Collecting and Recollecting: Gifts from the Recent Past

Instruments and Other Equipment

This set of late nineteenth century German-made surgical instruments was designed solely for amputation at a time when anesthesia was not yet perfected. Before the twentieth century, amputation was commonly used as an attempt to prevent the spread of putrefaction from an infected wound. Even a compound fracture of the leg might easily lead to death from the spread of infection. Surgeons intervened in an attempt to save the patient's life.

The assortment of knives corresponds to the size of limb being amputated. The serrated blades were used for cutting bone while the straight double-sided knives were used to cut across muscles. The Petit tourniquet included in this set became popular in the mid-1700's, and was the standard device for cutting off blood flow during surgery until the early 1900's.

The instrument handles tell another story. Ebony, bone and ivory handles were often decorated with cross-hatching, providing a firm grip to expedite the operation. Textured handles were a favorite hiding place for bacteria, and surgeons could unwittingly infect their patients. Joseph Lister introduced antiseptic techniques in surgery in England in the 1860's, however, all-metal instruments, capable of being sterilized, were not adopted until the 1890's when the germ theory of disease gained a wider acceptance among physicians. Nonetheless, late nineteenth century catalogues still advertised instruments with ebony handles. This set of surgical tools is probably an example of those late offerings of elegant, yet outdated instruments.

Gift of Dr. and Mrs. Steven Sanofsky, Barrington, Rhode Island

Iowa Trumpet Prototypes
circa 1960

The Iowa Trumpet is a needle-guide used to inject local anesthetics into the vagina to decrease the pain of labor and delivery. It permits the tip of the needle to be placed exactly where the physician wants it. Until the site for injection is identified, the tip of the needle remains within the Trumpet so neither the patient nor the operator is inadvertently "stuck" before the right spot has been located. The Trumpet and matched needle ensure that the injection is not made too deeply. This provides a safeguard during this "blind" procedure in which the correct location is felt by the physicians's fingers, but is not seen. The Iowa Trumpet actually originated in Kansas. While mowing his lawn one day in the late 1950's, James Lee, MD, a 1967 graduate of The University of Iowa College of Medicine, looked down at the throttle cable and sleeve on his lawnmower and envisioned a similar sleeve to guide the needle in administering transvaginal local anesthesia. After a successful first attempt at creating a prototype from copper, Dr. Lee had several stainless steel models made of his "Kansas Arrow."

9. Iowa Trumpet Prototypes

While attending a lecture by Dr. Lee on his innovative technique, Dan Egbert, MD, of Fort Dodge, Iowa, "became intrigued by the device," and received permission from Dr. Lee to modify his early prototypes. Dr. Egbert added a thumb ring and a small funnel to the front end and a "finger bulb" to the other end. Within two years, the Iowa Trumpet, named for its trumpet-like shape, was being manufactured and distributed by the Iowa Medical Supply Company of Fort Dodge. The instrument never received a patent, but its success is proven by its continued use in obstetrical medicine today.

Gift of Lloyd D. Holm, DO, Omaha, Nebraska

10. Close-up of Iowa Trumpet prototypes

History of Stethoscopes

Rene Laennec of France invented the first stethoscope in 1816 to protect the modesty of one of his female patients. This first stethoscope was fashioned from several sheets of paper rolled to form a cylinder. Prior to this invention, physicians listened to heart and lung sounds by pressing an ear to their patientsÕ chest. The stethoscope increased the range of sounds that were audible and was more acceptable to patients. The earliest models were monaural (physicians listened with only one ear.) A variety of materials and designs were used in the attempt to conduct sound efficiently. In 1837, Dr. Oliver Wendell Holmes returned from medical studies in Paris and urged his fellow American physicians to increase their use of stethoscopes. By the mid 1840s, the stethoscope had become integral to the practice of medicine in the United States.

11. Rene Laennec (1781-1826) Inventor of the first stethoscope

Although numerous styles were introduced during the last half of the nineteenth century, by the 1860s most physicians had switched to the basic design that is used today. This stethoscope, designed by George Cammann, was binaural. Cammann found that "The power of conduction is greatly increased by the reception of the sounds simultaneously into both ears." In addition to conducting sound more efficiently, a binaural instrument helps the listener block out external noise. The shape and composition of the ear and chest pieces have changed throughout the century, but the binaural style has remained. The two types of chest pieces used are the bell, which primarily transmits low sounds, and the diaphragm, which detects high frequency sounds. In 1926, the first workable combination of bell and diaphragm was designed and became the prototype for stethoscopes used today.

12. Laennec and the Stethoscope
At Necker Hospital, Paris, France, in 1816, Dr. Theophile Laennec devised hollow wooden cylinders for listening to sounds in patients' chests. These early stethoscopes helped physicians to better understand diseases of the lungs.
One of a series: A History of Medicine In Pictures, presented by Parke, Davis & Company
Directed by George A. Bender
Painted by Robert A. Thom

Tubegauz Improved Seamless Tubular Gauze Bandage and the new "Cage-Type"Applicators
Manufactured by Scholl Mfr. Co., Inc.
1956

Tubegauz Gauze Bandage, made from cotton yarn and available in a variety of sizes, was useful in protecting and supporting all body parts from head to toe. The "cage-type" applicators could be loaded with up to 10 yards of gauze and kept ready for sterilization for emergency or operating room use.

The accompanying manual claims Tubegauz is better than conventional bandages because "its functions can be performed with greater speed, ease, economy and of primary importance . . . patient comfort through its use." The manual also shows photographic examples of Tubegauz's varied applications in surgical and medical procedures. Comparisons between the time it takes to apply Tubegauz and the time required to wrap patients in other bandages are included to further illustrate the Tubegauz advantage.

Experience in auto mechanics or basket-weaving would be helpful to the doctor or nurse who worked with Tubegauz, as the techniques described are intricate and require some manual dexterity. Instructions for anchoring the gauze onto a limb resemble those for installing an oil filter: "Hold the Applicator with the Tubegauz firmly so that no more can slip off, apply slight tension and rotate approximately one-half turn until it grips lightly . . . move applicator in opposite direction, after this turn. Note: too much rotation will give an uncomfortable 'tourniquet' effect." Methods of "finishing" and "dressing" included cutting, twisting and tying, double-looping, stuffing with cotton and molding.

Tubegauz has been used at the UIHC in the departments of orthopaedics and dermatology. According to Mary Wolfe, RN in orthopaedics, it is still used, but only on fingers and toes, and "sometimes works better than anything else." Dixie Jergens, RN, in dermatology, recalls that the gauze hasn't been used in her area for about five years -- it was replaced by "Band Net," a flexible fish-net gauze more suitable for dressing burns.

Gift of the Department of Cardiothoracic Surgery, UIHC

13. Ear and eye instruments within display