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Signature of James L. Dusenbery and several photographs artistically combined.

Nineteenth-Century Medical Instruments

Ilouise S. Bradford

Mid-Century Microscopy

Although Harvard acquired its first compound microscope in 1731 (Warner 9), American medical schools did not introduce microscopy to students until the 1840s (11). At that time, Americans had to import instruments from Europe, which was both costly and inconvenient. Hamilton College teacher and self-made manufacturer Charles A. Spencer started a revolution in American microscopy in 1847 when he produced an excellent, yet affordable, model to rival the microscopes of well-established European firms (Warner 12–13). Microscopy became not only a tool for scientific research; it was also a new mode of middle-class diversion. Following Spencer's lead to meet popular demand for inexpensive quality instruments, George Mead of Racine, Wisconsin, offered the Craig Microscope for $2 (excluding postage). Reviewing the Craig in 1868, editors of The St. Louis Medical Reporter found the "very excellent, yet simple, instrument" to be "invaluable for physicians, scientific men, students and schools, and for every one who is a lover of the beautiful things in nature" (Alleyne 419–420). The microscope's labeling, transcribed below, speaks to its wide appeal:

CRAIG'S MICROSCOPE.
Patented February 18, 1862.

The Craig MicroscopeThe Craig Microscope. C. H. Wheeler & Co., Boston, MA.

Instrument Collection, Health Sciences Library, The University of North Carolina at Chapel Hill

DIRECTIONS.—To examine any fluid, such as stagnant water, blood, milk or pus, lift a small drop on the eye of a darning-needle or small stick, and place it on the under side of the lens, right on the centre—the smaller the drop the better. If you wish to see the globules of blood, pus, or milk, these fluids should be largely diluted with water. After placing the fluid to be examined, on the under side of the lens, place the latter on the top of the instrument, and then stand the latter so that the mirror will directly face the light, and turn the mirror until the light is reflected up the body of the instrument on the lens, when the objects contained in the fluid will become visible ; if not, turn the instrument to the right or left a trifle, and turn the mirror until it is right. For dry objects, such as hair, flies' or spiders' feet, the wings of insects, scales from the wings of moths, etc., etc., place them on the small slip of glass under the lens. When examining a drop of fluid, the slip of glass is not required. If you wish to examine the circulation in the web of a frog's foot, place the under surface of the lens directly in contact with the under surface of the web of the foot, and then place the foot on the top of the instrument, or else simply hold it up to the light.

THE CRAIG
MICROSCOPE.

DIRECTIONS.—Grasp the handle which turns the mirror, between the thumb and forefinger of the right hand, and the object glass (after being placed in the instrument) with the thumb and forefinger of the left hand. Then place the eye over the lens and move the object glass with the left hand until it is in range, turning the mirror with the right hand until the best light is reflected. The lens should rest directly upon the object—all mounted objects must be put in the marked side up. All the glasses should be kept perfectly clean.

C. H. WHEELER & CO.,
379 Washington St., Boston,
AGENTS.

☞Sent, postage paid, on receipt of $2, and 25 Cents in stamps ; mounted objects at the rate of $1.50 per dozen.

Cupping Sets

German Cupping SetGerman valved glass cupping set in wooden case. Kolb, Fürth, Germany.

Instrument Collection, Health Sciences Library, The University of North Carolina at Chapel Hill

Cupping was one of several ways a doctor could remove blood from a patient in the nineteenth century. The history of cupping, like the history of bloodletting as a cure for disease, dates back to ancient times (Davis and Appel 17). Although debates over the effectiveness of bloodletting are as ancient as the practice itself (Haller 52), it remained a common treatment well into the nineteenth century, and was occasionally used into the twentieth century (Haller 59–62).
Early cups were made of horn, but by the nineteenth century cups made of blown glass were more common (Davis and Appel 21). The set pictured here originally contained six glass cups fitted with metal valves at the top. The syringe included with the set would have been fitted to the top of a cup and used to create suction in order to draw out the blood more efficiently. Also included with this set is a scarificator: a brass box containing small sharp blades operated by a spring mechanism that could make incisions into the skin quickly and efficiently. The scarificator was invented in the 18th century and was "the major change in the art of cupping between antiquity and the nineteenth century" (Davis and Appel 21–22). This scarificator is square and contains thirteen blades, a shape and number more typical of German cupping sets than American or English ones (Davis and Appel 22, 24).
Cupping ScarificatorThirteen-blade brass scarificator from German valved glass cupping set. Kolb, Fürth, Germany.

