A most unusual large American surgical instrument case that is covered in leather and decorated with brass tacks on all six sides. No instruments present. This sort of decoration is seen on American trunks made during the 2nd quarter of the 19th century but not on medical cases. It was shown  to the dean of American medical museum curators and he said he had not previously seen its like.  This case surfaced in the American Midwest. The decorative work was presumably done either as a special order or after market. Some evidence of wear but overall the exterior of the case  in very good condition.