Medical History 19th Century

8/6/2019 Medical History 19th Century

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MEDICAL

COLLECTORS

ASSOCHTIONDear Collectors:I am pleased to present to you the

first newsletter for 1994. 1 had such a largeamount of material to present to all of youthat I have chosen to prepare an unusuallylong newsletter. The newsletter in the fall willprobably be considerably shorter in length.

First of all let me direct your attentionto the meeting which was held at the ParkCentral Hotel in New York on April 28th. Themeeting was very well attended and thepresentations were absolutely superb.Everybody had a marvelous time and inaddition there was a most worthwhile dealersexhibition following the meeting. The daywas concluded with a delightful dinner atCite' Restaurant where we all had a chanceto speak and get to know each other better.

At this dinner Dr. Rugendorff and hiswife grac~ously olunteered to host a meet-ing in Frankfurt sometime in 1996 or 1997.Therefore, preparazcx are now underwayto present to the membership a met ing inEurope in the not too distant future with Dr.Rugendorff's help. I also had an opportunityto mention this to Elisabeth Bennion whohas told me that shewould certainly be willingto help us in this en-deavor.Also in connec-tion with the meeting Dr.Jay Worth Estes and Dr.J.W. Rosenthal havekindly consented toallow me to append themanuscripts of theirpresentations to this

believe that written text still conveys a gredeal of very interesting and useful inform

We received presentations from DAlbert Kuhfeld from The Bakken Museumfrom Dr. Jon Erlen from Pittsburgh both inus to hold our 1995 meeting either at TheBakken or in Di. Erlen's case in conjunctiwith the American Association of the HistMedicine. Several problems arose in havthe joint meeting, the worst of which was conflict between the museum curators wha meeting the same time as ours and hadchoose one or the other meeting to go toBecause of problems in scheduling and abecause of difficulties with my schedule atime of the AAHM meeting in 1995 and afurther consultation with several regular ppants in the meeting, I have decided to hthe next Medical Collectors meeting at ThBakken Museum. It will be held on Friday9, 1995. Albert Kuhfeld is working at putttogether a program but it will undoubtedlyinclude tours of The Bakken, presentationthe morning, dealers tables and a socialevening for dinner. Details of the meetingbe presented to the membership sometimthe fall. I include with this newsletter a coAl's letter of invitation. Although we wereunable to establish a joint meeting with thAAHM for 1995 we are currently discussipossibility of a joint meeting in WilliamsbuVirginia in 1997.

I would like to bring a number of iesting items to themembership's attention

First of all the SoutStreet Seaport is plannhave an exhibition whicinclude a number of meitems. The exhibition isorganized by Dr. SteveI have enclosed with thnewsletter a notice fromasking for donations anlist of articles that he is


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exhibits are probably going to be opening sometime in the neighborhood of January ofso there is no great urgency but please if you have any material that might be of use acto Dr. Jaffe's request please contact either him or me.

It also should be of interest to many of you that Ellis Island has mounted a mediexhibit dealing with immigrant health traditions. The exhibit opened on May 10th and wcontinue through September 78th. I have enclosed with the newsletter an announcemethis exhibit.

Peter D'Onofrio has included a membership application for those of you who hainterests. The Society of Civil War Surgeons is an extremely active group and some of may wish to join this as well. The application and his letter can be found in the newslett

Getting back to more routine items, Ros Berman contacted me with an item thatbought as a tonsillotome and another item of unknown use that looked like a tongue desor. I have included both of these items in the column. The item that was sold to her asto~sillotomes listed in my instrument catalogues as a pharyngeal tonsillotome.I am notwhat the pharyngeal modifier means in terms of its relative use. The unusual thing aboitem that was sold to her as a tongue depressor is that it is made by Black Star& Frost wa very fine jewelry firm. I wonder if this was indeed medical at all other than the fact thabelonged to a physician. Please let me have your comments or send them directly to Raddress is listed in the membership section.

Dr. Terry Hembrecht has been kind enough to send me a copy of the patent for tractors. This patent was granted February 19, 1776. A very famous, or infamous, depeon your point of view, American healing instrument. The story of Elisha Perkins is an exinteresting one. Relevant to the patent, I have enclosed with the newsletter a partial abfrom the Perkinian Society which is an interesting group of individuals who obviously ththat Perkins tractors were a cure all for many things. In order to present the other side oI have abstracted some pages from Haygarth's book on the Imagination where he discuthe total lack of value of Perkins tractors.

Some debate between Dr. Rugendorff and me has gone on concerning the useinstrument which may be a hare lip forceps or may be a phimosis forceps but is probabI enclose this for your information.

I have heard recently from the Interdocumentation Company that they are expantheir instrument catalogue and I enclose this announcement for your interest.

I recently received a letter from a Mr. Arthur Stocks who is trying to sell some deequipment listed in the newsletter. There is also the usual inclusion of William Helfand'sexciting historical images of the drug market.

A few other announcements are included from the Hartford Medical Museum, thGraduate program for the History of Health, Medicine and Society and some recent offefrom Stanley Burns and from Jeremy Norman.This is quite a lot of material and I hope you all find it of interest. The membershalive and healthy as can be seen by the current membership list.

As usual I look for any contributions you may have to the newsletter.I hope that some material from the other presentations will be available for our n

newsletter.Please put aside the date June 9th for the next Medical Collectors meeting. Ple

contact me if you would like to present some material at this meeting. Minneapolis in Judelightful and Dr. Kuhfeld has informed that we will probably be able to arrange a lunch


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Can You I d e n t i f v T hi sMater ia l :Maker :Presumed Use:Date:

I t h in k t h i s i s a :From :


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MEDICAL

COLLECTORS

'March7, 1994

Erwin W. Rugendorff, M.D.Consultant Urologist bSiesmayerstrasse 6D-60323 Frankfurt am Main, GermanyDear Dr. Rugendorff:

Thanks for your comments about the forceps. In reviewyour photocopies one of the most striking differences to methat the Harelip instrument #I081 appears to have a saw bladeone of its components. While the Phimosis Clamp is flat at bends. I think this is a very important difference in additionthe screw. I have a cased instrument which was sold to me aPhimosis Forceps which has the blunt blades but does not have lateral screw.I think that it is very likely that a lot of manufacturmade instruments with minimal modification for different uses.would have been far too expensive to have a totally differen

designed instrument and present the great variety of instrumethat many of the catalogues had:I am enclosing with this letter photocopies of two pafrom the Tiemann catalogue of 1889 with Phimosis Forceps Harelip Forceps, both illustrations being identical.Thanks again for your interest. I will publish yreservations in the next newsletter. \

M . D . , Ph. D .

MDB: cmEncl


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Erwin W. Rugendorff,M.D.Consultant UrologistFellow of the European Board of UroSiesmayerstrasse6D-60323 Frankfurt am MainTel. 49 6972381 8F A X 49 69 173468

Dr. Dr. rned. E w n W. Rugendodl .Siesmayerstr. 6.Dm323 FranldufVMM. DONALD BLAUFOX. M.D., PH.D.1300 MORRIS PARK AVENUE324 MAZERBRONX, NEW YORK 10461U.S.A.. s

February 22, 19--

Dear Dr. Blaufox,

There has been a question about an instrument in a previous number of our journal. I hsent you a photograph of a similar instrument from my collection considering that it cobe a phimosis forceps.

Now, I have found a reproduction of the unascertained instrument in the catalogueDown Bros., Ltd., 1901 (see enclosure # 1081). Considering this reproduction, questionable instrument is probably a Hare-lip Forceps with parallel blades. As you see on # 2451, it resembles the Phimosis Forceps, but does not have the lateral screwthe handle. Therefore, I have reconsidered my view about my own instrument too.

Sincerely yours,


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GEORGE TIEMANN & (20.9 SURGICAL INSTRUMENTS.

FIG. 2836.-Girdner's Phimosis Forceps.

It is introduced into the preputial openingclosed ; then, relaxing the spring. causes thethe barbs to transfix, first, the mucous mem-brane, and then the skin.

FI G. 2837.-Cohn's Phimosis Forceps.

Dr. R. W. Taylor's procedure consists in making two incisions, one on either side, exactly in the middle lateral portion of the prepuce with a pair of strong scissors (Fig. 2839j. The result of this operation is that the pris converted into two flaps-an upper and a lower-with the glans penis between them, and the upper flap celevated and the lower one depressed with the greatest ease, so as to expose the whole surface. Then, after thedisease has subsided and the edges of the incisions have healed, these flaps may be snipped off without confinipatient to the house or taking him away from business. But, it will be objected, you thus have double the aof n w surface exposed to contagion. Very true, bat the advantage gained is more than n counterbalance, and, over, if the incision be properly cauterized and dressed, contagion will i n most cases be avoided. The caustferred by Dr. Taylor is pure carbolic acid, rendered fluid by a small quantity of water. Four pieces of lint arecut-two to fit the glans, the one above and the other below-and two strips to place between the cut surfaces. pieces of lint are soaked in the acid and put in their places ; he flaps are then brought together and a bandage waround the penis, allowing the meatus to be fm. The whole should be kept wet with cold water, and the drrepeated daily until the parts arc healed.

