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World's fairs provided an opportunity for instrument makers to display their craftsmanship; one of a kind instruments and sets (43-45) were made from the finest materials for exhibition with prizes awarded to the winners (46,47).

Anesthesia

Prior to the development of anesthetics, patients were given narcotics, alcohol, and other sedatives (48) though they were not able to tolerate procedures of any complexity that took any length of time. Surgical technique flourished after the development of anesthesia, which probably was America's greatest medical discovery of the 19th century. The first to use an anesthetic agent was Dr. Crawford Long, who used ether vapor in 1842 during a minor surgical procedure; unfortunately he lost his chance for fame by not making his discovery public. In 1844, a Hartford, Connecticut dentist, Dr. Horace Wells, was watching a demonstration of laughing gas (nitrous oxide) and noted that the injured leg suffered by one of the subjects was painless. The following day he asked a student to remove one of his molars under the same anesthesia and there was no pain. Unfortunately, however, a subsequent public demonstration failed and Dr. Wells too became a footnote in history. Finally, anesthesia achieved its landmark demonstration on October 16, 1846 at the Massachusetts General Hospital amphitheater when Dr. John Collins Warren removed a patient's neck tumor using ether. Dr. William Morton, who had been Dr. Wells' partner, assisted as the anesthesiologist (49,50).

Despite the obvious surgical benefit, many physicians refused to use ether or chloroform until well after the Civil War (51-53). William Atkinson, who was the first president of the American Dental Association, once said,

ìI think anesthesia is of the devil, and I cannot give my sanctionÖ
I wish there were no such thing as anesthesia! I do not think man should be prevented from passing through what God intended them to endure.î

Fine Instrumentation Succumbs to Aseptic Technique

The art of fine medical instrumentation lasted about 100 years, from the late 18th century through the latter part of the 19th century. The wonderful skills of craftsmen using ebony and ivory became antiquated in the face of requirements for sterilization and asepsis (54-59). It was Dr. Ignaz Semmelweiss, a Viennese obstetrician, who discovered that handwashing and other simple sterilization techniques made a dramatic difference in the survival of his patients from "puerperal fever", which was a common infection that took many women's lives immediately after delivery. He was belittled and subsequently jailed for his beliefs, ironically dying himself of infection while in prison. Others continued his work, including Joseph Lister, until by the beginning of the 20th century, instruments were made entirely of metal that could be made germ free. The changeover came slowly to many, however, including Dr. Samuel Gross, who was one of the leading surgeons and teachers of the late 19th century (60). Sterilization using a carbolic spray (61) marked the beginning of aseptic technique and the end of fine instrumentation - and instrument collecting.

43-45) Exhibition Surgical Set by Aubry, ca 1880

This is one of the finest capital surgical sets ever made and was hand crafted for competition at one of the world's fairs at the end of the 19th century. The set is in a fitted rosewood brassbound box and is made of ivory, blued steel, and gold plate. This set was in the Aubry family until just recently.

46 & 47) Prizes Awarded to Instrument Makers

Aubry advertised the prizes they had won in competition at the beginning of their Instrument catalogues. Perhaps the exhibition Aubry surgical set in this collection had won one of these gold medals!

48) Bite Bullet from the Civil War

Anesthesia was not always available on the battlefield so sometimes soldiers were given lead shot to bite during surgery, hence the expression "bite the bullet" (though there is no written documentation of this practice). This was found just outside the window of a battlefield hospital in Cross Keys, Virginia.

49 & 50) "First Operation Under Ether" (1881-1884), by Robert C. Hinckley

The discovery of anesthesia was America's greatest contribution to medicine in the 19th century. The glass container used to hold the ether in this operation had just come from the instrument maker, and the technique was subsequently named by a young Harvard professor where the surgery was done - Oliver Wendell Holmes.

51-53) Early Devices for the Introduction of Anesthesia

This 19th century ether globe by Collin would normally contain a bladder to be attached where the base is now mounted. The boxed Ombredanne ether apparatus (Drapier) does contain an original animal bladder with face mask. Also, an Esmarch's amber glass chloroform drip bottle and a 20th century ether mask.

54-59) All-metal Instruments from the Turn of the Century

Note that the all-metal instruments were manufactured with asepsis in mind. This folding surgical set is by George C. Frye and a larger boxed set by W.H. Armstrong, which is a "transition" all metal set fitted in an alligator case. Interestingly, the case is leather with subsequent sets made of wood since the instruments needed to be sterilized. Note the strap tourniquet, which evolved from the petit tourniquet that had been used for most of the 19th century. The large military "transition set" by Evans & Wormull has modern metal instruments in a cloth lined mahogany case of the more traditional style. This set is complete with suture material, needles, and key.

60) "The Gross Clinic" (1875), by Thomas Eakins

Professor Samuel Gross of Philadelphia's Jefferson Medical College was a major authority in the latter part of the 19th century. Note in the painting that he took no aseptic precautions, nor did his assistant who is handing Dr. Gross an instrument barehanded. At the left of the painting is a self-portrait of the artist and just below him, a close relative of the patient who was required to be present at the procedure.

61) Carbolic spray

Surgical instruments and the surgical field were sprayed with carbolic acid at the turn of the century in an effort to maintain sterile conditions, marking an end to the era of ebony and ivory.

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44) Ivory Aubry Set

47) Aubry Medals

48) Bite Bullet

49) Anesthesia

51) Collin Ether Globe

58) Evans & Wormull Surgical Set

60) The Gross Clinic

61) Carbolic Spray