Sources of Civil War Military Surgical Sets
By Dr. Michael Echols, (American Civil War Surgical Antiques website)
Topics: Civil War civilian surgeons, contract surgeons, Confederate and Union surgeons, U.S. Army Hospital Department, U.S. Army Medical Department, state militia surgeons, instrument sources, surgical instrument makers, gift surgical sets, European surgical sets, American surgical sets, English surgical sets,
Many Civil War collectors want to buy a 'real' Civil War military surgical set. So, what do you have to know to buy one? What we are discussing here is not every surgical item that existed during the Civil War...just the military sets, who made them, and how one can prove were used in the Civil War. If you enjoy buying old medical instruments or non-American maker sets, have fun, but that is not what this article is about. The objective here is to discuss proven authentic Civil War military sets or those likely to have been owned or used by uniformed state militia surgeons during the War.
To obtain a 'real' or 'authentic' Civil War military surgical set, first and foremost, you will have to be extremely lucky and knowledgeable. The safest set to buy, in my opinion, is one marked 'U.S. Army Medical or Hospital Dept.' with military latches on the case and contracted for production by famous American makers for the Union Army.
There were over 4,900 contracted military sets made just for the Union Army, so you would think the odds of finding one are good if you know where to look. However, not many of these surgery sets survived. Many were destroyed during the War or were sold at the end of the War as war surplus. One maker in particular, Hernstein, N.Y., sold many un-used sets at the end of the War and his company went bankrupt due to the over-production. At the end of the War many military sets which were not bought by the government, were sold at auction to distributors and doctors or re-packaged for the civilian trade. (This seems to be especially true for Tiemann sets and perhaps the reason we see a mixture of (pre-, during-, post- War) instruments in wood cases which were produced before and during the War from this maker.)
When sterilization began in the 1870-80's, most of the earlier non-sterilization working sets were discarded in favor of instruments that could be heated and cleaned for sterilization, thus creating a greater scarcity factor to consider. No one knows how many of these non-sterilization military sets survived. Unfortunately great numbers of the sets created for use during the War were not preserved and were of little or no value as sterilization came into use. (No, I do not believe there are 'troves' of surgical sets stored in some musty warehouse. They were simply discarded as the detritus of war or unusable after sterilization made them obsolete.)
Federal government purchased sets:
There are two major groups of Federal government contract-ordered military surgery sets used during the Civil War:
First, the Army Hospital Department was a subdivision of the Medical Department. From 1861 to 1865, the U. S. Army Hospital Department sets, were specifically made for use during the Civil War. Yes, there were a few Hospital Department marked sets which existed outside the War years, but they are easily identified and dated by the contents.
(Note: There were U. S. A. Hosp. Dept. marked sets used during the Mexican War of 1846, so the trick is to correctly identify the maker and production dates. The Army Medical Department before the Civil War was a small bureaucracy, which consisted of less than 100 doctors, most of whom were not performing surgery on a regular basis as there were no wars, so there were not that many surgical sets needed.)
Secondly, there are U. S. Army Medical Department sets, which were used by Army surgeons before, during, and after the Civil War. With Medical Dept. marked sets you have to figure out when the set was made via the maker address or style of the case and instruments, but the vast majority of these sets were purchased immediately before or during the first year of the War. The Medical Department engraved sets may have just been a matter of the small group of doctors in the pre-war Medical Department ordering military surgical sets out of a different military budget than the budget created to run the whole War effort and assigned to the Hospital Department bureaucracy.
At the start of the Civil War, the Army Medical Department consisted of one surgeon-general (colonel), thirty surgeons (major), and eighty-three assistants (lieutenant). Three of these surgeons and twenty-one assistants resigned "to go South," and three assistants were dismissed for disloyalty. In August, 1861, ten additional surgeons and twenty assistants were authorized, and a corps of medical cadets was formed, not to exceed fifty in number, to be employed under the direction of medical officers as dressers in hospital. (Google: 'THE MEDICAL DEPARTMENT' By Major Charles Smart, Surgeon U.S.A. for further details.)