FIG. 840.-Taylor's Syringe, for Sub-preputid Injections. " If, from any cause, an opebe impracticable, the subject ogenital phimosis should be diat each act of micturition to


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GEORGE TIEblANN 8; CO. 3 SURGICAL INSTRUKENTS.

Clamps and Forceps for holding the Lips, Scalpela and Scissors for paring the Edges of thCleft, and Pins to preserve them in contact in order to cause adhesion.

F I G .2310.1[, ,tchison's Harelip Forceps.

F IG . 2311.-Parallel Harelip Forceps.-5-.,,? .?I , ::

!:.---J'*

F IG . 2314.-Smith's Harelip Forceps.

G'See " HAINSBY'SHEEK COM PRESSOR."

FI G . 2312 .Whitson's HarelClamp.


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y was formed in 1980 by six

s epecialty in our hobby. Today,throughout the United States,ut; fromo Washington; and all areasbetween. Th e Society also hasers in Australia, Canada,France, US Virgin Island s

West Gqrmany, and is continually

Ohio in 1990 as a non-e Internal Revenue Service as a

he general public as to thehe American Civil War, T he

is accomplished through researchy members, publications, and

specific goal of The Society isboth for members as well

ge of the most turbulent period

h, and 130th Anniversary; various other 125th &

130th Anniversary events; and otherstoo n umerous to mention.The Society is also there t o help itsmembers further develop and/orenhance their portrayal of a CivilWar era medical professional throughmeetings, the bi-monthly newsletter,The North South Medical Times,encampments, living histories, andthe networking between members.As a group, Th e Society tr ies to pickone event a year as a maximum effortevent where as many members aspossible try t o attend. Because ofthe diversity of location of eachmember, these annual meetings canvary in size from as few as 6 membersto as many as 45 or 50 members.Therefore, most of The Society'sbusiness is done either by telephoneor by mail.The Society additionally hosts anannual convention in the fall of eachyear. Lectures and presentation areby members and nationally recognizedCivil War experts from throughout theUnited States. Convention cities arepicked with some Civil War relatedaspects in mind.However, The Society is open toanyone, not just re-enactors,interested in any aspect of Civil Warera medicine. We have collectors,lecturers, historians, researchers,museum personnel, and re-enactors asactive members.If you wish to join The Societyplease complete the form on thereverse side and send to t he addressindicated.

SOCIETY OF CI\?L V'AR SU

For Those Interestin

CIVIL W A R MED


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Sianificance of Carvinas on ChineseTortoise-Shell Swectacles

Most Chinese tortoise-shell spectacles have nately c a n e d bridges. Many are similar, but I have cated at least nine different motifs. The significaof some may as well be similar, but as the carvings done by various artisans, there are differences.

The sign of money, of course, needs no explanatiThe bat is a sign of happiness and longevity. It is blieved that certain types, if eaten, will ensure gosight.

A butterfly carving on the bridge is a symbol joy, of conjugal felicity--sort of a Chinese Cupid.

Where you find the most ornate,caning, however,the sign of freedom.

The ends of temple pieces are sometimes pla(round or oblong). But some of the round examples hasignificant carvings. They are carved (sometimes caif in brass) in the sign of money--and some in the siof the swastika. The latter is of great antiquity ais common to many countries: In India, it is the mongram of Vishnu and Siva. In Scandinavia and in Peruvi


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letter, he as well addressed what he considered to the "real" problems. He stated, "Myopia is much mocommon among ~ hinese han foreigners. I use frequent

9minus 10 to minus 15. In one man in town, a writer the American consulate, a man now nearly 60, wears a mnus 2 4 . "

By the latter half of the nineteenth century athe early part of the twentieth century, spectacles China were progressively made of more usable brass aalloy metals. Many of the more common frames were macompletely of brass. The lenses were made of glasnot quartz, which could be ground to more exact specifcations for nearsighted, farsighted, and presbyopic pesons. And quite possibly by this time, at least some the llcustomsll ad faded--as the lenses were smaller size.


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In the 16th century, lenses were worn at 45-degree angle, and the temples were always straigwith a joint for folding. (The Japanese, as well, witheir flat Mongolian nose, had a problem &upporting tspectacles on the bridge of the nose--which is a problyet to be solved today.) A thread or string was used a temple piece to hold the frame to the face. They weeither tied behind the head or looped over the ears--did the Spanish, with a weight fastened to the end the string and left to hang behind the ears. They weusually carried in a case attached to the clothing hanging over the arm.

I have a pair of folding spectacles in my colletion, probably dating in the 16th century, with a raff(reed) frame. Folding glasses were not only used wistring temples, but also had horn pad to press againthe forehead. They were kept in a small circular caof wood, leather, or shagreen. Some of the more ornaframes were made of carved tortoise-shell. The tortoisa sacred animal to the Chinese, is believed to be edowed with the ability to bring good luck and long lifTherefore, they used it to make spectacles and other ojects. (The decorative carving on the tortoise-she


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had dark or tea-stone lenses. Many lenses were not oplano, but fairly myopic. Both glass and tea-stlenses, as well as frames, were of a like thiness--most being very thin--about 2 mm. we find thvery light in weight, affording comfort and the abilto remain on the face. So much for the I1newly inventthin grind!!

Spectacles then--and in later times, being consered marks of literary attainment, were also used 'props' to show respect. It was always consideproper to remove the spectacles in China when in presence of superiors; and even in the presence of inriors or friends. Rasmussen said, "It is a grave sof disrespect to the presiding judge to wear spectacin his presence. . When passing a friend onstreet, it is also courteous to remove one's spectacimmediately before the greeting." This custom, coupwith the superstitions of the Chinese, sometimes hmore weight than the obvious benefits of spectacles medical treatment in later times. The dispenser of Cnese spectacles, also stated in his letter to A0 1910: "The Chinese are also very subject to the m


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We find intriguing and amusing methods, however, their purchase and uses, as well as in the curious cutoms associated with them. For instance, a Chinese di

1

penser of spectacles stated in a letter to the AmericOptical Company in 1910: "Wearing spectacles in thoancient times was generally thought to establish twearer as intelligent, affluent, and influentialSpectacles, therefore, became a status symbol to tChinese. Furthermore, the larger the spectacles, tmore intelligent the wearer was thought to be. This why many of the early Chinese spectacles were so larand predate our current large fashion eye wear by abo500 years. The dispenser commented, "The Chinese wearof old spectacles cares nothing for comfort or fit .sometimes think the increase in size shows a decrease mental capacity. 1

Most lenses at that time were fairly large and cicular, and were thought of by many to have healing poers. The Chinese eyeglass dispenser stated, "The lensare many times made of crystal which comes from secrplaces and is supposed to cure various diseases of teye. I am frequently asked if my glasses have gomedicine in them. . . Some lenses are said to have powto enable to see at nighte'and ome to see into the ear


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ANTIQUE CHINESE SPECTACLESJ. Wm. Rosenthal, M.D., D.Sc.

Let us consider the development of Chinese spec1

tacles. From the Caucasian standpoint, spectacles werinvented by an unknown Italian in Northern Italy abou1280 A.D. Probably, the invention of spectacles iChina predated that by a decade or two, but we are unable to record this precisely because of distance anlanguage difficulties. The latter, as well as the lacof historical libraries, precludes the credit to anparticular Oriental inventor. The Japanese apparentlobtained eyeglasses from the Chinese and were not involved in the origination process. In 1915 Rasmussestated:

To attempt to trace the. exact genealogy oanything in China is a well-nigh hopeless task.China is a vast beginningless and endless symposiuand is at once modern and antique. Things of antiquity are in present use while things of com-parative modernity are relegated to equal acceptability with ancient modes and methods. ThiOriental country with its revolutions and withoutits evolutions is the one great cyclical 'Middle


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ter of the revolving elements, moves the least.The story of Chinese spectacles differs lit

from the usual Chinese stories and is equally *

luminated with its fancies, superstitions, tales. Eminent Orientalists do not usually tall that the old Chinese writers state very seously, for with the evident absence of scientiknowledge the old historians could not very wellexpected to approach matters of natural laws wmore than a simple wondering attitude and a mready to believe in the mysterious, spirit-lorigin of that which they could not underitand.

Unfortunately, there are contradictions in the merous references made to the history of Chinese sptacles. W. H. Holtmann states in W. Poulet8s book,History of Spectaclestn: "The Chinese used spectac2000 years ago (circa 22 B.C.)--but not to improve thvision. They used them with the thought that imaginary force, the 'You Shiut--which was supposed be present in the glass--would help visually deficipatients. According to Greefe, these spectacles w


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Cases

The development of Chinese spectacles cases paraltleled that of the spectacles themselves. The foldin

spectacles, as previously noted, were kept in circulacases and were used with delicacy. Other cases folarger glasses were made of wood and many times bore inscriptions such as those shown here, which recite allegorical themes. "The river looks like a picture witthe morning clouds. After the rain the twin bridglooks like a reflection on the mirror. The rainbomixed with human activities of the Chinese National Treall disappeared among the stream." (Chuan-Cheng). Thiwooden case is circa 1780. The second case with inscription says: VVYou hould treat the word with modestand people with h~nesty.~ igned "Spring & Stone hermitlV--pseudonym. Another wooden eyeglass case carved osandalwood reminds cs of the hand-carved wooden casefound in Central Europe around 1500. It has a slidintop with integral tongue and groove fastening.

