American Surgical Instruments: The History of Their Manufacture and a Directory of Instrument Makers to 1900 (review)

American Surgical Instruments: An Illustrated History of Their Manufacture and a Directory of Instrument Makers to 1900. By James M. Edmonson. San Francisco: Norman, 1997. Pp. xi+352; illustrations, figures, notes/references, appendixes, index. $150.

This extensive and comprehensive survey of the American surgical instrument-making trade offers much food for thought on the relations between medicine and commerce. Both as a reference work and as a historical review it fills a gap in the growing literature on medical artifacts. It does for the American trade what Elisabeth Bennion did for British instrument makers in the appendix to her Antique Medical Instruments (London: Sotheby Parke Bernet, 1979). Nearly a quarter of a century has passed since Bennion's book was published, and the concerns of historians of technology, medical or otherwise, have changed. But there is still a need for the painstaking work involved in such surveys, and James Edmonson's book offers a great deal beyond this.

The narrative preceding the directory surveys the rise and fall of the American instrument trade. In it Edmonson puts flesh on the bones of the individual makers listed in the directory, assessing the quality and character of their work and relating the instrument trade to changes in medical and surgical practice. Five appendixes follow. The first deals with manufacturing techniques and materials. The second presents a detailed inventory of the Boston doctor, John Jeffries, compiled in 1809, "easily one of the most comprehensive arrays of surgical technology in early nineteenth century America" (p. 283). The third reproduces the 1818 trade catalog of Philip Browne of Philadelphia, probably the earliest issued by an instrument maker in the United States. The fourth surveys the instrument trade from 1785-1900 in selected American cities, while the fifth lists notable American collections now in existence.

In telling us so much, Edmonson inevitably raises fascinating questions that might reward further study. What makes a particular instrument a commercial success? Which were failures? How much of this relates to the properties of the instrument in question and how much to sales technique? The author is careful not to take the inclusion of an instrument in a catalog as an indication that it was used to any extent. In Britain, designs continued to appear in catalogs long after the instruments had passed into disuse, and some of them, one suspects, were scarcely used at all. Until well into the twentieth century, the British trade continued to produce the idiosyncratic designs of individual surgeons, however uneconomical this may have been. And if surgical practice was the main determinant of instrument design, what of influences from other trades?

How did surgeons choose what to buy? The nineteenth century saw the appearance of the commercial traveler, whose goods included medical supplies. And what of traveling surgeons? Visiting foreign surgical centers was de rigueur for aspiring American surgeons in the nineteenth century. Did this affect the demand for, or design of, instruments? Did a more "international" style result? This is a question perhaps best pursued in the period after 1900, when, as Edmonson documents, American surgeons once again had to rely on overseas imports, and not necessarily from traditional European centers of production.

Such issues, and Edmonson's detailed exploration of many related ones, emphasize the point that operative surgery is not the sole context for the study of surgical instruments. As a starting point for exploring this wider context, Edmonson's book could not be better. Plentifully illustrated with photographs of instruments, it also includes a few showing the instrument makers and sellers themselves. One might have hoped for more of the latter, but perhaps they are not to be found. Selling surgical instruments is not half so glamorous as using them, and those in "trade" have devoted rather less energy than surgeons to nurturing their historical roots.

Ghislaine Lawrence

Dr. Lawrence is senior...