A History of Surgery in the Instrument

Tray: Eponymous Tools Used

in Hand Surgery
Clifton G. Meals, BA, Roy A. Meals, MD

From the David Geffen School of Medicine at UCLA, Los Angeles, CA.

Hand surgery emerged as a specialty after World War II, and early hand surgeons borrowed
tools from established fields of the time. These tools remain in common use today, and many
are identified by the names of the men who created them. Because these men did not
specialize in surgery of the hand, their history remains obscure to modern surgeons who do.
We have investigated the history of eponymous instruments developed before 1945 and used
widely today in American hand surgery. Reflection on these eponymous instruments reveals
the rich and diverse history of hand surgery. (J Hand Surg 2007;32A:942–953. Copyright ©
2007 by the American Society for Surgery of the Hand.)
Key words: Eponyms, hand surgery, history, instruments.

anavel, Tinel, Dupuytren, Kienbock—these perform them efficiently. As they became specialized

K men’s descriptions of signs and diseases are

central to the understanding of hand surgery.
Their original publications are readily identifiable
through the hand surgery literature, and their ep-
onyms are lasting legacies of their observations and
contributions. When hand surgeons use such names
to describe findings and conditions, they pay respect
to and perpetuate the memory of these surgical pio-
neers.
The same is true in the operating room when one
asks for an Adson, a Kocher, or a Ragnell. The
difference here, however, is that many of the epon-
ymous surgical instruments used by hand surgeons
today were devised before the specialty of hand
surgery came about, and thus awareness of these
innovators and their writings is dim at best.
Consider the era when these surgeons were work-
ing. Beginning with the demonstration of general
anesthesia in 1846, the following decades saw the
adoption of aseptic techniques, the production of
nickel-plated and then stainless steel instruments, the
discovery and application of x-rays, the advent of
blood transfusions, and the development of antibiot-
ics. Surgery flourished. For the first time, surgery
exceeded its age-old role of letting blood, draining
pus, and performing amputations. Surgeons ranged
from scalp to toe devising surgical exposures and
complex operations along with the instruments to
in neurosurgery, gynecology, otolaryngology, urol-
ogy, plastic surgery, and orthopedic surgery, so did
their instruments.
The specialty of hand surgery emerged later, dur-
ing and immediately after World War II, when the
efficiency of caring for limb-injured soldiers by a
single, regional specialist was recognized and ef-
fected. At that time, surgeons specializing in hand
surgery borrowed freely from the instrument trays of
established specialties and generally found tools suit-
able for their needs. Hand surgeons use many of
these tools today, and the eponyms of the instru-
ments are common operating room parlance, yet
typically little is known of the innovators respon-
sible for their development. Among them is a Nobel
laureate, a Pulitzer Prize winner, a fundamentalist
Bible thumper, a political dissident, and a mountain-
eer. Recognizing these pioneers pays respect to their
contributions, allows for reflection on the rich and
colorful history of surgery, and raises awareness that
hand surgery arose from multiple surgical disci-
plines.
Seminal Events
Liston
The oldest eponymous instrument in the modern
hand tray is the heavy bone shear designed by Robert
Liston (1794 –1847)1 (Fig. 1). Liston was a Scottish

942 The Journal of Hand Surgery

Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
 Meals and Meals / A History of Surgery in the Instrument Tray
Figure 1. Instruments related to seminal events in surgery.
From left to right: Liston bone cutter, Lister scissors, Bard
Parker scalpel handle, Beaver scalpel handle.
surgeon, famous for his physicality in the operating
room. A colleague wrote, “[Liston] would amputate
the thigh, single-handed, compress the artery with his
left hand, using no tourniquet, and do all the cutting
and sawing with his right.”2 Liston was brusque with
his fellow surgeons, and it was said that he “was a
teacher more by what he did than what he said.”1
Likely a result of his uncompromising attitude, Lis-
ton engaged in no shortage of professional quarrels.
He was officially dismissed from the Royal Infirmary
for 5 years before returning to prominence.3
Standing over an operating table in 1846 (with a
young Joseph Lister in the audience), Liston an-
nounced, “We are going to try a Yankee dodge today,
gentlemen, for making men insensible.” The patient
was anesthetized with ether, as had been demon-
strated by William Morton several weeks earlier in
Boston. The amputation took 28 seconds and was a
painless success. Liston remarked, “This Yankee
dodge, gentlemen, beats Mesmerism hollow.”3
Lister
Whereas Liston was confrontational and quick, Jo-
seph Lister (1827–1912) was methodical and shy.4
His innovations spoke for themselves.
Lister introduced absorbable catgut sutures and the
bandage scissors that bear his name5 (Fig. 1). Lister
also held a unique opinion of the fact that simple
fractures healed while compound ones festered and
led to death.4 Unlike his contemporaries, he believed
that suppuration was the work of invisible and ubiq-
uitous microorganisms. Lister based his conviction
on Pasteur’s and Koch’s germ theory of disease and
was undoubtedly encouraged by his father’s work as
a microscopist.5
Using carboxylic acid, Lister performed the first
successful antiseptic treatment of an open tibia frac-
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
943
ture on an 11-year-old girl in 1866. A year later he
wrote, “Since the antiseptic treatment . . . wounds and
abscesses no longer poison the atmosphere . . . my
wards, though in other respects under precisely the
same conditions as before, have completely changed
their character, so that during the last nine months
not a single case of pyaemia, hospital gangrene or
erysipelas has occurred in them.”5
Lister’s success actually marginalized him among
his British colleagues. His practices were strongly
opposed by senior physicians, and London medical
students found that if they subscribed to Lister’s
antiseptic practices, which became known as Lister-
ism, they failed their exams. Lister received early
recognition outside of Britain, however, as empirical
proof mounted; and after years of patience, the doc-
tor finally received the recognition he deserved.
Baron Lord Lister rests in Westminster Abby in the
company of only 2 other physicians, John Hunter and
Thomas Willis.4
Parker and Beaver
Antisepsis in mind, scalpels with ornately decorated
handles hewn from wood, tortoiseshell, and ivory
gave way in the late 19th century to instruments with
a single piece of metal forming both handle and
blade. These tools still dulled quickly, however, and
an operating room technician was required to sharpen
and sterilize instruments as they were used.
