Tag Archives: nineteenth-century surgery

“You Will Know You Are At The Right Place”: The Innovative Care of the National Surgical Institute of Indianapolis

Advertisement for the National Surgical Institute, Indianapolis News, May, 26, 1887. Hoosier State Chronicles

During the latter half of the 1800s, Indianapolis was served by one of the best surgical institutions in the country. Dr. Horace R. Allen and his team at the National Surgical Institute focused on improving the lives and medical methods for the treatment of individuals with physical disabilities and orthopedic challenges. Originally founded in Charleston, IL in 1858, the institute grew when they moved their operation to the much larger city of Indianapolis in 1869. For nearly forty years, the organization drew patients from throughout the country to receive specialized treatment while also serving the emergency medical needs of the industrialized city, eventually expanding to other sites throughout the country. A tragedy cut short the mission of the Indianapolis location, but their efforts to improve the lives of the public changed the medical landscape and opportunities for the citizens of Indiana.

Physical deformations and muscular/skeletal damage are a major part of our modern culture, and pain relief resulting from these issues has become a major industry. The rise of prescription medicine usage to treat these conditions, particularly opioids, had led to serious questions about appropriate ways to treat pain. Alternative care, such as chiropractic treatments, orthotics, and physical therapy are now commonplace for both the general public and athletes. Congenital issues like cleft palates and club feet are rare in adults or teenagers in America, often being treated relatively soon after birth with surgery. Even when adults suffer from issues like rheumatoid arthritis, modern medicine can often prevent the characteristic deformity of hands and other joints.

This was not always the case. In the mid-19th century, surgeries were still experimental in many fields and fatalities were high. One Washington Post article describes some of the challenges from medical care at the time, including untrained physicians, poor hygiene, and limited pain relief or anesthesia. Sadly, this often meant a lifetime of pain and isolation for individuals with these conditions.[i]  An article from Collector’s Weekly in 2015 addressed the prevailing attitudes of the mid-1800s for individuals living with deformities, including the attempts of society to “fix,” ignore, mock, and experiment on this population.

The National Surgical Institute of Indianapolis, and its founders Dr. Horace R. Allan and Dr. W.P. Johnson, attempted to change both conditions and attitudes. They believed orthopedic surgery was a specialty that many family physicians and other surgeons didn’t understand fully, and that treatments were often ineffective due to improper equipment and training. An 1885 pamphlet from the organization articulates the purpose for founding this organization:

Upon arriving in Indianapolis in June of 1869, the Institute settled on the corner of Illinois and Georgia Streets in the former “Farmers’ Hotel” building. Upon reaching Indianapolis, they partnered with Dr. Charles L. Wilson, a specialist in ear and eye care, as well as other specialized physicians in the city. Dr. Allen became the face of the organization, and often took the lead in administrative matters.

Early Advertisement for the Indianapolis location, Daily State Sentinel, October 5, 1869, Hoosier State Chronicles

 

The first medical emergency handled at the new location was the Sinker-Davis boiler accident at the State Fair Grounds, which were located at 19th and Alabama Streets at the time.  The sudden explosion of a boiler during a steam-powered saw-mill demonstration on October 1, 1869 killed between twenty and thirty individuals and injured many more. The Institute took in a large number of those affected by the accident and offered care for free, a practice that continued throughout their time in the city.

“A Terrible Calamity”, Daily State Sentinel, October 2, 1869, Hoosier State Chronicles

 

In fact, the Surgical Institute frequently treated patients for accidents and injuries due to their central location in the city, as many other hospitals were further from the city center. This was particularly important in a period of rapid industrialization, when workplace accidents were common, often resulting in major injuries, amputations, or death.

Article citing some of the benefits of the National Surgical Institute, The Indianapolis News, September 1, 1874. Hoosier State Chronicles

 

While the institute often served the public in general care or emergency cases, the National Surgical Institute specialized in the treatment of individuals with physical deformities. More than that, as many of their promotional materials suggest, they sought to remove some of the concerns that prevented individuals from seeking care, such as trustworthiness, cost, and convenience, for their patients. Trustworthiness was of prime importance due to the prevalence of under-trained doctors or skeptics of the profession. This excerpt from their 1876 self-published trade book explains the qualifications of the organization:

In the treatment of ordinary fevers and diseases of the country, your physician would doubtless excel us; but with Institutions of original and most approved character, with ample means and every conceivable apparatus and facility, and with varied and valuable experience of having treated over thirty thousand cases, we do not consider ourselves vain or boastful in saying that it is in our power to excel, and effect cures impossible to them.

