The Chain Saw – A Scottish Invention.

SMJ 2004 49(2): 57-60

Mark Skippen1, John Kirkup2, Ronald M. Maxton1 and Stuart W. McDonald1.

1Laboratory of Human Anatomy, University of Glasgow, Glasgow, Scotland.

2Royal College of Surgeons of England, Lincoln’s Inn Fields, London, England.

 

Correspondence to:

Dr Stuart W. McDonald:  S.McDonald@bio.gla.ac.uk

 

Abstract

The prototype of the chain saw familiar today in the timber industry was pioneered in the late 18th Century by two Scottish doctors, John Aitken and James Jeffray, for symphysiotomy and excision of diseased bone respectively. The chain hand saw, a fine serrated link chain which cut on the concave side, was invented around 1783 - 1785. It was illustrated in Aitken’s Principles of Midwifery or Puerperal Medicine (1785) and used by him in his dissecting room. Jeffray claimed to have conceived the idea of the chain saw independently about that time but it was 1790 before he was able to have it produced. In 1806, Jeffray published Cases of the Excision of Carious Joints by H. Park and P. F. Moreau with Observations by James Jeffray M. D.. In this communication he translated Moreau’s paper of 1803. Park and Moreau described successful excision of diseased joints, particularly the knee and elbow. Jeffray explained that the chain saw would allow a smaller wound and protect the adjacent neurovascular bundle. While a heroic concept, symphysiotomy had too many complications for most obstetricians but Jeffray’s ideas became accepted, especially after the development of anaesthetics. Mechanised versions of the chain saw were developed but, in the later 19th Century, it was superseded in surgery by the Gigli twisted wire saw. For much of the 19th Century, however, the chain saw was a useful surgical instrument.

Key words: surgical instruments; chain saw; John Aitken; James Jeffray; Gigli saw; amputation; symphysiotomy


Introduction

Chain saws are commonly used in Scotland’s forests and its many public and private gardens, yet how many foresters and gardeners realise they wield a tool, devised not to fell or de-branch trees, but to enhance surgical and obstetric practice in the medical schools of Edinburgh and Glasgow? Two Scottish doctors, possibly independently, invented the chain saw in the 1780s.

 

The inventors of the chain saw

John Aitken (Fig. 1), an Edinburgh obstetrician who also lectured on chemistry, anatomy, medicine and surgery1, was one of the inventors of the chain saw. Little is known of his early life and even his date of birth is uncertain. He probably trained in Edinburgh1 and he published several books on medical subjects including Principles of Midwifery or Puerperal Medicine (1785)2 and A System of Obstetrical Tables with Explanations (1786)3. It is in these books that Aitken described and illustrated devices for use in obstetrics including, for the first time, the chain or ‘flexible’ saw. Aitken died in September 17904.

 

The other pioneer of the chain saw was James Jeffray (Fig. 2), Regius Professor of Anatomy at the University of Glasgow. Born at Kilsyth in 1759, he was a student at the University of Glasgow and graduated Master of Arts in 17785. He gained an M.D. on an obstetric topic at the University of Edinburgh in 17865 and was appointed Professor of Anatomy and Botany at Glasgow in 1790. The chain saw is described in his communication of 1806 entitled Cases of the Excision of Carious Joints by H. Park and P. F. Moreau with Observations by James Jeffray M. D.6. Professor Jeffray died in January 1848 after almost fifty-eight years in the Chair of Anatomy7, the longest tenure of any medical chair in Scotland. His life and times have been the subject of a previous article8.

 

The chain saw

Unlike endless chain saws mechanised for the timber industry, the surgical hand chain saw consisted of a serrated chain cutting on the concave surface (Figs 3, 4 & 5). It was modelled on a watch chain and had jointed links6 resembling a miniature bicycle chain with serrations along one side of each link. The chain terminated in hooks or eyes, on to which either a handle or a curved blunt needle was attached. At surgery, the needle passed the chain through the soft tissues around the bone. When the saw was in position, the needle was replaced by a handle and the second handle was attached. By pulling alternately on the handles the saw cut through the bone.

            Comparison of the illustrations in Aitken’s and Jeffray’s publications2,3,6 shows that their saws were very similar (Figs 3 & 5). Jeffray’s illustration shows the needle for introduction of the saw. Only the style of the handles differs in the two instruments.

 

Why was the chain saw invented

Being primarily an obstetrician, Aitken was familiar with obstructed labour when the mother’s pelvis was too small for passage of the baby’s head. In such instances, Aitken knew of three procedures employed with differing results: hysterotomy (caesarean section) which at that time commonly resulted in the death of the mother, embryotomy (craniotomy) which ended the life of the child and pelviotomy (symphysiotomy). For the last of these methods Aitken invented the chain saw2 to divide the pubic symphysis and thus increase the pelvic diameter for passage of the child. Previously a scalpel was used9 which risked damage to the urinary bladder and urethra, and failed if the joint had calcified.

