Surgical knives: the scalpel

摘要

‘From hand and mouth to sticks, stones and metal’1 ‘man is a tool-using animal…without tools he is nothing, with tools he is all’2 The word ‘surgeon’ derives from the Greek words kheir (hand) and ourgos (work). By far the most important ‘instrument’ in surgery is the human hand. Historically, it is believed that teeth were used to cut before sharp instruments were developed from organic and inorganic sources (stone or wood fragments). From simple probing to controlling complex robotic machinery, it is the hand that performs surgical manoeuvres (with the assistance of pedal instruments for coagulation). They are retractors, dissectors, tweezers, dilators, haemostatic aids, curettes, lancets (fingernails once upon a time), and manipulate the specialized tools of modern surgery. All too often the origin of the tools wielded have been forgotten. This new section of BJS is dedicated to bridging that temporal knowledge gap. Primitive cutting blades were made of flint, jade, or volcanic glass (obsidian or the ‘dragon glass’ in Game of Thrones) before metallurgy developed to shape tools into metal blades with handles. The scalpel (from the Latin scalpellum or scalpellus) came in various sizes and shapes, including historical derivatives such as the lancet (short and often hinged like a pen-knife) or bistoury (French—a longer, narrow blade). Modern scalpel blades are made from hardened and tempered steel, stainless steel, or high carbon steel. In addition, titanium, ceramic, diamond, and even obsidian blades are possible. The shape altered according to need such that earlier ablative and amputation requirements were long and durable. More modern scalpels are shorter, precision-focused blades and handles (Fig. 1).