Trephination

     Most people associate Civil War medicine with amputations and saws.  There were a lot of amputations performed when bones in the arms or legs were shattered, and in most cases it was the best method of treatment they had.  But what happened to the soldiers who suffered skull fractures?  Amputation would not be a good treatment in this case!

     Civil War surgeons would have reached for their trephining (or trepanning) kit.  Trephining is a procedure in which a cylindrical saw-like instrument called a trephine is used to cut a hole into the skull in order to relieve pressure on the brain or remove a blood clot.  This is a procedure which predates the Civil War.  In the Middle Ages it was used as a remedy for headaches, seizures, and “evil spirits”.  Some prehistoric human skulls have even been found with evidence of trephining.  



This is a diagram of a trepanning kit from an 1860 Snowden & Brother catalog (Philadelphia) which lists the instruments that were contained in the kit. Take a look at those prices too!



     

     The scalpel would be used first to cut a flap of skin from the area.  Next the trephine would be used to cut a hole in the bone.  Many trephines have a spike (identified as the "sliding centre" in the diagram) which was used to hold the instrument in place while it was rotated. 

    

This trephine is actually made in two parts. The wooden handle is removable and can be used with trephines of different sizes. The small round handle on the metal shaft is used to control the depth of the spike inside the blade.

Here you can see the spike that was used to anchor the blade in place.

     Another instrument which was used to reduce skull fractures was a Hey's saw.  It has a double-edged blade with one flat side and one curved side.  Once you've seen one, you'll easily recognize other Hey's saws.





The Hey’s saw was named after an English surgeon, William Hey.

A small bone brush was used to remove any bone dust produced by the saws. This one has a wooden handle and natural bristles.

Next an instrument called an elevator was used to raise or remove the portions of bone which were putting pressure on the brain. 

     Some symptoms of pressure on the brain from a skull fracture which have been noted in case studies are loss of consiousness, convulsions, headache, nausea, paralysis, and confusion.  In some cases, the symptoms would disappear shortly after a trephination.  Overall though, there was a pretty high mortality rate for these patients; less than half of them survived the procedure.

     If you are curious you can read about some actual trephining cases from the Civil War here: 
http://www.braceface.com/medical/Civil_War_Articles/Trephining_during_Civil_War.htm

    

     Though I would love to be able to purchase a trephining kit for the museum at the Civil War era prices listed above, it appears that price would only get me the following item:

     I wonder what a Civil War surgeon would have thought of this....

     Photos courtesy of the National Museum of Civil War Medicine

 

   

Artifact Conservation

     While I do the minor cleaning and repairs needed for the artifacts in the museum’s collection, there are jobs which are beyond my abilities.  A professional conservator is required in these cases.

    I would first like to clarify that there is a difference between conservation and restoration.  The goal of restoration is usually to bring an object back to its original appearance.  The goal of conservation is bring the artifact back to a stable condition.  Though improving the appearance of the artifact can be one of the objectives, it is not the main one.  In some cases, conservation of an artifact can result in leaving evidence of wear, or other “imperfections”.  Preserving the artifact and its history is the main goal here, not appearance.  Additionally, unlike restoration, any conservation work done is reversible.

     We are very fortunate at the NMCWM to have a volunteer who is a retired conservator and who can occasionally donate his time and talents in working on some of our artifacts.  He was recently able to stablize a surgeon's leather field case for us.  It was affected with red rot, and was displaying the characteristic powdery-red surface and weakened areas.      

    

This is the field case before treatment. You can see a reddish tinge to it. Not visible in the photo are small salt crystals on the surface of the leather. The straps were very thin and brittle. Even when I handled it very carefully, my white gloves would turn red where they contacted the leather.

Here is Spencer working on the case. He carefully removed the crystals from the leather and treated it with a consolidant called Cellugel which is absorbed into the leather and dries very quickly. He then applied a colored shoewax to the exterior surface.

