When I was first asked to write this article, I was just recovering from a bout with the flu. And though my desk drawer was well stocked with remedies, my thoughts turned to what sort of "cures" my ancestors might have endured.
Medical convention of the 18th century might have dictated bloodletting, the placing of hot coals on the body or blistering in order to draw bad "humors" from the body. Less adventurous patients might have looked to the apothecaries where quack cure-alls flourished, keeping enthusiasts in dulled states of inebriation. Those in the ranks of the very poor who could afford neither the physician's treatment nor the chemist's potions most likely relied on superstitions and homemade remedies. One is inclined to believe that the peasants were better off in the end.
Despite the prolific horrors of medical history, interest in antique medical instruments has grown steadily both among medical professionals and the general population. While the sight of drills, saws and knives can bring a grimace to even the most tempered face, it is this very macabre fascination that likely fuels the passion of many collectors.
Surgeon's kits complete with saws and drills seem to be among the most sought-after items, particularly those used in the Civil War, but they share the spotlight with enema kits, bloodletting devices, suture sets and apothecaries. These Civil War medical kits are antique and collectible for history buffs and collectors alike.
Medicine's Ancient Beginnings
As far back as prehistoric times, man has relied on the use of plants and minerals for medicinal purposes. Archeological finds indicate that surgeries, most specifically trepanning (drilling into the skull), were also performed on patients. (It is theorized that these operations were performed to rid patients of the demons responsible for various ailments.) Scientists have even found evidence that these neurological operations were, on many occasions, successful.
The first written record of medical subjects as we know today, appeared in the work of the Greek philosopher Hippocrates around 460 B.C. The ancient medical instruments and techniques he describes are strikingly similar to those found more than 2000 years later showing just how slowly the advancement of medicine progressed prior to the last half of the 19th century.
Obtaining artifacts of the first Greek surgeons may, however, prove elusive. Those instruments that did survive, mostly made of bronze, are extremely rare and are generally owned by major museums.
The Romans, dating from about 1 A.D., also showed great acumen for developing medical equipment, most notably the modern amputation saw. In fact, though treatment was crude by modern standards, it was less extensively and enthusiastically applied, making a patient's odds of surviving a trip to the physician far greater during Roman times than at any other time over the next 1700 years.
Though rare, Roman surgical instruments are available on the market, but collectors can expect to pay a dear price for pieces in good condition or for more desirable surgical sets. Recently, a rare 25-piece Roman surgical set dating from around 100 A.D. sold for $10,000. Apothecary chests were also employed by the Romans, but to date, few have been found, and most are in the possession of museums.
Collectors should be particularly wary when acquiring medical antiquities. Reproductions flourish in the marketplace and can be deceptively authentic in appearance. Though the price may be a little higher, buying antique medical equipment from a reputable dealer or auction house is always highly advisable.
Scientific instruments dating from the Middle Ages (1000 A.D.-1400 A.D.) and onward are slightly more accessible to the collector than their ancient counterparts and carry with them greater written accounts of usage. Examples dating from the 17th-19th centuries are generally more affordable and therefore, more popular among collectors.
The introduction of anaesthesia and sterilization in the latter half of the 19th century revolutionized the medical profession. Surgical and medical devices became less ornate and more suitable for sterilization. Wood, ivory, tortoise shell and other decorative materials, therefore, were eventually proscribed from use.
The earliest instrument makers were armorers who were later replaced by cutlers and silversmiths. While it is generally accepted that, prior to the 18th century, the greatest advances in medicine and in the development of medical instruments occurred on the European continent, it was the English who mastered the manufacture of those instruments. By the 18th century, specialized manufacturers took over the role of the tradesmen, yet maintained the English tradition for quality and excellence in production.
Like the instrument manufacturers, the role of the physician has undergone a vast transformation throughout the centuries. Until the 18th, and in many cases the early 19th century, the Church stood sentry over medical science. Believing that suffering was a visitation from God, the Church opposed the alleviation of pain by use of drugs or surgical procedures. Until the early Middle Ages, in fact, medicine and healing were the sole provenance of the monasteries. Through their close association with the monks, the task of healing later fell to the barbers who, though handy with a shaving razor, had little anatomical training or knowledge. Such a "surgeon" might perform minor surgery one hour and shave a man's beard the next, without ever washing his hands or the razor!