Another most interesting and beautifully carvewooden eyeglass case is of sandalwood. The carving ion a background of peonies, which signified riches


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story of the "Three Kingdoms." This famous Chinenovel shows in this instance, "treading through the snin pursuit of the plum flower." A magpie is flying ov

,

a plum twig.We find an identical picture on a snuff bottle

the year 1760 in "A Glossary of Chinese Snuff BottlRebus,11 by Raymond Li. It shows the "Three Kingdomnovel, which describes many tales about the heritage Ju-Gurliang.

ConclusionWe see that the development of Chinese spectacl

was apparently richer in tradition and heritage, as weas in use and fashion, than were the use of eyeglassand cases in Caucasian countries.


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OPIUM AND ITS ARTIFACTSJ. Worth Estes, M.D.@

I'm going to try to put some of the h d s of artifacts that are associated with opium into a sort ofhstorical pharmacologcal focus th s morning. Some of the artifacts I'll show you are in my own collec-tion; others are in museums and private collections around the world. 1don' t have slides of all possibleartrfact types, but I th nk I 'l l be able to provide a background for many that you may well already have inyour own collections.

SLIDE 1: Materia medica boxT h ~ ss one among many drawers in a box of samples of raw drug materials with w h c h students

of medicine or pharmacy were expected to become familiar in the 19th century. Most of the botanicaldrugs in it had been known to physicians since ancient times, and a large number of mineral drugs wasadded to the standard pharmacopoeia beginning in the mid-16th century.

SLIDE 2: Opium block in box

T h s sample from the box is a brick of opium. Such pressed blocks of the exudate collected fromthe unripe seed pods of the opium poppy [Papaver somnlferurn]contained about 10%morphne by weight,and about 6% codeine. Morplune and codeine are, of course, the two major naturally-occurring opioids;all the rest are either chemical modifications of those two molecules or are synthesized in the laboratory.

SLIDE 3: Opium field in TurkeyThe best yields of morphine an d codeine come from poppies grown in Turkey, where this picture

was taken. When we were there, we saw armed guards patrolling fields likethis one, espeaally after theseed pods had fiUed up with raw opium gum.

SLIDE 4: Opium poppy, Turkey, close-upT h ~ ss one of the Turkish poppies you just saw. The word opium comes from a Greek word that

means "poppy--" while codeine is derived from the Greek word for " p o p p y - u . "SLIDE 5: Harvesting technique

The tools and techniques for harvesting opium vary in different parts of the world. Turkishharvesters use th s large curved k d e o make circumferential cuts in the immature seed capsules, so thatthe exudate can escape to the outside. The same knife is then used to scrape opium gum rom the capsuleuntil it runs dry.

SLIDE 6: Poppy @ DurhamAlthough the opium poppy can grow in this country - photographed h s ne in North Carolina-- for some reason it does not yield nearly as much in the way of narcotic alkaloids here as it does in Tur-

key and southeast Asia. Besides, it's been illegal to grow opium poppies in the United States since 1942.SLIDE 7: Bottle, Louvre

Some scholars think that this glass bottle, which was made in Egypt sometime around 1000 BC ora bit later, was intended as a container for opium simply because it resembles an upsidedown poppy


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Mv own interest in the hs to ry of opium medications was initially aroused by this book, first published in 1700 by Dr. John Jones, and reissued a year later. Jones had earned a doctorate in civil law atOxford in 1677, and was licensed to practice medicine in London a year later, although we don't knowjust how he obtained h s medical training. He seems to have practiced medicine while working as aChurch of England lawyer.

SLIDE 14: Table from Jones's bookIn 731e A4ysteries ofOpium Reueal'd, Dr. Jones recommended, in t h s table,what he considered to be

the "Best and Safest Opiates." I t lists the doses he recommended for 15different opium preparationsappropriate to people of four graded body builds. ~s therapeutic recommendations were not based onany concept of selectivity of the drug's action, although he did emphasize opium's anti-anxiety effects.The other ch ical effects he observed include: increased sweating; pain relief; cessation of diarrhea;lowering of the pulse; dry mouth; flushed s h ; ncreased sexual activity; and dilation of the pupils --somehow, opium's clearcut miotic effect was not recognized for another 100years or so, not until 1816.

SLIDE 15: Dose-effect CurvesThe doses Jones gv es in his table can be regarded as equipotent doses, regardless of which

therapeutic effect was to be acheved. For each opium preparation he recommended three doses as asultable range of doses for each body build. For mstance, he suggests doses of 10 to 15 to 20 drops ofLiquid Laudanum for weak women, and 20 to 30 to 40 drops for strong men. Because the middle dosesare always midway between the two extreme doses in all dose ranges, the middle doses can be taken asmedian equieffective doses for each body build.

The handouts show the 15 preparetions !ha! !CIT~~C.lesCT;.F3ed,zrrllnlged Lq 8 .-.umbered eqiiipokiitgroupings. The first 6 groups are solid dose forms, while numbers 7 and 8 are liquids. Groups 1,2,3, and7 were relatively recent inventions, introduced in the 17th century. By contrast, the others - groups 4 , 5 ,6, and 8- date from the ancient Roman world, from the first century B.C. to the second century A.D. Theone exception -- Diascordium in group 6 - was designed to be a modem improvement on the ancientopiate called Mithridate.

For each of the 15 preparations I plotted the mzdian effective doses against M : i r weights appro-priate to persons of the body builds Jones specified. The resulting curves for the most @tent solid opiatesare summarized in Curve No. 1 on the left, lymg nearest the abscissa, the X-axis. The curve for the leastpotent solid dose forms in group number 6, Mithridate and Dtascordium, isn't shown here because itwouldn't f i t on th ~s raph. S~rmlarly,he curves or the equieffedive liquid formulations are on the right.

Part of the apparent efficacy 3 f Jones's orally adrmnistered opiates- hat was, of course, the onlyroute of administration open to h m may be attributable to his greater interest in their effect on anxietyrather than pain, effects which seem to be separable. These doseeffect curves computed from Jones'sdata reassure us that opiates used in the 17th and 18th centuries did have some measurable pharmacolog-ical effects, however those effects were evaluated clinically.

SLIDE 16: Table: Doses & Potencies of SOLID opiates

To what practical uses can we put data like those derived from Jones's median effective doses of15 opiates used in the 17th and 18th centuries? For \ example, they can help us decipher the therapeuticvocabulary of b torical opiates. For instance, in his great I 3 c tww-y of 1755, Samuel Johnson reportedthat, "A moderate dose of opium, taken internally, is generally under a grain." My calculations suggestthat Johnson had in mind the most potent solid preparations.

For another example: during the American Revolution, the standard medicine chest for a Con-tinental Army battalion contained 20 ounces of raw opium. Since army pharmacopoeias specified onegrain as the usual dose of the drug, t b able permits u s to calculate that the battalion chest containedenough opium for almost 9,000 doses. Even assuming that multiple doses were usually necessary, such a


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Abstracted from: J. Worth Estes, "John Jones's MystmZTies o f0 pi 1 11 11emal 'd (1701): Key to Historical Opiates,"Jorlrnal of the H is tm j of Me dkin e a l ~ d l lied Scicr lres 34 : 200-209, 1978.

No. of DoInactive Percent as

Preparation Ingredients* Opium Content Range of Doses Relative Potencv Mo1. Solid Panacea (by 1677) 0 1 0 0 ~ 0.5-2.0 3. 250 5Wedel's Laudanum (1662) 0 95% 0.5-2.0 gr. 250 4

LeMort's Extract (c. 1690) 0 1007; 0.5-2.0g. 250 52 Dr. Bate's Pacifick Pill (1691) 3 85% 0.5-3.0 gr. 204 4

London Laudanum (by 1677) 6 80% 0.53.0 gr. 204 43. Starkey's or Matthew's

Pill (before 1665)4. Philonium Romanum 13" 2.5 % 16-60 gr. 10 3

Philonium Persicurn 14" 5.7 % 16-60gr. 10 7(both IS'cen tu j AD)

5. Theriac ( lS tentury AD) 55**" 1.3% 30-180 gr. 4 3(=Venice Treacle)

6. Mitluida te (2* century BC) 50 0.3 % 1204.80gr. 1 3Diascordium (c 540) 15 0.3 % a 120-480gr. 1

7. Liquid Panacea (before 1677) 1 >15% w/v 1 0 4 rops 20 drops= 1gr.of Solid Panacea

Sydenham's Laudanum (1670) 2 > I I % w/ v 10-40 drops SameLaudanum Liquidurn 5 6 > 9 % w / v 1040 drops Same

Cydoniatum (before 1677)8. Diacodium (lStentury AD) 1 > 6 % w /v 0.4-1.5 02. 0.7 02. = I gr.

(= Syrup e Meconio) of Solid Panacea

t Excluding vchiclcs (c.g, watcr, alcohol, honey).t. Calculated on thc basis of 65 rng rnorphinclgrain, and morphine concentration as 1% of raw opium,

completely extracted.m Including henbane seeds, which Joncs rt~ornrnends e omitted.tn Including 2.670 squills.