Surgeons turned to the disposable, double-edged
razor blades invented by King Gillette in 1905, either
placing them in specialized holders or gripping them
with hemostats. Doctors weighed this convenience
against the difficulty of working with straight-edged
blades. A physician voiced this frustration at home,
and by 1915, the physician’s nephew, Morgan Parker
(1892–1976), had secured a patent for a 2-piece
scalpel, allowing spent blades to be quickly replaced6
(Fig. 1).
Later in the same year, Parker demonstrated his
invention at the American College of Surgeons
where he received encouragement to pursue large-
scale manufacture. Parker opened the telephone di-
rectory and contacted the first name listed under
medical suppliers. The Bard-Parker company was
born.7
Rudolph Beaver (1886 –1968) led a division of
Gillette that tried to parlay the razor blade into a
successful surgical knife. He later formed his own
company and patented a variety of highly specialized
blades and handles8 –11 (Fig. 1).
944 The Journal of Hand Surgery / Vol. 32A No. 7 September 2007
Instruments from Thoracic,
Abdominal, and Urologic Surgery
Halsted
After his appointment as chief of surgery at the
newly opened Johns Hopkins Hospital, William
Stewart Halsted (1852–1922) became a preeminent
figure in American surgery, establishing the surgical
resident system and training Harvey Cushing among
numerous other influential surgeons.12,13
His enthusiasm for Listerism was the logical ad-
junct to his meticulous surgical technique, delicate
handling of tissues, and rigorous hemostasis. Halst-
ed’s development of precision “mosquito” hemostats
likely contributed to his reputation as a bloodless
surgeon (Fig. 2). Halsted wrote:
The value of artery clamps is not likely to be overesti-
mated. They determine methods and effect results im-
possible without them. They tranquilize the operator. In
a wound that is perfectly dry, and in tissues never
permitted to become even stained by blood, the operator
unperturbed may work for hours without fatigue. The
confidence gradually acquired from masterfulness in
controlling hemorrhage gives to the surgeon the calm
which is so essential for clear thinking and orderly
procedure at the operating table.13
Like Lister, Halsted immersed his instruments in
carbolic acid. Repeatedly retrieving the instruments
from this sterilizing solution created a rash on the
hands of his chief nurse (and future bride), and Hal-
sted approached the Goodyear Rubber Company.
Together they developed a protective glove that did
not compromise the operator’s dexterity. Nurses and
surgeons alike began wearing rubber gloves, intend-
ing at first to protect themselves and realizing later
the benefit afforded to patients. In addition to rubber
gloves, Halsted introduced white surgical gowns, caps,
and masks to the American operating room.12,13
Figure 2. Instruments from thoracic, abdominal, and uro-
logic surgery. From left to right: Weitlaner retractor, Kocher
hemostat, Halsted hemostat, Crile hemostat, Mayo scissors,
Allis forceps, Senn retractor.
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
Halsted’s career was marked also by personal id-
iosyncrasies (he appears to have been obsessed with
the proper construction of his shoes), self-experimen-
tation with cocaine, and subsequent periods of addic-
tion. Despite his dependencies and quirks, Halsted
remains rightfully acknowledged as the father of
American surgery.12,13
Crile
During his internship at University Hospital in
Cleveland, George Washington Crile (1864 –1943)
witnessed a colleague succumb to shock after bilat-
eral high thigh amputations. “The cold sweaty skin
and the pallor, the fading pulse, the high pulse rate,
the sunken eyes, and dilated pupils fixed themselves
in my memory.” This event motivated Crile to be-
come one of the first, true American physiologists.
He popularized blood pressure monitoring in the
operating room, performed blood transfusions before
there was an awareness of blood typing (adverse
reactions were likely masked by the recipient’s mor-
ibund condition), and, in frequent collaboration with
Harvey Cushing, contributed greatly to the under-
standing of physiologic duress.14
In addition to the Crile hemostats in use today,
Crile developed a pneumatic rubber suit to fight
hypotension in neurosurgery patients (Fig. 2). Mod-
ern fighter pilots wear G-suits descended from
Crile’s design.15
Crile was a prolific surgeon, once performing 32
thyroidectomies in a single day, adding to a career
total of roughly 25,000. Crile was renowned for his
academic productivity, publishing 24 books and
more than 400 other works. On the foundation of this
abundant work, Crile helped to found the American
College of Surgeons and the Cleveland Clinic.14
Halsted and Crile hemostats vary principally in
size. Two distinctly different ratcheting forceps fea-
ture specialized tips for secure grasping of tissues.
Allis
Oscar Huntington Allis (1826 –1921) developed his
long-armed forceps as a means of manipulating in-
testinal ends during anastomosis. Allis described this
new means of closure: “When near the end of the
approximation I have found toothed forceps, with
serrations on the edge, convenient for turning in the
mucous edges, adjusting the serous, and holding
them approximated until sutured . . . I do not care to
recommend these instruments simply as aids in in-
testinal work . . . the forceps with lateral serrations
are often most convenient as hemostats, or as search-
 Meals and Meals / A History of Surgery in the Instrument Tray
ers for tendons which are retracted in wounds of the
hands and feet”16 (Fig. 2).
Kocher
In his textbook, Swiss surgeon Theodor Kocher
(1841–1917) described use of his toothed clamp.
“The bleeding points, however, should not be imme-
diately ligated for it is dangerous to expose ligature
material to the risk of contamination during the
whole course of the operation. The newer pattern of
artery forceps has the advantage that even when a
large number are necessary, they are conveniently
hung out of the way and do not interfere with the
surgeon’s movements. The variety we use is very
light, is easily applied and takes a firm grip in the
case of dense tissues”17 (Fig. 2).
Kocher was an image of deliberation in a time
when surgeons were valued for their speed and flair.
