MedHum Mondays Presents: The Applications of a Surgeon’s Operating Case

DailyDose_darkstrokeWelcome back to the Daily Dose and MedHum Monday! Today we present an essay by Sydney Tenaglia, a student at Case Western Reserve University. Sydney spent time in the Dittrick Museum examining artifacts and discovering that it’s not just the knife, it’s how you use it! History provides us with a useful lens for examining medicine and the implications of tools for doctors and for patients.

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The Applications of the Surgeon’s Operating Case

IMG_3306      Throughout the nineteenth century, operating was oftentimes the only solution for most major injuries and chronic illnesses. Before Alexander Flemming’s discovery of penicillin and the widespread use of antibiotics during the twentieth century, removal of the infected portions of the body was the only cure. Serious injuries such as shattered bones or head trauma also provoked operative treatment. Thus, “a cased set of amputation and surgical instruments constituted the most prized possession of the nineteenth century physician and surgeon” (Dittrick Medical Museum). These cases typically included saws, knives, and tourniquets for use in amputations; equipment for trephining; a myriad forceps, probes, and needles; and catheters (Dittrick Medical Museum). A well-stocked operating case could mean the difference between life and death, usually from infection of an untreatable wound.

While it gave many patients suffering from catastrophic injuries, infections, and general chronic maladies an opportunity to evade what was, for the most part, certain death, nineteenth century operations tended to be almost as likely to kill the patients as the inflictions which plagued them. Before the latter half of the nineteenth century and the emergence of ‘germ free’ surgery, the materials that many surgical tools were made from could not be properly sterilized, if an attempt at sterilization was even made at all (Dittrick Medical Museum). Mortality rates of amputations performed at the London Hospital in 1842 were around fifty percent, the majority of the deaths occurring from sepsis and shock post-surgery (Chaloner).

Due to the procedure’s significant mortality, amputation was deemed a “capital” operation and reserved as a last resort in the avoidance of sepsis from injury (Goddard). Surprisingly, risk of the patient bleeding out during an amputation was minimal due to the use of tourniquets and the speed at which the operation was performed. Nineteenth century surgeon Doctor Robert Liston was one of the finest and fastest surgeons of the time, and an example of both the benefits and detriments to performing such high speed operations (Soniak). Before the widespread use of anesthetic, speed was paramount in minimizing pain and reducing the chance that the patient would die from shock mid-surgery. While “only about one of every ten of Liston’s patients died on his operating table at London’s University College Hospital, the surgeons at nearby St. Bartholomew’s, meanwhile, lost about one in every four,” a testament to how quick operations spared patients both pain and deadly stress (Soniak). High speed surgery, however, also greatly hindered the surgeon’s accuracy and precision while operating. Robert Liston was no exception to this rule. His most famous mishap occurred while amputating a patient’s leg. He was cutting so fast that he also took off the fingers of one of his surgical assistants, and while switching between instruments, accidentally slashed a spectator’s coat. The patient and assistant both died from infection and the spectator was so frightened by his near stabbing that he died from shock, resulting in the only known surgery to garner a three hundred percent mortality rate (Soniak). Thankfully, the discovery of anesthetics made the use of such reckless speed obsolete in favor of rendering the patient passive and unconscious.

The use of anesthesia not only made surgery more comfortable for the patient, but safer as well. Surgeons were able to use more precision and take their time whilst operating, so shock was no longer just as likely to kill the patient as their affliction. The discovery of microorganisms and germ theory brought about the shift to using surgical implements made from metals as opposed to porous substances such as wood (Dittrick Medical Museum). Wooden handles on surgical instruments retained the infectious diseases from one patient and were liable to transfer them to another, resulting in deadly post-surgical sepsis. By changing to instruments entirely crafted of metal, a material which could be sterilized easily, the chances of patients dying from infections after surgery were reduced.