Instrument Collection, Health Sciences Library, The University of North Carolina at Chapel Hill

"Practical" Phrenologists in the United States

The popularity of phrenology in the United States skyrocketed in the 1830s, particularly after the lecture tours of prominent European practitioners Johann Spurzheim (1776–1832) and George Combe (1788–1858). Spurzheim's death in Boston in 1832 cemented his lasting influence and hastened the founding of the Boston Phrenological Society on December 31, 1832, and the first printing of the Annals of Phrenology in October 1833. Likewise, Combe's lecture tour from 1838–1840 resulted in the 1838 founding of Philadelphia's American Phrenological Journal and Miscellany (Riegel 75–77).
This spike in popularity gave the Fowler brothers of New York a new avenue for commercial success. After a series of lectures in upstate New York and later New York City, Philadelphia, Baltimore, and Washington drew enthusiastic listeners, Orson Fowler encouraged his brother Lorenzo—and eventually their sister Charlotte—to go into business with him in 1835, which they based at Clinton Hall in New York City. The family firm, renamed Fowler and Wells [1] in 1844, "served as a phrenological museum and library, a publishing house, and a lecture booking bureau" and offered cranial readings to interested parties (Greenblatt 798–799).
Fowler HeadFowler HeadFowler HeadFowler HeadFowler HeadPhrenological Head (L. N. Fowler), modern facsimile. (Top view)

Special Collections, Health Sciences Library, University of North Carolina at Chapel Hill

According to his obituary in The New York Times, Lorenzo Fowler and his brother "encountered great opposition from medical men and clergymen, and phrenology was ridiculed in all directions" ("Noted Phrenologist Dead"). The younger Fowler, however, was enthusiastically received in Britain, where his lectures and readings "held his audience spellbound to the finish" ("Noted Phrenologist Dead"). He settled there with his wife, Lydia Folger Fowler, who attained her medical degree in the United States and wrote extensively as well, and founded the British Phrenological Society in 1887 (van Wyhe). Although both brothers published widely, Lorenzo seems to have performed the most cranial readings, examining the heads of Charles Dickens, Edgar Allan Poe, William Cullen Bryant, and Walt Whitman [2] ("Noted Phrenologist Dead"; Hungerford 362). A modern facsimile of the Fowler bust, housed in the Health Sciences Library at the University of North Carolina at Chapel Hill, bears the following inscription:
For thirty years I have studied Crania and living heads from all parts of the world, and have found in every instance that there is a perfect correspondence between the conformation of the healthy skull of an individual and his known characteristics. To make my observations available I have prepared a Bust of superior form and marked the divisions of the Organs in accordance with my researches and varied experience.
Indeed, modern vestiges of nineteenth-century phrenology come primarily from practitioners like the Fowlers. Collectors will find that a "phrenological bust in an antique shop will almost invariably bear the label 'L. N. Fowler'" (van Wyhe).

Medicinal and Surgical Kits

Medicinal Saddle BagSaddle bag containing vials of various medicinal compounds (dated 1892).

Instrument Collection, Health Sciences Library, The University of North Carolina at Chapel Hill

