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Surgery

Ornate bow-frame amputation saw, 1601-1700

Ornate bow-frame amputation saw, 1601-1700

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Surgery in the past, surgery today

Surgery is probably no longer the most feared medical procedure. Many of us will go under the surgeon’s knife at some point in our lives. We have come to think of surgery as a safe, painless and reliable method to cure us from illness, but this was not always the case. With no pain control and the risk of infection, surgery used to be painful, horrific and dangerous in roughly equal measure and many people died on the operating table. It was usually the last resort for both patient and practitioner.

Early surgery in the Neolithic and Egyptian periods

The earliest form of surgery was trephining, which involved cutting a small round hole in the head. It was practised as early as the Neolithic period, for reasons that remain a mystery. There are many theories about the reasons behind this practice. The only thing we know for sure is that some patients survived the procedure, and sometimes even had more than one performed. Later, the Egyptians practised trephining in an effort to cure migraines - the idea was to ‘let out’ the illness that was causing the headaches.

The discovery of new materials and their effects on Greek surgery

The Ancient Greeks benefited from new materials, such as iron, which they used to make surgical instruments. Greek surgeons could set broken bones, bleed patients, perform amputations and drain the lungs of anyone unfortunate enough to catch pneumonia. Despite this the dangers associated with surgery meant that it remained the last resort, even for notable doctors such as Hippocrates.

The influence of the Greeks and war on Roman surgery

Romans surgeons had ample opportunity to pick up surgical skills at the infamous gladiator schools and during the many wars that Rome inflicted on its neighbours and others further afield. Their surgical instruments were similar to those employed by the Greeks. Turpentine and pitch were used as antiseptics, but internal surgery was still considered too risky. The Romans also performed amputations, trephining and eye surgery. The most famous surgeon in Rome was Galen, who was surgeon to the Roman emperor.

Al-Zahrawi and Islamic influence on Western medicine

Al-Zahrawi (Albucasis), the famous Islamic surgeon and physician, was highly influential from around 900 CE. He wrote several books detailing subjects such as orthopaedics, military surgery and ear, nose and throat surgery. His books were used extensively for many centuries by Islamic and Western medical scholars.

Surgeons, women, antiseptics and anaesthetics in the Middle Ages

Bleeding was still common in the Middle Ages, but the lack of effective antiseptics and anaesthetics continued to limit the scope of surgery. Some simple anaesthetics such as herbs and alcohol were in use, but they were often so strong that they could kill the patient while the surgeon was still sharpening his or her knife. Women could not become physicians at this time, but surgery, considered a lesser profession, was open to them. Surgeons did not go to university to study, but were apprenticed to practising surgeons to learn through observation.

Medieval barber-surgeons and war

But many surgeons were not surgeons in the modern sense. In fact, most were barbers, who combined small surgical operations with performing bloodletting and tooth extraction. In the medieval period, barber-surgeons travelled around the country. They would take up residence in a castle, treat the occupants and also care for any soldiers who were injured in the many small battles that were undertaken between rival factions.

Paré and new methods of surgery in the 1500s and 1600s

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From the 1500s to the middle of the 1600s surgeons experimented with new methods. Cauterising wounds was still popular and helped prevent infection, but some surgeons rejected these established methods in favour of more innovative approaches. In the mid-1500s Ambroise Paré, a French war surgeon, popularised the use of ligatures to control bleeding after amputation. He also used bandages to cover wounds.

The decline of women surgeons

Women continued to train as surgeons throughout the 1500s and 1600s, often treating the poor. In fact they were not pushed out of surgical practice until the 1700s, when surgical training moved to the universities - from which they were banned.

The experience of surgery with newly found pain relief

In the early 1800s the most important talents a surgeon could possess were speed and accuracy. Surgeons were famed for their speed, particularly in amputation. As there was still no effective anaesthetic, they had to perform their procedures quickly and were limited to external tumours, amputation and trephining. The development of new anaesthetic gases changed the experience of surgery for patient and surgeon. With the patient rendered unconscious, surgery could become more invasive and this also gave the surgeon the opportunity to be both slower and more methodical. The anaesthetic gas ether was first used in 1846 but was soon replaced by chloroform, which was originally used to relieve the pain of childbirth.

