Castillo de San Marcos – Medical Instruments

We’re going to take a short break from looking at the fort’s construction and history at Castillo de San Marcos in Jacksonville St. Augustine, and look at another angle, if a slightly queasy-making one: what the modern surgeon was using in the 18th Century or so. When OTR visited, a volunteer reenactor had a display of surgical instruments. Later, we’ll return to the mechanics of fort and firearm, we promise, but for now we are going to divert ourselves with a look at the instruments that might have been applied to you if you had the poor fortune to catch a musket ball, met the pointy end of a bayonet or edge of a sword, or had your butterfingered buddy drop an iron cannonball on your foot during, say, the siege of 1702.

If you need to catch up, the first part of the story covers much of the history and the approaches to the Castillo de San Marcos (later known as Fort Francis Marion in American Army hands, before reverting to its original Spanish name).

In normal circumstances, pre-1821, the Spanish military wouldn’t have treated its sick and wounded in the castle. They’d have been removed to the military hospital in town (which has also been well restored, equipped and staffed with interpreters). It’s surprising to most people, but Spanish medicine and surgery was advanced — for its day.

Bear in mind that medical science was ignorant of the germ theory of disease, of the importance of sterile conditions, and had no anesthetics (except alcohol) and no antibiotics. They had nothing to do for gas gangrene, which was a death sentence unless it was in an amputatable extremity. And no weapons, neither preventive nor curative, were at hand against endemic malaria. Yet the claim has been made that while the language, tools and skillsets of the 18th and 21st century internal-medicine physician have very few points of congruence, the historical and modern surgeons would have more common ground for discussion.

Not being surgeons, we have our doubts about that.

This is not somebody’s table at the Acme County Gun and Knife Show. These are a military surgeon’s tools; do they pass the “Common ground” test?

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Either the surgeons of 1720 were much concerned with one’s fundamental orifice, or the guy who collected all this gear has some kind of anal fixation. An enema set (appears to be British origin):

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And the next to those: suppositories. Eh, we’ll take our chances with the mange, the grunge, the itch, the twitch, the thrush, the scroff, the rot. To borrow a line. We’ll get to the sutures in a bit, what are those “…etal Scrapers?” “Metal Scrapers?” Wait, that’s a “c”. They can’t be fractal scrapers, can they?

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Uh, no. They can’t. Yeah, this guy has issues… or maybe 18th Century surgeons did.

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Arrgggh. Can we move on to some other region of diseased anatomy, please?

Thank you. The stitch kit doesn’t seem too archaic, although sterile and disposable it isn’t.

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Next we’ll move on to stuff for excavating the Brain Housing Group. The thing that looks like a heavy-duty Forstner bit on the upper left in the image below isn’t too far off — it’s a trepanning saw, for making holes in the cranium. That was usually done as a last ditch attempt to reduce brain swelling and save an otherwise doomed patient. If it didn’t work, well, the guy was standing in the door anyway. Maybe there will be a better view of this tool below.

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Cautery Irons were used to burn blood vessels shut during surgery. They’d be heated red hot, then jammed into the wound.

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Now this is a piece of lifesaving gear that is recognizable. It uses a thumbscrew to apply pressure and it seems probable that the 18th-Century surgeon used it, primarily, during deliberate amputations.

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After the jump you can see more grim instruments from bygone days, when the promise that “to cut is to cure” was much less certain than today’s well-informed surgeons can offer. Click “more” if you dare.

Here’s the promised better view of the trepanning saw, or “trephine” as the display calls it (it was also called a “trepan.” The reason a surgeon would do this might be to excise foreign matter and dead brain tissue, or more commonly to relieve pressure on the brain from any kind of traumatic brain injury. Contained in the cranium, the brain has nowhere to go if an injury makes it swell, and rising intracranial pressure can do bad things to the brain and the central nervous system — fatal things. 
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While cranial trepanation is normally something only used when a patient is already seriously injured, there are nut jobs out there that swear that doing it voluntarily has expanded their consciousness. (Medical science thinks these characters have a hole in their heads).