Surgical conditions continued to improve throughout the twentieth century, and due to the creation of antibiotics, surgery was no longer the only treatment for serious infections. Surgical operations lacking anesthesia were associated with a less than stellar success rate due to complications related to the pain response of the patients and a lack of understanding in regards to germ theory. The introduction of pain relievers and ethers into surgical practice greatly reduced the probability that the patient would die outright from shock or other complications caused by writhing around in pain, improving the survival rate dramatically. Today, infections are diagnosed in a timely manner, before they can cause any serious complications that require surgical amputation to treat, and are purged with non-invasive medications. Amputations are rare, only to be performed in cases of reoccurring or serious disease, in part due to the increasing precision of surgical instruments and techniques today. Like any other surgery, anesthetic is used to render the patient unconscientious, preventing pain and allowing the surgeon to operate on a still, relaxed individual as opposed to a patient who is struggling against him. What once would have required a painful, traumatic, and unsanitary ordeal that resulted in the complete loss of a limb can now be corrected with the precise and painless removal of the infected area with only a small incision scar as proof of the event. Current surgical implements tend to be small, and some surgeries are not even performed directly by surgeons, but instead with robotic arms and lasers, all lending to a safer, less invasive, and more comfortable experience for patients today, who recover far better than those of the nineteenth century.

Sources Cited:

Chaloner, E J, H S Flora, and R J Ham. “Amputations at the London Hospital 1852-1857.” Journal of the Royal Society of Medicine 94.8 (2001): 409–412. Print.

Dittrick Medical Museum.  “No title.” Cleveland, Ohio: Dittrick Medical Museum, no date. Plaque.

Goddard, Jonathan Charles. “The Navy Surgeon’s Chest: Surgical Instruments of the Royal Navy During the Napoleonic War.” Journal of the Royal Society of Medicine 97.4 (2004): 191–197. Print.

Soniak, Matt. “‘Time Me, Gentlemen’: The Fastest Surgeon of the 19th Century.” The Atlantic. Atlantic Monthly Group, 24 Oct. 2012. Web. 6 Feb. 2015.

 

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MedHum Mondays: Blogs you should be following

DailyDose_PosterWelcome back to MedHum Mondays on the Daily Dose! Today will be the third installment of our blog promotion; starting next week we will expand to include new books in medical humanities and other news and updates. Have something you would like to see featured here? Let us know!

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imagesChirurgeon’s Apprentice

Surgeons are amongst the highest paid professionals in the medical world today. They are the ‘miracle-workers’ of the 21st century, capable of saving and transforming the lives of their patients.

Nevertheless, the place of the surgeon amongst today’s medical elite was not always guaranteed. At the beginning of the 17th century, ‘chirurgeons’ [surgeons] were closely related to barbers and other craftsmen who learned their trade through apprenticeships. After the Restoration, however, chirurgeons broke from their medieval role and began participating in important medical debates. Their advocacy of ‘practical’ medicine and experimentation distinguished them from their university-educated counterparts, the physicians, and helped elevate their role in the medical marketplace.

This website, developed by the talented Dr. Lindsey Fitzharris, is dedicated to a study of early modern chirurgeons, and all the blood and gore that comes with it.

tumblr_inline_mpq0l8QU4J1qz4rgpGeorgian London

Okay, so it may seem a stretch to include a blog on the history if the 18th century as medical Humanities…but as with the Chirurgeon’s Apprentice, this blog features the story of the past and all its (occasionally frightening) intersections with medicine. I myself am a historian of the 18th century, and one of the things I enjoy about this period is its freedom from categorical boundaries. Everything is everything in the era before distinct professionalization of science and medicine, a time when philosophy and literature were not yet estranged from the sciences.

Developed by Lucy Inglis (also the author of a book by the same title) this blog is the largest body of study on eighteenth century London freely available online.  It’s ‘award-winning’ – in January 2010 it won an unprecedented two Cliopatrias in the US History News Network’s Awards and is used as a secondary source by students from institutions such as King’s College London, University College London and Christie’s.  It has featured in The Times, the Guardian and Time Out.

cropped-author-photo2The Not So Innocents Abroad

This blog is dedicated to “Historical Ramblings on Sex, Food, and Other Bodily Pleasures, in Paris, Capri, and Beyond.” Like the two above, its focus is largely historical, but nothing proves a better mirror for the present than the (sometimes saucy) past. Rachel Hope Cleves is a history professor at the University of Victoria, and she brings the past to life with clarity and relevance. Here is a recent post (that appeared also on Nursing Clio) about the history of same-sex marriage.