Killing and preventing germs: surgical developments in the 1800s and 1900s

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The development of germ theory provided understanding of how to prevent post-surgical infection. In 1867 Joseph Lister published a paper in The Lancet detailing his method of controlling infection by spraying a mist of carbolic acid over the wound and then wrapping it in carbolic-soaked bandages. This method of killing all known germs was called antisepsis. It was followed in the 1900s by asepsis, which prevented any bacteria from coming into contact with the wound. These twin developments revolutionised surgery.

Improved surgery in the 1940s

By the beginning of the 1900s surgery was usually less painful and risky, but many patients continued to die from internal infection and blood loss. It was not until the development of safe blood transfusion and antibiotics such as penicillin in the early 1940s that surgery became relatively safe.

Specialist surgeons

X-rays also allowed surgeons to plan their surgery effectively by allowing them to see exactly what was wrong. Safer gases and intravenous anaesthetics replaced chloroform, and surgery became more specialised - surgeons spent many years studying a speciality, such as orthopaedics or cardiac surgery.

Complex surgery from the 1900s

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As the 1900s progressed, surgery became more complex. Transplant and replacement surgery become relatively common. Elective surgery - non-life-saving procedures - is now performed regularly and some surgery has been developed principally for cosmetic purposes. Keyhole surgery and microsurgery are used increasingly to minimise exposure to infection and reduce the shock of surgery. While surgery has become safer, it remains a risky business.

Bibliography

R Cooter, Surgery and Society in Peace and War, Orthopaedics and the Organisation of Medicine 1880-1948 (London: Macmillan, 1993)

L Davis (ed.), Fifty Years of Surgical Progress 1905-1955 (Chicago: The Franklin H. Martin Memorial Foundation, 1955)

J Duffin, History of Medicine: A Scandalously Short Introduction (Toronto: University Press, 1999)

H Ellis, A History of Surgery (London: Greenwich Medical Media, 2001)

J Le Fanu, The Rise and Fall of Modern Medicine (London: Little and Brown, 1999)

S H Greenblatt, (ed.), A History of Neurosurgery (Parkridge, IL: The American Association of Neurological Surgeons, 1997)

R Holmes, Scanty Particulars: The Life of Dr James Barry (London: Viking, 2002)

L Klenerman (ed.), The Evolution of Orthopaedic Surgery (London: Royal Society of Medicine Press, 2002)

C Lawrence (ed.), Medical Theory, Surgical Practice: Studies in the History of Surgery (London: Routledge, 1992)

C Lawrence and T Treasure, `Surgeons' in R Cooter and J V Pickstone (eds), Companion to Medicine in the Twentieth Century (London: Routledge, 2003)

R Porter, The Greatest Benefit to Mankind (London: HarperCollins, 1997)

F G Slaughter, The New Science of Surgery (London: Sampson Low Marston & Co Ltd, 1956)

Glossary:

Pneumonia

Inflammation of the lungs caused by bacteria. The air sacs (alveoli) become filled with inflammatory cells and the lungs eventually become solid.

Antiseptic

A chemical that destroys or holds back the growth of bacteria and harmful micro-organisms. It can be used to cleanse skin wounds and treat some internal infections if it is sufficiently non-toxic.

Cauterise

Using a hot iron to seal a wound to stop bleeding.

Ligature

A thread or string for tying the blood vessels, particularly the arteries, to prevent bleeding. The word ‘ligature’ can also refer to the action or result of binding or tying, e.g. the ligature of an artery.

Antisepsis

The practice of using antiseptic drugs to eliminate harmful micro-organisms.

Bacteria

Micro-organisms which can cause disease but have an important role in global ecology.

X-Rays

A wave of electromagnetic radiation that has high energy and short wavelength. It is able to pass through many materials, except those of high density such as metals or bones. Discovered in 1895 by William Roentgen.

Orthopaedics

The branch of medicine concerned with the preservation and restoration of the muscular and skeletal systems in the body.

Microsurgery

Reconstructive surgery on small body parts. Microsurgery is performed under magnification using delicate instruments and precise techniques.