It is rare to find a neglected subject in the history of medicine. Almost every aspect has been subject to repeated detailed scrutiny and recording by amateur historians and professionals alike, resulting in a plethora of articles, monographs and books. Although individual types of surgical instruments have occasionally been the subject of historical research and publication, this magisterial book is the first to give a detailed overview of the entire history of surgical instrumentation. In the English literature, only one book has previously attempted this. In 1942, CJS Thompson, then curator at The Royal College of Surgeons of England, published a short history of surgical instruments in a pocketsized book of only 113 pages, many of which were taken up by illustrations. It was inevitably superficial. Now, his successor as curator of surgical instruments at the College, John Kirkup, a retired orthopaedic surgeon, has produced what must surely be the definitive work on the subject. It is difficult to believe that it will ever be surpassed. The work is in four parts. Part 1 gives a general introduction but is largely taken up with a description of the sources used in compiling the information to follow. These include not only a very large number of historical articles and books on surgery but also a study of surgical instrument makers' catalogues over the past 200 years and, not surprisingly, the very large collection of instruments owned by the College as well as collections in other museums in Europe and the US. Part 2 comprises nearly 100 pages describing the different metals and other materials that have been used to make instruments over the centuries. These include animal parts such as bone and ivory, plants, stones, minerals, rubber, plastic, gum elastic as well as no less than 13 different non-ferrous metals and six ferrous metals. Part 3 is the perhaps the core of the book and is titled ‘Structure and Form’. It has ten chapters dealing in great detail with the evolution of different classes of instrument. Probes, needles, blades, forceps, retractors, scissors, catheters, haemostats, dilators and their various allies as well as implants and prostheses, diagnostic and therapeutic instruments – the list goes on. Each chapter comprises a historical introduction followed by an analysis of structure and then of function. Some of this material has been published previously in the Annals and formed the substance of the author's MD thesis. Part 4 is on applied instrumentation and, for example, deals with haemorrhage, wound closure, extraction of foreign materials and amputation. This section contains much of general surgical interest and for the occasional reader may be of greater interest than some of the more specialised earlier chapters. The book is lavishly illustrated throughout with more than 500 black-and-white line drawings and photographs. There is also a central section of 30 colour plates showing boxed collections of 19th-century instruments and plates from illustrated surgical manuscripts and books of the past. Each chapter is extensively referenced. To conclude, there is a comprehensive bibliography and a useful appendix detailing museums and collections throughout the world that exhibit surgical instruments. Are there any criticisms? I could find only one error during a detailed reading and that relates to an illustration rather than the text! Plate III is incorrectly labelled. Beyond this I found some of the illustrations disappointingly small given the detail they contain and a few have reproduced poorly. Overall, however, I believe this to be a unique reference volume that will be consulted for many years to come by those who wish to understand how the developing craft of surgery necessitated developments in instrument design and, conversely, how serial advances in materials technology allowed developments to take place in the craft of surgery. It will also be of special interest to instrument collectors and medical historians.
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Jan 31, 2024
Amit Desai 
Open Access