Ironically, it took war to bring the role of physician into a more respected light. Because soldiers were an expensive commodity during the Hundred Years' War (1337-1453) and later the War of the Roses (1453-1497) the need for skillful surgeons on the battlefield was high, and noblemen of all sides paid handsomely for medical services.
Once organized, Barber-Surgeons established apprenticeships, taught by means of lectures and dissections and issued licenses to practice. In fact, dissection of humans, primarily executed criminals, was virtually the only means of scientific research. The need for bodies became so overwhelming that grave robbers were in high demand and they went to many extremes, some even say murder, to provide corpses for medical research.
Unfortunately for their living patients, surgeons learned by trial and error. Error often predominated and most patients never lived to schedule a follow-up visit.
Despite low success rates, physicians and surgeons continued to garner favor, particularly from the wealthy class who could most afford their services. Looking back, however, it becomes clear that the wealthy were at a decided disadvantage, for their money only multiplied the number of bizarre and often deadly cures available. Many accounts tell of patients having hot coals placed on their bodies followed by bloodletting at various intervals and perhaps topped off by the raising of blisters using scalding plasters to cure their ailments.
It is told that George Washington, who had survived the icy winter at Valley Forge, met his end at the hands of an overly-zealous bloodletter who drained him of more than 9 pints of blood in 24 hours. He was suffering from a throat infection.
Surgeries, for the most part, were virtually limited to those to set or amputate a limb, often undertaken with appalling and haphazard speed and always at the risk of sending an already weakened patient into shock. Poor hygiene, rigorous physical exertion and monotonous diets provided ample human suffering, yet treatment proved so hazardous and so painful, that only under dire circumstances would anyone even contemplate a trip to the surgeon. The agony experienced by those who did seek treatment sends shivers down the spine.
Filthy surgical instruments, floors strewn with hay and sawdust used to catch blood, surgeons cloaked in bloodstained overcoats and the unbridled terror of a patient strapped to the table provided the backdrop for these operations. Keep in mind, there was no anaesthesia. Patients might be given a strip of leather to bite on as the surgeon scrambled to complete his task. Curious observers ogling from the audience would have topped off what must have been a very bizarre, circus-like atmosphere.
Hospitals were even worse. Only the very poor sought treatment here and were required to pay the cost of their funeral before they were admitted.
It must be pointed out, however, that surgeons and physicians of the time, though misguided in many of their treatments, were generally men of great compassion. They worked with what little knowledge and resources they had available to procure merciful treatment for their patients.
Looking back it is easy to dismiss physicians and surgeons who practiced during the early days of medicine as quacks or worse, butchers. However, many of the surgical instruments they developed are strikingly similar in form and function to those still in use today. While modifications have been made along the way, knowledge of human anatomy as far back as ancient Roman times, led to the development of very specific and accurate surgical instruments.
Saws For centuries, amputation was the prescribed method of treatment for everything from broken bones to gangrene. Early versions of the amputation saw were extremely heavy and unwieldy, with highly ornate handles made of horn, wood, silver or ivory that were very difficult to grasp tightly. Later refinements made the strenuous job of a quick amputation a little easier on the surgeon if not always on the patient. The beginning of the 18th century saw the emphasis shift from decorative appeal to ease of use and easier grip, thereby making saws plainer and lighter.
During the Civil War, field surgeons, working under the most deplorable conditions imaginable, were faced with literally tens of thousands of wounded men. It is not surprising that this long war and its surgeons became notorious for the number of amputations performed on the battlefields. Heavy, soft lead bullets distorted on impact causing large, gaping wounds filled with dirt and bits of clothing, shattering any bone they hit. War-weary surgeons, presented with these horrific wounds and the imminent onset of deadly infection, most often chose amputation as the quickest and most successful means for saving lives, while the dismembered limbs of thousands of soldiers piled ever higher as the war raged on.
Amputation kits used during this bloody conflict are in extremely high demand among collectors of medical antiques as well as Civil War aficionados. Most amputation kits contain at least a saw, tourniquet, knife and suturing instruments and many also include hooks, chisels, scalpels, spatula or interchangeable saw blades and come in portable, fitted cases. Prices are rising steadily, as examples are scooped off the market into private collections. Kits that cost $1200 five years ago could easily command more than $5000 today.
Accounts of neurological surgery can, through archaeological digs, be traced back to prehistoric times, and by written record to the ancient Greeks. Ancient remains also indicate that these primitive operations were often more successful than those that would follow thousands of years later. The Greeks first developed a conical shaped trephine (cylindrical saw used for opening the skull) made of metal with a serrated edge that, when turned, would cut a circular groove into the skull. Later instruments were developed that prevented the trephine, once past the skull, from sinking into the brain. And, even later, more elaborate, mechanically-operated trephines were developed.