            

James Jeffray’s reasons for inventing the chain saw were entirely different from those of Aitken. After reading an article by a Liverpool surgeon, Henry Park10, Jeffray became interested in the method by which diseased joints might be excised. Park’s operation was directed at knees and elbows infected by tuberculosis or damaged on the battlefield. It involved cutting through the bone with an amputation saw, on each side of the defective joint, to remove diseased tissues. In the case of the knee, the cut surfaces united through callus formation and the final result was a stiff but usable limb. In the case of the elbow, the bone ends did not unite and scar tissue formed which connected the cut ends and, fortunately, permitted a degree of mobility. In 1806, Jeffray reprinted Park’s descriptions and translated an account of similar cases undertaken by a French surgeon, Moreau. The operations proposed by Park (1783)10 and Moreau (1803)11 aimed to reduce the need for limb amputation, the standard treatment for severely infected and damaged bones and joints in the Eighteenth Century. Jeffray’s communication of 1806 arose from his interest in Moreau’s publication, although he probably never carried out joint excisions himself. 

            

In the 1780s, Jeffray had watched a bone excision operation and the experience made a great impression on him:

“Very soon after Mr Park’s book appeared, I had an opportunity of seeing an attempt made to cut out a piece that was diseased, near the middle of the thigh bone. To do that with the common saw, was next to impossible; for the wound necessary to allow the skin and flesh to be depressed so much on either side of the bone, that the saw could be applied, must have been made to extend almost from the knee to the groin. A saw, therefore, was prepared, of a different kind, to rasp the bone across, without hurting the flesh; but the difficulty that attended the execution of this operation, the time spent in performing it, and the pain which, not withstanding all the care that was taken, the patient seemed to suffer, made such an impression on me, that I could not rest from thinking of some method, by which bones might be cut out more easily.” 

Jeffray stated he made a drawing of his idea for a chain saw, and some years later, about 1790, he had it manufactured by a London jeweller, Richards of Brick Lane6. It was in 1790 that Jeffray was appointed to the Regius Chair of Anatomy and Botany in Glasgow and maybe it was only then that he could afford the expense of having the chain saw produced. Jeffray’s drawing no longer exists.

 

Were the saws devised by Aitken and Jeffray independent inventions?

It is possible Jeffray and Aitken devised their chain saws independently. The literature is ambiguous in determining whether one invented the saw before the other. For example, Ollier (1885)12 regarded Aitken as the inventor whilst Cooper (1822)13 attributed it to Jeffray. Between 1782 and 1785, Jeffray was studying in Edinburgh and Aitken was lecturing there on subjects that would have interested Jeffray6,1,8. Jeffray was aware of Aitken’s work as he wrote to Professor Hamilton in Glasgow,

           

 “I was waiting till Boog should have some of Aitken’s instruments ready - so far from finding them as Aitken says in his paper there is not one of them in a cutlers shop in Edinr. except particularly ordered.”14

 

Although this letter of 1783 refers to a paper by Aitken, Jeffray was to study in Edinburgh for a further two years where he completed a thesis on an obstetric topic, placenta praevia, in 1786. It must be very probable that he knew Aitken, an established obstetrician, and also his publications. Although Jeffray’s paper of 1806 acknowledged awareness of Aitken’s illustration of the saw, “In the meantime, a sketch of such a saw was published by Dr John Aitken of Edinburgh.”, he continued “I do not know that any other saw (other than his own) has ever been made.”6. He seemed unaware of the existence of Aitken’s saw. Jeffray indicated that Aitken’s drawing was made after he had conceived the idea but before he was able to have it produced. We are unable to offer any formal evidence of the truth of this statement. False claims would, of course, have risked Jeffray’s integrity.

            

In 1785, John Aitken introduced the flexible saw for pelviotomy in the Second Edition of his book The Principles of Midwifery or Puerperal Medicine.

            “A flexible saw, which I have contrived to be used...”2.

 

In the 1786 publication A System of Obstetrical Tables with Explanations3, medical improvements devised by John Aitken are listed, including the flexible saw. It is noteworthy that Aitken’s illustration of his saw2 demonstrates a form which remained virtually unchanged until displaced by Gigli’s wire saw over 100 years later. The author of an anonymous review of Jeffray’s paper in the Edinburgh Medical and Surgical Journal of 1807 wrote:

“A drawing is given of this saw, which Dr Jeffray has annually used in the anatomical class, ever since the year 1790, and occasionally lent to surgeons, and used in their operations on the living body. It is just the saw we remember to have seen Dr Aitken of Edinburgh divide bones with, in his anatomical demonstrations, nearly twenty years ago, and which he called his flexible saw.”15 Although the saw Jeffray illustrated in 18066 is more robust, the linked chain is identical to Aitken’s.

            

The possibility that two Scots doctors, around the same time and in the same city, would have the same idea about a new surgical instrument with no communication between them seems unlikely, yet it is possible. There is no evidence of any argument between the two men when Aitken’s illustration of the invention was published in 17852. Both were aware of contemporary issues and their converging ideas may have created converging solutions.

