Edging the Competition: Surgical Instruments in the 18th-Century

As I’ve written about in other posts about razors and posture devices, in the second half of the eighteenth century, the introduction of cast steel transformed products for the body. Steel had many physical properties that rendered it very useful across a range of instruments. Unlike its predecessor, blister or shear steel, which was of uneven quality and could be brittle, cast steel was durable and capable of carrying a very sharp edge. It could also be polished to a mirror-like shine, making it very attractive to wear as ‘brilliant’s – imitation diamonds.

Many of the instruments I’ve written about, from razors to spectacles, were things that people bought to use upon their own bodies. But there was another group of instruments that was transformed, but one which people generally did their best to avoid – surgical instruments.

The surgeon’s knife held something of an ambiguous position within medicine. For patients the briefest glimpse of a scalpel or, worse, an amputation knife, was enough to send them into a swoon. Some surgeons argued that people would much rather subject themselves to the dubious ministrations of the quack than to the slice of the blade. Surgeon’s instruments also suffered from the taint of the manual craft. It was argued that almost anyone could wield a knife or a saw, without any need for theoretical knowledge of the body. As such, surgical instruments were little more than tradesmen’s tools.

Nevertheless there was an increasing demand for instruments in Britain in the later eighteenth century. Across Europe numbers of medical students were swelling. In France the numbers of surgeons nearly tripled between 1700 and 1789. By the early years of the nineteenth century, around 300 students per year were enrolling in London hospitals, as well as Edinburgh and Glasgow. As well as the increasing numbers, medical education was changing, especially in the matter of dissection. Before the 1750s, anatomisation was generally a theatrical event where the dissection was carried out by a surgeon, watched over by a crowd of enthralled and doubtless, sometimes, nauseated crowd.

But changes in medical education meant that trainee surgeons were increasingly given access and encouraged to get their hands dirty. Reading books about anatomy was fine as far as it went, but could never replace empirical observation and experience. This was also an age where views of the body were changing, and the human form was likened to a machine. As Thomson’s The Art of Dissecting the Human Body, in a plain, easy and compendious method dissection manual put it, there were only two possible ways to discover the workings of a machine. One was to be taught by its creator…difficult in this case! The other was simply to take it to bits and put it back together again.

Surgical manuals began to set out the requisite kit for the gentleman surgeon. One was to purchase a set of pocket instruments containing the most commonly-used items. The German anatomist Lorenz Heister advocated a pocket set including lancets for opening veins and abcesses, straight and crooked scissors, forceps, probes, a razor and needles. A similar kit was popular in London, containing knives ‘made of best steel’, lancets and scissors, as well as a salvatory and plaster box. Clearly some surgeons were apt to keep buying until they had amassed a huge number of instruments. The surgeon and author Benjamin Bell cautioned against such acquisitiveness, arguing that too many instruments confounded the surgeon under the pressure of the operation.

Image from http://collectmedicalantiques.com/gallery/cased-surgical-sets
Image from http://collectmedicalantiques.com/gallery/cased-surgical-sets

The increasing demand for instruments opened up a range of new opportunities for the makers of instruments. Traditionally cutlers had been the mainstay of surgical instrument manufacture. With their experience in making edged tools and of tempering metals to exact requirements, they were the best qualified. But by 1763 the Universal Director, a directory of London trades, was describing surgical instrument manufacture as ‘a distinct branch from the common cutler’. By 1800 the first dedicated surgeon’s instrument catalogues were being produced by prominent makers such as J.H. Savigny of the Strand in London. Savigny’s catalogue contained a wide variety of different instruments from knives and saws to catheters, tourniquets and even apparatus for the recovery of the apparently dead!

Image from Savigny's instrument catalogue, 1800
Image from Savigny’s instrument catalogue, 1800

Surgical instrument makers were also keen to puff their products in newspapers. The market for these products was fairly narrow and specialised; these were not items marketed for the public. Nevertheless it is noticeable that makers did their best to clothe their advertisements in the language of polite commerce, and include popular and elegant designs in their trade cards. The language of advertisements was all polite puffery. The tone of advertisements for ‘Thurgood’s Surgeon’s-Instrument Manufactory’ in Fenchurch Street was deferential, seeking to reassure ‘any professional gentlemen’ that ‘nothing shall be wanting on his (Thurgood’s) part to render full satisfaction’. Many other adverts were targeting ‘gentlemen of the faculty’ and seeking to encourage their business.