In January 1900, B. T. Whitmore nostagically elegized the "ancient physician," a traveling healer and dispenser, and his saddlebag full of "Roots and yarbs" in the Journal of the American Medical Association:
There was then no opportunity for specialism nor for office practice. The old doctor was called to cover a wide district in his gig, more often on the back of an equally sedate horse, which had through long experience learned the doctor's calling list, even if not his method of treatment. But whether in the gig or on horseback the ancient physician made his welcome way, he was never to be dissociated from his saddlebags. They were the outward and visible sign of his profession . . . Who will ever forget the pride of the errand when the good old doctor said, "Sonny, run out and bring in my saddlebags?" There was always some reward, an inch of Spanish licorice or some such matter, that made the errand pleasant to run. (Whitmore 25)
Ethical responsibility guided most dispensing physicians, but there was also a financial advantage to filling their own prescriptions. Whitmore's "good old doctor" was losing business to homeopaths and counter-prescribing druggists in the mid- to late-nineteenth century (Haller 257–258). To relieve economic frustration and combat poorly administered and ineffectual remedies, physicians appealed to patients "by diagnosing illness and filling the prescription—all paid for in one visit" (Haller 271). Dusenbery opened a Lexington drugstore with sheriff James Stimson in 1855, but he likely still made house calls and dispensed medicines on horseback, his "Roots and yarbs" in tow.
Winfield Scott Marshall of Illinois patented the pictured convertible saddlebag and handcase in 1886, making subsequent improvements "designed specially for the use of physicians" in 1890 and 1892 (Marshall 2). [3] The contents of these cases, generally kept in corked glass vials, ranged from the potentially toxic—sulfuric acid—to the utterly benign—garlic. George B. Wood, Dusenbery's professor of materia medica and pharmacy at the University of Pennsylvania, sheds light on the possible contents of a physician's medical bag in his 1856 Treatise of Therapeutics, and Pharmacology or Materia Medica. Wood classifies medicines and other remedies by the effects they generally have on the human body, allowing that "it not unfrequently happens that a remedy belonging to one class, has additional powers, which serve to rank it in another" (90). Ipecac, for one, could be administered as an expectorant and an emetic, though in varying doses. The list below, compiled selectively from his two-volume treatise, reveals additional cross-classified remedies:
  • Astringents (to produce contraction in living tissues): Tannic Acid, Alum, Iron, Zinc, and Copper Sulphates
  • Tonics (to increase or restore various vital functions): Cod-liver Oil, Peruvian Bark with Quinia, Sulphuric Acid
  • Cerebral Stimulants (to relieve pain, deaden the senses, and/or induce sleep): Alcohol, Ether, Camphor, Opium
  • Nervous Sedatives (to reduce irritability or excitement of the nerves): Digitalis, Tobacco, Lobelia
  • Emetics (to induce vomiting): Ipecacuanha, Tartar Emetic, Zinc Sulphate
  • Cathartics (to evacuate the bowels): Castor Oil, Rhubarb, Aloes, Calomel, Colocynth
  • Diuretics (to increase the flow of urine): Squill, Cream of Tartar, Turpentine, Garlic
  • Diaphoretic (to increase perspiration): Tartar Emetic, Ipecacuanha, Potassium Citrate, Sassafras
  • Expectorants (to promote the secretion and expulsion of matter from the chest and lungs): Ipecacuanha, Tartar Emetic, Squill
  • Antacids (to neutralize acids): Potassium Bicarbonate, Ammonium Carbonate, Charcoal [4]
The contents of these vials took a variety forms—powders, tinctures, ointments, pills, lozenges, extracts, spirits, vinegars, syrups, vapors—and served a variety of functions, depending on the patient's needs.
Surgical KitSurgical kit, used for amputations. W & H Hutchinson: Sheffield, England.

Instrument Collection, Health Sciences Library, The University of North Carolina at Chapel Hill

The Civil War required many physicians to expand their medical accountrement to include surgical kits, particularly amputation kits. Minimalist and lightweight, nineteenth-century surgical kits were most often velvet-lined mahogany cases with brass hardware (Kirkup 129). Although there were domestic surgical instrument makers in the mid-nineteenth century, the pictured amputation kit was manufactured in Sheffield, England. The kit's orange labeling features the lion and unicorn coat of arms of Great Britain and reads:
W & H Hutchinson
Sheffield
Surgical Instrument Makers To the Royal Navy [5]
The instruments inside are typical of those required for quick action on the battlefield:
  • Arterial forceps—"Use: For grasping arteries without injury to arterial wall" (Dammann 11).
  • Capital saw—"Use: Cutting through the larger bones of legs and arms during amputation procedure" (Dammann 9).
  • Surgical silk suture material and assortment of suture needles—"Use: To tie off major blood vessels and to close major defects in tissue" (Dammann 17).
  • Tenaculum—"Use: For pulling out the arteries from the stump in order to tie them off. Usually the silk suture material was placed around the instrument, and after the atery was extruded, the suture was slid from the instrument over the blood vessel and tied" (Dammann 16).
  • Tourniquet [6]—"Uses: To reduce the amount of hemorrhage during surgical techniques. They put pressure on an artery, thereby limiting the amount of circulating blood in the area" (Dammann 17).
  • Trocar and cannula—"Use: With its three-edged extremity, [the trocar] is used to draw off various kinds of fluids such as serum or pus" (Dammann 16). The trocar was enclosed in a metal tube, or cannula, to aid in the drainage process.
  • Tracheostomy tube—Use: To establish an unobstructed airway through insertion in the trachea.