Illustration of the National Surgical Institute display case at the 1876 Philadelphia Centennial, from a promotional pamphlet, 1885

 

The Surgical Institute often focused on changing body mechanics to strengthen and utilize areas that may suffer from deformation to help overcome limitations, rather than focusing on drug usage or unnecessary surgeries.[ii] Techniques utilizing atmospheric pressure were often applied to stimulate areas where muscle loss or minimal movement existed previously. They treated everything from spina bifida, to club feet, to rheumatoid arthritis. According to “The History of Indianapolis and Marion County,” Dr. Allen’s “mechanical surgery” treatment methods were adapted in England. The technology he developed even won an award for “Instruments of Medicine, Surgery, Etc.” at the 1876 Centennial Exhibition in Philadelphia. However, newspapers of the time rarely covered the stories of therapeutic treatment, other than to say that patients were treated by the National Surgical Institute.

The success of the organization in Indianapolis led to the development of other locations in the country. By 1875, the organization expanded to three other locations in San Francisco, Atlanta, and Philadelphia. Initially, sharing news of the Institute was difficult due to restrictions on taking out advertisements about medical treatments. However, heavy promotion in the 1870s, as well as direct promotion to potential patients, brought in many individuals. Rival surgical institutes began springing up throughout the country during the 1880s and ‘90s, including organizations in Terre Haute, Louisville, Champaign, Chicago, and Buffalo, all of whom sought publicity in Indiana newspapers:

German advertisement for a competing surgical institute in Buffalo, NY, Indiana Tribüne, February 13, 1886. Hoosier State Chronicles

 

This is not to say the Institute was beyond scrutiny. Several individuals reported patients on the sidewalks in front of the institute and were characterized as “advertisement” for the institute.  By the early 1890s, the NSI was still performing many successful surgeries, but a series of troubling incidents occurred with the building, including several small fires and the collapse of a chimney in 1891:

In an article discussing building failures in the early 1890s, the Surgical Institute was highlighted,
The Indianapolis News, June 26, 1891, Hoosier State Chronicles

 

This event was not isolated, and clearly there were issues with the safety of the building, despite assurances of safety from the owners. Unfortunately, a horrific fire in January of 1892 proved to be fatal, killing nearly twenty individuals and injuring several more. The Indiana State Sentinel, which had previously written glowing reviews of the Institute, was one of the local newspapers that called the building a “deathtrap” and suggested the building should have been condemned. Many blamed Drs. Allen and Wilson for allowing improper living conditions, but both were absolved from responsibility for the fire by the coroner a month later, (although not a popular decision at the time, as the deputy coroner resigned his post following the decision).

In March, Allen suggested he was considering moving the Institute out of Indianapolis in a letter to the Commercial Club, covered by the Indianapolis Journal. The letter indicated the weight that financial difficulties and public scrutiny from the fire put on Dr. Allen, and he did not feel supported in rebuilding the Institute in Indianapolis.[iii] Yet, by mid-May, plans for a new building were drawn up to be built on the corner of Ohio and Tennessee Streets (Capitol Avenue), directly across from the Indiana Statehouse. Dr. Wilson left the Institute by 1893 to start his own competing surgical institute in town, leaving Dr. Allen as the sole proprietor.

Image of the H.R. Allen National Surgical Institute on the corner of Ohio St and Capitol Ave, The Indianapolis News, December 6, 1894. Hoosier State Chronicles

 

Renaming themselves the “H.R. Allen National Surgical Institute,” the organization continued on for a few more years under the control of Dr. Allen. However, the financial strain on the organization led to the eventual closure of the Institute by 1898. The building was sold, eventually becoming the Imperial Hotel. Dr. Allen passed away two years later in Chicago, and is buried in Crown Hill cemetery in Indianapolis.

Despite the sad ending to the National Surgical Institute, tens of thousands of individuals were bettered by the work of the organization. Being at the center of a major city allowed them to be connected to the needs of the public in the area and convenient to people travelling for treatment. The prominence of this organization may have helped inspire the boom of surgical institutes throughout America in the 1880s and ‘90s, offering a new level of care and supporting the work of specialized care for difficult-to-treat conditions, as well as treating serious accidents. Most importantly, the National Surgical Institute placed patient interests at the forefront of their mission and goals, and sought to serve them with innovative care.