Bleeding was a cutting-edge technique, once. The next picture shows two fleams (it sounds like something from Mad Magazine, but it’s really what these bloodletting instruments  were called), one apparently factory-made, and another blacksmith made (just above it). The thing that looks like a pestle is probably a fleam stick, used to hammer the fleam into one of the patient’s superficial blood vessels. The bowl is a blood bowl. Bleeding doesn’t seem to have cured anything, but it usually didn’t harm the patient much, and it gave the patient, the family and not least the surgeon a warm feeling that something was being done.

 

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Alternative medicine? In 1702, the only alternative to natural herbal painkillers was sucking it up and dealing with the pain. It takes hard men to fight over a new continent.

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Some of these next instruments appear to be spoons for giving medicine — made of various materials including silver, bone (or ivory?) and tortoise shell.

How you would use a “crotchét” to help birth babies is beyond us. Hey, we’re just weapons men around here, we hold the mother’s head while the 18D works on the messy end.

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Look at those scalpels, in the next image, and it’s easy to see that the professional divergence of surgeon and barber was not long past.

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And if you’re going to have scalpels, you had better have forceps:

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We’ll close with the torture kit dental instruments. Hand forged and frightening-looking.

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And, an exercise for the reader: which medical procedures and which tools that are in use today will look as primitive as bleeding and the “trephin,” two or three hundred years from now?

18 thoughts on “Castillo de San Marcos – Medical Instruments

  1. guy

    About the ‘fundamental’ tools –

    Could they have had a problem with intestinal parasites? I ‘d think anywhere malaria is a problem worms and the like would be a pain in the butt.

  2. S

    Digital extraction of coprolith; or, use a scraper, your choice, doc. Is there an article on siege/naval rations and their effect on the digestive system? That reminds me, whatever became of Doctor Bill?

  3. C. Harris

    I remember using suppository molds during pharmacy practical labs at uni and they haven’t really changed at all other than to move to nice stainless steel. I’m not sure a mold would have been part of a surgeon’s gear it’s more something from the apothecary side of the trade. Of course a surgeon on a remote posting might have had to do a bit more in the way of multi tasking to care for his charges.

  4. staghounds

    He has the wrong spelling, and the wroooong description of what a crochét is for. Dr. Gosnell wore several out.

    And you say forceps, but I count six ceps.

  5. Cap'n Mike

    “And, an exercise for the reader: which medical procedures and which tools that are in use today will look as primitive as bleeding and the “trephin,” two or three hundred years from now?”

    The Chief Medical Officer, USS Enterprise gave us some insight on this in Star Trek IV :)

    McCoy: [probing Chekov’s head] Tearing of the middle meningeal artery…

    Doctor #1: What’s your degree in, dentistry?

    McCoy: How do YOU explain slowing pulse, low respiratory rate and coma?

    Doctor #1: Fundascopic examination!

    McCoy: Fundascopic examination is unrevealing in these cases!

    Doctor #1: A simple evacuation of the epidural hematoma will relieve the pressure!

    McCoy: My God man, drilling holes in his head is not the answer! The artery must be repaired! Now, put away your butcher’s knives and let me save this patient before it’s too late!

  6. LSWCHP

    Bloody Hell! Imagine going through trepanning while fully awake and aware, or gunshot wound cauterisation, or tooth extraction? Anaesthetic is a true blessing.

    As for how the future will view us? I have a good friend who is a senior medical specialist. He says that while great advances have been made, the profession generally tries to give a vastly better impression of its capabilities than is warranted and that much surgery is still a rough combination of butchery, carpentry and plumbing.

    If the human race is lucky, the medics of the future will view our primitive efforts with smug smiles as per Star Trek. If we’re not lucky, they may well look back in wonder at the long lost miracles of the ancients.

