© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
REMINISCENCE: ARTEFACTS FROM THE HONG KONG MUSEUM OF MEDICAL SCIENCES
Doctor’s bag belonging to Dr Wai-cheung Chau
Winnie Tang, MB, BS
Member, Educational and Research Committee, Hong Kong Museum of Medical Sciences Society
These days, to get medical advice from a medical doctor in Hong Kong, it is usually necessary to go to a clinic or hospital, but this was not always the case. In the past, especially in rural and isolated areas, doctors would visit patients at home; in some regions outside of Hong Kong, such home visits are still routine medical practice. To provide correct diagnosis and treatment during a home visit, a doctor must carry all the essential equipment and medications for any circumstance that might arise. Thus, a doctor’s bag must be strong, reliable, and easy to carry, with the ability to be opened widely for easy access to the contents.
Medical practitioners have been carrying such bags since ancient times, with the first mention of a doctor’s bag recorded in the Hippocratic Corpus known as ‘Decorum’, dated to about 350 BCE.1 The type of cases or bags that doctors carried has changed over time, depending on requirements and situations, as well as the newest technologies and fashions. For example, early doctors had wooden or leather chests mainly for surgical instruments that were brought on navy ships or taken to war with the army. Doctors in the eighteenth and nineteenth centuries often used saddle bags, because the doctors travelled to the patient’s home on foot or by horse. By the end of the nineteenth century, the familiar doctor’s bag based on the Gladstone bag became widely adopted. These bags are made of stiff leather over a wooden frame, with a large opening at the top to allow convenient access.
This doctor’s bag (Fig 1) belonged to Dr Waicheung Chau (周懷璋醫生). Dr Chau graduated from the medical school at The University of Hong Kong in 1916. He worked in public service after graduation for 2 years at Ho Miu Ling Nethersole Hospital and Tai Po Dispensary.2 In 1923, he wrote in the journal of the Hong Kong University Medical Society, Caduceus, describing his experience of working in Tai Po Dispensary.3 He had been called to attend to a patient who had delivered at home 3 days prior in a hut in Sheung Shui, which was rural Hong Kong at that time. She had copious loss of blood because of a retained placenta. Dr Chau was able to save the patient by removing the placenta piecemeal while the patient was under chloroform anaesthesia administered by the midwife who accompanied him. From his account, we can deduce that Dr Chau brought with him the necessary equipment and medications to make this possible.
Figure 1. Photograph of Dr Wai-cheung Chau’s doctor’s bag, which was kindly donated to the Hong Kong Museum of Medical Sciences by his daughter, Mrs Dorcas Hu. The wood and leather bag, made in around 1930, has a shelf on top for placing large-sized instruments and several drawers and pockets for smaller items
Dr Chau later worked in private practice, first in his own private clinic and then at Hong Kong Sanatorium & Hospital. At that time, house calls were routine, especially for those too weak to attend his clinic, and he would have carried this bag, made around 1930. Unlike the Gladstone-style doctor’s bags, Dr Chau’s bag is rectangular, similar to a small suitcase, 35.6 cm (14”) wide, 24.1 cm (9.5”) tall, and 14.6 cm (5.75”) deep. The bag has a wooden frame, is lined with thin leather on the outside, has two metal clasps, a plastic handle on top, and four metal studs on the bottom. The inside is lined with waterproof paper and divided into different-sized compartments, some with drawers with leather flap handles. The lid is lined with fabric and leather, and has some pockets for securing small items.
The contents inside a doctor’s bag varied with the type of practice of the doctor, but were invariably tools for diagnosis and medication for treatment.1 4 Diagnostic instruments carried in a doctor’s bag always included a stethoscope, a sphygmomanometer, a clinical thermometer, a tongue depressor, and some form of illumination such as a flashlight. Depending on the patients’ symptoms, the doctor might also carry other tools, such as a tuning fork, a percussion hammer, an otoscope, or an ophthalmoscope. Syringes, needles, cotton wool in spirit, gloves, dressings, bandages, catheters, and test tubes were also carried as required. In Dr Chau’s bag, there were boxes of glass slides for him to prepare smears for further pathological examination. As technology improved, some of these items, such as syringes, needles, gloves, and lancets, were replaced with disposable versions, and test strips replaced the bulky laboratory apparatus.
Medication carried in a doctor’s bag was varied, including drugs for emergency use or for preventive use. In the nineteenth century, doctors even carried vaccines to patients’ homes for smallpox inoculation.4 Although there are often new or more advanced drugs produced, a doctor’s bag always carried some core drugs, including antimicrobials, sedatives, analgesics, anti-asthmatics, anti-allergics, hormones, cardiac stimulants, and vitamins and minerals. In Dr Chau’s bag, there was a variety of medicines. Most drugs carried in a doctor’s bag were for parenteral administration, and stored in rubber-stoppered vials, glass ampoules, or hypodermic tablets in small glass tubes, to be dissolved or boiled before injection (Fig 2). The parenteral route enabled the drug to work fast enough for the doctor to observe the effect and assess whether he could safely leave the patient after treatment. Further medications, if required, would be collected from the doctor’s clinic the next day.
Figure 2. Photograph of some of the medicines from Dr Chau’s doctor’s bag in vials and ampoules, which are stuck to a plate. The tube on the right contains hypodermic tablets of strychnine sulphate, to be boiled in water before injection
Paperwork for home visits was usually simple, and doctor’s bags usually had only small notepads for writing prescriptions or clinical records. In Dr Chau’s bag, there were name cards and envelopes in the pockets.
As the population of Hong Kong ages, and the number of homebound individuals increases, there may be a change in demand for home visits. In the past 3 years, many medical facilities and services were unavailable because of measure to mitigate the spread of COVID-19. Thus, many patients had to, or chose to, isolate themselves at home. Doctors were called to see patients at care homes for the elderly or at their private residences, especially at the peak of the pandemic in Hong Kong in the first half of 2022. Many of these found themselves more at ease with healthcare service delivered to their residence. Although home visits by doctors are unlikely to return to the mainstream as they once were, there may be increased demand for home visits in future.
If home visits do regain popularity, it is likely that the doctor’s bag will also enjoy a resurgence. However, the form will have to evolve to accommodate modern technology and adapt to different settings of the patient’s residence, similar to the bags carried by modern paramedics. Traditional Gladstone-style doctor’s bags are now more of a fashion item, and designers have taken elements from the original bags, modernising and making stylish briefcases, travel bags, purses, or handbags. The few remaining original doctor’s bags have become collectable antique items or museum exhibit, with some still retaining aromas from the medicines they once carried.
1. Dammery D. A historical account of the doctor’s bag. Aust Fam Physician 2016;45:636-8.
2. Ho FC. Some unusual and some outstanding personalities. In: Ho FC, editor. Western Medicine for Chinese: How the Hong Kong College of Medicine Achieved a Breakthrough. HKU Press; 2017: 161-3. Crossref
3. Chau WC. Two cases of difficult labour. Caduceus 1923;2:44-5.
4. Low JA. The doctor’s bag in 1911. CMAJ 2012;184:E100-2. Crossref