Friday, February 21, 2020

The Disappearance of Needle Stylets

A thing of beauty is a joy forever. A stylet at home in the bevel of a needle

New fangled disposable injection needles with their cheap looking plastic syringes were just beginning to show up on wards at the beginning of my nursing journey. I just love that "journey" vernacular so common in today's healthcare lingo. See, I can talk just like a whippersnappern if I try really hard.  Anyhow, old school nurses had lots of laments about disposable equipment of any permutation because it  went against the grain. We were taught to reuse just about everything. Throwing away Monoject disposable syringes was bad, but the elimination of stylets was even worse.

Reusable injection needles always had a stylet running the length of the needle bore that terminated at the beveled business end of the needle. Whippersnapperns might start out their day by logging on to a computer, but their predecessors started out by sharpening injection needles. The stylet was a vital component to reusable needle maintenance and sharpening. Ramrodding a stylet through the needle served to clean the bore of any residual debris. When sharpening was completed the stylet served to clear the needle bore of any residual micro shards from the grinding process.

Stylets also served as a template to maintain the appropriate angle of the needle bevel during the sharpening operation. Minimalist minded nurses could sharpen a dulled needle on an ever present match book striker. Needle sharpening was one of those rare instances when a nurse was off her feet and the matchbook was a cue for a quick smoke. Smoking and sharpening needles went together like peanut butter and jelly. Mechanical devices for needle sharpening were most commonly hand cranked gizmos where the bevel of the needle was rocked back and forth by a cam while pressed against a rotating wheel all the while an indwelling stylet maintained the bevel angle.
Every nurse's station needs a needle sharpener

Biopsy needles with their very shallow bevel always have a stylet as a stiffening mechanism and as a control over the cored tissue sample. When sampling liver tissue from an obese patient the stylet is left fully engaged during it's journey ( I go again with that "J" word) through the subcutaneous tissue. When the final liver destination is reached the stylus is withdrawn to snatch a core of tissue. Stylets are also needed to expel the cored tissue from the biopsy needle.

When performing spinal taps or removing fluid from a body cavity, the stylet is also necessary to control the flow of fluid. No stop cock can halt the flow of fluid through the lumen of a needle like a trusty stylet.

Inventive nurses discovered that stylets have  unintended uses that have loads of utility. When the hinge screw mysteriously disappeared  from my ever present eyeglasses a quick fix was needed. I discovered that a stylet from an 18 gauge needle was the perfect diameter to fit the void left by the missing screw. With the stylet in place, it was a simple matter to bend it in the shape of a horseshoe with a needle holder. A perfect fix. It was also common knowledge that a stylet was the perfect instrument to pierce ear lobes for those nurses that liked to decorate themselves with earrings.

It's nice to know that stylets have survived into the present age with spinal tap and biopsy needles, but once upon a time every needle worth it's jab had a stylet.

Wednesday, February 12, 2020

John R. Brinkley - A Pioneering Transplant Surgeon

Dr. Brinkley in action. Just say BAA
The recent outbreak of Corona virus piqued my interest in past outbreaks so I began reviewing the events underlying the great influenza outbreak of 1918-19 and lo and behold the strange career of Dr. John Brinkley came to light. This man was no ordinary surgeon, in fact his only medical credential was a $500 phony diploma he purchased from the Eclectic University of Kansas. His skills as a pitchman exceeded his surgical skills by huge margin.

Dr. Brinkley, a physician of questionable  competence, to say the least, began his career treating victims of the great influenza outbreak. On  a house call to a farmer named Stittsworth, he found the hapless patient  complaining of impotence, Brinkley had an epiphany that would make him a millionaire. Eyeing the proud testicles of a nearby penned up Toggenburg goat he remarked, "You wouldn't have any tumescence troubles down there with one of those goat glands in you."

The troubled farmer replied, "Well why don't you just put one of them goat balls in me?" To an eager surgeon, the external anatomic character of male genitalia is like dangling the keys to a Pontiac Trans Am before the eyes of a hot rodder. All that exposed  anatomy is just begging to be incised, dilatated, or ram-rodded with a scope.

In 1920, the eager surgeon went to work on the readily accessible scrotum and implanted a goat testicle in the impotent Farmer Stittsworth. There was no neurovascular connection or fancy anastomosis to the vas deferens; the transplanted gland was popped in and left to hang there like a drunk dangling from a bar stool. A rubber crutch would be more functional.

Soon the farmer was singing the good doctors praises albeit a few ovtaves higher about his new found libido. (The placebo effect of sham surgery is even greater than it's pharmaceutical counterpart.)  When the farmer's wife gave birth to a healthy baby boy who was named after the good doctor, word spread far and wide. Large groups of forlorn men showed up at Brinkley's office eager to pony up with the surgeons goat gland  implant fee of  $750 ( equivalent of $10,000 in today's money.)  Exploiting desperate patients like this was a foul ball of the highest order, but Dr. Brinkley was a master of self promotion with little regard for the welfare of his patients.

What he lacked in respect from the medical community he made up with acquisition of material goods which included a fleet of Cadillacs, an airplane, a yacht and an opulent mansion. Before his medical license was revoked in 1923 on the grounds of unprofessional conduct he performed nearly 16,000 goat/human xenographs.

The man who fittingly sported a goatee throughout his career developed a deep vein thrombus necessitating the amputation of his leg in the early 1940s. His handicaps did little to slow down his huckstering spirit. Perhaps the inspiration of sacrificing goats on the surgical alter led him to the study of theology. His dreams of launching a mega church died with him.

Karma seems to catch up with just about everyone. This gland grafting gooofus died penniless.