A third and minor category of 'government', but not 'Federal', military sets are those purchased by the state volunteer militias. These sets are a minor source of military 'style' sets purchased by various state voluntary militias existing prior to and during the Civil War. The state groups, which were later mustered into the Regular Army, could have ordered military-style sets for their own use prior to or even during the War. The instrument makers made sets for the state militia groups before the War or during the first year before the Med. or Hosp. Dept. purveyors ordered the 4,900 sets for the Federal Army. This would account for the small number of military sets we see from regional makers like Rees, Brinkerhoff, Goulding, Otto, Shurtleff, etc. These regional makers could have provided military-style sets for their local militia volunteers, but were never under contract to supply the main-stream sets ordered and used by the Union Army during the War due to their inability to supply the large numbers or quality of instruments.
Remember, the vast majority of instrument makers in 1861, other than someone like Tiemann in New York or Gemrig in Philadelphia, were not geared for large scale production, but rather crafted individual hand-made instruments which were custom ordered by the surgeon or put-up in cases for sale as a design by 'doctor so-and-so'. Other makers imported instruments from England and France to assemble sets as requested by a given doctor or retail outlet such as a pharmacy or apothecary dealer.
It is possible any given military group could have contracted with any given instrument maker to provide a set of instruments for their group with military latches and military dedicated instruments. The markings or lack there-of on the brass plates or instruments would be the telling point. Only the official Union ordered sets would be engraved and marked as U.S.A. Hosp. Dept or Medical Dept. All others would be either unmarked or otherwise marked depending on the owner. This may account for some un-marked or inconsistently marked brass plates on military 'style' sets during or prior to the War years.
State Volunteer Militia Surgeons:
Before the War started, there were state militias and each militia had 'medical' staff of some sort. Unfortunately the state militias did not necessarily qualify their medical officers and some if not many were simply medical wannabes: druggists, preceptors, and individuals who 'attended' a medical lecture or two. Yes, some were qualified surgeons as the literature proves, but there were qualifying boards which vetted these individuals before they were allowed to be designated as military surgeons in the Union Army and most likely by the Confederate medical staff. The boards who qualified these doctors as surgeons were often staffed by teaching faculty at leading medical colleges. Among the famous surgeons and faculty who performed this vetting service were: Alexander Mott, M.D. and Joseph Janvier Woodward, M.D.
There are surgical sets, military and civilian issue (as previously discussed), which were provided to and/or owned by surgeons who were part of State Volunteer Regiments or some division, and who may have brought their own surgical sets when they were mustered into the Regular Army. These sets would NOT be marked for the U.S.A. Hospital Department because the sets were provided to or owned by a state militia or surgeon and not by the Federal Government. Of course it would be difficult to prove unequivocally if a given set belonged to the surgeon unless engraved or heavily documented. This is a very difficult area to prove or disprove.
Ownership of sets:
If there is any question in your mind about the Army regulations regarding surgeons returning government issued military surgical sets to the Army when they left the service, please read William Grace's: The Army Surgeon's Manual. The Manual covers this topic in detail as specified by the Surgeon-General...bottom-line: the surgeon had to sign-out for the instruments and kits, and they were expected to return same after their service. The surgeons were held personally responsible for the return of the surgical sets to the government. There is nothing in the regulations or history to suggest a surgeon was allowed to retain his 'personal' set, nor would they have been allowed to engrave their name on a government-owned set if they were serving in the Union Army. The ‘1861 Army Supply Table’ spelled out this point early in the War, as well as what instruments were specified during the first year of the War. We do see military sets, usually with the brass name place removed, that were sold after the War to the public and it is possible a given surgeon bought a set after the War, but it is impossible to determine if it was the same set he used during the War. As much as we would all like to romanticize that ownership, it cannot be proven beyond doubt for government supplied sets.
Unmarked sets purchased and used by the Confederate forces are very difficult to prove to have been used during the War unless there is believable documentation or evidence associated with the owner and a chain of ownership. Again, the set itself must be verified and dated as being made pre-War or made during the War. Confederate sets may be of American, English or French origin. As previously mentioned, most CSA surgeons were trained in the north and they would most likely have purchased sets at the time and place of their training and most likely those sets would have been American-made, but not necessarily.
