FC117A: A Brief History of Surgery

Until the 19th century, surgery remained a brutal craft often left to barbers simply because they had the cutting tools.  The lack of anything to kill the pain of surgery, along with continuing reservations against dissection, created a vicious cycle where there were few people willing to undergo surgery, which led to limited research and knowledge, further discouraging people from undergoing surgery and so on.  Thus surgery progressed very little through the centuries.  All that changed in the 19th century.

It started with the discovery of the anesthetic properties of ether and chloroform in the 1840s, thus making surgeries painless, although there was plenty of pain after the anesthetics wore off.  Still, the number of people willing to undergo surgery rapidly multiplied.  However this led to another problem: infections from surgery killing patients after presumably successful surgeries.  Previously, with so few people willing to undergo surgery, and so many of them dying on the operating table, infections from surgery itself were relatively rare, and their causes (i.e., unclean surgical instruments and operating conditions) remained a mystery.  Then came the answer: germs.

When people such as Louis Pasteur and Joseph Lister first linked microbes to disease and infection, they were met by widespread skepticism from people who refused to believe disease and infection could come from things so small we can’t see them without a microscope.   However, when Pasteur came up with a vaccine against rabies based on his theory, people took notice.  Lister applied this theory to surgery by spraying a fine mist of carbolic acid on patients during surgery to kill any germs.  As a result, deaths from infections after surgery dropped dramatically.  

Unfortunately, some patients and medical staff reacted badly to the carbolic acid.  This had two results. First, experiments showed that patients’ infections had the same germs as those on surgeons’ hands.  Secondly, to protect his trusted head nurse’s sensitive hands, Lister had the Goodyear Rubber Company make some rubber gloves.  Out of these two things came aseptic procedure, where everything in the operating room was sterilized, thus eliminating the need for the annoying carbolic acid.  Ironically, the rubber gloves first developed to protect the hands of Lister’s head nurse (whom he later married) were now used to protect the patient from germs on the medical staff’s hands.

Aseptic procedure drastically reduced the number of infections from surgery and dramatically increased the number of surgeries being performed.  This brought up another problem: blood loss.  At first, doctors tried random blood transfusions from other people, saving some patients but killing others.  This led to new research and the discovery of blood types.  Now blood donors’ blood could be accurately matched with that of patients.

Then came World War I and the need for blood donors drastically increased.  However, donors’ blood clotted soon after being taken, preventing its storage or transport long distances to field hospitals where it was needed.  Then someone discovered that sodium citrate kept blood from clotting, thereby saving thousands of lives.

In spite of all these advances, invasive procedures like surgery were still a shock to the system and quite painful during recuperation.  Fortunately, one more discovery during World War II helped reduce the need for surgeries: penicillin and other antibiotics that could cure infections without the patient having to go under the knife.

Since World War II a staggering number of advances in surgery have taken place.  At the same time germs have mutated quickly, so our arsenal of antibiotics is becoming less and less effective.  The battle goes on.