Keeping in mind that anaesthesia would not be developed until the late 19th century, it is hard to imagine anyone volunteering to have their head wedged between the knees of the surgeon and their skull sawed open, and records indicate that very few survived. For that reason, many of the advances and developments in such surgeries and instruments were achieved at the grave expense of patients who had been committed to insane asylums and had little choice in the matter.
Surgeons also employed various skull saws, most often convex in shape with serrations on both sides of the central handle. These saws with varying degrees of curve and design were known as Heys saws named after their inventor and were used to saw through the cranium.
Most neurological instruments are found in boxed sets with earlier and rarer 16th- and 17th- century examples being more ornate than later models. A typical neurosurgery set might include a set of skull saws, at least two trephines of varying diameter, scalpel, elevator for raising the bone after it has been cut, a brush for removing small skull particles, cranium forceps and a lenticular for depressing the brain.
The practice of bloodletting (phlebotomy) has been around for thousands of years and was "logically" based on the theory that excess bodily humors (blood, phlegm, and bile) were the cause of many ailments. By the Middle Ages, the barber-surgeons were peddling their bloodletting services to a willing, albeit misguided, populace. The practice reached its pinnacle during the 18th and early 19th centuries around the world and it was not uncommon for an unfortunate patient to lose up to a pint of blood daily at the hands of an eager bloodletter.
NOTE: The modern red and white barber pole actually dates back to the barber surgeons, who used it to advertise their services. The red ribbon of color symbolized blood and the white the tourniquet and bandage that stopped the bleeding. The pole itself symbolized the stick or rod held by the patient to dilate the veins. Though barbers officially broke camp with surgeons in the 16th century, the symbol remains as the most recognizable symbol of the barber profession.
The widespread practice of prescribing bloodletting for virtually all ills eventually lost favor during the fading years of the 19th century, but remained a viable means of treatment for afflictions such as apoplexy and pneumonia for a painfully long time.
Generally, bloodletting or phlebotomy was undertaken by use of a lancet (general phlebotomy) or by means of local bloodletting by which blood was drawn from specific areas via cupping, scarification or leeching.
The lancet, used to puncture the veins of the hands, arms, jugular veins or ankle (or various other sites) was a preferred instrument for general bloodletting. The blood was caught in a shallow, handled bowl designed for this purpose. While minor modifications were made over the centuries, the lancet and the bleeding bowl have changed little. Spring lancets were developed during the 18th century but found little favor outside of Germany where they were introduced, making them rare and desirable in today's market.
Bleeding bowls are most often distinguished by a single ornate handle and shallow, flat-bottomed bowl made of pewter, porcelain or silver. Many have measurement indicators inscribed on the inside of the bowl much like a measuring cup. Lancets can be found in many varieties with handles made of various materials including ivory and ebony. Thumb lancets have a small double edged blade that pivots between horn or tortoise shell handles. Ornate lancet cases are also highly collectible, though they are becoming more difficult to find in good condition with their lancets intact.
Bleeding by lancet to release bad humors, seemed by all appearances to alleviate the symptoms of the patient. After the bleeding bowl was full, the patient, once flushed with fever, became more pallid and cool while breathing seemed calm and restful. Such were the "healing" powers of the lancet.
Cupping, leeching and scarification, while ancient in origin, enjoyed a resurgence of popularity during the 17th, 18th and 19th centuries. The purpose of cupping was to draw "bad" blood away from deeper areas of infection without actually allowing it to leave the body. A heated cup, when placed on the skin caused a vacuum which drew blood toward the surface. Favored areas included the temples, the base of the spine or behind the ears. Cupping instruments vary as widely as the ailments they were purported to cure and can usually be dated by their various innovations. Dry cupping brought blood to the surface without allowing it to escape. Wet cupping necessitated a series of incisions by a scarificator followed by the placement of a cupping device to draw blood from the prepared area.
Cupping devices are usually found in boxed sets of at least three and include a warmer and scarificator. Many sets include more "modern" cupping devices such as the mechanical leech (used for treating eye infections and uterine afflictions) or valved cups. Complete sets are most desirable and valuable.