  7. Eric

    I’m a RN and I take care of people after surgeries. A common complication of abdominal surgery is ileus. That is when a section of bowel goes to sleep. The bowel above the ileus can get very distended and make one vomit green bile. Worst case is the distended bowel perforated which usually leads to sepsis and death when bowel microbes grow on the wrong places.
    I get to prevent and treat this by giving enemas and suppository bullets. Today we also put a NG tube in to decompress the upper GI tract. I don’t like putting my hands there but the surgeons do it from the inside. Anything to save a life.
    PS consider being an organ donor if you’re not one. Tell your family. I see transplants save lives every week.

  8. Tim, '80s Mech Guy

    Stainless and the Autoclave were big additions but the rest of that shit can still be picked up at Harbor Freight.

    Visited the castle four years ago, still trying to get back. Grooving on this series .

  9. jjak

    Pretty sure the primary use of a crotchét was to assist in removing a deceased fetus from the mother.

    1. Eric

      No it does not. Suppositories tend to melt with heat because of there are wax composition. The minie bullet expands to engage the rifling. I have only encountered unrifled rectums in my work as an RN. Probably more like the round ball ammo than mine ball.

      1. DSM

        I hesitate to say that my question was “tongue in cheek” given the nature of the conversation but you get the gist. Ha!

        But in all seriousness though, and maybe it’s that I’m not overly versed in the practice of booty medication that a suppository would be the first thing coming to mind seeing that device, that assembly looked to me to be a mold for the casting of bullets. Was Mr. Minie the recipient of such a treatment and made that mental leap as it were to, “Hey, what if I made this out of lead and shot it out of a musket?” They say your best thinking is done on the crapper. Just a random thought for the day.

  10. Mr. AR-10

    Thanks WM, this will help me decide on what to do re my pending back surgery.

    Also have to re-watch The Knick.

    :-)

  11. Aesop

    Don’t be too harsh on the collector. The preponderance of rectal devices and instruments is merely an accurate reflection of proto-medicine’s fixation on a readily available human orifice requiring no infection and death-prone incision to utilize. (“When all you have is a hammer, &c….”)

    As for 17th- and 18th-century surgical instruments in general, the modern variety can be had by travelling no farther than the dissection department of most good biological/scientific supply company master catalogs, as the bone saws and such haven’t even been changed in over a century, save the use of stainless steel, for durability/longevity.
    Anyone with the implements to dissect a cat or butcher a hog presently, has, for all intents and purposes, the same kit any MD from circa 1700-1800 possessed, while also having about 90 times the medical education available at that time by the time they finish middle school science class.

    For that matter, as a point of interest, a 21st-century orthopedic surgical suite invariably contains a stainless steel Craftsman rolling tool cart, and a full set of carpentry items one could purchase anywhere from the hardware department of Sears, or at Horror Freight, including no small numbers of stainless steel pins, nails, and screws, and frequently an assortment of sterilizable power tools not unfamiliar to our Bloghost from his foray into aircraft construction.

    Nota bene: As they’ll tell you themselves, the chief difference with successful modern surgeons vs. modern carpenters and mechanics, is that that the former have to perform their carpentry and electrical repairs while the machine’s engine is still running.

  12. Docduracoat

    I have been in practice for 23 years and I have lived the history of Anesthesia.
    I can remember when the Anesthesia Machine was just a cart to carry the copper kettle vaporizer.
    We used Jackson Reese breathing circuits in pediatrics and Halothane gas for inhalation induction.
    Procaine and Lidocaine were commonly used spinal anesthetics.
    Now all of these things are found only in a museum.
    Even Spinal Anesthesia itself has almost been completely abandoned.
    When I tell a trainee student that I used these things, they look at me like I said I used leeches or bloodletting.
    100 years from now, I am certain it will be like Star Trek. They will put something on your head and control your brain waves and you will be in the anesthetic state
    They will laugh at us with our Intravenous narcotic drugs and our blood pressure cuffs.
    It will be a brave new world.

  13. Eric

    The rectal scrapers look like modern day probes used in the treatment of peri-anal abscesses and anal fistulas. Draining a peri-anal abscess relieves pain like nothing else.

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