 

Works Referenced

Hix, Lisa. “Healing Spas and Ugly Clubs: How Victorians Taught Us to Treat People With Disabilities” from Collector’s Weekly, July 21st, 2015. Website, accessed on 03/04/2019. https://www.collectorsweekly.com/articles/healing-spas-and-ugly-clubs-how-victorians-taught-us-to-treat-people-with-disabilities/

Imperial Hotel, Indianapolis, Indiana, 1907. (Postcard) From the Joan Hostetler Collection of Indiana Album, accessed on 03/07/2019, https://indianaalbum.pastperfectonline.com/photo/1C3EE72F-8329-4BFC-BFB0-914722026138  

List of awards made by the United States Centennial commission to the American exhibitors, International exhibition 1876, at Philadelphia. (S.T. Souder & Company, Philadelphia, 1876). Accessed from Archive.com via Library of Congress, 03/04/2019, https://archive.org/details/listofawardsmade00unit/page/112.

National Surgical Institute (National Surgical Institute (publisher), Indianapolis, IN, 1876), p 39. Accessed from the U.S. National Library of Medicine Digital Collection, 02/12/2019. https://collections.nlm.nih.gov/catalog/nlm:nlmuid-66811200R-bk

Sarner, Moya. “Back pain: how to live with one of the world’s biggest health problems” from The Guardian, June 14, 2018. Website, accessed 03/04/2018, https://www.theguardian.com/society/2018/jun/14/back-pain-how-to-live-with-one-of-the-worlds-biggest-health-problems

Stone, Will. “Patients With Chronic Pain Feel Caught In An Opioid Prescribing Debate” from NPR (National Public Radio). Website, Accessed 03/04/2019, https://www.npr.org/sections/health-shots/2018/07/08/622729300/patients-with-chronic-pain-feel-caught-in-an-opioid-prescribing-debate

Sulgrove, B.R. History of Indianapolis and Marion County. (L. H Everts & Co.: Philadelphia, 1884)

The National Surgical Institute. Pamphlet, 1885. From the U.S. National Library of Medicine Digital Collection, accessed on 03/06/2019. https://collections.nlm.nih.gov/ext/dw/101532257/PDF/101532257.pdf

[i] Three previous Indiana History Blog articles, one focusing on Central State Hospital physician Dr. Sarah Stockton and a two-part article on Civil War surgeon and hospital designer, John Shaw Billings, help provide some context for medical conditions during and following the Civil War.

[ii] In fact, the Institute even suggested that they could cure opium addiction in the January 25, 1878 edition of the Indianapolis News. No details were provided of the treatment method, nor were there successful cases mentioned, but patients who attempted the cure were assured of “no charge” if it didn’t succeed.

[iii] For more information on the fire and the immediate reaction in the newspapers, read Libby Cierzniak’s Historic Indianapolis article, “Indianapolis Collected: After the Fire”.

The 20% Solution: An Unlikely Breakthrough in Eye Surgery, 1884

Thomas Eakins, Portrait of Dr. Samuel D. Gross (The Gross Clinic), oil on canvas, 1875, Philadelphia Museum of Art. {Painting depicts surgery in front of a class of medical students; note the man applying a rag, likely soaked with ether.]
Thomas Eakins, Portrait of Dr. Samuel D. Gross (The Gross Clinic), oil on canvas, 1875, Philadelphia Museum of Art. [Painting depicts surgery in front of a class of medical students; note the man applying a rag, likely soaked with ether.]
By 1884, Indianapolis newspapers were reporting on the success of eye surgeries and procedures, including tattooing the cornea, by using a brand new anesthetic… cocaine.

Dr. Carl Koller, photograph, circa 1885, accessed the Foundation of the American Academy of Opthamology
Dr. Carl Koller, photograph, circa 1885, accessed the Foundation of the American Academy of Ophthalmology

According to A. Grzybowki’s 2008 article “Cocaine and the Eye: A Historical Overview,” doctors had been experimenting with coca leaves in Europe since the 15th century.  However, it wasn’t until the 19th century that they learned to extract the active component: cocaine.  Early studies focused on the “many physiological and pathological effects,” as opposed to any numbing effects.

