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[From the New-York Medical J our mil for May, 1831.]
        DESCRIPTION

OF A NEW INSTRUMENT
EXCISING  EMiARGED  TONSILS.

     BY DAVID L. ROGERS, M/D* OF NEW-YORK.


                   .*-.'$* '
  Perhaps  there  is'nq'ofcera'tion  in  surgery of the same
magnitude, that has  been  attended with greater difficulties,
than the removal  of enlarged  tonsils.  The situations of the
tonsils,  their connexion with large  vessels of the neck,  and
the  spasmodic  contraction of the surrounding muscles, have
at all times  rendered their excision a  difficult,  and some-
times a fatal operation.  The older  surgeons resorted to the
actual and  potential cautery for their removal.   This was not
more cruel, nor dangerous, than the  practice pursued  in the
times of Paulus iEgineta, of dividing the mucous membrane, and
tearing them  from their bed by  hooks.   At the  present time,
the common scalpel, the scissors and the ligature, are in more
common use in this country and in Europe.  I shall offer but a
passing remark upon  these different instruments, which will be
confined  to stating the inconveniences attending them.  The
use of the scalpel is attended with great difficulty, in consequence
of having to employ the double hook in a part so deeply situ-
ated, and is likewise attended with great danger, from the proxi-
mity of the carotid artery and other vessels of the neck.  Of the
truth of this the records of surgery bear sufficient  evidence.*
  The objection to scissors must be apparent to every one. They
must of necessity, upon the principle upon  which they cut, make
* Burns on the Anatomy of the Head and Neck. 
2      D. L. Rogers on Excision of enlarged Tonsils.

an irregular, lacerated wound, which is always liable to slough;
and the  inconvenience  attending ligatures is such, that no sur-
geon would willingly employ them, except from prudential mo-
tives.
   Several ingenious instruments have at different times been in-
vented, for the purpose of excising the tonsils, without endanger-
ing the neighboring parts.  Among the number, the one pro-
posed by Dr. Physic, of Philadelphia, is most deserving of no-
tice.  It consisted of two steel rings attached to a handle.  Be-
tween the two rings he  placed a lancet-shaped knife, which
moved by  a spring placed in the handle.  This instrument has
undergone several modifications ;  one  by Dr. Cox, of this city.
There is an objection to this latter  instrument, in consequence
of the ring and knife being separate, and the knife  having  to
be adjusted, after the ring is  placed upon the tumor.   The in-
convenience is noticed particularly in children, who will object
to a cutting instrument entering their mouth ; and, besides, by
their constant movements, the parts within the  mouth  are  in
danger of being wounded.
   The instrument which I now offer to  the profession, is so con-
structed as to avoid the  inconveniences  and dangers, which  I
have stated as existing in relation  to the others.  It possesses
the advantage of a single instrument, and it cannot by any pos-
sibility injure any other part than the one to which it is applied.
The great advantage this instrument possesses over all others,
is that it may be used in  children  without producing the least
alarm, as the knife is  entirely concealed, and can  be applied
without  exciting suspicion.  A difficulty often exists in chil-
dren,  to keep the mouth open during the operation.   The form
of this instrument effectually prevents them from closing it. One
ring will answer for any sized tumor ; a slight movement of the
knife fixes the instrument; and, lastly,  its simplicity and cheap-
ness will place it within the power of any practitioner to pos-
sess one.
  Having  operated  several times on children and adults, I  am
not conscious that any alteration could  be made in this  instru-
ment, for the better. Having for the same reasons requested Pro-
fessor Mott to use it, and express to me  his opinion of its merits,
he has obligingly sent me the following note:—

                             25 Park-Place, March 5,1831.
Dear Doctor,
  I am delighted with the use of your new instrument for ex-
cising the tonsils. The rapidity with which the operation can be
performed, combined with the safety, gives it, in my  opinion, a 
        D. L.Rogers on Excision of enlarged Tonsils.      3

great superiority over any other instrument, or method of re-
moving these parts, of which 1 have any knowledge.
               Yours sincerely,
                                   VALENTINE MOTT.
   Dr. D. L. Rogers, Market-st.

                Description  of the  Instrument.

   To  a common handle is  attached  a steel ring, of sufficient
breadth to admit a groove on its inner surface; deeper at its junc-
tion with the handle, with an opening on its superior surface, of
a half an inch in length, through which a common probe-point-
ed bistoury is introduced, possessing a curvature  equal to  half
the circumference of the ring.  This bistoury is attached to the
handle  of  the  instrument, fixed  to a slide by a rivet, and sup-
ported on its under  surface, by a small  spring, which keeps the
bistoury in its place within the ring.   To the end of the bistoury
is attached a handle, of sufficient size to give the operator a com-
plete control over the bistoury.
  In using this  instrument,  the patient  should be placed in  a
chair opposite a strong light, and an assistant should stand be-
hind to steady the head, and  one to  hold open the mouth, on the
opposite side from the one on which you are about to operate.
The bistoury being  well pushed forward, so as to be completely
concealed within the ring, it is  then to be placed upon the ton-
sil. After being satisfied, that it is  at the base of the tumor,  a
slight movement of the handle of the bistoury upwards, fixes the
instrument.  When you are ready  to complete the operation,
continue to  elevate  the handle of the bistoury, and at the same
time to pull it forward, when  it traverses the groove of the ring
by dividing every thing contained within its circumference.   It
is done with such rapidity, that the  patient is hardly conscious
of its completion.*
  * I am much indebted to Mr. George Teiman, Surgeon's Instrument
Maker, No. 35 Chatham-st., for the neatness with which he has executed
my orders in making this instrument.
Clnyton & Van Norilen, Printers, 42 Willinm-Btreet- 
 
 
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