Image: Examples of the delicate touch needed to manipulate scalpels. 
Jean Baptiste Marc Bourgery, Nicolas Henri Jacob, Traité complet de l’anatomie de l’homme. 
Volume 6. Plate 15. Paris, 1839. http://digi.ub.uni-heidelberg.de/diglit/bourgery1831ga

The Surgical Touch – Connecting Artifacts and Trade Literature

One of the exhibits that will be in the renewed Canada Science and Technology Museum is organized around the theme of medicine and the five senses, and their central role in medicine over centuries. Medical Sensations will feature the human dimensions of sight, sound, smell, taste and touch in medical practice, as well as the instruments that have evolved to extend the use of these senses. The exhibition will showcase a number of significant artifacts from the museum’s collection, as well as artifacts on loan from museums around Canada and the world.

The sense of Touch will be explored with artifacts and stories about the use of touch in learning and practice. The learning element will include old anatomical models as well as new 3D prints. The practical aspect will explore the “surgical touch” and the more refined, skilled use of hands and instruments to heal the sick and fix the injured. Unfortunately, we could not display the entire collection of surgical artifacts held by the museum, nor the incredible visual material held in the library and trade literature collections which date back to the early 1800s.

Image: The surgical instrument catalogues contain images and technical descriptions for the surgeons to make their purchase decisions.  Instruments would sometimes be organized into kits, such as this one that contains the necessary instruments for a private practitioner. Surgical Instrument Catalogue, J. H. Montague in London, 1897. Trade Literature Collection. Canada Science and Technology Museum.

Image: The surgical instrument catalogues contain images and technical descriptions for the surgeons to make their purchase decisions.  Instruments would sometimes be organized into kits, such as this one that contains the necessary instruments for a private practitioner. Surgical Instrument Catalogue, J. H. Montague in London, 1897. Trade Literature Collection. Canada Science and Technology Museum.

These resources provide a window into how doctors would have learned about the latest technical development in practice. One of my projects during my placement at CSTM has been to examine this literature and have some of it digitized and put into the museum’s new Digital Asset Manager and online Open Archives Portal. The images from the trade literature and textbooks greatly enhance our understanding of the surgical instruments that are in the museum’s collection. The small selection of instruments going on display in the exhibit includes a trepan, a scarificator, eye surgery tools and an amputation saw. Surprisingly, many of these instruments have changed little over time, showing the stability of surgical practice. However, through the trade literature and instruments, we see changes in materials and style, the commercial context for surgery, as well as broader changes in the surgical practice and technology. During this project, I also discovered several historic image resources from on-line medical collections across Canada and the world such as the Thomas Fisher Rare Book Library at the University of Toronto, the Wellcome Library and University of Heidelberg.

Image: Examples of the delicate touch needed to manipulate scalpels. Jean Baptiste Marc Bourgery, Nicolas Henri Jacob, Traité complet de l’anatomie de l’homme. Volume 6. Plate 15. Paris, 1839. http://digi.ub.uni-heidelberg.de/diglit/bourgery1831ga

Image: Examples of the delicate touch needed to manipulate scalpels.
Jean Baptiste Marc Bourgery, Nicolas Henri Jacob, Traité complet de l’anatomie de l’homme. Volume 6. Plate 15. Paris, 1839. http://digi.ub.uni-heidelberg.de/diglit/bourgery1831ga

Some of the collection and images evoke a graphic medical past. Hundreds of years ago, surgeons who were known for their brute force and speed would operate on completely conscious patients. Anaesthetic was not tested until the 1840s, so patients before then faced traumatic pain when going into surgery. The most dramatic of these operations were amputations where patients looked for reprieve in alcohol, painkillers, or a solid knockout. The surgeon could purchase kits that contained all the tools necessary for the operation. When the surgeons allowed themselves more time, the finesse of an amputating chain saw allowed them to saw through the bone, while not damaging as much of the surrounding tissue.

Trepanning involves drilling a hole in the skull, and was practiced as early as 8000 years ago. The reason behind the drilling is not completely clear, explanations have included expelling bad spirits from the body, relieving pressure from headaches, curing epilepsy and fixing a broken skull. Drills such as trephines were an alternative to larger, less precise trepans.

