Page 1 2 3

Dr. Robert Liston (1794-1847) was a very prominent surgeon in the 19th century and invented a number of surgical techniques used today. In fact, many of the instruments in his surgical sets were named after him. Dr. Liston was a large man who cut a broad figure in the operating room and was proud of his reputation as a fast surgeon, a reputation that was well respected in this preanesthetic era for obvious reasons. Legends of his operating techniques are numerous, including the carved notches Dr. Liston made on his amputation knife following each procedure. He would hold a major artery with his large left hand while making one great cutting pass with the right. With the knife held in his teeth, he would then suture the limb, the whole procedure lasting only a few minutes. On one occasion while he was trying to break his speed record for a leg amputation, Dr Liston accidentally amputated one of his patient's testicles and two of his assistant's fingers.

Rapid surgical techniques were also popular because of the potential reduction in perioperative blood loss. The cautery iron was used in the Middle Ages to reduce bleeding and was replaced by caustic chemicals and finally ligatures (21-24).According to William Clowes, surgeon to Queen Elizabeth:

The yron is most excellent but that it is offensive to the eye and bringeth the patient to great sorrowe and dread of the burning and smart.

Prostheses

Plastic surgery was in its infancy during the 19th century when the threat of infection and the inadequacies of anesthesia favored a quick amputation. Prosthetic devices thus were more in demand, especially during the Civil War (25,26).

Instruments to Die For

Ironically, it was not unusual for surgical instruments themselves to cause the demise of patients they were intended to help. Wonderfully crafted materials were used that could not be sterilized, thereby resulting in infections that could not be treated (27). Indeed, physicians were proud to display their beautiful instruments of ebony, ivory, mother of pearl, tortoiseshell, and sometimes gold well after Joseph Lister had clearly demonstrated the germ "theory" and importance of aseptic technique. Physicians stored their instruments in a number of ways in the 19th century, the most convenient of which was the folding pocket surgical set, popular overseas (28-32) and in America (33-38). These sets were quite extensive and most surgical procedures could be performed by them with the exception of major amputations.

The highlight of instrument production (and collecting) can be found in the capital surgical sets produced during the latter part of the 19th century. Wonderful materials were used to attract proud physicians who would then display their instruments to impressed patients (39-42). Without adequate sterilization, however, these instruments likely added to the morbidity and mortality of the surgical procedures in which they were used.

21-24) Managing Blood Loss

Joseph Pancoast illustrates the use of 19th century tourniquets for controlling bleeding in "Operative Surgery" (1844), while the use of the cautery is demonstrated in "Feldbuch der Wundartzney (1497), by Hans von Gersdorff. Cauteries were used through the 19th century and were replaced by styptic, and sutures. The Singer Sewing Machine Company had a medical division into the 20th century.

25 & 26) Artificial Eye and Hand

Blown glass eyes were wonderfully handpainted in Europe until the latter part of the 19th century when American makers became active, and began to use other materials. The artificial hand was probably produced for a lady.

27) "Traite Complet de L'Anatomie de L'Homme" (1867-1871), by Bourgery et al.

Surgical technique with a tortoise shell bistoury (knife). Note the lack of sterile technique.

28-32) Two Extensive French Pocket Surgical Sets

Collin/Charriere and Aubry were the two preeminent instrument makers in France during the 19th century. Below the pictured Collins set are, clockwise, a tortoise shell vaccinator, a bleeding lancet, a double bistoury (knife), a trocar set, and a silver syringe. The pictured illustration is from the 1900 Aubry catalogue and below the closed Aubry set is one of several unusual forceps that holds multiple fitting ends. This pocket set is their largest type.

33-38) Outstanding Pocket Surgical Set by Tiemann

This is one of the finest sets available by an American maker and has all the capabilities of the larger sets including minor amputation. Note the multiple blades that fit tortoise shell universal handles. Another set by Tiemann with a different style of multiple blades is illustrated.

39-42) Parker Surgical Set by Tiemann, ca 1880

Very fine four level capital surgical set by America's premier instrument maker. The leather carrying case is very rare and the brassbound rosewood case is of the highest quality. This ivory set is complete and marked the high point of surgical instrument making prior to the aseptic era.

Page 1 2 3

21) Cautery (1497)

26) Artificial Hand

27) 19th Century Technique

29) Pocket Collin Set

34) Tiemann Folding Set

42) Ivory Tiemann Set