Advertising also offered opportunities for illustration. The trade card of John Chasson of London depicts a variety of amputation knives, saws and other instruments set against an elegant rococo surround. The razor and surgical instrument maker Henry Patten’s card shows a range of instruments, including lancets, hanging from branches of its elaborate frame. Given their associations with manual trades, it is noticeable that advertisements began to pay attention to the form as well as the function of instruments. John Chasson’s instrument cases, for example, could be bought in elegant boxes covered in fashionable shagreen (sharkskin). The handles of knives and saws began to change from traditional wood and bone to more exotic and expensive products like ebony, ivory and tortoiseshell.

M0015899 Surgical instrument maker's trade card, 18th century.

Image courtesy of Wellcome Images
Image courtesy of Wellcome Images

Perhaps the most surprising claim made by some makers, however, was that their products lessened pain and improved the experience of patients. In 1778, J. Savigny advertised his newly-invented lancets to the faculty. Stressing his metallurgical skills, Savigny argued that they were ‘wrought to such a degree of accuracy, as will greatly lessen the pain of the patient, and totally remove all apprehension of disappointment in the operator’. In another, he argued that the ‘extraordinary degree of accuracy’ in their edge would lead to the ‘approbation of the patient and reputation of the phlebotomist’. It’s interesting to note that the patient comes first. Many surgeons agreed that speed was of the essence in any surgical technique, and that this could only be achieved by keeping instruments maintained since, as Benjamin Bell noted, they were ‘injured with every use.

Amputation

The late eighteenth century, then, was something of a golden age in the manufacture of surgical instruments. As the medical faculty sought desperately to separate itself from accusations of quackery and establish itself as an learned profession, the need for new instruments, based on the latest scientific and philosophical principles, was key. Likewise, with an expanding market and greater opportunities to promote their products, surgical instrument makers were continually engaged in developing and refining their products. Whether it would be of any comfort to a poor patient to know that the knife about to saw their leg off was made of the latest cast steel, however, is a moot point!

‘He is gone from his service before his time’: Medical Apprenticeships in Early Modern Britain

One of the biggest frustrations in studying Welsh medical history is the lack of institutions. In the early modern period Wales was unique amongst the individual nations of the British Isles in having no universities and no medical training facilities. Unlike England, Scotland and Ireland there were no colleges of physicians or surgeons. Why was this? One of the main reasons was the lack of large towns. Wrexham, in north Wales, was by far the largest town in early modern Wales, with a population of around 3500 in 1700. There were many other smaller Welsh towns but, without large populations to cater for, there was no need for practitioners to form trade gilds or corporations.

Over the past few weeks, however, I’ve been turning my attention to the Welsh Marches – the border between England and Wales – and doing some research on large towns such as Shrewsbury and Chester, which were important centres for Welsh people and, it seems, for Welsh practitioners too. One area that I’ve been particularly interested in is that of medical companies and trade guilds. As part of our project in Exeter, we’ve been looking in more detail at the role of barbers and barber surgeons in medicine, both in terms of what they did and how they were described, but also exploring the important question of medical apprenticeships. One company in particular, the Chester Company of Barber Surgeons and Wax and Tallow Chandlers is a particularly rich source of evidence.

L0048991 Arms of the London Barber Surgeons' Company. Engraving

The Company were responsible for the regulation of barbers, barber surgeons as well as chandlers who made candles and soap. The relationship between the trades may not immediately be apparent but, in fact, was often interchangeable. People described as barbers were commonly medical practitioners as well as hair cutters and beard trimmers. Barber surgeons often ran barbering shops. The gap between them was extremely fuzzy.

But also, for reasons that are less clear, barbers might also make and sell candles. In the records, barbers can be found referred to as wax chandlers (ie those making wax candles), or as both. Wax candles were relatively expensive since they burned for a long time. Interestingly, however, there appears to be no overlap between barbers and tallow chandlers. Tallow was animal fat, used in candle production. Although tallow candles were cheap, and as bright as wax candles, (around half the price of wax, or less) they burned for only around half the time, so were less effective.

Tallow candles

In conjunction with the borough the Company regulated trade and practice, laid out rules for members and also oversaw apprenticeship. Membership bestowed certain rights but also carried responsibilities. Brethren who did not abide by the rules risked censure and fines…and the list of rules was long!