Image of an amputating chain saw being used to remove part of the ulna. Jean Baptiste Marc Bourgery, Nicolas Henri Jacob, Traité complet de l’anatomie de l’homme. Volume 6. Plate 56. Paris, 1839. http://digi.ub.uni-heidelberg.de/diglit/bourgery1831ga

Image of an amputating chain saw being used to remove part of the ulna.
Jean Baptiste Marc Bourgery, Nicolas Henri Jacob, Traité complet de l’anatomie de l’homme. Volume 6. Plate 56. Paris, 1839. http://digi.ub.uni-heidelberg.de/diglit/bourgery1831ga

A more common occurrence for surgeons was bloodletting, which used heated metal or glass cups, to draw the blood to the surface and scarificators pierced the skin, and allowed the blood to flow. Teeth pulling instruments were also very common, and specialized tools for each type of tooth were invented to facilitate the operations. Surgical catalogues would often have many pages of dental equipment, such as tooth forceps, and excavators.

Tooth Keys were a somewhat archaic device sold alongside forceps. They would grasp a tooth in its claw, and with a sharp twist, the tooth would hopefully become dislodged.  Instrument Catalogue, Arnold and Sons, in London 1876. Trade Literature Collection. Canada Science and Technology Museum.

Image: Tooth Keys were a somewhat archaic device sold alongside forceps. They would grasp a tooth in its claw, and with a sharp twist, the tooth would hopefully become dislodged.  Instrument Catalogue, Arnold and Sons, in London 1876. Trade Literature Collection. Canada Science and Technology Museum.

The collection on display also recalls the delicate, fine motor skills refined by surgeons. Cataract surgery is another ancient surgical practice, dating as far back as Ancient Egypt. The tools for these procedures were small (compared to the amputation instruments) with refined workmanship, materials and decorative features. The delicate procedure needed a specific series of precise tools to detach the lens from the eye, and push it down into the eye in the earliest known cataract procedure known as couching. Needles were eventually invented to extract the lens. At the end of the 19th century, eye instruments were still noted for their elegance. Kits were a handy purchase for surgeons, who could also choose from a selection of virtually indistinguishable knives.

When anaesthetic was invented, and proven to work, it was revolutionary for surgeons and, of course the patients. Within the span of just a few years, every surgeon was using anaesthetic on their patients.

Image: One type of ether inhaler used to administer the anaesthetic to the patient before a surgery. Surgical Instrument Catalogue, J. H. Montague in London, 1897. Trade Literature Collection. Canada Science and Technology Museum.

Image: One type of ether inhaler used to administer the anaesthetic to the patient before a surgery. Surgical Instrument Catalogue, J. H. Montague in London, 1897. Trade Literature Collection. Canada Science and Technology Museum.

As the sense of touch was removed for patients, surgeons started to explore new dimensions of their use of touch and instruments.

The trade literature reflects a rapid growth in the diversity and complexity of the techniques and instruments during this period, as well as several different versions of the same instrument, and instruments named after an inventor of famous surgeon.

Image: Surgeons would have appreciated this spring-loaded double bistoury only 150 years ago because the folded blades were compact and remain sharper than exposed blades.  Instrument Catalogue, Arnold and Sons, in London 1876. Trade Literature Collection. Canada Science and Technology Museum.

Image: Surgeons would have appreciated this spring-loaded double bistoury only 150 years ago because the folded blades were compact and remain sharper than exposed blades.  Instrument Catalogue, Arnold and Sons, in London 1876. Trade Literature Collection. Canada Science and Technology Museum.

Surgical theatre also went through several changes in the 19th century that impacted the evolution of surgical touch. Before antiseptic surgery, surgeons rarely washed their hands and they wore blood-soaked smocks with pride. Sawdust was strewn on the floor of operating theaters in an attempt to manage the blood.

Inventions such as the Revolving Flushing Table were an attempt at modernizing the surgical theater and collect the blood. Surgical Instrument Catalogue, J. H. Montague in London, 1897. Trade Literature Collection. Canada Science and Technology Museum.

Inventions such as the Revolving Flushing Table were an attempt at modernizing the surgical theater and collect the blood. Surgical Instrument Catalogue, J. H. Montague in London, 1897. Trade Literature Collection. Canada Science and Technology Museum.

As antiseptic surgery emerged in the latter nineteenth century, instruments in the collection and trade literature reveal a new emphasis on materials and sterilization. Organic materials for the tools gave way to solid, nickel-plated handles that could be sterilized between each procedure. Nickel-plated tools gave way to stainless steel in the mid-20th century. Doctors started washing their hands, and wearing gloves, masks and hats, while they operating in clean, organized, private theaters. They adapted to the gloves that significantly changed their sense of touch, and the simple, sterile, solid metal tool, and the clean, careful and cautious surgical operation that is recognized today materialized.

See some of these changes in the exhibition in November 2017, or now in the sample of images from our extensive trade literature collection.

Erica Nadeau is a Student Intern from the Applied Museum Studies program at Algonquin College working on the Medical Sensations Exhibit.

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