An Austrian ophthalmologist named Carl Koller is credited with discovering the effective use of cocaine as a local anesthetic for eye surgery in 1884. Koller found that a cocaine solution applied to the cornea left the eye temporarily unable to move or feel pain.  Before this discovery, it was almost impossible to operate on the eye because of its involuntary movements. His findings, published on September 18, 1884, were widely accepted and reproduced in the United States. Newspapers throughout the Midwest began reporting on the wonder drug almost immediately.  In fact, the first articles we found in searching Hoosier State Chronicles date to only one month after Koller’s discovery. The rising popularity of the drug was apparently driving up the cost.

The New Anesthetic in Indiana Apothecaries

As early as October 1884, the Indianapolis News listed the price of the “new and successful anesthetic.”

Indianapolis News, October 24, 1884, 2, Hoosier State Chronicles.
Indianapolis News, October 24, 1884, 2, Hoosier State Chronicles.

The following month, the Daily Wabash Express noted that 18 karat gold cost about $16 an ounce while cocaine cost $224 an ounce.

[Terre Haute] Daily Wabash Express, November 30, 1884, 2, Hoosier State Chronicles.
[Terre Haute] Daily Wabash Express, November 30, 1884, 2, Hoosier State Chronicles.
In December 1884, a Bloomington dentist wrote a letter to the editor of the Indianapolis News  encouraging his Indianapolis colleagues that they advertise their use of the new anesthetic in an article titled “Try Cocaine.” This tongue-in-cheek letter is referencing the high price of cocaine.  Thus, he jokes that if the city doctors advertise this expensive service, “great will be the reward reaped from their country cousins,” as most people would rather deal with the physical pain and the cost.

Indianapolis News, December 25, 1884, 3, Hoosier State Chronicles
“Try Cocaine,” Indianapolis News, December 25, 1884, 3, Hoosier State Chronicles
cocaine-indianapolis-news-december-26-1884-4-hsc
S.C., “Try Cocaine,” Indianapolis News, December 26, 1884, 4, Hoosier State Chronicles.

In response to the “country cousin” dentist, an Indiana man with the initials “S.C.,” also wrote to the editor of the Indianapolis News about the new anesthetic.  He wrote: “Hydrochlorate of Cocaine has been in use in the United States about two months . . . The anesthetic solution requires four grains in 100 drops of water.” He too complains about the high price and predicts that it will go up more, encouraging some patients to “grin and bear it” without the pain reliever.  S.C. continued: “The writer has a sample which he uses, not as a reward reaper, but to facilitate matters in examining ‘sore eyes.’ It has wonderful analgesic power in many directions, and physicians and dentists are using is as fast as they can obtain a supply – and a paying customer.”

Cocaine Solution and Eye Surgery

Antonio Baratti, engraving, 1772, National Library of Medicine, accessed U.S. National Library of Medicine Digital Collections, https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101425480-img
Antonio Baratti, engraving, 1772, National Library of Medicine, accessed U.S. National Library of Medicine Digital Collections.
cocaine-article-long-indianapolis-news-march-18-1885-2-hsc
“Surgery without Pain,” Indianapolis News, March 18, 1885, 2, Hoosier State Chronicles.

In March 1885 the Indianapolis News reprinted “Surgery without Pain,” from the New York Tribune, describing the success of one “prominent eye surgeon” at the New York Post Graduate School of Medicine using cocaine as an anesthetic. When asked by the reporter if he uses the drug in surgery, the doctor replied: “Well, I should say so; in operations upon the eye I feel now that I could not get along without it. In general practice it has driven ether and chloroform out of the field. It is not only a wonderful discovery, but it is astonishing how rapidly it has risen into favor.”

The surgeon went on to tell the story of Dr. Koller’s recent discovery of cocaine as a local anesthesia in September 1884 and its immediate experimental adoption in the US.  He stated: “There is hardly a field in which it has not been used with success. Too much cannot be said in its praise in surgical operations upon the eye, ear and nose.”

"The New Anaesthetic," [Terre Haute] Saturday Evening Mail, February 21, 1885, 8, Hoosier State Chronicles.
“The New Anaesthetic,” [Terre Haute] Saturday Evening Mail, February 21, 1885, 8, Hoosier State Chronicles.
On February 21, 1885, the [Terre Haute] Saturday Evening Mail ran an article detailing the history and medical uses for cocaine, including eye surgery.  By dropping a cocaine solution “2 to 20 percent” the eye was made insensitive  “and the most trying operations may thus be performed . . . without pain.” The article also contained a deadly-sounding recipe for a crystallized version of the drug that not only used ether, but also lead.

