Neurosurgery

Warring nations have always given physicians both the obligation and the opportunity to find new ways in which to treat trauma (1-4b). Invasive surgery was not possible prior to the 19th century discovery of anesthesia, though certainly neurosurgical procedures were illustrated in some of the earliest printed works. Artistic representation of the brain and central nervous system was far in advance of the ability of physicians to repair damage done by wartime injury (5-7).

Trepanning had been in use from primitive times when "healers" drilled holes into skulls, presumably allowing the departure of evil spirits (8-10). Healed wounds found in ancient skulls attest to the fact that many patients seem to have survived these procedures. Head trauma is not unusual in battle and sometimes resulted in subdural hematomas, or blood clots around the brain, that may have been evacuated successfully by trepanning. Some neurosurgical sets were beautifully manufactured for that purpose and date back to the time of Napoleon (11,12).

Orthopedic Surgery

Some of the finest early illustrations in medicine were those of the skeletal system (13,14), and orthopedic repair was a subject of some of the earliest medical texts (15-18). Fine instruments made for orthopedic surgery were often included in general surgery sets though occasionally specialized orthopedic sets were manufactured (19-23).

1-4b) Early Surgical Illustration

In 1497, Hans von Gersdorff wrote "Feldtbuch der Wundartzney" which was a field manual for military surgeons. As you can see from the illustrations, there were multiple ways to inflict injury in war and all needed to be addressed surgically. Note the very common blunt trauma to the head that required early neurosurgical intervention. A 1st century fresco at the Museo Nationale in Naples shows the Greek surgeon Iapyx removing an arrowhead from Aeneas' thigh. A very early double bistoury from the beginning of the 16th century is also shown here and is represented in the 1540 edition of Gersdorff, where it is described as an arrow remover. A 13 1/2" screw type bullet extractor from the same period is included -- when armor protected against arrows, but not early firearms.

5-7) Fine Anatomy in Text and Wax

This is an illustration from the finest illustrated text of the 19th century, "Traite Complet de L'Anatomie de L'Homme" by Bourgery, (1866-1871). Wonderful wax models from the 18th century can be seen in Florence, Italy at Il Museo della Specola, including these of the central nervous system.

8-10) Early Neurosurgery, Illustrated

Early physicians sometimes performed trepanning to "let out evil spirits", as in this oil by Heironymus Bosch called "Removing the Stone of Madness", ca 1490 now at the Prado in Madrid. A 15th century illustration of trepanning by Gersdorff, and a later 19th century example is by Bourgery. Note the neurosurgical instruments with a large trephine at the top of the page.

11-12) Grangeret Neurosurgical Set

This is a very fine ivory neurosurgical set by the instrument maker to Napoleon. Note the trepan and the large trephine brace with multiple cutting attachments. The mallet is rarely found in a cased set.

13-14) More Fine Illustrations by Bourgery

The anatomic art in Bourgery is unsurpassed, as can be seen in these two illustrations. The "exploded skull" is actually a technique used in models of the skull which are currently available.

15-18) Fracture Repair

The repair of broken bones has always been an important medical problem, and commands the attention of those now practicing the surgical subspecialty of "orthopedics". Noted here is a fine illustration of several fractured bones by Bourgery, while Hans von Gersdorff shows what repair of a broken bone would be like in 1497. Traction to repair a broken bone is seen here in "Armamentarium Chirurgiae", by Ioannis Sculteti (1693), and the final illustration is by Laurence Heister in "A General System of Surgery" (1743). Note the numerous assistants required to restrain the patient in this pre-anesthetic era.

19-23) Specialized Orthopedic Sets, ca 1880

This specialized boxed set of instruments was made by Evans & Wormull for the removal of dressings, and is followed by a complete boxed set for drilling bones. Also included is a large three layered orthopedic set by Lindenmaier, once owned by Dr. E. Jacques (1877), engraved on the cartouche. The set of 40 Civil War era splints were by A.M. Day of Vermont and B. Welch of Connecticut, the two major suppliers of splints for the Union army during that conflict.

1) 15th Century Trauma

4) 16th Century Arrow Remover

5) Dissected Head, Bourgery

9) 16th Century Trepanning

12) Grangeret Neuro. Set

13) Exploded Skull

15) Fracture, Bourgery

22) Orthopedic Cased Set