This philosophy and Kocher’s strict adherence to
asepsis were responsible for his patients’ remarkably
low mortality rate, especially after thyroid surgery,
which Kocher helped pioneer.18 For this advance and
for his related experimental work, Kocher received
the Nobel Prize, the first of only 2 surgeons to be so
recognized.4
Mayo
The Mayo Clinic bears the name of the remarkable
family at its core. William Worral Mayo (1819 –
1911) moved to Rochester, Minnesota, in 1863 to
establish a medical practice.19 He believed his sons
should be “handy,” and raised them in close associ-
ation with his own work. The older son, William
James Mayo (1861–1939), said of his upbringing,
“We were reared in medicine as a farmer boy is
reared in farming.”20 The younger son, Charles
Horace Mayo (1865–1939), became his father’s
anesthetist as a teenager.21 That both brothers be-
came doctors was inevitable.
In 1883, a tornado swept through Rochester. The
Mayos and a local convent of nuns collaborated to
treat victims. Subsequently, the nuns began raising
money for a local hospital and asked the Mayos to be
the hospital’s surgeons. The Mayo Clinic was born.22
Today, the Mayo Clinic’s international importance
and reputation for innovation are broadly recognized.
Although the Mayos added much to surgical tech-
nique and medical education, attribution of accom-
plishments to either brother individually is difficult.
A friend of the brothers was known to have said, “I
believe if Dr. Will were elected president of the
United States he would accept the office in the name
of his brother and himself.”23
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
945
We were unable to determine specifically which
brother developed the Mayo scissors (Fig. 2). Con-
versely, the Weitlaner (often bastardized as Wheat-
lander) self-retaining retractor is clearly attributed to
Austrian Franz Weitlaner, although we have been
unable to discover anything about this surgical inno-
vator24 (Fig. 2).
Senn
Another wound retractor came from Nicholas Senn
(1844 –1908), a PhD, a doctor of laws, and a physi-
cian. In his book, Senn depicts a number of instru-
ments of his devising. His well-known retractor il-
lustrates the section on rupture of the urethra25 (Fig. 2).
Senn worked in Milwaukee and later in Chicago,
was an early proponent of Listerism, and initially
advocated operating under a fog of carbolic acid
spray.26 Senn realized that aseptic technique de-
manded an evolution in surgical instruments, saying,
“All attempts at ornamentation have been aban-
doned . . . . The modern surgical instruments are made
as plain and smooth as possible.”27
Senn earned his reputation as an innovator with
hard work. His partner said, “When [Senn] was in his
creative moods, he was quite unaware to whether he
had changed his clothing, eaten or slept—such was
the thrust of his hunger for work and for the satis-
faction of his ambitions.”28 Senn did much of his
experimenting in a private basement laboratory. His
tinkering reportedly coincided with a disappearance
of cats from the neighborhood.26
Senn was additionally an intrepid world traveler,
numbering Siberia, Tahiti, Africa, the Arctic, and
South America among his destinations. Senn died of
myocarditis, probably exacerbated by a Andean
climb to 16,000 feet.26,28
Instruments from Gynecology
Kelly
Howard Atwood Kelly (1853–1943), a contemporary
of Halsted at Johns Hopkins, established gynecology
as a specialty and is known for the widely used Kelly
clamp29 (Fig. 3). Kelly was a staunch advocate of
social reform, a fundamentalist Christian, and an avid
collector of reptiles.29 Kelly’s son, also a physician,
described the family library:
. . . its walls solidly lined with books and thronged with
curiosities from all quarters of the globe . . . never the
same place from one day to the next, its stacks of newly
arrived books on tables and chairs, its mysterious half-
emptied packages of strange and foreign objects, and its
never-ending stream of visitors served to make of it a
living organism.29
946 The Journal of Hand Surgery / Vol. 32A No. 7 September 2007
Figure 3. Instruments from gynecology. From left to right:
Kelly clamp, Gelpi retractor.
Actual living organisms—specimens in Kelly’s
herpetological collection—were allowed to slither
freely through the home.
Kelly aided women in all walks of life. He sup-
ported women’s suffrage and worked to expose prej-
udice against women entering the medical profes-
sion.29,30 Outside the hospital, he rented a home
where prostitutes were invited to live, rent-free,
while they sought more seemly employment.29
In doing good, Kelly surely earned his share of
detractors. He worked with the Lord’s Day Alliance,
who patrolled Maryland on Sundays to discourage
citizens from alcohol, games of chance, sports, and
movies. Kelly’s most famous critic was the irrev-
erent H.L. Mencken, and the two friends sparred
publicly.31 In 1932, Mencken delivered this shot:
He happens to be a man I have long known, and in
every respect save the theological, greatly respected.
But in that theological respect, it seems to me he is so
plainly a menace to the peace and dignity of this town
that what he believes should be made known to every
one, that the people may be alert to his aberrations and
keep a curb upon his public influence. If he had his way,
it must be obvious, life here would be almost impossi-
ble to civilized men.29
Mencken could tease, but he could not detract
from the ability of a man who, through tireless will,
erected an enduring place in medicine for the care of
women. Kelly could also, it appears, return Menck-
en’s sarcasm. He once wrote to the editor of the
Baltimore Sun:
If Mr. Mencken would put a photospectroheliograph on
his ramshackle tergiversating cerebrum, I think he
would discover that he was something of a synentog-
nathous physoclistous levirate leventine belone with
perissodactyl affinities . . . . This is my most gentle
response to his last innocuous blusterings.32
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
Gelpi
Maurice Gelpi (1883–1939) worked in New Orleans
and served a term as president of the Orleans Parish
Medical Society.33 In the society’s journal, he de-
scribed his self-retaining perineal retractor:
Anyone who realizes the tremendous number of surgi-
cal instruments in existence today can appreciate the
fact that it takes considerable moral courage to increase
that appalling number even by a single unit . . . . It is
only fair to state here that of those who tried the
instrument our own chief, Dr. Clark, was the one by
whom the instrument was commented upon with the
least enthusiasm. Yet, in spite of this, both Dr. Kost-
mayer and myself have managed at different times to
slip in the retractor in Dr. Clark’s instruments and have
seen him use it apparently with perfect ease and success
on several occasions. Certainly the finished perineor-
rhaphy didn’t seem to have suffered from the use of the
retractor . . . . simplicity was an argument in its fa-
vor . . . . The old instruments require more assistance
because they must be held in place and are often un-
satisfactory because they may be pulled out of the
mucous membrane by a careless assistant34 (Fig. 3).