The scarificator, introduced in the early 1700s proved more merciful than its predecessor for making incisions. Many scarificators are quite handsome in design and ornamentation and can be found crafted of silver, brass or steel and can often be found in decorative cases. Those made of brass are often less ornate. The premise of the scarificator was the spring action of several blades (anywhere from 6 to 20 ) that when triggered would instantly create a series of parallel incisions in the skin from which the blood was suctioned.
The practice of leeching has intrigued collectors for the last hundred years. Leeching, while practiced to an extent by the Romans and the Greeks, was a matter-of-fact way of life during the 17th, 18th and 19th centuries. Leeches could remove blood from very confined and restricted areas such as the eyes, the trachea and bodily cavities by attaching themselves to the skin with a small suction cup, then puncturing the flesh with sharp teeth and injecting an anticoagulant venom into the vein to keep the blood flowing. Hospitals and physicians housed literally thousands of leeches for use in bloodletting.
While few people collect leeches, the demand for the jars that housed them is tremendous. Comparatively, the leech jar is considered by many collectors to be the most visually pleasing, if not always the most significant of all the medical antiquities. Vessels for housing leeches ranged from the very plain to the extremely ornate but, for the most part all possessed the same functional features. Authentic leech jars were most often made of glass, pottery or porcelain in the shape of an urn and possessed a turned lip to prevent the leeches from escaping. With exception of a few glass models, leech jars were fitted with lids outfitted with multiple air holes.
Considering the widespread use of leeches, surprisingly few leech jars can be found in excellent condition. Ornate jars in mint condition are particularly scarce and therefore bring a higher price. Depending on rarity and condition, leech jars can fetch astronomical prices, but can generally be found in fine condition for around $4,500. Leech carriers, made of pewter or other metal, came in many shapes and were used by physicians when making "house calls." They are very difficult to find and are often overlooked by collectors who might not be aware of their use. Look for the telltale air holes punched into the lid or sides of the case.
While little thought was given to preventive measures, and even less to root causes of many illness, much consideration was given to the tools by which symptoms could be alleviated and cures exacted. Kidney and bladder stones, for example, were common in 18th and 19th century populations when diets were poor and monotonous. The development of catheters, therefore, was the focus of much attention over the centuries. Unlike most surgeries, removal of a stone was one of the few operations from which a patient might hope to recover. It was also one of the few ailments whose symptoms were so painful, many patients considered the operation a blessing. Simply surviving such an operation was cause for great celebration and it was common for patients to save their stones as relics or souvenirs which they kept in ornate cases duly inscribed. These cases are equally prized today by collectors lucky enough to find one.
The catalog of medical instruments and their development has filled volumes and the reasons for collecting them are just as numerous. Many collectors use their own profession or specialty as a springboard for choosing how to build a collection.
The ear, nose and throat specialist for example, may find the Tonsil Guillotine of particular interest, while the ophthalmologist may be more interested in procuring a set of instruments used for early cataract operations. Other collectors choose items that are ornate or those that have a particular historical significance, like Civil War Amputation Kits or instruments whose provenance shows that they were used on famous, or infamous, characters in history.
Medical instruments whose design and function were primarily to treat injuries sustained in battle have remained popular for decades and are among the most highly prized pieces in any collection. Naval cases used aboard warships, field surgeon's kits and many post-mortem kits have all enjoyed an avid following of collectors. The prolific development of these instruments is certainly a sad commentary on the abundance of circumstances for which they were called into use.
No other medical collectible, however, can raise eyebrows quite like the antique enema kit. While many rectal afflictions have been treated with various forms of enemas for hundreds of years, its popularity as a preventive measure blossomed during the Victorian era. Ladies and gentleman alike had a wealth of varieties from which to choose including the unusual "tobacco enema;" and in keeping with stoic Victorian tradition, these instruments were often highly decorative and discreetly ensconced in handsome, anonymous-looking cases.
Even today, a trip to the dentist can be frightening. Take heart that you are not contemplating such a trip during the 12th century. Then you would have made trip to the barber-surgeon (or perhaps the blacksmith) where your head would be placed firmly between the knees of the barber and the affected tooth yanked out, the wound swiftly cauterized with a red-hot iron. Many such extractions were performed at fairs and gatherings for the amusement of the crowd.
For centuries, this was the only form of dental treatment available other than potions and home remedies. It wasn't until the 17th century that dentistry as a separate science came into existence, and along with it the development of instruments specific to dental operations. True to the medical opinions of the day, bleeding, cupping, or burning with a cautery were still considered practical means of treatment for toothache.