Patient Note Addressed to Dr. James Fuller

Patient LetterPatient Note, addressed to Dr. James Fuller. A Compendium of Lectures on the Theory and Practice of Medicine. Philadelphia: Lea and Blanchard, 1846.

Health Sciences Library, The University of North Carolina at Chapel Hill

Compiled by Nathaniel D. Benedict and published in 1846, A Compendium of Lectures on the Theory and Practice of Medicine displays the "soundness of theory and concept" (v) of Dr. Nathaniel Chapman (1780–1853), professor of physic and clinical medicine at the University of Pennsylvania during Dusenbery's tenure of study. The Health Sciences Library at the University of North Carolina at Chapel Hill houses a copy of Chapman's lectures once owned by a Dr. James Fuller. Though little is known about Fuller's identity, a surviving patient note from "R Clifford" affirms he was in fact a physician. The transcription below reflects the original spelling and punctuation of Clifford's note:
Dr Fuller sir
i Want yo to Come up Ritee
a Way to sea my limb for i
think that it tis getten Warce
it as Bean DisChargen very free
since Sunday after nune
and it thair is Blud Comes
With this matter thair is
Somthing in the howl looks
lik a [Cancer] i am still
using the Poltes on the
Soar and the lo[t]en a Round
it
yo must Be There
and Come up Rite a
Way
R Clifford
As the note suggests, Dr. Fuller made house calls and dispensed his own remedies, as did most nineteenth-century physicians.

Notes

^1. Samuel Robert Wells (1820–1875) joined the Fowler firm and family in 1844, marrying Charlotte Fowler that October. Wells published the Illustrated Annals of Phrenology and Physiognomy was "chiefly devoted to the general conduct of the [Phrenological] Cabinet's business, and especially to the publishing department" (Hungerford 354).

^2. Lorenzo Fowler performed a cranial reading on Walt Whitman in July 1849. He reported the following: "This man has a grand physical constitution, and power to live to a good old age. He is undoubtedly descended from the soundest and hardiest stock. Size of head large. Leading traits of character appear to be Friendship, Sympathy, Sublimity and Self-Esteem, and markedly among his combinations and dangerous faults of Indolence, a tendency to the pleasure of Voluptuousness and Alimentiveness, and a certain reckless swing of animal will, to unmindful, probably, of the conviction of others" (Hungerford 363). Fowler and Wells even advertised and attempted, unsuccessfully, to sell copies of the first edition of Leaves of Grass in 1855. The following year Whitman published the second edition with Fowler and Wells; sales were again abysmal (Hungerford 355–356).

^3. Stamped into the leather of the saddlebags' top flaps are W. Scott Marshall's patent dates:

MARSHALL
PATD APR. 20. 1886
" MAR. 25. 1890
" JUNE 7. 1892

^4. For a complete list of George B. Wood's therapeutic classifications and recommended remedial agents, consult the contents of A Treatise on Therapeutics, and Pharmacology or Materia Medica (Philadelphia: Lippincott, 1856), also available online at Google Books.

^5. William and Henry Hutchinson apparently benefitted from the increased demand for surgical instruments during the Civil War when "a ship bound for the US was wrecked and found later to have large numbers of surgical instruments marked 'W. H. Hutchinson'" (Bennion 322).

^6. The brass screw on the tourniquet has "F. Liese" inscribed on it.

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