So a few weeks ago I begged the question “Are we healthier now than we were 100 years ago?”. The answer seems to be that while we have the potential to be healthier, we choose not to be, opting for convenience instead. One of the things I mentioned in that post was that there are a lot of supposedly modern things that have been around for far longer than people realize. And realizing just how long some of our “modern” conveniences have existed might change your perception of what life was like back in the day.
Surgery is one of those things that people assume is an invention of the last fifty years or so. Actually, it’s not. Surgery – operating on the human body to remove, relieve, or alter something that is causing disease – dates back to prehistoric times. Yep, it does. Archeological evidence and ancient documentation from cultures in the Indus valley, Egypt, and China all include references to surgery and surgeons. Granted, these were primitive procedures, amputations, removal of external tumors, and trepanation (drilling holes in the skull to relieve pressure – also sometimes a spiritual practice), but significant evidence exists that patients survived these procedures.
The Classical world had a thriving surgical practice, led by the efforts of the Greek physician Hippocrates (you may have heard of him) and dedicated to the healer-god Asclepius. The Ancient Greeks attempted and even succeeded at surgeries that were reasonably complicated. The surgeon Galen (who also contributed much to the theory of the humors) is even recorded as having performed brain and eye surgeries. Things that no one attempted again for nearly two thousand years.
Of course, as with everything else, a lot of knowledge was lost in the Middle Ages. But that didn’t mean medieval physicians didn’t achieve their own advances. As the university movement grew in the High Middle Ages, universities, particularly in Bologna, began experimenting with surgery again, including caesarian births and even cancer surgery.
But the era of modern surgery, surgery as we would recognize it, was a more recent invention. How recent, you ask? Surely mid to late twentieth century, right? Nope. Try mid nineteenth century, with some key advances coming as early as the seventeenth century.
The key to advancing modern surgery came with the recognition that for it to be a viable form of medical treatment, three things had to be controlled: blood loss, pain, and infection.
Blood loss was the first hurdle that was cleared. Before the Early Modern era, cauterization was used to close serious wounds and stop blood flow. But it was problematic in the long run. It was the 16th century battlefield surgeon Ambroise Paré who returned to a method of stopping blood flow long enough to operate used in the ancient world – ligatures. With the rediscovery that you could tie off blood vessels, treatment for gunshot wounds and other dire situations advanced.
But there were still the problems of pain and infection. It was difficult to operate on a patient who was screaming and writhing as you cut into them. In the ancient world patients had been drugged with opiates to keep them steady, but by the nineteenth century, more was needed. The discoveries of ether and chloroform and their practical use in the 1840s by James Young Simpson and John Snow meant that you could put a patient under, giving you time to operate. And no, that wasn’t a typo. 1840s. That’s probably about a hundred years before most people assume something like that was possible.
Of course, the biggest factor in bringing surgery into the modern world as an effective tool for treating disease was the control of infection. The work of Louis Pasteur and the advancement of the germ theory of disease helped people to understand infection, but even before they understood it they realized it was an issue.
In 1847 a Hungarian physician, Ignaz Semmelweis, noticed that there were fewer incidences of mother and infant death from infection when doctors washed their hands before delivering babies. He made the connection … but was laughed at. But others were beginning to notice the connection as well. John Lister, who studied Pasteur’s work, began using phenol during surgeries as a “disinfectant”. Lister published an article on surgical disinfectants in 1867. Others built on those advances and experimented with other means of disinfecting instruments, surgeries, and wounds. Note that, 1867.
Last year when I was reading the book The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee, I was struck by his extensive description of cancer surgeries and tumor removals, including mastectomies, that were happening in the 1870s and 1880s. That book and Mukherjee’s research is what inspired me to look into the question of how long ago were major surgeries being performed. The answer surprised me, and I’m a history apologist. The fact is, but the second half of the nineteenth century, surgeries were being performed with an ever-increasing survival rate. Granted, they weren’t as common as they are now, but the knowledge and technical advances were all there.
So next time you think of medical treatment in the nineteenth century as being gross and archaic, stop and think again. This was an era when scientific advancement was all the rage and progress was a daily occurrence. From the 1840s on the technical know-how did exist. It would take a while for it to become mainstream, especially for the poor, and as the understanding of infection and later the invention of penicillin came to light it would become more effective with a smaller mortality rate, but surgery has been a part of our medical history for well over a hundred and fifty years.