In warfare, amputation and infection control have continually been an important area of concern for military doctors and medical officials.  Poor sanitary conditions, the presence of foreign bodies in wounds, hasty first-aid treatment, and the large number of wounded, have all contributed to the challenges faced by military medical staff.  Faced with mounting casualty rates and complex injuries, doctors on the front lines have had to adapt civilian practices to how they have dealt with the injured. 

How were these changes in infection theory and amputation reflected in medical instruments and tools?
Throughout the 19th and 20th centuries, changing perceptions of bacteria and infection control had a profound impact on medical practices and procedures.  Such changes were highly reflected in medical tools and instruments, used by doctors, both in the civilian and military fields.  While not all of the cases shown in this module were used by doctors on the front lines, the instruments and supplies included in the various surgical cases provide a clear indication of what 19th and 20th century military doctors had at their disposal.  As notions of bacteria control and infection prevention became more accepted, military-medical practices as well as their tools and supplies became much attuned to the needs of medical officials.  Consequently, with an increased understanding of how to control and limit the spread of infection in wounds, the practice of amputation drastically decreased, as did the overall mortality rates during military campaigns.  As illustrated through the medical cases, Improvements in infection control and amputation also affected the composition on surgical instruments, the compounds and chemicals used and the types of surgical dressings and applications.  Overall, a noticeable shift towards more sterile practices took place, which was highly reflected in medical-military surgery.

Learning Objectives

After completing this module students will understand:

surgical kit

Step 1: Objects and Their Properties

For each object, answer the following questions:

  1. What do you think the object is and why?
  2. When, where, by whom and for whom was it made?
  3. What are the objects and instruments made from? Do the materials suggest when it was made?
  4. What is its physical structure, shape, size, style, ornamentation?
  5. What techniques were used to make it?  Is it well made?
  6. What does the construction suggest about the date and use of the object?
  7. Looking at the surgical knives in the Tiemann Amputation Set and the Seaborn Surgical Set, what kind of writing do the instruments have on it, if any? Why could this be important for infection control?
  8. What does the construction suggest about the use of the instrument?
  9. How does the construction reflect the prevalent theories of infection control?
  10. Are there differences between instruments for military use and civilian practices?
  11. Looking at the instruments in the surgical setst, do the objects show visible wear-and-tear? Which appear more worn and why?
  12. Focus on the Tiemann set and catalogue images.  Compared to the catalogue references, how are military-medical kits and civilian kits similar?  How are they different?
  13. When looking at the doctor’s kit, are certain compounds favoured over others? If so, why?

Tiemann Amputation Set Case (About 1865)
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Alternative Images

Surgical Set (Late 1910's)
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Doctor's Kit (1890)
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Step 2:  The Meaning of an Artifact

For each object answer the following questions:

  1. What does the function of the objects reveal about the philosophy of medicine and health at the time?
  2. According to the primary source accounts, how was infection viewed by those in the medical field?  Did this view change?
  3. How did perceptions of amputation in war change over time?
  4. What does the changing view of amputation reveal about the relationship between civilian and military medical practices?
  5. Where were medical procedures performed?  How did changing theories of infection control and amputation affect where and when doctors and medical officials treated the wounded?
  6. In the Doctor’s Kit, what do the various compounds and chemicals tell us about medical treatment in war?  What do the additional sources say about the various compounds?  Which were favoured by military doctors?
  7. For the Tiemann Amputation Set and the Seaborn Surgical Set, is the composition of the objects an accurate reflection of the prevalent medical theories of the period?
  8. After examining the construction, use, and prevalent theories of infection control, do the objects balance practicality and the sterile treatment of wounds?  If so, in what ways?

George H. Macleod. Notes on the Surgery of the War in the Crimea (Philadelphia: J.B. Lippincott & Co., 1862), 87-93. (PDF 4.2 Mb)

American Armamentarium Chirurgicum: George Tiemann & Co. 1889 the Centennial Edition (Arlington: Norman & the Printers' Devil, 1989), 61-62, 95-97. (PDF, 2.6 Mb)

Manual for the Royal Army Military Corps (London: Harrison and Sons, St. Martin's Lane, 1904), 32-39, 52-67. (PDF 5.2 Mb)

Principals of War Surgery: Based on the Conclusions Adopted At the Various Interallied Surgical Conferences (Washington: Office of the Surgeon General, 1918), 4-11, 47-49. (PDF, 5.3 Mb)

Principals of War Surgery: Based on the Conclusions Adopted At the Various Interallied Surgical Conferences (Washington: Office of the Surgeon General, 1918), 19-22. (PDF, 2.1 Mb)


Selected References for Further Reasearch

 

Primary Sources

Delorme, Edmond. War Surgery. New York: Paul B. Hoeber, 1915.

Fauntleroy, A M. Report on the Medico-Military Aspects of the European War. Washington: Government Printing Office, 1915.

Hull, Alfred J. Surgery in War. Philadelphia: P. Blakiston's Son & Co., 1916.

Penhallow, Dunlap P. Military Surgery. London: Oxford University Publications, 1916.

Stevenson, W F. Wounds in War: the Mechanism of Their Production and Their Treatment. New York: Longmans, Green and Co., 1910.

 

Secondary Sources

Abstracts of War Surgery: An Abstract of the War Literature of General Surgery That Has Been Published Since the Declaration of War in 1914. St. Louis: C.V. Mosby Company, 1918.

Duffy, John. From Humours to Medical Science. Urbana: University of Illinois Press, 1993.

Edmonson, James M. Nineteenth Century Surgical Instruments: A Catalogue of the Gustav Weber Collection At the Howard Dittrick Museum of Historical Medicine. Cleveland: Cleveland Health Sciences Library, 1986.

Lawrence, Christopher, ed. Medical Theory, Surgical Practice. London: Routledge, 1992.

Medicine and Surgery in the Great War 1914-1918. London: The Wellcome Institute of the History of Medicine, 1968.

Rutkow, Ira M., and Stanley B. Burns. American Surgery an Illustrated History. Philadelphia: Lippincott-Raven, 1988.

Shryock, Richard H. Medicine in America: Historical Essays. Baltimore: The John Hopkins Press, 1966.