Medicine on the Move: Kits, Cases and Carry-alls from the History of Healthcare
Kits and Cases in Catalogs
The pages of medical supply catalogs provide insight into the changing role of portable kits and cases in the nineteenth and twentieth centuries. In the 1880s and 1890s, for example, medical suppliers’ catalogs boasted entire sections on leather medical bags, portable pharmacy bags, and surgical kits. Some suppliers dedicated full page spreads to buggy cases and saddlebag kits.
By the 1960s, the portable cases for sale in catalogs were primarily limited to a few nurses’ kits and “cabin bags” for practicing medicine on trains or ships. Surgical kits for the individual practitioner disappeared from catalog pages, making way for larger surgical equipment designed for use in hospitals and medical centers.
Inside a Doctor’s Bag
In the 1969 article, “The story of a ‘little black bag’” in the Journal of the Royal College of General Practitioners, author S. Morris observed, “Nothing changes faster than the face of modern medicine, thus it is expected that the general practitioner's 'little black bag' will also change, but whatever form it may eventually take it will always be the symbol of family medicine.”
Throughout the nineteenth and early twentieth centuries, much of patient care occurred in the home. Physicians, especially in rural areas, made house calls to their patients. Many people did not generally seek medical assistance until they experienced an illness that did not resolve on its own or with home remedies. A doctor needed to enter a patient’s home prepared to diagnose and determine a course of treatment for acute and chronic illnesses.
Many tools typically associated with primary care first came into usage in the nineteenth century, including the stethoscope, thermometer, and otoscope. Doctors needed a reliable means to carry this ever-growing list of diagnostic tools to the homes of their patients. The quintessential black doctor’s bag succeeded a variety of wooden and leather cases and compartments for carrying tools and medicines in common usage.
Inside a Public Health Nurse’s Bag
Though the doctor’s house call declined as the twentieth century progressed, replaced with clinic and hospital visits, another emblematic bag emerged in community and rural healthcare: the public health nurse’s bag. Nursing pioneer Lillian Wald coined the term “public health nurse” to describe a community-focused nurse who addressed social and economic factors affecting the health of a patient. Home visits and mobile clinics formed a core component of this developing model of preventative care. After the public health initiatives of the Progressive Era, and the social welfare programs of the New Deal, local government public health departments instituted more robust programs to provide care to underserved communities.
The City of Portland and Multnomah County public health departments each employed public health nurses in programs for school health, vital statistics, infant and child care, and communicable disease control, among others. The departments merged in 1968, making Multnomah County the public health authority in the area. The county subsequently expanded its services and established new geographical districts for public health nurses. County public health nurses carried their bags for home visits as well as for mobile clinics in schools and community centers.
Along with diagnostic tools, the practitioner making house calls in the nineteenth and early twentieth centuries brought with them a selection of botanical and chemical compounds for treating ailments.
In the nineteenth century, drugs commonly carried in a doctor’s bag included opium (or its derivative, morphine), calomel (mercurous chloride, used as a purgative), Dover’s powder (a sudorific, to induce sweating), ammonia (in the form of “smelling salts”), quinine (used to treat malaria as well as tremors) and cathartic pills (laxatives).
The growth of the pharmaceutical industry in the mid to late nineteenth century drove a twentieth century marketing explosion for new compounds on the market. Pharmaceutical companies produced complete portable cases conveniently supplied with their preparations. Manufacturers began to offer a variety of pocket-sized emergency medicine kits outfitted with ready-to-dispense doses of common drugs. The development of new drugs like insulin also created a growing demand among patients for discreet, portable medicine cases.
Emergency Medicine and Field Surgery
Into the early the twentieth century, hospitals functioned primarily as charitable institutions, a destination for the destitute and the desperate. Surgeons often performed procedures in private offices or patients’ homes in an emergency capacity and with their own instruments, which they carried with them in a wooden or leather case. Surgical suppliers also offered pocket surgical instrument cases for unexpected emergencies or minor procedures.
Surgery in the nineteenth century was primarily used a last resort, and included procedures such as amputations, growth removals, setting broken bones, and sewing up cuts, often performed on an emergency basis. Before the development of anesthesia in the mid-nineteenth century, surgery was so traumatic that surgeons were expected to perform procedures as quickly as possible.
During the American Civil War, three out of every four surgical procedures were amputations, totaling an estimated 30,000 procedures at two to ten minutes in duration per operation. Before the establishment of larger army field hospitals, surgeons moved quickly from patient to patient in makeshift hospitals near the battlefield. An amputation performed as soon as possible after injury proved to be one of the best options available to field surgeons at the time.