SURGICAL INSTRUMENTS AND APPLIANCES. The chief fact about the surgery of the present day, that it is aseptic or antiseptic, is exemplified in the make of surgical instru ments and in all the installation of an operating-theatre. Take, for instance, a scalpel and a saw that are figured in Ambroise Pare's (1510-159o) surgical writings. The scalpel folds into a handle like an ordinary pocket-knife, and the handle is most ele gantly adorned with a little winged female figure. The saw, after the same fashion, has a richly chased metal frame, and, at the end of the handle, a lion's head in bold relief, with a ring through its mouth to hang it up by. If one contrasts with these artistic weapons the instruments of 185o, one finds no such adornment, and for general finish Savigny's instruments would be hard to surpass ; but the wooden or ivory handles, cut with finely scored lines like the cross-hatching of an engraving, are not more likely to be aseptic, even with prolonged attempts at sterilization, than the handles of Pare's instruments. At the present time, instead of such handles as these, with blades riveted into them, scalpels are forged out of one piece of steel, their handles are nickel plated and perfectly smooth, that they may afford no crevices, and may be boiled and immersed in carbolic lotion without tarnish ing or rusting ; the scalpel has become just a single, smooth, plain piece of metal, having this one purpose that it shall make an aseptic wound. In the same way the saw is made in one piece, if this be possible; anyhow, it must be, so far as possible, a simple, smooth, unrusting metal instrument, that can be boiled and laid in lotion.
Or we may take, at different periods of surgery, the ligatures for arrest of bleeding from a divided blood-vessel. In Pare's
time the ligature was a double thread, and he employed a forceps to draw forward the cut end of the vessel to be ligatured. From the time of Ambroise Pare to the time of Lister no great im provement was made. Then came Lister's work on the absorb able ligature; and out of this and much other experimental work has come a sterile thread that can be tied, cut short, and left in the depth of the wound, with certainty that the wound may at once be closed from end to end and nothing more will ever be heard of the ligatures left buried in the tissues.
Much the same is true of surgical dressings. When inflamma tion and suppuration were almost inevitable, dressings were usually such as could be easily and frequently changed—ointment, or wet compresses, to begin with, and poultices when suppuration was established. Now, after passing through a period when they were impregnated with some antiseptic, they are usually non medicated but rigidly aseptic, and applied dry and are changed as little as possible in every aseptic operation.
The great principle of aseptic surgery combined with discovery of anaesthetics led to a great enlargement of the field in which surgical operations could be undertaken. As a result instruments for special purposes were devised that were without counterpart in olden times while appliances such as the laryngoscope, ophthal moscope, cystoscope, sigmoidoscope, bronchoscope were invented and facilitated diagnosis. These means of improved diagnosis, in their turn, pointed the way towards yet more specially derived instruments so that the modern instrument maker's catalogue is a bulky and profusely illustrated volume.