The case not only looks much better, but it is now stronger and less brittle. Though the red rot did do some damage, the case has now been stabilized. 

     Another artifact which had professional conservation work done on it is the commission pictured below.  The document was in fair condition when it was acquired.  It was somewhat yellowed and faded and had some surface dirt, and it had been stored folded for many years.  The document was weak along all the fold lines, and one segment was completely detached.

This is a commission for Lt. John Henry Dye, 25^th PA Infantry. He drafted maps for the Battle of Gettysburg. We have this document because his wife, Clarissa Jones Dye, was a Civil War nurse. You can see that the document is yellowed and in two pieces.

This detail photo shows damage along fold lines. This is a good reason to store paper items flat and unfolded!

     The commission was sent to Cleveland Conservation of Art on Paper.  The conservator reported the treatment as follows:  The surface of the paper was cleaned in the non-image areas, using grated polyvinyl eraser crumbs.  The paper was immersed in deionized water conditioned to a pH of 8.0.  As a result, the paper became lighter in color and the acidic content was lowered.  The back of the paper was sprayed with a very light alkaline reserve spray of magnesium oxide.  This will help to keep the acidic content of the paper lower.  The tears were mended and the weak folds were reinforced with kizukishi conservation paper and zin shofu wheat starch adhesive.  And finally, the document was placed in a stable, archival quality paper folder, which will allow the gradual migration of acids out of the document and into the folder paper while it is in storage.

As you can see in this photo, the document is now in much better condition than when we received it, and is much better preserved for the future.

     It is amazing what can be done for these artifacts!  It is fascinating to me, and I have to admit that if I had to pick another career, I’d definitely look into the conservation field.

Photos courtesy of the National Museum of Civil War Medicine

A Visit to Clara Barton’s House

     A few days ago I was able to visit the Clara Barton National Historic Site in Glen Echo, Maryland.  I was pleased to be able to tour the site, but I also enjoyed getting a closer look at some of the artifacts.  I was there with some coworkers to look at artifacts which we may be able to borrow, and some which we will try to reproduce.  We will be adding a Clara Barton display to our main museum, and of course we are working on opening Clara Barton’s Missing Soldiers Office.  While we do have artifacts which were found in her Missing Soldiers Office that we can display, these additional artifacts should allow us to tell a more complete story of her life and work.

This is the house that was Clara Barton’s residence for the last 15 years of her life. It also served as the first permanent headquarters of the American Red Cross.

 

I liked this image of Clara Barton that was taken later in her life. You can see another image of her in the background, from her younger days.

Those are stained glass windows in the doors. There’s no doubt that Clara was (rightfully) proud of her work!

  

Here’s an artifact that ties in to the Missing Soldier’s Office. I did make sure to get permission before I photographed any artifacts!

More Red Cross stained glass! This set looks out from the top floor of the house.

     We were able to examine several items which were out on display, and then we were taken upstairs to look at some artifacts in storage.  When the curator pulled out a book listing the Union soldiers buried at Andersonville Prison, I had to take a closer look.  This time it was personal.  My great-great-great grandfather died there.  So, I took the opportunity to look up his name.

Here it is, C.B. Seeley of the 15^thNY Cavalry, died Oct. 24, 1864 of scorbutus. Scorbutus is another term for scurvy, a condition caused by a deficiency of vitamin C. It is a cause of death listed for many Andersonville inmates, which is not surprising considering that they suffered a deficiency of food overall.

     We also saw a period dress bodice, nicknamed “The Traveling Bodice” since it is designated for going out on loan to other institutions.  Notice in the photo that the bodice is padded with acid-free tissue, to prevent creases from forming in the fabric, and that there are rolled pieces of tissue along the exterior to keep it from shifting in the box.  These rolled segments of tissue paper are sometimes referred to as “sausages”. 

The bodice is packed well for storage and for transport, with a sturdy box, a foam form, cloth straps, and lots of tissue paper!