Wor th Estcs, hl.D.Dcpartmcnt of PharmacologyBoston Univcrsity School of M~dicinc8 April 1 9 4


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chest permitted treating a great many wounded men, and many cases of diarrhea - ndeed, the chestallowed 15 doses for each of the 600 men normally comprising a battalion.

SLIDE 17: Table: Doses & Potencies of LIQUID opiatesAs another example of potential uses of these data, those for the liquid preparations confirm

Thomas de Quinces's estimate of their relative potencies. In h s Confess-011s of an Engl ish Opium-Eater, eQuincey wrote that 25 drops of Laudanum were equivalent to one grain of solid opium. This means thathis Laudanum was only about 80% as potent as the Liquid Laudanum described by John Jones a centurybefore. In 1813, de Quincey was takmg 320 grains of opium daily, as 8,000 drops of Laudanum measuredby the wine glass full.He preferred Laudanum to opium pills, because the onset of action was morerapid for the liquid dose form, as we'd expect today. Although the exact formulas of the 15 preparationslisted in the handout changed somewhat after Jones wrote his book, their relative potencies did notchange very much.The extraction and purification of morphine from opium were first reported in 1817, athoughthey had been accomplished in 1806. However, in 1822,Dr. Jacob Bigelow of Boston, one of the authorsof the first United States Phmmacopoeia, wrote only that: "At present we may venture to predict thatmorphine probably will not supersede crude opium in medial practice."

There was, of course, no good way to administer purified morphine until the modem hypoder-mic syringe was invented, in the 1850s. In the meantime, Bigelow and his contemporaries continued toprescribe the most potent oral opiates then available. At the same time, they allowed the older, lesspotent, dose forms, those with the most exotic names and compositions, to continue their slide into whatwe can now recogmze as pharmacolopcally deserved oblivion.

SLIDE 18: Laudanum bottleLaudanum was the most potent liquid preparation of opium available for long after Jones pub-

lished his book. The invention of the word laudanum" has been asaibed to Paracelsus, who died in1541. Although it's not clear just how he derived the word, he seems o have intended it, in the first place,for a preparation made with pearls and gold. Whatever the case, the Enghsh were applying the term"laudanum" to tincture of opium as early as the year 1600. That this bottle of Laudanum was made lessthan 100 years ago is good evidence of the drug's great therapeutic success over three to four centuries.

The LeMort's Extract in Group 1 in the handout was invented about 1690. By 1746 it was calledParegoric, derived from a Greek word for "soothing." It was made with camphor and other ingredients aswell as opium. From about 1650 to 1850, Paregoric, Laudanum, and other opium preparations were usedfor three primary purposes: as antidiarrheals, as sedatives, and asanalgesics, more or less in that order ofdescending frequency. Opiates were also prescribed for cough, which is reasonable, and to relax thecommon bile duct, which we now know is not reasonable, since morphine actually constricts its smoothmuscle. Sometimes opiates were given along with purgative drugs such as calomel, to counteract theirstrong cathartic effects.

A new application of opium appeared in 1732, when Dr. Thomas Dover added opium, ipecac,and a couple of potassium salts to wine. The undissolved mixture, called Dover's Powder, was used formany years as a potent diaphoretic, to help sweat out the edema fluid that commonly accumulated indropsy and other chest ailments, as well as for other purposes, especially serious fevers.

SLIDE 19: Theriaca Adromachus jarLf Laudanum was - s - he most potent of the orally administered opiates, Theriac was one of

the least potent preparations described by John Jones, or by anyone else, for that matter. Theriac hadbeen invented in the first century A.D. as an improvement over the older Mithridate as an antidoteagainst poisoning with any poison - he word "theriac" was Greek for a venomous animal or serpent.This ar for theriac was probably made during Jones's lifetime.

SLIDE 19A: Theriac jar


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T h ~ ss an 18th-century French jar for Theriac. Most recipes for its manufacture specified wellover 50 ingredients; one used in Edinburgh in 1794 had 61. Most physicians recognized that i t s onlyactive ingredient was opium. Nevertheless, no one urged that the inactive components be elurunated.

SLIDE 20: Theriac in Tacr{irrrrtnTheriac is the subject of this picture in a Ha~rdbookof Heulth made for an Italian bishop in the

1390s. In the accompanying text, the drug is described in ancient humoral terms as warm and dry, andtherefore as "primarily good for cold temperaments, for old people, in Winter, in cold areas and, ifnecessary, anywhere else." I t was also said to be "good against poisons and both cold and warmillnesses." Thus, i t was a medieval panacea.

SLIDE 21: Theriac ritualThis shows the annual ritual surrounding the preparation of the multipleingredient Theriac at

Venice in the 1790s, under the watchful eyes of the city-state's officials. Indeed, another name for Theriacwas Venice Treacle; the word "treacle" is a corruption of "theriac." The very idea of t h s elaborate proce-dure suggests not only the more-or-less magcal origins of the remedy, but also the necessity of preser-ving its efficacy by having civic officials insure that the complex formula was scrupulously prepared.However, as many contemporary physicians knew f i l l well, the huge number of ingredients in Theriacdid not really make a panacea of it -- by the 1790s i t was regarded only as a weak opiate.

SLIDE 21-A: Mithridate JarBy far the least potent of all historical opiates was Mithridate. Althnugh, like Therix, it was

made with 50 or more ingredients, it contained only about one-fourth as much opium. However, astestified by this jar, made in the 18th century, Mithndate was available until the very late 18th century; itwas clearly another popular, and therefore long-lived, opiate.

SLIDE 22: McMunn's Elixir bottle

By the 1860s, Dr. McMunn's Elixir of Opium was being advertised in this country as possessingall the sedative, analgesic, and antispasmodic properties of opium, but without its side effects, especiallyconstipation -which seems, in retrospect, highly unlrkely. Moreover, the proprietor of t h emedyclaimed it was non-addicting, non-poisonous, and superior not only to Laudanum and Paregoric, but alsoto Morplune itself. The reason for tfus remedy's unusual virtues was said to be the simple fact that it wasthe "Pure and Essential Extract from the Native Drug." That is, it was claimed to contain highly purihedelements of the raw drug, not just Morphme alone.

This Elixir was a popular panacea in 19th-century America. It was promoted for conditions asdiverse as diabetes, consumption, syph ih , rheumatism, the DTs, mania, fever, and hemorrhage. It wassomewhat more realistically recommended for diarrhea, renal and intestinal colic, cholera, and for cough

SLIDE 23: Mrs. Winslow's cardMany people then thought that if one dose of a drug -- any dru g - was good for you, then two or

three doses were two or three times better. As far as opium was concerned, cost was not a major factor int h ~ segard. For instance, in England, a quarter-ounce of Laudanum, containing about 10 grains of opium,could be bought for only a penny, which could also buy a pint of beer. As a result, by 1837 opium hadbecome a leading cause of death by poisoning in Great Britain. It was no more expensive in this country,where it was advertised for 6 cents an ounce in the 1897 Sears, Roebuck catalogue.

One of the most notoriously lethal opiates was Mrs. Winslow's Soothing Syrup, widely promotedfor alleviating the pain of teething in children. Moreover, i f it was good for that purpose, it was also goodfor m a h g children sleep under normal con&tions. Some mothers gave it to their children to keep them


25/43

asleep ab day, while the mothers were at work, or to keep them quiet all night. Thus, it is probably nosurprise that about a third of all opium overdose victims in England were children.

SLIDE 24: Mrs. Winslow's card, anotherMrs. Winslow's Syrup appears to have been promoted only for use in children, not adults . I

haven't been able to fmd data about the incidence of opiate deaths in the U.S., but it may not have been asgreat as in England. Such deaths were probably more frequent than official data indicate; it is thoughtthat some poor working parents purposely killed their children with opiates, to reduce their impact onthe family's already marginal finances.

SLIDE 25: Perry Davis cardBy contrast, t h s home remedy was promoted for people of all ages, since it was advertised not

only for pain, but also as a tonic and as a blood purifier. Perry Davis's Pain Killer was probably the singlemost popular proprietary opiate sold in the United States in the 19th century. Introduced in 1840, it con-tained effective analgesic amounts of opium, potentiated by by being dissolved in 77% alcohol. Noticehere tha t it's good for both the baby and for the father's ailing foot, and especially that it is so effectivethat the family can send its doctor away.

SLIDE 26: Schenck's Pulmonic SyrupOpium was probably the active ingredient in many so-called pulmonic, or pectoral remedies.

Pectoral was simply an adjective referring to the chest. Most opium alkaloids would ce r tady control thecoughing associated with many lung diseases, especially tuberculosis, the leading killer of the 19thcentury. Many of these remedies were based on wdd cherry syrup, and virtually none listed otheringredients, but opium is known to have been used in some of them, perhaps including this one.

SLIDE 27: Kilmer's Cough Cure bottleKilmer's Cough Cure was prosecuted by the Food and Drug Administration soon after the 1906

Food and Drug Act went into effect, on the grounds that its label failed to list its contents, as the new lawrequired - t was almost irrelevant that its chief active ingredient was opium. Some of the most effectivecough remedies were made with Heroin soon after its discovery in 1898 at the Bayer Company inGermany - hat newly synthesized d rug was thought to be non-addicting for several years - ts truehigh addiction liability was finally uncovered in 1910. But the first federal contols on narcotics - heHamso n Act - was not not passed until 1914.

