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According to Hippocrates (460-370 BC):

What cannot be cured with medicaments is cured by the knife, what the knife cannot cure is cured with the searing iron, and whatever this cannot cure must be considered incurable.

Some of the earliest instruments have been recovered from ancient Roman sites (1-2) where surgical procedures were minor and physicians treated their patients with herbs and potions. For many hundreds of years, early minor surgery was performed by "barber-surgeons" and included such minor procedures as abscess drainage, tooth extraction, bloodletting, cupping, wound care and the treatment of fractures and dislocations. Barber-surgeons were looked down upon by recognized physicians of the day and wore short robes, leaving long robes to those physicians who did not soil their hands with the surgical blade (3-5). The present barber pole is a vestige of those times, the colors representing bandages and blood. The first instrument makers were armorers followed by cutlers and silversmiths until finally surgical instrument making became a profession in the 18th century.

In 1540, The Barber's Guild in England united with the Guild of Surgeons to form The United Company of Barbers and Surgeons (6), advantageous to the surgeons because of the large barbers' treasury. The two groups separated in 1745 and The Royal College of Surgery was established in 1800.

Amputation

Prior to the aseptic era, the predominant major surgical procedure was amputation, which also was one of the earliest operations depicted in medical literature (7-12).The amputation saw evolved over the last 500 years, though its obvious function remained unchanged (13-13c).The gradual evolution from the early circular amputation procedure with a curved blade in the 18th century to the flap procedure of the 19th century can be reflected in the instrumentation of the times (14, 14a). Amputation sets (15,16)and surgical etuis (16a, 16b)from the 18th century are extremely rare  though became more available as makers addressed the needs of a growing American population that subsequently became engaged in a Civil War (17-20). Most instruments were imported from England and France as British surgical sets were sent to the confederacy in hopes of maintaining their textile industry with southern cotton. In the middle of the 19th century, George Tiemann, a German immigrant living in New York, became the most prominent instrument manufacturer in the United States as the production of surgical supplies became a rapidly growing industry.

1-2) Egyptian and 2nd Century Roman Medical Instruments

Representation of Egyptian instruments from a pyramid tomb wall with 2nd century Roman scoops, scalpels, and probes that retain their natural patina. In this 1st century fresco, a Greek surgeon, Iapyx, removes an arrowhead from Aeneas' thigh, Museo Nationale, Naples.

3-5) Surgery in the 16th and 17th Century

In "Opus Chiruricum" (1565), Paracelsus illustrates a renaissance hospital. The long robed physician in the middle is making a diagnosis by examination of the urine (uroscopy), while the short robed physicians do the less desirable minor surgical procedures. Barber-surgeons were depicted as monkeys in this early engraving, now at the Bibliotheque Nationale in Paris. It illustrates the low esteem in which barber-surgeons were held by many, performing such duties as hair cutting, bloodletting, dental extraction, wound care, and orthopedic treatment. Barber-surgeons traveled from town to town performing minor surgical procedures, frequently in a carnival atmosphere, as illustrated by Adriaen Brouwer in "Operation on the Back" (1637).

6) Barbers and Surgeons are United in England

This oil painting depicts Henry VIII handing the Act of Union between barbers and surgeons to Thomas Vicary, in 1540.

7-12) Illustrations of Surgical Technique

Hans von Gersdorff illustrates an early amputation in "Feldbuch der Wundartzney" (1497). Though the surgeon is using his left hand as a tourniquet to both control bleeding and compress nerves for pain control, there is still significant blood loss. A styptic of several chemicals, including alum and lime, was then applied to the stump which would be covered with an animal bladder. Incidentally, the man on the right had such a dressing and wore a "T" which indicated that he suffered from St. Anthony's fire, probably a streptococcal infection. Note the number of assistants necessary to restrain the patient before adequate anesthetics were available in "A General System of Surgery" (1743), by Laurence Heister. Note the absence of sterile technique in a circular amputation illustrated by Bourgery in "Traite Complet de L'Anatomie de L'Homme" (1867-1871). Mastectomy was one of the few major surgical procedures available in the 17th century with bleeding controlled by a cautery as seen in "Armamentarium Chirurgiae" (1693). Unfortunately not much progress was made in mastectomy during the following century.

13, 13a, 13b, 13c) Amputation Saws

The large amputation saw (24 ‡î) is probably German in origin and from the early 16th century. The illustration is by Woodall, "Surgeon's Mate", 1639. Also pictured are various forms of capital amputation saws manufactured over the last several hundred years (to help collectors differentiate them from saws used for other purposes).Starting at the bottom:Ottoís saw by Savigny (ca 1770) ñ serrated edge saw by Tiemann (ca 1850) ñ pistol grip saw by Tiemann (ca 1880) ñ exhibition bow saw by Aubry (ca 1880) ñ tenon saw by Spencer & Coker (ca 1870) ñ detachable pocket saw by Tiemann (ca1870) ñ metal tenon saw by Evans & Wormull (ca 1900).To the bottom right: Butcherís bow saw (ca 1850) ñ Rustís bow saw (ca 1880).

14 & 14a) Amputation Knives

This 18th century knife was designed for a rapid circular amputation with the sharp edge located on the upper curved surface. The comparison of the circular and flap amputation techniques is beautifully illustrated in ìTraite Complet de LíAnatomie de LíHomme (1867-1871), by Bourgery, et al.

15 & 16) Surgical Set by Savigny, ca 1770

Savigny was one of the premier instrument makers of the 18th century and was located on Pall Mall in London. This is an early circular amputation set characteristic of those used during the Revolutionary War (by the British). The set is housed in a fine carrying case of Santo Domingo mahogany.

16a & 16b) Surgical Etui

This 18th century etui is probably by Savigny and contains scissors, scalpel, tongue blade, tweezers, probe, ear scoop, and thumb lancet ñ most etuis of the time contained toilet articles and were not designed for medical use

17-20) Amputation Instruments from the 18th and 19th Centuries

Included are some wonderful illustrations by Dr. Laurence Heister in "A General System of Surgery" (1743), and Bourgery in "Traite Complet de L'Anatomie de L'Homme" (1866-1871). The surgical set by Spencer and Crocker, ca 1870, is a pristine flap amputation set from the mid 19th century. Note the large Liston knives with a petit tourniquet to control bleeding.

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1) Roman Instruments, 2nd Century

5) Minor Surgery

6) Barbers & Surgeons Unite

7) 15th Century Amputation

13) 1540 Amputation Saw

14)Amputation Knife

16) Savigny, Open

16a) 18th Century Medical Etui

20) Spencer & Croker