4. Scalpel/Bistoury: Development of the surgical knife
Surgical Instruments at the Turn of the 19th Century
The classic doctor’s bag was equipped by the doctors
with their personal tools-of-the-trade.
1. Two 18th–19th century standard military
surgical sets and a rare 17th-century surgical
set (“trousseau”): containing a scalpel (iron
and ebonite handles), curettes and toothextracting
forceps, metal catheter and directors.
2. Four forceps, locking forceps and hemostatic
(to stop bleeding) powdering container.
3. Two sets of amputation knives: World War I
and World War II.
4. Four curettes and two tissue retractors.
5. A honing and sharpening stone: c. 1930, for all
surgical instruments and needles, made in
Israel.
6. Three scalpels: 19th century, steel blade and
turtle shell handles (these are available in
many sizes). When a very delicate and
controlled incision was needed, the surgeon,
feeling the awkwardness of the classical knife
hold, started to hold it like a pencil. The flat
handle felt awkward, so it was narrowed (as the
tenotomy knife) and sometimes even rounded,
but remained short in order to be held within
the palm (see the three following bistouries).
7. Seven tenotomy knives (tenotome) designed
for the subcutaneous division of tendons.
Various kinds of bistouries include blunt,
pointed, straight or curved ones, as well as
hernia knives and directors.
During the early 1900s, several attempts were made
to develop disposable, very sharp surgical blades
that could be connected to the classic, short, flat
handle. In 1925, Sharp and Smith invented the
B-R-X system for detachable blades that was on the
market for two years. The same year, Frank C. Betz
Company sold their system to Bard Parker (BP)
with a different connection (called a “nose”) that is
used until this very day. Charles Fox is said to be the
inventor of this system.
8. The Sharp and Smith B-R-X system: with a
detachable blade (see pictures on pages 161 and
163).
9. Bard-Parker’s knife: handles with
detachable, disposable blades.
10. Barron handle with the Bard-Parker “nose”
and a round, slightly longer handle.
Feeling the need to stabilize the handle in a
three-point support (like a pencil), longer
handles were designed, including a very thin
one for fine blades (“beaver” or “feather”
handles), in hopes that a tiny, delicate
instrument is easier to control with precision
during delicate procedures.
11. Beaver knife handle with its detachable blade
and thin BP handle with their BP blades. Both
of these long-handled knives offered threepoint
support but since they were so thin, the
surgeon had to strain his fingers to grasp them.
12. The Rosenberg original prototypes and the
standard production handle with the BP
modified nose.
Further modifications were made, mainly
1) a nose that provides easier blade loading
and unloading, 2) its weighted side (see
arrow) to prevent the instrument from
rolling, 3) an option of suction through the
handle of the incision line, as well as 4) an
option for electrocautery using the back of
the blade in order not to dull it.
This prototype marked the first time a
“soft-touch” silicon coating offered a better
interface contact between the soft resilient
surgeon’s finger and the soft handle surface.
Such “soft touch” instruments are common
now in medicine, household instruments
and industry.
13. Prototypes of suction and electrocautery:
with the special blade.
14. Two prototypes of easy blade release and
attachment.