Instruments from Otolaryngology
Freer
Otto Tiger Freer (1857–1932) of Chicago developed
a series of elevators, “flat knives with rounded, pad-
dle-shaped . . . blades,” to correct deflections of the
nasal septum (Fig. 4). His published descriptions
make frequent reference to dental instruments from
which some of his tools were derived. In discussion,
he explained that “. . . many of them are little knives
whose blades have varying shapes and attachments to
their shanks to enable them to move in the proper
directions on the field of operation, which all must
Figure 4. Instruments from otolaryngology. From top to bot-
tom: Yankauer suction tip, Lempert rongeurs, Metzenbaum
scissors, Freer periosteal elevator.
 Meals and Meals / A History of Surgery in the Instrument Tray
reach by the same narrow passage—the nostril . . . .
Their simple form and cheapness make up for their
number.”35
Yankauer
Sydney Yankauer (⬃1872–1932) designed an anes-
thesia mask on which ether or chloroform could be
dripped.36 The device became standard issue in op-
erating rooms across the globe, although now en-
tirely obsolete. He held a patent for a scalpel with a
detachable blade, which was displaced by Parker’s
1915 revelation.37 Conversely, his tonsil suction tip,
originally made of steel, remains an operating room
staple today in both metallic and plastic forms (Fig. 4).
Yankauer contributed greatly to the specialization of
bronchoscopy and devised also a pharyngeal specu-
lum, an electrode for fulgurating the larynx, and a
radium needle for the esophagoscope.38
Lempert
As a youth in Czarist Russia, Julius Lempert (1890 –
1968) was pursued by police after participating in an
antigovernment demonstration. The experience con-
cerned Lempert’s father, and the family soon emi-
grated to the United States.39 If Lempert’s young life
was shaped by a rebellious act, his professional life
was no different.40
In New York, Lempert developed a 1-stage fenes-
tration operation for the treatment of otosclerotic
hearing loss.39 To this end, he developed special
tools, including a small single-action rongeur, the
prototypes of which Lempert rejected in great num-
ber41 (Fig. 4). His perfectionism and the obstreperous
defense he mounted around his controversial proce-
dure so perturbed the elders of his profession that he
was barred from the American Otologic Society.42
Lempert’s operation, nonetheless, earned him wide
recognition. Lempert is said to have completed more
than 3,000 fenestrations while simultaneously teach-
ing his technique to a worldwide audience of sur-
geons.42
Perhaps Lempert became uncomfortable as his de-
tractors dwindled. He took on the American govern-
ment, failing to properly pay the tax on his sizeable
income.42 When stapectomy superseded his fenestra-
tion technique in popularity, Lempert refused to
budge. To his death, Lempert resisted the inversion
of the status quo he had personally established. Al-
though this quirk of Dr. Lempert’s was lamented by
some of his students, it is possible that precisely by
rejecting stapectomy, Lempert did much to improve
it.42 Faced with a formidable opponent, the doctors
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
947
that championed this new technique had to be at their
best.
Metzenbaum
Myron Firth Metzenbaum (1876 –1944) practiced
otolaryngology in Cleveland, and he used the scis-
sors he invented to remove inflamed tonsils (Fig. 4).
Metzenbaum owed much to his famous mentor,
George Crile. When Crile solicited freshman medical
students to live in the hospital and assist in the wards,
Metzenbaum volunteered. The two bonded, Metzen-
baum boarded in the hospital and eventually accepted
an invitation to join Crile in practice. Metzenbaum
later became interested in facial reconstructive sur-
gery and was a founding member of the American
Board of Plastic Surgery.
Metzenbaum organized the Cleveland ambulance
service, which was probably the first service of its
kind in the United States. He also developed a drop-
ether anesthesia technique after experiencing diffi-
culty sedating hard-drinking Cleveland factory work-
ers. This refinement persisted in American medicine
for 50 years.43
Instruments from Ophthalmology
Stevens
George Thomas Stevens (1833–1921), a veteran of
the Civil War, was a professor of physiology and
diseases of the eye in New York.44 In 1889, he
described his technique for correcting strabismus.
Stevens recommended an intratendinous shortening
and tenorrhaphy of the underactive rectus muscle
using scissors of his design, which are depicted and
described in his article: “Their cutting properties are
perfect, they are strong enough to overcome every
resistance, while their points are so very slender that
they work beneath the conjunctiva through an ex-
tremely small opening” (Fig. 5). Previous techniques
for correcting strabismus involved advancing the at-
tachment of the rectus muscle on the eyeball.
Stevens2 observation on those procedures were in-
sightful and remain pertinent. “It is probable that
nearly every surgeon who has had any considerable
experience in these operations has learned that each
of the methods which have from time to time been in
vogue promises much better than it fulfills, and that
failure in producing any exact results is the rule
rather than the exception.”45
Barraquer
After he observed a leech lift a small stone from the
bottom of an aquarium, Ignacio Barraquer (1884 –
948 The Journal of Hand Surgery / Vol. 32A No. 7 September 2007
Figure 5. Instruments from ophthalmology. From lower left
to upper right: Barraquer needle holder (locking version),
Stevens scissors, Castroviejo needle holder (nonlocking
version).
1965) wondered if he could, in similar fashion, re-
move a human cataract with suction. The technique
he developed was a resounding success. Dr. Bar-
raquer’s numerous other innovations, including the
needle holder used today in microsurgery, live
on—as does the Barraquer family, which, for more
than 100 years, has contributed greatly to medicine
and health care (Fig. 5).
Barraquer’s father inducted him into the Spanish
fraternity of ophthalmology, the elder Barraquer having
laid much of the groundwork in this field himself.