Some orders were routine and concerned attendance and appearance. Every member was expected to attend all meetings unless they had a valid reason, and to wear their gown. They should ‘behave themselves orderly’, not disturb or interrupt meetings and should always call their fellow members by their proper names…on pain of a fine. Other rules related to respect and civility. One brother of the company should not ‘dispraise anothers work’ nor lodge any lawsuit against a fellow member. Neither should they disclose any secrets of their work to lay people, nor give out details of the meetings.

All fees (fines) were to be promptly paid and recorded in the register. These paid for the costs of meetings and food, but also for the burial of departed bretherin. Rule number 14 provided for ‘the decente and comely burial of any of the saide companye departed’ and it was expected that every member should ‘attend the corpse and burial’ unless they had good reason. The fine for non-attendance was a hefty 12 shillings!

Popular culture and religious belief also features strongly. An ‘order against trimming on Sundays’ forbade the cutting of hair on the Sabbath day, again for a fine of 20 shillings. Every year the company also participated in a popular midsummer parade and festival in the city. This involved a procession of decorated carnival floats, and was a throwback to an ancient pagan ceremony. Unusually, it continued long after the Reformation and also survived the Puritan assault on popular revelries. In 1664, an order stated that money should be set out for the stewards to arrange for a small boy (a ‘stripelinge’) to be dressed and ride Abraham, the Company’s horse, in the procession, and to ‘doe their verie best in the setting forth of the saide showe for the better credit of the said societie and company’.

Chester midsummer festival
(Left image: public domain; right licensed under Creative Commons-Attribution-Noncommercial-Share Alike 2.0 Generic)

Perhaps one of the most important aspects of the Company’s function was apprenticeship. The rules of apprenticeship were clearly set out, and this sheds light on a very important and under-researched area of medicine. Only freemen of city, and Company bretherin, were allowed to take on apprentices. Apprenticeships were usually for seven years, but this could vary according to individuals. According to the company rules, no brother should take on another apprentice until his current one was within the last year of his service. The fine for disregarding this rule was a ruinous £10! All apprentices were to be entered into the register or risk a 30 shilling fine.

Why people sent their children to be apprentices in medical professions is not always clear. Medicine was not regarded as a prestigious occupation and, indeed, surgery was sometimes analogous with butchery. Nonetheless an established business in a town could be lucrative, especially given the range of services that barbers provided. As such, the decision to enrol children with urban medics could be pragmatic.

Barber-surgeon with Scared Patient

A brief glance at the apprentice registers reveals a number of interesting points. Firstly, it is clear that apprentices were often drawn from a town and its hinterlands. Although some came from further afield, the majority were local or lived within roughly a twenty-mile radius. On 18th Feb 1615 Richard Howe was apprenticed to Edward Wright, barber and wax chandler of Chester, for 8 years. Nicholas Halwood of Chester joined Robert Roberts, Chester tallow chandler for 7 years, while Robert Shone of Broughton’s apprenticeship to a Chester chandler was for 12 years.

In some cases family connections were clearly important, and parents might apprentice their child to a brother, cousin or more distant kin. This was a useful means of drawing on connections to further a career. James Handcocke was apprenticed to his uncle William Handcocke, a barber and wax chandler in September 1613, while Robert Glynne was apprenticed to Richard Glynne to learn the art of barber surgery. Fathers might also take on their own sons as apprentices, a situation that must sometimes have led to fraught relations. Nicholas Cornley was apprenticed to his father Richard for 7 years in 1626, while others such as Robert Thornley, a barber surgeon and painter (!) took their sons to follow in their footsteps.

The conditions in which an apprentice lived and worked depended so much on their masters. While many were well-treated and provided for, which was in fact a central condition of apprenticeship, some masters could be cruel and neglectful of their young charges. Robert Pemberton’s service to Randle Whitbie ended 3 years into his 10-year indenture when he was found to be ‘gone from his service’. John Owen of Cartyd, Denbighshire, ‘ran away before his time ended’ as did Philip Williams, apprentice to Raphe Edge, who took to his heels after a year. Nothing is given as to the circumstances of their treatment; it was not unknown for apprentices to complain of ill treatment, however, and authorities took this seriously. In other cases the stark phrase ‘Mortuus est’ (he is dead) indicates another reason for the termination of an apprenticeship.

The number of entries and records for the company is huge, and will take a concerted programme of research to thoroughly investigate. It will also be interesting to compare these sources with other similar companies across Britain to build up a bigger picture of the activities of medical trades in early modern towns. Once this is done we should have a much broader picture of the role, function and daily activities of medical practitioners in the past.