Another source of sets would have been English sets brought back from an English medical college where many surgeons of the time went for training. Otherwise, it is at most 'difficult' to say any given set is Confederate owned or used. The Confederate sources were often pre-War American or European sets in existence before the War or European sets obtained from blockade runners during the War.
From time to time Civil War items are shown to us marked 'CSA' and are out-and-out fakes. Confederate sets are the most difficult to prove to have been used during the War because they were not issued by the CSA Medical Department or labeled as such. Even if a given set has been in a family for many years, unless there are original hand-written documents or period engraving showing ownership on the top of the set cartouche, proof is extremely difficult because there were no 'official' surgery sets made specifically for Confederate surgeons to my knowledge. With all the surplus military sets floating around immediately after the War, it would not be unusual for a doctor to purchase one for his use and if marked for the U.S. Army, to remove or obliterate the marking on the set.
(Note: the Confederate Army never contracted for American-made surgical sets and none will be marked as such to my knowledge (2013). Recently, (2013) an English-made surgical set turned up in Canada and the cartouche (brass plate) was engraved with 'CSA Medical Dept.' Personally I would be very suspicious of this set and it's engraving because no such marked set has ever turned up in the past 150 years. The confederate States Army Medical Department used existing American, English, or European made sets and purchased sets from Europe and the English during the War and smuggled them into the country by the blockade runners. There were many existing American-made sets as most of the CSA surgeons were trained in the North prior to the Civil War.)
Early amputation sets:
When you see a basic early (1820-1855) amputation set, no bullet forceps, no trepanning instruments, just a tourniquet, a couple of knives, and a saw, think twice about that set having been used during the War. War-time surgery was not just basically whacking off an arm or leg. Basic amputation sets are grossly deficient for even a 'simple' amputation. Those early small amputation sets were for 'heroic' intervention, not delicate surgery by a trained surgeon during the War years. Yes, the small military amputation sets existed, but in most cases they were a part of a larger complement of instruments or reserved for minor surgery.
The more you read about the procedures which were reported in the six volumes of the ‘Medical and Surgical History of the War’, the more you will understand just how special the military surgeons were and how much they knew. To get a good feel for the extensive procedures taught even in the mid 1850's, see the drawings from Dr. Henry Smith's 'A System of Operative Surgery'.
Post-War and gift surplus military sets:
Many Civil War era doctors purchased or received 'testimony gift" surplus military sets after the War, so those sets could be in the family of the surgeon and passed on to this day. In this case, it takes knowledge to determine when the given set was made and thus determine when or if it was ever used during the War. I have seen more than a few War-years production sets that have had the cartouche (brass name plate) removed, turned over, or the engraving buffed off. The theory, as mentioned above, is a surgeon bought the set and didn't want the marking on it for the Union Army.
Non-government and contract doctor sets:
As previously discussed, there would definitely have been European and English sets used by both southern and northern doctors who served in the early days of the War as 'contract' or state volunteer militia surgeons after local battles. Surgeons in leading medical schools and hospitals also treated soldiers in the first and following years of the conflict. Many of these teaching or practicing surgeons would have had their own extensive surgical sets. The Union army and certainly the Confederate part-time contract surgeons may have (and the emphasis is on 'May Have") brought their existing sets or pocket kits with them to a given battle.
Medical supplies were in short supply in the first years of the War. The source of these sets would have been European, English, and American in origin. The challenge is proving they were actually owned by the doctor and the set existed before or during the War. This is extremely difficult, but not always impossible. Again, accurately dating a surgical set is essential to matching up the dates the set existed and when the surgeon could have owned it. If a set was not made until after the War, obviously it could not have been used during the War. If a particular set was not made until after the War and was purportedly owned by a Civil War surgeon/doctor there is no way the set can be labeled as 'Civil War'.