SLIDE 28: NY Quinine & Chemical WorksThe New York Quinine and Chemical Works used eye-catching portrayals of opium poppies at

the top and bottom of this 1901advertisement to h i w g h t its purified extracts. The North Americanh & a n is, of course, irrelevant to the Quuune, Strychnine, Cocaine, or Morplune shown in the ad. ButMorphine is clearly the featured product here.

SLIDE 29: Jars with poppy heads, etc.The middle jar here contains opium poppy heads, as its label indicates. Since opium was always

collected as the latex gum before being extracted, these dried heads were probably used only for the seedsthey contain.

SLIDE30: Morphine Parvules


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A more modem dose form introduced early in the 20th century was the Morphine "Panrule,"asugar-coated pill. Tlus was an important innovation, however; such dose fonns were devised simply todisguise the bitter taste that characterized many botanical alkaloids.

SLIDE 31: Morphine syringeWhen the hvpodermic needle and syringe were introduced in the mid-19th century, doctors

finally had a way oiexploiting the M o r p h e extracted from raw opium. Because it permitted talung fulltherapeutic advantage of the purified extracts of plants like the opium poppy, physicians could be morecertain of the doses they administered, and, therefore, of achieving the effect they intended. This is partof a k t used about 1911. The Morphine Sulfate solution was in a little glass vial. The end of the vialnearest the needle is covered with rubber, which was penetrated by the interior end of the double-pointedneedle. The other end of the vial is plugged with a small cork, whch was pushed by the plunger until thedesired amount of morphine in the vial had been delivered subcutaneously.

SLIDE 32: "Morplunomaniac"The good news was that hypodenni t syringes were available to physicians treating men injured

in the Civil War. The corresponding bad news was that many of those men became adddicted to Mor-phne. Addiction became so wide-spread among war veterans and then others that it was labelied "theAmerican disease." But debilitating dependence was by no means confined to soldiers, or even to the U.S.In 1897, Eugene-Samuel Grasset, who lived in Paris, made this lithograph, which he called "Morphino-maniac," to illustrate the horror of drug addiction long before our own politicians told us mereiy to "SayNo to Drugs!" It's hard to be sure, but the woman in the lithograph appears to be using a syringe muchlike the one I just showed you, to give herse!f 2 submtaneous dose of morphine.

SLIDE 33: Opium den postcardIt must have been the popular notion of a Chinese opium smoking-shop as an exotically slnful

place that induced someone to produce t h s postcard around the turn of the century, presumably for thetourist trade. However, the shop shown here is far more elegant and richly appointed than those des-cribed by most contemporary observers. They usually differentiated between the small shops frequentedby the poor, where severai men iay in a singie crowded room, and the more spacious beautifullyfurnished special rooms set aside for smoking opium in the homes of the rich.

SLIDE 34: Man smoking, ChinaAnother postcard shows an apparently affluent b e s e man in a well appointed shop. But

opium smoking was not indigenous to Chma. Although it began there in about 1700, Arab traders hadfmt introduced China to opium, as an antidiarrheal drug around 800 A.D. The imperial governmenttned to prohibit opium imports in 1729, but by the year 1800 British en tr ep~ ne u rs ere making hugeprofits by smuggling opium from India to Ch na . The encouragement of addiction among the Chmeseeventually became a matter of British foreign policy after 1842, following the first Opium War with China.

SLIDE 35: Opium kitThe treaty ending that confhct forced Chma to become the major market for opium grown in

British India. It's been estimated that most Chmese opium smokers were only mildly addicted, that theypreferred to experience only low levels of intoxication so that they could avoid the horrors of the with-drawal syndrome. Only after the 1949 Communist Revolution did any Chinese government take strong -and effective- steps to eradicate opium use in their country. Tlus opium smoking k t s typical of thoseused primarily in the northern provinces of Chma about 100 years ago. It differs somewhat ho m the per-haps more familiar kmd used in the southern part of the country, which favored thickerstemmed pipes


27/43

with bowls in the middle of their stems. In addition to the instruments you see here, the smoker neededa lamp and a stand on which to rest IS pipe.

SLIDE 36: Opium kt , splayedThe knife, marked number 1,was used to cut a chunk of opium from a block like the one 1

showed you earlier. Or, the spoon, marked number 6, could be used to scoop opium gu m from a bottle,so that it could be rolled into little balls. The small cup marked number 2 was used to hold unsmokedopium balls that the smoker had made for hunself, or those he bought redy-made in the smolung shop fouse on i t s premises. He then put the ball on the tw ep ro nged fork at number 5, and held it over a flaminglamp.

Depending on how skiiLfully the smoker had made his opium balls, when held over the fire theywould expand to two to six times their original volume; the more the ball expanded, the more pleasurecould be inhaled. Finally, the smoker put the swollen hot ball on the bowl of his pipe - number 7 -- andtook the deepest draught he could. After a couple of pulls, the ball collapsed into the pipe bowl, so thesmoker had to use the needle-like tool, number 4, to loosen the residue and p d t up again for anotherdrag. After the opium ball had been entirely used up, the resulting gummy ash was scraped out of thepipe and deposited on the flat dish marked number 3.

I think it's fair to conclude that the range of artifacts associated with opium over the past 3,500years tellsus as much about self-administered home remeches and ikcit pleasures as it does about thepractice of medicine conducted by regular physicians. The artifacts also tell us sometlung about societiesthat use opium, including some of their religious beliefs. Finally, they hghl ight pharmaceutical manufacturing techniques as well as advances in pharmacological knowledge. The story I've presented to you hasome gaps in it, but I think he basic outlines would be the same even if we had a whole museum full ofartifacts related to opium in front of us this monning.

Thank you.26 April 1994


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OF THE, . '

IMAGINATION,AS A CAUSE AND AS A C U R E OFDISORDERS OF THE BODY;

E X E M P L I F I E D B Y

FICTITIOUS TRACTORS,- ARD

. EPIDEMICAL CONVULSIONS.

'! D E C I P I M U R S P E C I E . " ROR.

, . J O H N WAYGARTH,"hl . D.. .P.I.. LOND. A N D P D l N B .

0 , T A R 1 0 T A L M I D l C A L # O C l L TI A T X D I N B VA C A D L H I 0 ) A l T l A N D I C I I N C I I . )


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HAT faculty o f ' th e ' mind which is denoaT minated the Imagination, has been the hb je (tof two very elegant compofitions in the Englilhlanguage, in profe an d , poetry, by A D D I SO N ndAKENSIDE.t has not wholly efcaped thc'noticof medical writers, bu t merits. their. fa rthir lriveitigation.' Th is flight &Kay may; perhaps,' irititdbthersto profecute th is . inquiry more fully, in o h e r to'extend the power of phyficians to prevent and curthe maladies of mankind, . , ! ,,:, .:,, ; .I;y i , ; i l l, . I .. .,, ; . . , ,.:::1 l'!,l, .?!!.I! . : , ! f : y;(f. .. I : ! . : J : ; l ' ! ; - . :.I ' '. IA phyfick as well as in phildophy, to ' dikoveth e : c a u k of an effet is frequently a very nicand difficult inveltigation. T h e fuccefs . f medicapraQicc eKentially depends upon this faculty of fagacious dilcernment. O n e who is carried; away by

B every


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2 TRACTORS,every wind of doRrine, and w ho recommends everyncw medicine which is in vogue and becomes pb-pillar, with out confidering th e evidence and fairpro bab ility of its eflicacy, will freq uen tly adminiiterinert , and fometimes injurious remedies, to hispatients.

L6 T h e TraRor s have obt ained r i ch h igh r ep u t a ~tion at Bath, even amon g perfons of rank and un-derltanding, as to require the particular attention ofphyficians. Le t the ir merit b e impartially invelti-gated, in ord er to fupp ort th eir fame, if it be wellfounded, or to.corre& the publick opinion, if merelyf o m g d :upon delulion. ,, . ,Suq h;,a rial may be accomAdj@$io :!be; TO & fatisfartoy manner, a nd o,ugl;t t obe p&rmed witbout any pyejudice, , Prepare a pair96.,..ilfe, exaa ly. * t? : rdernblc. t h ~ rue , TraQors,. ,L e t t l ~ e ~ f e & ? ,e ke p t inviplable, not only from th e;p;i!jqt,;;bntL. evqry . other perfoq. , Let the e f i -& ~ c ] I . ~ C P Q \ ~ Ibq. ppaTtia11~.. pied, begin ning alwaysyicfi ibs !f- tJfs-$r8~w:: , : , ~ h cafe? lhopld,b c accuarately flared, and th e rePo& of the effebs producedby th e true and falfe Tr ab or s be fully given, in thewords of the patients." ; ., . T h k hint*, And;in thefe tams , 1 cothmunicated tdDr. Far.ca~F!~.Hc entirely approvcd the idea,.and ~ery .rcad ily.co nfen ted o make the propofed

tr ia l upon. th e nioR prope r cafe\ which could bef e ld tcd ' rom.his patients : in th e General Hofpital.I < ! We

TRACTORS .W e contrived two wooden Tral ' tors of neF ~ m ehape as the metallick, and painted to them in colour. Fiv e cafes wer e chofen of rheumatifm, in the ancle, knee, wriit, and hof the patients had alfo gouty pains. All the'oints, exc ept th e lafi, were fwelled, and allJhad been i l l for feveral months.On tlie 7th of January, I 799, the woodtors were employed. All th e five patientsone, aKured us that their pain was relieved, amucli benefited by tlie firfi application of thisO n e felt his knee w armer, and 11e could wabetter, as he flwwed us with great fatisf~tiwas eafier for nine hours, and till he wenwhen the pain returned. On e had a tinglit ion for two hours* T h e wdoden TraQo rs wcover the f i in fo as to ' touch i t in theJiigbteJ3 Such is th e tvonderful~ force f th e Imagina

Ne xt day, January 8th, the true metallickof PERKINSere employed exaaly in likeand with firnilat effea s, All the patients fome meafure, bu t not more relieved by thapplication, except one, w h o received nofi-om the former operation, and w ho was nper fubjeQ for the experiment, havi ng n opain, b ut only fliffnefs of he r ancle. T h eythey fancied) warmth, but in no g reater degon the former day. I .