It’s always good to have handling and packing instructions for loaned items. 

     It was a fascinating visit!  The next step now is to consult with my coworkers to determine which items we want to request to borrow.  We certainly saw many of them that we’d like!

Photos courtesy of the Clara Barton National Historic Site.

A Civil War Preventative

     I’ve posted previously about dealing with a moth infestation on my first day on the job at the museum.  My second day on the job was memorable as well.  I’d gotten a quick look at the collection room the previous day, but I wanted to get a closer look at the artifacts stored there.  It was partly to ensure that the moths hadn’t infiltrated the collection room, but mostly because I was curious about the artifacts!  So I started opening drawers.  The contents of the very first drawer I opened caused me to do a double-take though.  I had to check the label to be certain that it was what it appeared to be.  It really was a Civil War era condom! 

This condom is made of sheep or goat skin. The thin ribbon across the top was not used to tie it in place, but added stability and helped to prevent the condom from splitting.

     By the 1860s, animal skin and rubber condoms, sometimes called “preventatives” or “French letters”, were available for use.  Typically they were used to prevent sexually transmitted diseases.  Syphilis and gonorrhea were common in both armies during the Civil War.  However, this condom was accompanied by a circular which also touted its use for married couples as a birth control device.

The paper circular from Mr. De Young regarding condoms for sale at his store in Philadelphia. It explains the nature of condoms and the reasons for their use, but with more emphasis on birth control than disease prevention.

 

     Sex was not a topic which was discussed openly at that time, so it is interesting to note the language and euphemisms used in the circular.  You can see how carefully he words his description, “…as to the nature of the article, they are called CUNDUMNS, or Preventatives; they are used for a private purpose by males when having intercourse with the opposite sex.  The object in using them is as follows:  Single young men use them to prevent themselves from becoming diseased when having intercourse with women of a public character…” 

     He continues and points out the merits of using them as contraceptives, “…but where I sell one for the above purpose, I sell a hundred for domestic use, for the husband to use with his wife…  Indeed, all wives when they become acquainted with this article, they become strong advocates for the husband to use the preventative with them, and they certainly show their good sense in doing so, for the wife saves her own health, and can have just as many children as they can comfortably raise, and need not have any more than they think fit.”

     Being a good salesman, he then lists the price, “$3.00 per single paper or dozen.  Also on hand Yarners or Ticklers, at $3.00 per dozen.”  That was a bit pricey for the time, which may explain why it is reported that sometimes condoms were washed and reused!  Surprisingly though, they did appear to be effective at preventing the transmission of diseases.

     Displaying the condom presented some challenges.  The animal skin is delicate and very prone to damage from light, heat, and relative humidity (RH) at both ends of the spectrum.  A high RH can promote the growth of mold or mildew, while a low RH can dry out the skin and cause it to shrink or crack.  I had to ensure that the conditions in its display would be appropriate for it. 

     There was also some apprehension about the public’s reaction to a condom on display.  I had several conversations with the museum’s director about the pros and cons of displaying it, and how to most appropriately display it.  In the meantime, it went out on short-term loans twice, which gave us a chance to gauge the reaction to it.  The displays in both venues, Arlington House, the Robert E. Lee Memorial in Arlington, VA, and the National Civil War Museum in Harrisburg, PA, had positive reviews.

Here are the condom and circular on display at the National Civil War Museum in 2009. Currently they are on display at my museum, the National Museum of Civil War Medicine.

Photo courtesy of the National Civil War Museum.

     Ultimately, we felt that that the condom did help to tell the story of the Civil War soldiers, and was in line with the museum’s mission of preserving the legacy of Civil War medical innovation.  We did put it in one of the higher cases though, so that it is not in obvious view of our youngest museum visitors.

     So I guess the lesson this week is to be careful which drawer you open!

Photos courtesy of the National Museum of Civil War Medicine, except where otherwise noted.