Ignacio’s 2 sons and several grandchildren have con-
tinued the family tradition in ophthalmology. Ignacio
Barraquer established an eye clinic in Barcelona, a rich
source of continuing education, and a hospital where
nearly half of all beds were reserved for indigent pa-
tients. Barraquer designed a small zoo at the center of
his institute where he indulged his love of animals. Dr.
Barraquer donated his own eyes to science.46
Castroviejo
Ramon Castroviejo (1904 –1987) also grew up in
Spain but spent most of his professional years in New
York. He tenaciously perfected the keratoplasty,
turning a dangerous and rarely attempted proce-
dure into one that now affords sight to countless
patients. Castroviejo’s success had much to do with
his enthusiasm for the microscope and his willing-
ness to develop smaller instruments.47 Whereas oth-
ers persisted in the use of clamps with inferior re-
sults, Castroviejo took advantage of newly developed
atraumatic suture needles and used locking micro
needle holders (nearly identical to those designed by
Barraquer except for the shape of the handle) to
suture transplanted tissue to the cornea48 (Fig. 5). He
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
developed roughly 60 instruments in his career. Cas-
troviejo said of the creative process, “Maybe when
you are operating, your subconscious speculates on
what you should do and with which instruments. But
it is when your are driving the car that you suddenly
realize and discover what you must do the next
time.” He laughed about his passion for innovation,
“When I die, the epitaph on my tomb should be
‘wake me at 8 a.m.’”47
Castroviejo once arrived at a Chicago conference
where he learned that many of the attendees intended
to dismiss his claims. Castroviejo hired a rail coach
and delivered dozens of his New York postoperative
patients to Chicago. He supplied each patient with a
pen light so that detractors were treated to lucid
justification for Castroviejo’s keratoplasty.48 When
he died, Castroviejo also donated his eyes.47
Instruments from Neurosurgery
Cushing
Harvey Williams Cushing (1869 –1939) is among the
most famous neurosurgeons of all time. He trained
under Halsted and served at Johns Hopkins before
moving to Harvard. His fame is attributable to his
lust for hard work, his pioneering use of electrocau-
tery, and his progressive understanding of human
physiology. Before Cushing, neurosurgery was prob-
ably as threatening to patients as the tumors they
developed. Cushing did much to change this.
Cushing traveled and collaborated greatly. Early in
his career, he developed, with Ernest Codman, the
“ether chart” so that surgeons and anesthesiologists
could cooperate in the monitoring of operative pa-
tients. Trips through Europe inspired him to turn
exclusively to the brain and particularly the pituitary
gland. His work with physicist William Bovie was
instrumental in developing a cautery tool, so impor-
tant in neurosurgery, that would both sever and seal
bleeding vessels. Cushing introduced and popular-
ized use of the mercury sphygmomanometer in
America.15 He was also the first to use a pneumatic
tourniquet in surgery, first on the upper limb and then
placing it around the head and inflating it with a
bicycle pump to quell scalp bleeding during craniot-
omies.49 The pneumatic tourniquet sees daily use in
extremity surgery, as does the Cushing vein retractor
(Fig. 6).
Cushing was gentle with his patients and a fierce
taskmaster among his co-workers. He frequently de-
manded that his operating room staff join him in
surgery on Saturday and Sunday mornings. Off-
hours, Cushing was a tireless author and talented
 Meals and Meals / A History of Surgery in the Instrument Tray
Figure 6. Instruments from neurosurgery. From top to bot-
tom: Cushing retractor, Adson forceps, Frazier suction tip.
illustrator. In 1926, he won the Pulitzer Prize for his
biography of his next-door Baltimore neighbor, Sir
William Osler.50
Frazier
In the early 1900s, Cushing and Charles Frazier
(1870 –1936) were considered to be the only 2 Amer-
ican doctors with extensive neurosurgical practices.
At the University of Pennsylvania (where Alfred
Adson was enrolled), Frazier was known both as a
charitable tutor and a fearsome pedagogue. A “Fra-
zier Club” sprang up at Penn welcoming those stu-
dents who had been ignominiously dismissed from
“Pop Frazier’s” operating room. In fits of insomnia,
Frazier was known to call his interns at 3 in the
morning and demand that they “pre-op.” His legacy
includes the suction tip that bears his name51 (Fig. 6).
Adson
Early in his career at the Mayo Clinic, Alfred Wash-
ington Adson (1887–1951) removed a brain tumor
while three elite European military surgeons looked
on. One later reported seeing a high school boy
perform neurosurgery. Thirty years old at the time,
Adson’s appearance belied his ambition. The interest
these esteemed men showed for this particular case
inspired Adson, and from this point, he focused in-
creasingly on surgery of the brain and nerves. The
pick-ups with small biting teeth attributed to him
were well adapted to precise lifting and removing of
neural tissue52 (Fig. 6).
Instruments from Plastic Surgery
Brown
James Barrett Brown (1899 –1971) probably added
two rows of multiple, fine teeth to one of Adson’s
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
949
instruments, creating the so-called Adson-Brown pick-
ups (Fig. 7). During his career at Washington Uni-
versity in St. Louis, Brown coined the expression
split-thickness skin graft as he revolutionized burn
management and coverage of large wounds.53 Attri-
bution is not clear, however, especially in light of
Alfred Adson’s close association with George Elgie
Brown (1885–1935), who worked in the Department
of Medicine at Mayo and shared Adson’s interest in
the effects of sympathectomy on blood flow in a
number of disease states.54,55
Webster
The Webster needle holder has, at times, been attrib-
uted to different individuals (Fig. 7). It is sometimes
credited to a pioneer plastic surgeon, Jerome Pierce
Webster (1888 –1974). He was long-time chief of
plastic surgery at Columbia and may have been com-
plicit in the foggy history of this instrument.56
George Van O’Linda Webster (1911–1988), no ap-
parent relation, trained under Jerome Webster. The
younger Webster then served in the U.S. Navy during
World War II and was a founding member of the
American Society for Surgery of the Hand as well as
its 13th president.57 In an article published by
George Webster, he describes a small needle holder
with absolutely flat jaws and slightly rounded edges
that furnish “a secure, noncutting grip even with the
finest silk suture.”58 It is said that, as a resident,
George Webster had the idea to grind off the teeth of
a needle holder. Jerome Webster told him that doing
so would be grounds for dismissal. In later years, the
elder Webster apparently declined to rectify errone-
ous attribution of the ground-down instrument to
himself (E. Zook, MD, personal communication,
2006).