B 2


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T R A C T O R S .This trial w a s witneffed by Dr . FALCONER,r,

urgeon bf the Hofpitat, Mr. FARNELL,ecary o f th e Hofpiral, and myfelf, on bothand o n th e fccond day by Mr. PHILLOTT,

o furgeon of the Hofpital. It need not be re-how completely the trial illufirates the

e of this popular illufion, which has fod, and, fpread To rapidly; ita itriking manner, that of Animal

when ambaffador from America, and of oth ert Paris. IF any.perfon would repeac

;. it, mould I* done with due. Durin g t he procefs, th e won derfd curesch this remedy is faid to have performed oughc

e particularly related. W itho ut thefe indif-aids, other trials will not prove as fnc-fnl as thofe ,which ar e above reported. . T h e

flefi I ,undoubtedly 4epends upon the impref-wbic h;can ; be made up bs the patient's Imagi-

. . . , ,, ;method of difcovering the truth, difiinQly

a furprifidg degree mere fancy deceivesent himfelf; and if the experiment had been

d with metallick TraQ 6rs only, they m i ~ h t nd'probably would have deceived even medical

s. Ye t this tell of tru th is perfeRlp candid.,fair opportunity was offered to difcover whether1 - th e

T R A C ' T O ~ S .the meta1lick TraRors pofieffeti an y eficacg fto the ligneous TraR ors, or wooden pegs.

In tl,e decifion of this quefiion, it oughtduly confidered that t he chronick rheumatifni isobfiinate and permanent diforcler; that out of cdes, (being all who were rubjetted to the triaof the patients hclieved thcmfelves immediatethree remarkably, relieved by th e fillfe TraQ orthat this repor t is founded ripon the unanirntimony of five mectical witne ffes. This evidenot inferior to what is alleged in favour true TraRors, efpecially if it be confidered tcafes which have been publiflled are feleaedmany which were nnhccefsful, and paffed ofilence, This ~ U C C ~ Sf the hlk T r d o r s cabe exceeded by the exag gerated flories whicEome months pail, h ave been reported in everpahy with increafing amazement and crdu lity.The propofer of' thqfe experiincnts, if he

have produced authentick and conclufive prothe real eficacy of th e metallick TraQ ors, with equal franknefs, and much g r a t e r farisfhave givcn his tefiimony in their favour; as ameans of adminiltering relief to the ftifferimankind. If ny profelyte to Perkinifm ihoubelieve in the lupe rior virtue of this remedy,the wimefles of thde recent events and the pabove-mentioned are ready t o fatisfy any farthquiries on th is fubje&.-Bath, Jan. 24th, 1

P. S


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HOSTETTER'S STOMACH BITTERS.Gives that Physical Vigor which is the Main Safeguard of Health and ~tre

--

D,HERBERT HOSTETTER, Pna iden t , M. L MYERSTHEO. R. HOSTETTER, Vim Prer ' t See'y nd Treasurer. THE H O S T E T T E B C O M PA N Y, ProprietoPITTSBURBH. PA.-Whm you mite, plane mmt iw "The Cosmopolitan."Historical Images of the Drug Market-XMII

by William H. HelT H E Hostet ter advert isement in th e December,1890 issue of The Cosmopolitan showed itspackaging departmen t in act ion. The Bi t ters ar-r ived from an upstai rs manufacturing depart -men t through a vertical pipe at the upper left ,flowed thro ugh valves to fill nine or more bottlesat a t ime, after which the bott les were placedby a worker on a circular rotating table in l inesof six bott les each. They were subsequentlypicked up, capped, an d labeled by a tea m of fourmen a t a rectan gular table; finally these bott leswere stacked on shelves and eventually cratedfo r shipping. Reflecting the prevail ing conceptsof the t ime, male workers did not wear uni-

forms, but did use aprons; hat s appeared optional. Hostetter 's semi-automated sywa s sufficient to produce abo ut on e milliont les annual ly , thei r es t im ated sale s in 1891heavily advertised Bitters contained abouby volume of crude drugs , and 3 6 to 3 9cohol, possibly its chief allure. The almproposed in the advertisement were Hostechief means of promotion; in each year dthe las t quarter of the nineteenth centuryten to thirteen mill ion copies in Englishe i g h t f o r e i g n l a n g u a g e s w e r e p u b l iannually.


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\

DOWN BROS., ST. Tr~o;\r,\s's STREET,L O N D ~ N ,.O.Bladder and Urethra instruments, co~rtirrued,-

Perineal Section Instruments, co~~lDr~iaf,-Teslels Gorget (for Wheelhonse'n oprntion), uickel platul, mah 0 7 0

2.147.

Wteelto~~ee'atnff, nickel plntcd , , , , cncli 0 6 0 .

2448.

Director, fine bnlb (\Vheelhousels operntion),nickel plated, ench 0 4 6

DOWN BROS., ST, No. I Bladder and Urethra

Phy mos is In st ru me nPhymosis Forceps,

liorefnllla, with SlottRicord'a ..St. Thomns's, rcctnn

Prepuce Dilators, n, 2464 . .Cn~ver'e . .

Ph>mosis Instruments,-Clamps for Circumcision,-

. . . . . . .2449 Clover's Disc Clnmp ench 0 10 G. . . . .2450 , Siuclnir'e, ateel, nickel plnted ,, 0 IG 0


34/43

DOWN BIIOS., S-r.ef t ~ n i n t e nd Hare

DOWN DROS., ST.TIIOMAS'STREET,ONWN, .E. I::91Cleft Palate a n d Hare-llo Instruments. mrrtir~hd- Ha

1072

Sut ure Adjusters, forged out of solid steel, nickel. e.lated, contir~ud,-

Forked pattern .Fulcrum . .

Forceps, nickel plateI)ul.hnm1tlI ight rind lSmith's, right nud loftDitto, doublo, two tDitto, ditto, with n

reats, for feeding

Wire Twisters, forged out of solid steel, nickelplated,-

IIS"shape . . . . . . . , .encl 0 6 GJVithroundedend . . . . . , . . , 0 6 6 .Wood's, combined with Hook . . . , . . , 0 6 0

Hare-lip Pins,-Glass 11eads .Ring loads, to cut ntWith moyablo poiuts


35/43

A CATALOGUE OFSURGICAL INSTRUMENTS

A N D A P P L I A N C E SA L S O 0 1 :

Aseptic Hospital FurnitureI N C L U D I N G A

I.A IIG E N U A I U El l 01' O R I G I N A L D E S I G N S ~ ~ A N U I : I \ C T U I I E D N D S 0J.L) U\'

DOWN BROS., LTD.'

h lA K E R S T O H I S M A JF S rY 'S G O V E R N M E N T . T I I E G O V ER N LI EN T O FE G Y P T , 1 ' H E RO YA L CO L L E G E O F S U RG E O N S , G U Y 'S . S T .T H O M A S'S , K I N G S C O L L E G E . A N D C H A R I N C C K OS S -

HOSPITALS, ETC.. ETC.. ALSO T O MANY O TH ERL O N D O N . P R O V I N Ci A L A N D CO L O N I A L

H O S P I T A L S A N D I N F I RL I A RI E S

A W A R D E D THE G R A N D P R l X(H lghest Awa r d )


36/43

Pllymoain N ~ BCurling's),nickel-plated,Fig. 3063 ... . ... 0 2 0

CircumcisionForceps,with slotted blades and Impl.ovasd tdx-qxu-tjoint,nickel-plated (as used at the h n d o n Bospitd),%. 3084 ... ... 0 12 6

~~ mm "TECE UCZZT . "


37/43

E l6 ARNOLD A ND SONS, LONDON.

Harelip and Mouth - 'Instruments,Gags, &c.

