in the hospital permanently; it was therefore decided to teach him to pass the instrument for himself. He proved capable of this, after a certain amount of instruction ; and it then occurred to some one about the hospital that the daily performance of this operation might be made the means by which the man could earn a livelihood. Accordingly, the patient was advised to get a bougie made as much as possible to resemble a sword. This he did ; and for a long time afterwards was to be seen about the streets of London making money by what looked like the swallowing of a sword. In his case there was really ‘no deception’ as regards the passing of a long instrument down towards his stomach was concerned, the only deception being that the instrument was not the weapon it represented. His daily street performance thus served him in two ways—it supplied him with food, and also kept open the passage by which that food could be conveyed to his ‘ inner man.’ The contraction about which we have spoken as taking place in scars formed after burns of the gullet, and which is so dangerous there, also occurs in burns on the surface of the body, and often leads to a good deal of deformity. Burns, indeed, are a great source of trouble to the surgeon in many ways. For instance, if a burn is very extensive, there may be great difficulty in getting a cicatrice to form over the whole of it. Cicatrisa- tion only begins in the immediate neighbourhood of living epidermis, and therefore a burn or ulcer must heal from the circumference to the centre. But the further that the cicatricial tissue extends from the margin of the bum, the more slowly and the more imperfectly is it formed ; and indeed it may fail altogether to reach the centre. This difficulty has often been met by a small operation called skin-grafting. A piece of sound skin about the size of a split pea is pinched up—say, on the outside of the arm—and the epidermis snipped off with a pair of curved scissors, the scissors just going deep enough to cut slightly into the second layer of the skin and draw a little blood. A special kind of scissors has been invented for the purpose, that will only take up just the right amount of skin, so that the operation is thus made even simpler still; and if it is skilfully performed, it causes only very trifling pain. The little fragment of skin thus separated is then placed gently, with its raw surface downwards, on the unhealed surface of the bum. The same thing is repeated again and again, till there are many grafts, if the bum is a large one. Isinglass plaster, or some other similar material, is employed to keep the grafts in position and preserve them from injury. In about four days they should have taken root, and then the covering can be removed. There is now a number of foci from which cicatrisation can start; for, as before said, it will begin from where there is an epidermal covering, and thence alone. After a time, a number of little islands of scar tissue may be seen, which go on increasing until at length they coalesce with one another, and also join that extending from the margin of the bum. This is what happens if all goes well; but, unfortunately, there is a very great tendency for a cicatrice formed from grafts to break down and disappear, so that the result is not by any means always so satisfactory as it at first promises to be. Another trouble with bums is the great pain which they invariably cause ; and numberless are the applications which have been recommended for its relief. The great essential in all such applications is that they should completely exclude the air ; for the very slightest irritation to](https://iiif.wellcomecollection.org/image/b22468584_0003.jp2/full/800%2C/0/default.jpg)