Figure 7. Instruments from plastic surgery. From lower left to
upper right: Ragnell retractor, Webster needle holder, Adson-
Brown forceps.
950 The Journal of Hand Surgery / Vol. 32A No. 7 September 2007
Ragnell
Allan Ragnell (1902–1982) trained in plastic surgery
in England before returning to Sweden. In 1944, he
became chief of plastic surgery at Serafimerlasarettet
in Stockholm, the first department of its kind in
Scandinavia. His influence spread, and he later di-
rected a larger plastic surgery and burn department at
the Karolinska Institute. At the time of his death, 7 of
8 Swedish plastic surgery centers were chaired by
either first- or second-generation descendents of Rag-
nell’s training.59 His elegant, double-ended retractor
has further memorialized his name (Fig. 7).
Instruments from Orthopedic Surgery
Lambotte
Albin Lambotte (1866 –1955), a Belgian, was as
much a mechanic as he was a surgeon. His workshop
aptitude allowed him to make his own surgical in-
struments, including the eponymous osteotomes
and many of the bone clamps in contemporary
use60 (Fig. 8). Lambotte also crafted fine violins.61
He coined the word osteosynthesis to describe
bone healing and greatly advanced the techniques of
both internal and external fracture fixation. His 1913
book describes the intramedullary nailing of scaph-
oid fractures and the pinning of Bennett’s frac-
tures.5,62 Lambotte fostered mechanical ability
among his students at the University of Antwerp—
insisting that they saw straight, drill, and thread pre-
cisely.60 Lambotte himself was a model of precision,
operating with white gloves and using a meticulous
Figure 8. Instruments from orthopedic surgery. From upper
left to lower right: Bennett retractor, Cobb periosteal elevator,
Key periosteal elevator, Lambotte osteotome, Hohmann re-
tractor, Verbrugge clamp.
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
“no touch” technique that he believed protected his
patients from infection.5
Verbrugge
Jean Verbrugge (1896 –1964) was an esteemed stu-
dent of Lambotte and his eventual academic succes-
sor. Verbrugge learned the science of fracture fixa-
tion from its progenitor and applied it with success,
especially in children.63 The Verbrugge bone clamp
is a contemporary symbol of his seminal work (Fig. 8).
In marked distinction to domineering surgeons of his
time, Verbrugge was known for his friendliness. He
was heard to address a clumsy operative assistant
saying, “I do not think that I would have set about it
that way.”64
Key
Medical school for John Albert Key (1890 –1955)
was interrupted by financial hardship. After a stint as
an anatomy instructor, he returned to his studies and
volunteered in World War I France as a student-
intern. While in Europe, Key received notice of his
medical school graduation by cablegram. On return
to the United States, he taught applied physiology at
Harvard and then orthopedics at the University of
Maryland before settling in St. Louis where he be-
came research director at the Shriners Hospital.
Later, Key became chief of orthopedics at Washing-
ton University. Key is remembered not only for his
periosteal elevator but also for his generous support
of students and trainees of limited means65 (Fig. 8).
Hohmann
Georg Hohmann (1880 –1970) started and finished
his career in Munich with intervening years in Frank-
furt. He founded an early rehabilitation center for
veterans disabled in World War I and summarized
his vast experience gained from the treatment of war
injuries in his thesis on pseudarthroses and flail
joints. He described transferring the pectoralis major
to restore elbow flexion as early as 1917 and devised
popular techniques for treating tennis elbow, bunion,
and hammer toe.66,67 The bone retractor bearing his
name is an additional memorial (Fig. 8).
Bennett
A bone retractor similar to Hohmann’s carries the
name of Irish surgeon Edward Hallaran Bennett
(1837–1907) who is perhaps best remembered for the
eponymous thumb metacarpal fracture (Fig. 8). Ben-
nett contributed greatly to the Irish body of medical
knowledge and became president of the Royal Col-
lege of Surgeons of Ireland in 1884. Bennett ex-
 Meals and Meals / A History of Surgery in the Instrument Tray
panded the Trinity College collection of fracture and
dislocation specimens and was a supreme authority
on fracture care through the end of the 19th cen-
tury.68 With his interest in bones and joints, it was
natural that Bennett embraced the nascent science of
radiology. He was also an early and outspoken pro-
ponent of Listerism and aseptic technique.69 Upon
his retirement, 200 former students gathered to show
their appreciation. He returned their gift as a fund
from which Trinity College began awarding out-
standing students.68
Cobb
John Robert Cobb’s (1903–1967) obituary in the
Journal of Bone and Joint Surgery reflects, “He
loved carpenter’s tools and surgical instruments of
which he had great knowledge and mastery.” He
arrived at orthopedics after serving on a merchant
steamer and paying his own way through Brown
University, where he earned a degree in English
literature. Cobb joined a dynamic staff at the Hospi-
tal for the Ruptured and Crippled in New York and
was charged with developing a scoliosis clinic.
Through strict adherence to evidence-based decision
making, Cobb made valuable contributions to the
understanding and treatment of scoliosis. He divided
scolioses by etiology and severity and taught that
only those idiopathic curves with proven progression
required surgery. All his patients, over whom he
watched “as a father over his own children,” must
have benefited from his careful and conservative
care.70 His periosteal elevators find current use in
hand surgery principally for exposing the pelvis dur-
ing bone grafting procedures (Fig. 8).