Regarding 'contract' surgeons, there is an excellent reference by Dr. Bollet, Civil War Medicine: ‘Challenges and Triumphs’, a well documented book where he makes the point that (after some initial confusion about doctor abilities by the Army Medical Department) contract surgeons to the Union Army were relegated to working in the rear area hospitals changing dressings and attending to the general health of patients, not doing complicated amputations or field surgery. The qualified surgeons were admitted to the regular Union and Confederate Armies or were part of the Army volunteer militia and were reviewed for their competence, or lack there of, and eliminated from doing surgery if they did not pass muster. In general, the Union Army's less experienced surgeons were assistant surgeons, not full surgeons. In state militias, politics could have intervened and allowed an inexperienced or improperly trained surgeon to practice.
My point here is once again that 'contract' part-time surgeons were not in the field or rear hospitals using some little pocket surgery kit or minor amputation set to amputate limbs or resect fragments from bullet fractured bones. It just didn't happen often if at all after the War was underway during the first year. The real 'surgeons' for the Union were the regular Army Medical staff or certified volunteer militia surgeons who were supplied by the Army, with Army owned and purchased surgical sets, not the sets found in some closet one hundred plus years after the fact. There is ample evidence the 'working' surgeons in the CSA were also well-trained doctors who chose to fight on the side of their birth and produced results similar to those of the Union surgeons. I make this statement based on my research of the history of the various doctors in the education part of my Civil War collection.
No matter how much some dealers, collectors, or families would like to romance the idea their set was used during the War, be suspicious and ask lots of questions. I am belaboring this point because every military collector wants to own a 'real' Civil War set and there are dealers and auction houses who are more than willing to fulfill the desire to own a piece of this history. Unfortunately 'real authentic' provable Civil War sets are extremely rare and the odds of you finding one 'cheap' at a gun or Civil War show are slim to none! Of course there are fake or put-together sets and you can find these sets on-line being displayed as 'authentic' Civil War sets, but close expert inspection will show they are 'mistakes' and the owners were unknowingly 'taken'. This is especially true with 'engraved' cartouches. Buyer beware, especially those who have more money than research time to spend!
Documented ownership of 'gift' sets:
If you are fortunate enough to find a U. S. Army Medical Department or U. S. Army Hospital Department set, do not make the mistake of saying a given set 'belonged' to a given surgeon, unless you have hard evidence (provenance) to prove otherwise. The Federal government-issued surgical sets were not given to a specific surgeon and as mentioned above, the Federal government sets were formally recalled at the end of the War by published special orders. Yes, some of those sets were sold after the War, but they will not have the name of the surgeon maker-engraved (and certainly not machine impressed, lasered, or stuck with individual block letters!) in the cartouche or brass plate on the top of the set unless that set was purchased by the surgeon or someone bought one and had it engraved after-the-fact as a gift.
If you find a government issued military set with the name of a doctor engraved in the cartouche, you need to ask yourself if it is either faked or created after the War when the government released or sold the set. That said, some troops bought civilian issued sets as presentation gifts to respected surgeons. These sets come up from time to time and should be approached for purchase with great caution as it would be too easy to fake such a 'gift' set. Get an expert opinion before you buy one and research the heck out of the provenance for any mistakes.
(Note: When the War was 'over' for a given doctor or surgeon would depend on when he left the military. These doctors were not conscripts and could leave or return as they saw fit. Many stayed until the end of the War in 1865, but many left to return to their communities or other duties at any point during the War.)
The point of the 'end of the War' statement is to illustrate that a 'gift' surgery set could have been presented after the surgeon left the military, not necessarily after 1865 when the War officially ended. So a set with engraved dates that are during the War may be correct.
The other major problem is with surgical sets that 'belonged' to a documented Civil War surgeon. There can be extensive provenance about the owner (surgeon), but the set will be post-Civil War issue and simply 'owned by' or 'presented to' the Civil War doctor after the War. (I see this kind of material all the time.) In that case, the surgical set is not 'Civil War', but merely was owned after the War, or after the surgeon left the military, by a Civil War doctor, assuming some enterprising dealer didn't have it engraved. It could be a set just 'associated' with the doctor. Even with engraved names, you can't believe all you see. (Check out the following story about engraved brass cartouches or plaques.) With the kind of money real Civil War sets bring, you can't believe everything you see or hear. Prove it or convince me why I should believe what you say.