The tools of the dental trade are particularly handsome, and highly sought by collectors. Mother of-pearl, ivory, silver and gold were all employed to fashion very handsome dental instruments, many of which can still found in complete sets.
Not all medical antiquities are surgical in nature. Many collectors concentrate on medically-related items such as ear horns, eyeglasses, infant feeders, false teeth, phrenology heads and even glass eyes.
While most surgeons concentrated on developing instruments of the trade, others were busy creating devices to enhance the quality of life for unfortunate victims of illness or old age. For example, the ear horn, the predecessor to the modern hearing aid, made it possible for the hard of hearing to participate more fully in conversation. Fabulously engraved silver, gold and rare tortoise shell examples were used during the 18th and 19th centuries and many ear trumpets were designed to blend discreetly with the fashions of the day, perhaps hidden in a bonnet or walking stick.
Other medical-related aids, while they have little surgical relevance, were none-the-less vital to medical practitioners and caregivers. Medical receptacles such as measuring spoons and inhalers are very popular with collectors. Because they were used by the general population in great number, many of these items are less expensive and more easily attained than surgical instruments. Inhalers, similar in function to a humidifier, have been used since Egyptian times and were widely prescribed during the 19th century. The most recognizable and affordable inhalers are made of pottery in the shape of a bulbous container with a spout and a mouthpiece of pottery or glass. Some very handsome examples, such as the "Dr. Nelson Improved Inhaler" with blue marbling in mint perfect condition can be acquired for as little as $600 or $700.
Infant or invalid feeders are also popular medical collectibles. Unfortunately, ornate pristine examples are getting harder to find and can fetch handsome prices on the open market. The flat boat-shaped infant feeders of the 19th century are most often found made of pottery, porcelain and less frequently of glass with a central opening in the top for filling and a spout for attaching a nipple. Invalid feeders come in many shapes and forms and are most often made of pottery or glass. Earlier 16th- and 17th-century versions were less decorative and tankard shaped with a curved side spout.
Building a collection
Building any kind of collection is a highly personal endeavor. However, whether you choose to base your collection on a specific area of medicine, on a specific instrument as it developed through the centuries, or simply on those pieces that capture your interest, one premise holds true: Buy quality, not quantity. Experience has shown that most collectors run out of room long before they run out of money. Collections of superior value and importance are those whose pieces were selected primarily for their quality, rarity or provenance and secondly for their price.
Generally, instruments that come with cases intact bring a higher price than those that have been separated from their set or case. And, in turn, complete sets often fetch higher prices than individual pieces, unless the individual piece carries an important provenance, is a prototype or is ornately crafted of an unusual material or precious metal.
A good percentage of the medical antiques on the market today are English. Use of the instruments might have occurred anywhere in the world, but most bear the names of English manufacturers. In light of that, instruments of other foreign manufacture are likely to command higher prices on the market due primarily to their rarity.
Beware of buying pieces that seem too inexpensive. Reproductions can be deceptively authentic looking, as in the case of many apothecary bottles, and can fool even the most trained eye. Examine items closely whenever possible. Remember, materials used to construct cases, handles or tools are good telltale signs of age; plastic, sheet metals, aluminum and polyester materials were not common 100 years ago and can be dead giveaways to fakes.
If you are inclined to purchase medical antiques, or any type of antique for that matter, through a mail order catalog, be certain you are ordering from a reputable company that offers a return policy if you are not satisfied. There are several extremely trustworthy antique dealers around the world who offer just such a guarantee, and collectors are generally very pleased with their purchases. Any dealer unwilling to stand behind his merchandise should be treated with suspicion.
Two very thorough books on the subject, to which this author owes a great debt, and from which a great deal of this research was obtained are "Antique Medical Instruments" by C. Keith Wilbur, M.D., and a scholarly work by Elisabeth Bennion called "Antique Medical Instruments." Both books are indispensable to the serious collector.
Avid collectors can also find forums for discussing their collections and efforts by contacting various specialty newsletters and organizations. Most medical universities also have a wealth of information for the serious collector and most will allow you to browse through their archives on request. Many cities are also home to small, but very impressive, historical medicine museums, such as the Pharmaceutical Museum in New Orleans' Historic French Quarter.
The afflictions of our ancestors were as varied as are the maladies affecting society today. Likewise, the instruments and treatments, many arcane by 20th-century standards, were just as varied, giving the collector a fantastic array from which to choose.