Indianapolis News, April 15, 1885, 2, Hoosier State Chronicles.
Indianapolis News, April 15, 1885, 2, Hoosier State Chronicles.

On April 15, 1885, the Indianapolis News also reported on “Cocaine, the new anesthetic” and how a patient not only “submitted to the ball of his eye being punctured by a delicate spearhead knife,” but also “chatted pleasantly with the operator” during the surgery.

Surgery Under
“Surgery Under Cocaine,” Indianapolis News, June 2, 1885, 2, Hoosier State Chronicles.

One June 2, 1885, the Indianapolis News ran a story claiming a patient felt “no pain during the section of ciliary or optic nerves” when a 20% cocaine solution was applied before the operation and dropped on the eye throughout.

cocaine-dog-eye-surgery-greencastle-times-march-14-1889-8-hsc
“The Use of Cocaine,” Greencastle Times, March 14, 1889, 8, Hoosier State Chronicles

The Greencastle Times reported on a doctor who used cocaine for eye surgery in 1889, only this time the patient was “a very fine hunting dog, who had got a thorn in his eye.”  The good doctor applied a 5% cocaine solution to the dog’s eye, removed the thorn, and the dog “soon trotted home as well as ever.”

Tattooing the Eye

Crawfordsville Review, December 11, 1897, 5, Hoosier State Chronicles
Crawfordsville Review, December 11, 1897, 5, Hoosier State Chronicles.

Perhaps most interestingly, the Crawfordsville Review reported that “the latest discovery of scientific medical men is that the human eye may be tattooed any color.” The procedure is recommended for blind or “dead” eyes in order to “restore it to its natural appearance, so that nothing but the closest scrutiny can detect the difference between it and its fellow.” The eye was covered thickly with India ink and then punctured “by means of a little electrical machine which operates a specifically made needle.” Of course, this 19th-century medical miracle was also brought to us by cocaine.  According to the article, “The operation of tattooing is performed by first treating the eye with cocaine until it becomes absolutely senseless to pain.”

Indianapolis News, February 10, 1900, 6, Hoosier State Chronicles.
Indianapolis News, February 10, 1900, 6, Hoosier State Chronicles.

The following year that this very procedure was successfully performed by a surgeon at the nearby Miami Medical College in Ohio.  The Indianapolis News reported, “Miss Ada Duhrens . . . has had the color of the pupil of her eye restored by tattooing with india ink.”  We can only assume she has cocaine to thank for the “lost color restored” in her eyes.

Advertisement, Terre Haute Saturday Evening Mail, October 24. 1885, 3.
Advertisement, Terre Haute Saturday Evening Mail, October 31, 1885, 3, Hoosier State Chronicles.

By this time, cocaine was also being used as an anesthetic for nose, throat, and for dental procedures. It was completely unregulated. Anyone could walk into a pharmacy and purchase cocaine powder or tablets. It was also the main ingredient in many “stimulating tonics” designed to combat fatigue and even soothe kids’ tooth aches. Ads appear throughout Indiana newspapers in the 1880s promoting it as a cure for hay fever, hair loss, and recommending cocaine lozenges as essential for speakers and singers.

Later, it turned out, there were some complications with the wonder drug.

 Edward Jackson, Essentials of Refraction and the Diseases of the Eye (Philadelphis: W. B. Sanders, 1890), 136, accessed U.S. National Library of Medicine Digital Collections.

Edward Jackson, Essentials of Refraction and the Diseases of the Eye (Philadelphis: W. B. Sanders, 1890), 136, accessed U.S. National Library of Medicine Digital Collections.

For more information on cocaine and eye surgery see:

  1. Grzybowski, “Cocaine and the Eye: A Historical Overview,” Ophthalmologica 222: 5 (September 2008, accessed Karger Medical and Scientific Publishers, https://www.karger.com/Article/Abstract/140625
  2. Goerig, D. Bacon, and A. van Zundert, “Carl Koller, Cocaine, and Local Anethesia,” Reg Anesth Pain Med 37:3 (May-June 2012), accessed PubMed.gov, https://www.ncbi.nlm.nih.gov/pubmed/22531385