Meyerding
Another spinal surgeon, Henry Meyerding (1884 –
1969), spent his career at the Mayo Clinic and wrote
widely on bone tumors, fractures, Volkmann’s con-
tracture, back pain, and spondylolisthesis.71,72 Sev-
eral flat-bladed retractors bear his name, including a
“finger retractor,” presumably named for the closed
loop at its nonworking end that is easily retained by
a single hooked finger. Meyerding was a master of
clinical diagnosis and stressed its importance in this
conversation with his son in 1960:
Maybe it was a good thing you didn’t become a phy-
sician after all . . . . Medical colleges are turning out
nothing but technicians now. All they know is what dial
to turn and what pill to prescribe. And do you know
with all this technology they’re always harping about,
they’ve had at their disposal all along a single instru-
ment that contained all the information about what was
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
951
going on in their patient’s bodies, right down to the
atomic level: the patients’ brains. But most of these
young fellows couldn’t interview a patient to find out if
it was raining, let alone find out what was ailing him.72
Discussion
The lives of these 33 men span nearly 2 centuries
from Liston’s birth in 1794 to G.V. Webster’s death
in 1988. Collectively, the work of these men and
their contemporaries forms the basis of modern sur-
gery. Many of these physicians will remain well-
known for generations to come. Other names, such as
Gelpi and Weitlaner, might be inclined to fade were
it not for the usefulness and ubiquity of their inven-
tions.
Of the inventors described, patents were obtained
only by Parker and Beaver, neither of whom was a
doctor. The surgeon innovators apparently shared
their instruments altruistically, as they shared their
techniques and experiences. A search of the United
States Patent and Trademark Office, however, re-
veals a multitude of patented surgical instruments, all
more complex and task-specific than the ones de-
scribed by us. Simplicity and wide applicability has
fostered the endurance of these legally unprotected
tools.
Every surgical specialty is represented in the hand
surgery instrument tray. These eponymous tools me-
morialize men exclusively, evidence of a now wan-
ing tradition in surgery. We were unable to attribute
the Edna towel clamp, which may have been named
for a female operating room nurse (T. Fischer, MD,
personal communication, 2006). Other unsolved
mysteries include the Backhaus towel clamp and the
Hiess (or Heiss) self-retaining retractor (sometimes
described as a mastoid retractor).
Undoubtedly, we have excluded many readers’
favorite eponymous instruments, both those honoring
their mentors and others of particular personal use-
fulness. Before accurate attribution becomes impos-
sible, we encourage others to document the origins of
such tools, including all that have been developed
since 1945. In doing so, we maintain a vital connec-
tion with the great heritage of surgical craft.
Received for publication March 16, 2007; accepted in revised form May
8, 2007.
No benefits in any form have been received or will be received from
a commercial party related directly or indirectly to the subject of this
article.
Corresponding author: Roy A. Meals, MD, 100 UCLA Medical Plaza,
#305, Los Angeles, CA 90024; e-mail: rmeals@ucla.edu.
Copyright © 2007 by the American Society for Surgery of the Hand
0363-5023/07/32A07-0001$32.00/0
doi:10.1016/j.jhsa.2007.05.007
952 The Journal of Hand Surgery / Vol. 32A No. 7 September 2007
References
1. Bailey H, Bishop WJ. Notable names in medicine and sur-
gery. 2nd ed. London: H.K. Lewis & Co. Ltd., 1946:51–53.
2. Mc Dowell F. Commentary by the editor. Plast Reconstr
Surg 1971;48:168 –169.
3. O’Dowd MJ, Philipp EE. The history of obstetrics and
gynecology. New York, London: The Parthenon Publishing
Group, 1994:83– 84.
4. Firkin BG, Whitworth JA. Dictionary of medical eponyms.
1st ed. New York, London: The Parthenon Publishing
Group, 1987:242–243.
5. LeVay D. The history of orthopaedics. Carnforth, UK: Par-
thenon, 1990:105–108.
6. Parker M. Detachable blade knife. United States Patent
1,139,769. Issued May 18, 1915. Available at www.uspto.
gov.
7. Kirkup J. Who made what? Bard-Parker scalpels. J Med
Biogr 2005;13:206.
8. Beaver R. Detachable blade surgical knife. United States
Patent 1,915,244. Issued June 20, 1933. Available at www.
uspto.gov.
9. Beaver R. Cutting instrument. United States Patent
2,242,936. Issued May 20, 1941. Available at www.uspto.
gov.
10. Beaver R. Knife. United States Patent 1,813,723. Issued July
7, 1931. Available at www.uspto.gov.
11. Ochsner J. The surgical knife. Bull Am Coll Surg 1999;84:
27–37.
12. Jacek B. Man behind the enstrument (2) Halsted, William
Stewart (1852–1922). Br J Theatre Nursing 1994;4:25.
13. Crowe S. Halsted of Johns Hopkins. The man and his men.
Springfield, IL: Charles C. Thomas, 1957:47–56, 181.
14. Hermann RE. George Washington Crile (1864 –1943).
J Med Biogr 1994;2:78 – 83.
15. Crile G, ed. Grace Crile. George Crile. An autobiography.
Philidelphia: Lippincott, 1947:146.
16. Yap LH, Ahmad T. Allis forceps: notes on the inventor. Br J
Plast Surg 2001;54:561.
17. Kocher T. Textbook of operative surgery. 3rd English ed.
from 5th German ed. New York: Macmillan, 1911:33–34.
18. Kazi RA, Theodor E. Kocher (1841–1917): Nobel surgeon
of the last century. J Postgrad Med 2003;49:371–372.
19. Spinner RJ, Al-Rodhan NRF, Piepgras DG. 100 years of
neurological surgery at the Mayo Clinic. Neurosurgery
2001;49:438 – 445.
20. Clapesattle H. The Mayo brothers. Minnesota Med 1954;37:
779.
21. Carson C. Charles Horace Mayo (1865–1939). Invest Urol
1981;18:313–314.
22. Jacek B. Man behind the enstrument (11). Br J Theatre
Nursing 1995;4:25.
23. Clapesattle H. The doctors Mayo. 2nd ed. Minneapolis:
University of Minnesota Press, 1954:667– 696.
24. Weitlaner F. Ein automatischer Wundspreizer [An automatic
wound spreader]. Wiener klinische Rundschau 1905;19:
114 –115.
25. Senn N. Practical surgery for the general practitioner.
Philadelphia: WB Saunders, 1901:306.
26. Natvig P. Nicholas Senn of Milwaukee and Chicago, his
contributions to plastic surgery. Plast Reconstr Surg 1978;
61:167–176.
