For all the whimsical cause-and-effects that James Burke (famed for his BBC /PBS television series, Connections) has managed to lace together in his entertaining but convoluted perspective of history's significant events, I never understood why he missed the most compelling association of all: The Defenestration of Prague and the development of intervertebral disc (IVD) rongeurs.

History recalls that in 1618 a defiant group of outraged citizens threw two councilors out of the windows of Hradcany Castle and into the soft but humiliating dung-filled moat below. The citizens had been protesting the renege of religious freedom recently granted them by their King Ferdinand II. The human genome has a propensity to save and savor these seemingly lighter moments, but the brutal Thirty Years War this prank-like incident precipitated was, by any measure of civility, hardly a "light" affair. It is not so long a journey from Prague to the area surrounding the tiny Teutonic town of Tuttlingen, where nobler outcomes from that fateful event can be articulated in the mechanical (and subsequently, surgical) sense thanks to the due diligence of hard working, and less politically motivated individuals. In these little lost emerald valleys, where modern-day remnants of medieval hamlets still cling tenaciously to steep, short hillsides or cluster like peeping chicks under the watchful eye of turreted manors, the glorious Danube, of centuries old commerce and Viennese waltzes, is but a lazy meandering stream. Here a boy of 10 or 12 might easily be tempted to leap upon the mint green mane of an encroaching willow to sail across its bog-bound banks.

Here too, the tap, tap, tap of skilled surgical instrument craftsmen diligently working at their benches can be heard echoing through the hallucinative ears of a runaway imagination. The sounds may be far-fetched, but the craftsmen, their benches and the product of their profession are very real and omnipresent. For more than a century, surgical instruments of the finest quality have poured forth from this region as faithfully as the relentless flow of its resident river.

In recent years, leading shops in the area are abuzz with excitement over some of the newer design innovations in cup rongeurs for removing intervertebral body disc material. These instruments incorporate a remarkable blend of intricate craftsmanship with traditional design concepts. Honing the inner surfaces of upper and lower cups to fashion properly occluding edges capable of cutting cartilaginous material on initial contact requires exceptional skill. Placing four rows of 4 x 5 interdigitating teeth on the proximal, lateral edges of the cups to stabilize specimens to be excised adds further challenge to the daunting task of proper construction. To capture significant portions of tissue for removal with minimal shredding, jaws are hollowed, but neither the sharpest edges nor the perfect occlusion can overcome hydrostatic counter pressure induced by compressing the tissue within the confines of the hyperbolic cups. In these circumstances, the surgeon's efforts to achieve complete closure are thwarted.

Which brings us back to that nasty incident in Prague. Adopting the best of James Burke's reasoning it is this writer's opinion that designers turned slightly East and nearly four hundred years into history for innovation when fenestrations were added to these instruments as a means of releasing pent-up pressures by forcibly passing soft bodies through open windows.

Buxton's product line includes more than 50 versions of the Caspar-style IVD Rongeurs. One may start his or her collection from an offering of shaft lengths ranging from 140 mm through 300 mm. Another may choose by cup angle, in straight, up 30°, or down 30°. Still others might wish to begin one bite at a time, in 2 mm, 3 mm, 4 mm, 5 mm, and 6 mm cup sizes.

Talking Back, Vol. 2, No. 4