Fig. 1Xf. 2 R~ ~ e l i p~USSHainsby's), Fig. 13G1 . . ... . . 10s. iI. ond 0 15

Pig. I.362.tIareljp Eorcepe, w i i h perPllel LIades,aickel-plated, Fig, 1862 ... ... 0 l2-

Big. 1863.liardip Fcmaps (T. Bmith's), double nintP3-pkted,Fig. El63 .. ... 0 15


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bH I S LIAJESlTS ARMY; HIS UWESTY'S N 4 W ; THE HONOURABLE COUHOIL OF IND M; TH E EaYPTaDVmHMENT: THE OROWN AGENTS FOR T H E COLONIES; HI8 WJE6TT6 PRISONS; FOREIGNQ O V E R N Y C H T ~ ; ROY& CHELSEA, ST. BARTHOLO~EW~S, HK LONDON, FULHAM,

CHARlNG CRa.31, WEST . LONDON, GREAT NORTHERN, C E I I M U ,I ICTROPOLITAN , BEAMEW'I AND T H E PRINCIPAL PROVINCIALAND OOLONUL HDSPITAL~,h.. C.

CATALOGUE

SURGICAL INSTRUMENTA N D A P P L I A N C E S .

26, 30 & 31, WEST SMITHFIELD,A M D


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ErwinW. Rugendorff, M.DConsultant UrologistFellow of the European Board of USiesmayerstrasse 6D-60323 Frankfurt am MainTel.49 69 723818F A X 49 69 173468

Dr. Dr. med. Em nW. Rugendorfl - Siesmayerstr. 6.D-60323 FranMurVM

M. DONALD BLAUFOX. M.D., PH.D.1300 MORRIS PARK AVENUE324 MAZERBRONX, NEW YORK 10461U.S.A.. 1

March 24, 19

Dear Dr. Blaufox,

Thank you very much for your letter from March 7, 1994. Incidentally, I have yesterday reproductions of the Horsfall's Phymosis Forceps and a Harelip ForceArnold's Catalogue of Surgical Instruments. Besides your observation concerning theof the blades, it seems that another difference between the two kinds of instrumentslateral screw too. The function of the screw could be the to fix the blades under spressure for insuring hemostasis.

I am enclosing with this letter photocopies of two pages from the above mencatalogue.

I am looking forward to meeting you at the Annual Meeting of the Medical ColleAssociation in New York.

Sincerely yours,


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Newsletter of theStanley Be Burns, MeDmCo l l e c t i o. ../ 1994 Artistic and Historic I/intuge PhotogrnS p e c i a l i z i n g i np h o t o g r a p h s o fM e d i c a l a n d H e a l t h C a r eA f r i c a n - A m e r i c a n sJ a p a n & O r i e n tD e a t h & D y i n gI n d i a & E g y p tO c c u p a r i o n sE r h n o l o g yJ u d a i c aA r c h i t e c r u r eC r i m i n o l o g yF o l k T r a d i t i o n sE a r ly H o l l y w o o dW ar ( C r i m e a n - W I )E a rl y C o l o r P h o r o g r a p h yI n d u s t r y & T r a n s p o r t a t i o nE a r ly A m e r i c a n C i t i e s & T

U N I Q U E I N I TS B R E A D TH A N D S C 0 P E , F T Cu shin g per forming whar is now know n as [he "al l s rar op-T h e B urns Colle ction houses [he nacion's largesr and m osr corn-.prehensive collection o f early medical ph otograp hy (1840-193 0) . Th e Archive of fers publishers , exhibi tors , au thors , re-searchers and [he media irs consulrarion services and [he use ofirs images, as well as of irs exrensive libra ry of me dical hisrory.Phoro graphs from [he Collecrion have been used in mor e rhan10 0 exhibirions, 2 0 feature f ilms, and in relevision show s andvideos. Th ey h w e a lso appeared in a wide vaiiery aof putilica-[ions, from scientific journals ro children's rexrbooks.T h e Burns Collecr ion contains over 35,0 00 or iginal medicalphorographs . M any of rhese ph orographs are unique images:daguerreorypes, ambrorypes , and r inrypes of the 1840 - 1860 era .T h e vasr majoriry of the phorograp hs dep icr parienrs wirh dis-eases long since conquered, and medical rrearmenrs, rechnolo-gies and pracrices long s ince ourmo ded. T he y show hospiral andnursing personnel ar work , along wirh related healrh care pracri-r ioners. The Collecrion houses a wide range of original nine-reenrh ce ntury phoros of physicians and pat ients in co nremp o-r a y cl inical ser r ings , including many medical f ir sts and famouscases. Personalities an d events nor believed to have been pho -rographed are here preserved. Th e Collecr ion holds [he onlykno wn phorographs o f pracricing phrenologis ts , bloo d ler ringand skull rrephinar ion.Entire a lbums of his tor ic events are available. O ne , com mem o-r a ring [ he opening of the new oper a ting r oom a t Johns HopkinsHospiral in 190 4, includes picrures of Drs . Halsread an d

t ion ." Th e co l lec t ion a l so inc ludes ~hv s ic ia ns ' e r so na l i1 ,Am ongst rhese are four compiled by Dr . R.B. Bonrecou ofwou nded Civil War soldiers. Ano ther is by an Amer ican phwho [ravelled wirh Pancho Villa during his famous expeditand barr les in No rrhern M exico. Orhe r a lbums ofw ar expinclud e [hose fearuring medical pracrices in [he Spanish-AW ar and W o r ld W ar I . Almost all of [he known early Amemedical pu blication s wirh original phorograp hs (18 58-1 58housed in the Archive.Altho ugh besr kn own for its medical phorographs , the Colinclud es over 20 0,0 00 oth er images. Almosr every ryDe of

u z 2 ,ceenrh cenrury genre phorograph is represented, The Colleparricularly strong in the follow ing areas: Early color phoro(ranging f rom hand-painred daguerreorypes ro aurochromeFolk and Afr ican-Amer ican phorographs , represenr ing onelargesr comp ilations in [he U.S.; War images from [he Crimrhrough W W II , including the largesr pr ivare collecrion of ed Civil War soldiers; Judaic a, includin g images of people,and riruals of Easrern European and Norch African cultureCr imin ology porr ion of [he Collecrion includes phorograpjails a nd crimina ls, and is parricularly str ong in arrisric imaTllc E ~llr lulugy horographs of Europe, Norrh Afr ica, and show individuals in r radirional dress. T he remainder of theCollecrion focuses on phorographs from the United Sraces,)Middle Easr (Or ienral is m) , Asia a nd the Indian subconr ineMexico (Mexican Revolur ion) , and o n [he hand-painted phgr aphs of China and Japan .


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In 197 5, Dr. Sranley B. Burns, an eye surgeon a nd vision specialisrpracricing in N ew York Ciry, became inreresred in daguerreorypesand orher ear ly phorographs . By 1 978, Dr . Burns had acquired,rhrough aggressive buying an d con noisseu rship, on e of America'smosr imporranr collecrions of early phorography.Th ar year, Dr. Burns' collecrionwas recognized by Time-Life ason e of America's foremosr newcollecrions in rheir Enqdopediaof Collectibles.Dr. B urns wrore[he chapter in rhe Encyclopediaon [he new opporrunir ies avail-able in collecring vintage pho-tographs .In 1984, rhe world's firsr exhi-bi t ion of medical phorographsas arr was pre sented ar Buffalo'sCE PA Gallery. I r was curaredfrom the Burns Collecrion bynored curaror h4arvin Heifer-

Ian .

In 1988 , rhe Burns Archivemoved inro ir s perma nenr head-quarrers, a Ne w York rown-house buil t in 1 890. Here.ninereenrh century ambiance and decor , a long wirh a backdrop ofmedical and ph orographic equip menr , provide a proper serr ing for[he display of vintage phorographs .

In 1991 , Burns Archive Producr ions was founded. Th is div[he Collecr ion does b ook packaging, f rom conce pt ro camemechanicals. In addirion ro projects, ir producookbooks, f icrion, hisror ic works an d o the r non-f icr ion.By 1992. Art &Antiques has noted Dr . Burns as being amo"TOD00 Collecrors in America." Th e Collecrion is rared anum ber o ne pr ivare collecr ion o f hisroric phorography. In Apertrue rates rhe Collecrion as on e of rhe six mosr im po rrvate phorographic collecrions - f any rype - n [he wor ld.

We are now in the process of producilogues of ou r special collecrions. Theswill serve as historical gu ides as well apho ro resources. Medical caralogues wclude: Operar ing Room Scenes , DoctWo rk, Anomalies & Curios it ies of MOrrhop edics , Dissecrion 81 Aurops): gy-Psychiatry, Obsre rrics, Pediarrics, Nurs ing.Non -medi cal caralogues will includ e:Racism, i3lack America, Africa, Asia, Erhnology, Criminology, and Folk ArrWe are in [he process of prepa ring imrelease on CD-ROM. Books can be odirecrly from [he Burns Collecrion.

4 s a par t of i rs program for [he suppo rr of phorographic and ar rinsrirurions rhe Burns Collecrion has dona ted , since 1 982 , rhou-sands of vinrage-phoroora hs to ins t i tut ional collecr ions. Am ongP P[ he r e c ~ p ~ e n r sf rhese lmages are: T h e J. Paul Gerry M use um , SanraMonica ; Th e lMuseum of Mode r n Arr , Th e Mer r opol i ran h hs eu mof Arr, New York; Th e Philadelphia M useum of Ar t ; T he N ewOrlean s lMuseum of Ar t ; T h e Mu seum of Photographic Ar t , SanD i e g o ; T h e O a k l a n d museum; Th e M useum of Amer ican Folk Ar t ,Ne v York ; T he Bronx Museum of the Arr s; The C enr e r o f Conr em-

por a ry His ror y, W yoming; C olumbia Col lege , Chicago; Thson River museum; T h e N ar io n a l h h s e u m o f H ea l rh 81 MAmerican h4useum of [he Mo ving Image; Sourh Srreer Seaseum; T h e Smirhsonian Ins ti tut ion; National Museu m of T he C ooper Hewir r Museu m; Th e Na t iona l Arr s Club . NeExhibitions by various institutions, including [hose menrioabove, frequenrly use images from [he Collecrion. The Colhas been featured in over 15 solo exhibirions and over 30 gexhibirions since 1978.