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
27. Edmonson JM. American surgical instruments: an illustrated
history of their manufacture and a directory of instrument
makers to 1900. San Francisco: Norman Publishing, 1997:
319 –320.
28. Hamilton S. The great master of abdominal sugery: Nicholas
Senn, MD, 1844 –1908. Wisc Med J 1992;91:245–249.
29. Speert H. Memorable medical mentors: III. Howard Atwood
Kelly (1858 –1943). Obstet Gynecol Surv 2004;59:227–233.
30. Allen PM. Howard Atwood Kelly (1858 –1943): his life and
his enduring legacy. South Med J 1991;84:361–368.
31. Karp LE. Doctors afield: the fundamentalist and the
iconoclast: H.A Kelly and H.L. Mencken. N Engl J Med
1975;292:297–299.
32. Davis AW. Dr. Kelly of Hopkins: surgeon, scientist, Chris-
tian. Baltimore: The Johns Hopkins Press, 1959:194 –195.
33. OPMS. OPMS Presidents 1978 –2004. Available at www.
opms.org/about/presidents.htm.
34. Gelpi MJ. A new self-retaining perineal retractor. N Orl Med
Surg J 1913;66:182–183.
35. Freer OT. The correction of deflections of the nasal septum
with a minimum of traumatism. JAMA 1902;38:636 – 642.
36. M.A.G. In memoriam: Dr. Sidney Yankauer. Laryngoscope
1932;42:818 – 820.
37. Yankauer S. Scalpel. United States Patent 445,237. Issued
January 27, 1891. Available at www.uspto.gov.
38. Anonymous. Sidney Yankauer. Ann Otol Rhinol Laryngol
1932;41:1278 –1281.
39. Cawthorne T. Julius Lempert, a personal appreciation. Arch
Otolaryngol 1969;90:680 – 686.
40. Senturia BH. Julius Lempert. Arch Otolaryngol 1969;90:
702.
41. House HP. Memories. Arch Otolaryngol 1969;90:694 – 696.
42. Hoople GD. Personal recollections of Julius Lempert. Arch
Otolaryngol 1969;90:690 – 693.
43. Metson R. Myron F. Metzenbaum, MD: innovative surgeon,
caring physician. Otolaryngol Head Neck Surg 1994;110:
477– 481.
44. Anonymous. Deaths, George Thomas Stevens. JAMA 1921;
76:465.
45. Stevens GT. Tendon resection and tendon contraction for
shortening the recti muscles. N Y Med J 1889;49:345–348.
46. Greene AK. Ignacio Barraquer (1884 –1965) and the Bar-
raquer family of ophtahlmologists. Can J Ophthalmol 2001;
36:5– 6.
47. Murube J. Ramon Castroviejo centenary: a life dedicated to
corneal transplantation. Surv Ophthalmol 2005;50:215–225.
48. Polack FM. Ramon Castroviejo 1904 –1987. Cornea 2000;
19:593– 602.
49. Cushing H. Pneumatic tourniquets: with special reference to
their use in craniotomies. Med News 1904;84:577–580.
50. Thompson EH. Harvey Cushing, surgeon, author, artist.
New York: Schuman, 1950:114.
51. Boockvar JA, Virella A, Kotapka M, Flamm ES, Grady MS.
Neurosurgery at the University of Pennsylvania Medical
Center. Neurosurgery 2000;46:1223–1228.
52. MacCarty CS. Alfred Washington Adson. Surg Neurol
1977;7:53–54.
53. Cannon B. James Barrett Brown. Ann Plastic Surg 1981;7:
79 – 89.
54. Shepherd J, Vanhoutte P. Local modulation of adrenergic
neurotransmission. Circulation 1981;64:655– 666.
 Meals and Meals / A History of Surgery in the Instrument Tray 953

55. Nerve Congress. Time. Monday, Auguest 12, 1935. Available at
www.time.com/time/magazine/article/0,9171,771796,00.html.
56. Tanzer RC. Obituary: Jerome Pierce Webster, M.D. Plast
Reconstr Surg 1975;55:728 –731.
57. Gurdin MM. Obituary: George Van O’Linda Webster, M.D.
1911–1988. Plast Reconstr Surg 1989;84:860 – 861.
58. Webster GV. A new needle holder for plastic surgery. U S
Naval Med Bull 1948;41:1434 –1439.
59. Keh BJ. In memoriam: Allan Ragnell. Scand J Plast Recon-
str Surg 1983;17:161.
60. Anonymous. Albin Lambotte 1866 –1955. J Bone Joint Surg
1956;38A:464 – 466.
61. LeVay D. The history of orthopaedics. Carnforth, UK: Par-
thenon, 1990:315–318.
62. Lambotte A. Chirurgie: operatoire des fractures. Paris: Mas-
son and Cie, 1913:3–50.
63. LeVay D. The history of orthopaedics. Carnforth, UK: Par-
thenon, 1990:318.
64. E.V.E. Jean Verbrugge, 1896 –1964. J Bone Joint Surg 1964;
46A:924 –926.
65. Abbot LC. John Albert Key 1890 –1955. J Bone Joint Surg
1956;38A:453– 463.
66. LeVay D. The history of orthopaedics. Carnforth, UK: Par-
thenon, 1990:205.
67. Guentz E. Georg Hohman zum 70 Geburtstag. Archiv fuer
orthopaedische und unfall Chirurgie 1949 –1951;44:133–
134.
68. Anonymous. In memoriam: Edward Hallaran Bennett, M.D.,
M.Ch.. Dublin J Med Sci 1907;124:78 – 80.
69. Anonymous. Obituary: Edward Hallaran Bennett, M.D.,
FRCSI. Br Med J 1907;1:1575–1578.
70. P.D.W. John Robert Cobb 1903–1967. J Bone Joint Surg
1968;50A:1074 –1076.
71. Social Security Death Index Search Results. Available at
http://ssdi.rootsweb.com/cgi-bin/ssdi.cgi.
72. Wright IP. Who was Meyerding? Spine 2003;28:733–735.

Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com by Elsevier on January 20, 2021.
For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.