Pieced together sets:
Another 'gotcha' problem is during the War, makers like Hernstein and Tiemann of New York and Gemrig of Philadelphia were so busy producing for the Union War effort, apparently their production for the civilian trade was reduced. After the War or during the last years of the War, they started piecing together wood cases and instruments from before and during the War to sell to the civilian trade. For that reason, we see sets that contain War-time saws and bullet forceps, labels from during the War, but cases made before the War. From a 'dating' standpoint, sometimes it's a nightmare to figure out who did what and when, but experience is the great teacher and having seen hundreds of sets teaches one what to look for and what to reject as being 'Civil War' issue. There are extensive photos and information on American Civil War Surgical Antiques website to help you decipher these issues.
As previously mentioned, other examples of outright fraud can be found, but faked mechanically 'engraved' cartouches on the set tops is testimony to someone being unknowingly 'taken' by an enterprising forger. Early period engraving by-hand has a distinct 'look', patina, and upon examination with a microscope it is easy to determine what is fake and what is not. Block lettering mechanically impressed or burned into brass or leather is not consistent with mid 1800's hand-engraving used by Civil War makers.
Was he really a 'doctor'?
Another issue is proving a Civil War doctor really was a 'doctor'. You can access the American Medical Association records for some (less than 50%) deceased physicians and find their name in some cases, but certainly not always. There were also 'doctors' who attended 'less than acceptable' medical school lectures before the War and may never have been officially certified 'graduated' before, during, or after the War. Some 'attended' lectures at a reputable medical college, but did not graduate. These individuals could easily obtain some type of amputation surgical set and call themselves a 'surgeon'. There was little enforcement to stop these individuals from committing the ultimate fraud on the public, but during the Civil War boards were formed to interview these individuals and remove them if they were found to be deficient. This is why identification and creating a chain of provenance for both the set and doctor is essential and takes a lot of research.
Many students attended some medical school lectures at a young age, but few actually graduated. As an example, the number of students registered for the school year 1850-1851 at Albany Medical College was over 200, verses how many actually graduated, less than 20. Many just attended, but very few made it through or were simply taking 'refresher' courses. Many of the famous medical colleges also served as 'refresher' courses for existing practicing doctors. Again, these non-degree-seeking students would fill the school's rolls, but only those few who completed the courses are listed as graduates. The reason for qualifying boards in the early months of the War was to weed out the 'wantabes' and 'charletons' to provide real, trained surgeons to the soldiers.
Buying eBay, European, or English sets:
One of the big problems with buying any European set is dating the set to a specific time frame because there is very little information available about specific European and in most cases English sets, with which you can accurately date the sets to five or ten year time frames. There are a couple of books on European and English topics (Bennion, Kickup), but nothing to match Edmonson's comprehensive work on ‘American Surgical Instrument Makers’, or sets. I guess one could buy a European military set made immediately before the War and romance about it being used in the War. European sets are much more extensive than American sets prior to the Civil War and the French sets are most impressive in particular, many of these well-made and technically advanced sets were imported to the United States before the Civil War began, but were most likely found in larger cities among well-trained physician/surgeons practicing or teaching in leading medical colleges or hospitals such as Bellevue Hospital in New York.
If you are a real gambler, go play the game on eBay. Roll the dice and make a bid on a 'True Civil War' set offered almost nightly. Typically they are listed by the seller as "Civil War Era" to be safe. Documented Civil War sets are extremely rare. Finding one on eBay or at any auction is going to be pure speculation on your part unless you possess a great deal of knowledge, but they do surface from time to time, so do your homework first if you spot one.
Again, keep in mind; some dealers hype their sets as being "Civil War" because those sets bring a premium. Some are not above generating provenance to prove a fake. The same follows for dealers who 'plant' instruments in sets to fill them out. You have to know what is correct and what is not or you are going to end up with a set which is less valuable than what you paid for, or a sore point in your collection.
You are not likely to get a serious Civil War set unless you study and get out there to associate with other Civil War and especially medical collectors with deep knowledge. If you go to just any internet sales site, auction, or local antique shop, and think you are going to get an honest representation on a 'real' Civil War set... well, there's that bridge in Brooklyn for you too.