The design of the saw

Jeffray wrote, “…I conceived it to be possible, that a saw might be constructed with joints like the chain of a watch, so as to allow itself to be drawn through behind a bone by a crooked needle, like a thread, and to cut the bone from behind forward, without injuring the soft parts.”6

            

The chain that Jeffray had in mind was one found within watches of this period. In the early days of clockwork watches, the problem of preventing a watch becoming slower as it wound down was overcome by the use of a fusee, a wheel in the shape of a truncated cone, round which a delicate chain was wound to mediate between the spring and the mechanism16. This chain (Fig. 6) was the prototype for the surgical saw, although the saw was much larger than a watch chain. The approximate size of the saw is indicated in Jeffray’s illustration6 (Fig. 3). In the drawing, the chain is 37 cm (about 15 inches) long and is reported as being somewhat reduced in size.

 

The T-shaped design of Jeffray’s handles would have allowed a stronger grip than Aitken’s rounded handles. Interestingly, Gigli’s twisted and barbed wire saw, a later flexible but non-linked saw, incorporated handles similar to those of Jeffray17. The materials used by Aitken and Jeffray for their chain saws are not described but it is probable they were made from crucible steel, available at that time18. Jeffray considered his chain saw resistant to wear. He used it in the dissecting room from about 1790 and claimed, “…, I can say there will be very little danger, having now used, and sometimes roughly, the same saw for these fifteen years past, without either sharpening or mending.”6

 

Chain saws were constructed in different sizes, as Jeffray confirmed when he had a larger version produced6. Later, surgical chain saws were generally about 33 cm (13 inches) long19.

 

Subsequent use of chain saws and their derivatives in surgery

The operation suggested by Aitken, although commendable in its day, was little used especially by British obstetricians20. Aitken was among a small number of advocates for symphysiotomy. The mortality rate for mother and child was high. Approximately a third of mothers and two thirds of children died after the operation21. The risks of fatal bleeding, laceration of the urogenital tract, infection17, and longer term problems of excessive movement and incontinence21 all caused concern. On the other hand, a severely contracted pelvis prevented delivery with inevitable death of the mother unless the child was extracted dead with destructive instruments.

            

Jeffray’s technique for excising the ends of bones stood the test of time. Cooper in his Dictionary of Practical Surgery (1822)22 wrote, “Dr Jeffray has recommended a particular, and, indeed, a very ingenious saw” for excising diseased joints.  Syme, however, deprecated the chain saw and said a combination of an ordinary amputation saw and Liston’s bone forceps were all he used when he reported 18 joint excisions between 1825 and 183023. Nevertheless, in orthopaedic surgery, the chain saw was a valuable improvement on the stiff-bladed amputation saw, causing less damage to surrounding tissues24. We have no evidence that Jeffray ever used it other than in the dissecting room, although he remarks that it had been loaned to surgeons on a number of occasions. It was acclaimed as an ingenious instrument in the surgical arsenal12 and was used in Europe and the United States25. The chain saw also found a use in neurosurgery to divide the vault of the skull between burr holes to gain access to the brain17.

            

The use of a needle alone to thread the saw around the bone was superseded by the chain saw carrier. This consisted of a handle bearing a curved needle with an eye. The carrier needle was guided around the bone, and a thread, to which the chain saw was attached, was passed through the eye of the needle. As the chain saw carrier was pulled back along its initial path, the thread followed. The chain saw, fastened to the end of the thread, was then drawn round the bone to be cut17,19.

            

The invention of the chain saw led to the development of several other surgical instruments. John Aitken himself wrote that a cutting edge instead of teeth gave a flexible knife2.

            

Breaking of the chain and entrapment in the bone were the main complaints against the chain saw22. In 1830 Bernard Heine introduced the first mechanical chain saw, the “osteotome”26. This device incorporated an endless chain saw in a rotary mechanism which cut on its convex surface (Fig. 7). Sadly the speed of the hand gearing was low and it bounced off compact bone making it difficult to manipulate. It had a limited surgical application, mainly in cancellous bone27. In replacing the back-and-forth motion of the hand chain saw24, the “osteotome’s” endless motion became ultimately, the model for today’s powered saws of the timber industry. Other modifications were suggested but, in 1894, Leonardo Gigli, an Italian obstetrician, took the design further by introducing a fine twisted wire saw28. The Gigli saw, which was to replace the chain saw in the excision of bone, gave a narrower and quicker cut, and if clogged, blunted or damaged was easily changed for a new saw. Gigli saw replacement was not only immediate but cheap.

Acknowledgements

We acknowledge the kind support of the staff at the Glasgow University Library and of Mr Andrew Lockhart with photography.


References

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2.      Aitken J. 1785. Principles of Midwifery or Puerperal Medicine. 2nd Edition. Edinburgh.

3.      Aitken J. 1786. A System of Obstetrical Tables, With Explanations; Representing the Foundations of the Theory and Practice of Midwifery, London: J. Murray.

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23.  Syme J. 1831 Treatise on the Excision of Diseased Joints. Edinburgh: Adam Black.

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25.  Edmonson J. 1997 American Surgical Instruments: An Illustrated History of their Manufacture and a Directory of Instrument Makers to 1900. San Francisco: Norman Publishing. p 90.

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