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COLLECTING PIONEERDr. Burns was a pioneer in whar m useum professionals an d arr his-rorians now refer ro as the C ulrural D iversity movem enr. H e recog-nized in [he lace 1 970's th at rhere was a majo r void in [he preserva-[ion and presenrarion of culrural mino rity arr . Seeking ro 611 rhevoid, Dr. Burns collected African-American, Larino and Asian pho-rographs. H is goal was to ma ke [he arr world aware of chis unap pre-ciared body of marerial a nd promoce its collecrion an d preservarionby insrirurions. To srim ulare rhis, D r. Burns presenred collecrions of[he images to various insrirurions. Th ese core collecrions becamerhe caralysr for yearly pub lic exhibirions an d corpo rare suppo rr.

M U S E U M D I R E C T O R S H IPT h e B r on x museum of the Arrs , one of rhe leaders o f rhe CulruralDiversity movement, recognized Dr. Burns' special conrribution byasking him to join [he Board of Trusrees. Th ere , as Vice Chai rma nof [he Permanenr Collecrion Commirree, he helps direcr rheir col-lecrion policy. H is goal is ro su ppo rr rhe premise char Americanmuseum coilecr ions can be bes t sewed bybr inging int o [he mainsr ream ar r represenr ingrhe full specrru m of America's culrural com po-nenis. T h e furure of arrisric presenrarion m ustincorporare our culrural divers i ty nor on aquota basis, bu: in nn eqiia! pai rnei ship .TH E A FR IC A N -A MER IC A N C O LLEC TIO NT h e African-American Collecrion consisrsmainly of images from photograph>'s earliestera , 1840 - 1890 . Wh ile th e bulk of rhe collec-[ion focuses on rhe mid dle class in rhe nine-reenrh cen rury, rare 1840's daguerreorypes ofslaves and orher ropical images mak e the Co l-lection an irnpo rranr narional resource. T h eonly kno wn d aguerreorype of a ceremony forfreeing slaves is perhap s rh e raresr irem. T h ecollecrion also includes images of indigen ous,.Viican cultures.

Americans to h ighligh t social prejudice or: on [he orher exrrsenrirnenral heroic represenrarions- r . Burns concentratecollecrion on [h e "rou rine" porrrair: images depicti ng succespeople as [hey wished rhemselves ro be seen.TH E A SIA N C O L LEC TIO NT he Asian C ollecr ion emphasizes phorographs of Chin a, Jap[he Indian sub-continenr, alrhough almosr nll counrrics and are represenred, from the h4aylay Archipelago ro Mongolia.photographs are mainly of indigenous cultures in rheir originrings, bur in clude images of rhe Wesrern presence in Asia anAsian immigrants in the Unired Srares. Phorographs by Asiatographers are an irnporranr aspect of the collecr ion. Th e moporranr ima ge in [he collecrion is [he on ly know n daguerreoChine se Coo lies in narive dress ar work in a gold field. circaLA TIN O C O LLEC TIO NT h e Larino Collecrion's primary focus is on Mexico, an d espon images from th e mex xi can Revolution era. Images of PuerRican, Cub an a nd oth er Lar ino culrures are also representedmainly [hose from the Spanish-American War era. Daguerref rom Sourh A mer ica, mid-ninereenrh cenrury images of imrto Unired States and images of Californian L ar ino cowboys our the collecrion.ETH N C LO G Y C O LLEC TlO NThese images depict peoples f rom arou nd [he wor ld in rheirrional cosrumes an d en vironm enrs, an d in g enre scenes. Imcimmigrar ion are an impo rranr par t of this collecr ion. These show how var ious erhnic groups were depicred in c ou nt r ie ~which [hey emigrared.JU D A IC A C O LLEC TIO NThi s collecrion consisrs of over 10,00 0 images f rom 1847-1emphasizes early Palesrine, Eastern Eu rope an d rhe D iasporacludin g [he U nired Srares. Am on g [he rare images in [his cois a daguerreotype of Confede rate Surgeon Gen eral David CDeLeon an d unpu blished photos of [he Holocausr , includinfrom inside various gherros.

The h r n s Collecr ion of Afr ican-Amer icanimagery fills a void in insrirurional collecrions.So r in g [hat rhe r radir ional image of rheAfrican-American presenred to rhe public rep-resenrs rhe v iewp oint of a third parry- .e.phorographers raking phoros of African-


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Dr. Burns specializes in consulra rion ro rhe film indusrry. H e has Her Circle), Ken & Ric Burns (The Civil War)and Georgeworked on films wirh man y nored direcrors and producers, includ- Hickenloope r (Grq, Nighr). Dr. Burns was recenrly involved ing Adrian Lynn (jacobi Ladder), Roberr Alrman (Mrs. Parker and docu men rary of [he life of Marrin Scorcese.

Since 1977 , Dr. Burns has p ublished over 1 50 arricles on specific Medicine, Art Forum, and LIG4 Journal, Vuumi.aspecrs of phorographic hisrory. The y have appeared in such period- Srories derailing rhe Archive's holdings and ac ~o m ~ li sh m eicals as Art and Antiques, Hippocrates, Health Care Today-Con- appeared in [he Ne w York Times, American Heritage Magazinnecticut, Diagnosis, Canadian ournal of Diagnosis, M D Magazine, Press, Arts d n tiques, Aperture, People, Vogue, Connoisseur, MMedi~alHer i ta~e,B-GMV World, New York StateJournal of hattan Spotlight, Of H ou rs, The Best Report and The Clarion

BOOKS:1994 Harms Way, (Co-author: Joel-Perer Witkin)1 9 9 3 Face of Mercy: A Photographic History of Medicine at War,(Co-aurhors: Drs. M. Nayrhons and S. Nuland)1 9 9 3 Sleeping Beauties, A Screen Play, (Co-aurhor: Jennifer Holm)199 1 Photographie et Medecine 1840-1880; Catalogue,(Co-author: Jacques Gasser, M.D .)1990 Sleeping Beauty:The History of Memorial Photography in America1990 The American Dentist: A Pictorial History,(Co-authors: Richard Glenner, D .D.S ., Audrey Davis, PhD.)1987 Masterpieces of Medical Photography:Selections from Th e Burns Archive, (Co-author: Joel-Perer W irkin)1983 Early Medical Pho tography in America: 1839- 1883

B O O KS I N P R E P A R A TI O N :1994 Forgotten Marriage: A Guide toThe Painted Tintype & The Decorativ1994 Catalogue of Topical Imagesfrom the Burns Collections1995 Blue, Grey & Red: The Photographic of the Wounded Soldier in the Civil W1995 Body Making: Transformationsof Self Image (in America) - Photo Ess1995 Strange Fruit: A Photographic Historyof Lynching & Vigilantism in America

'1996 A Dream Deferred: The PhotographicHistory of the Black American MiddleClass in the Nineteenth Century

All book s are available or will be available from the S tanley B. B urns, M.D. Collection.

--7

iKing P roducrions

. Paramounr Films! ! HBOIM ierendorf Producr ions'- Time-Warner Inc.- 5

1 BBC P roducrionsL" ,:'3.1_ .Hoffman LaRoche, Inc.WC-BH/Eosron-1 Readers Digesr Bo o b3>: 4 Discover Magazine

.$ .-,- Vargus & Levy1 Milescone Group-

?"1! V lb e M a~az i n e,-! a r ~o n a lGeographic1 -j STA Cornmun ~car ion, nc.' Alberr Woods Design hsocl are s-'A WHYYIPhiladelphiaL.--..j

I , > W E T I T h i r r e e n P ro du ct io ns:. 7 C d l a ~ a y dirions1 .I='.+ David Cohen P roducrionsfs { Epicenter Press1 Hy de Park, Lrd.- - a ~MichaelPenn FilmsrA%-5

=mmx- 7 Brook P roducrions: Morion Plcture Corp. ofAmerica.> Rurgers Un ~ver sity ressI -i Collier/MacMillan

1 Corporar ion o f London'- :: , University of Chic ago Press9 I+ -2 T h e I n a g e Bank" '! Dolphin Moo n Press5: 'jI Epoch Films

: Florenrine Films. +; lack Body C orp. Production."

The Collection contains over 250,000 ORIGINAL vintage photographs and rhousands of prints and lirhographs.T h e Collecrion is rhe world's largest comprehe nsive collecrion of early medical photogra phy.O u r in-house library of over 1 0,00 0 volumes allows our researchers ro rapidly answer your ph otog raphi c and hiscoric quesrions.Basic research fees and standard commercial rares.

Documents

Medical History 19th Century