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Surgery was, and still is, a very important aspect in medicine. The development of surgery has come a long way, but it is important to look back at its roots. Looking back and understanding the changes that occurred allow us to see the different advances in surgery, the mortality rate for surgeries, and how surgery lead to the understanding of bacteria and its relation to infection. As surgery increased, so did the fatalities. It is these fatalities that led Joseph Lister to devote his time to figuring out more about operative infections.
Surgery started out being viewed as inferior, the work of hand not head (Porter, p.110). Today, surgeons are well respected and viewed as the upper class. This was not always the case. Surgery was very limited because it was so dangerous and painful. Surgeons were often barbers and would lance boils, cauterize, and set fractions. Bloodletting was also a very popular practice. Illnesses were mostly treated with herbal medications. Surgery was usually the last resort, especially amputations. The Greeks discovered that certain infections, like gangrene, required amputation. Even though amputations were necessary, they were still constricted to below the knee because of the lack of resources. The closer to the body the amputation was, the more likely the patient would die. The battlefield is where many people performed and learned more about surgery. Paré was a war surgeon and introduced vascular ligature. Surgery was so risky and constricted because of the high risks of infection and the lack of anesthesia. It was way too painful for people to endure. Surgery started to develop as more knowledge and resources became known.
Surgeons were often trained by observing or apprenticing. Soon enough, anatomy schools provided more education about the body and surgeries. Surgeries were performed in operating theaters and observed by crowds of people. People not even involved in medicine would come to watch the procedures. The environment these surgeries took place in were filthy. Fitzharris (2017) described the operating table as a wooden table stained with the telltale signs of past butcheries, and said that the floor was strewn with sawdust to soak up the blood. Today we know that this is extremely dangerous, but in the 1840s they had no idea this was doing harm. They did not know about bacteria and that it would cause deathly infections. Outside germs were brought in by all of the people, and the surgeons themselves were covered in bacteria. Surgeons never washed their hands, equipment, or their aprons which were covered in blood. Fitzharris wrote that surgeons believed pus was a natural part of the healing process rather than a sinister sign of sepsis. Surgeons thought pus was normal after surgery. There is a lack of knowledge because the dangers of bacteria have not yet been discovered. Along with the bacteria and infections, pain was still a problem. Alcohol and other plant-based substances were used but were still not good enough to numb the pain or keep the patient alive during surgery. This was until the use of ether. Before ether, surgeries had to be very quick because they could not keep the patient open long. Porter (2002) said the breakthrough in anesthetics came when William E. Clarke used ether to extract a tooth. Even though Porter said this was the breakthrough, in 1842, Crawford Williamson Long became the first documented doctor to use ether as a general anesthetic. Robert Liston then completed an amputation using ether. When ether was first used, it was referred to as the Yankee dodge due to its being first used as a general anesthetic in America. Because of ether and new anesthetic techniques, surgeons were able to dive deeper into the body. Surgeries did not have to be constricted to superficial procedures now that they can successfully numb the pain. Surgeons are able to work slower and cut access areas in the chest and abdominal cavities. This was a huge milestone.
The use of anesthetics led to an increase in surgeries which ultimately led to more deaths. Patients are no longer dying from the pain, but from infections like septicemia. The infections came from thing like the unsanitary tools, the surgeons, and the operating theater. Ignaz Semmelweis realized how infection was spreading. Porter (2002) said that in 1848 Semmelweis realized infection was being spread from people working in post-mortem then going to directly delivery rooms. Mortality rates dropped when he implemented the rule of washing hands and tools in between autopsies and seeing patients. Many people disagreed with the idea that doctors were spreading diseases, but people became more aware of the spreading of infections. A few substances were being used to try to prevent infections, but the first antiseptic technique and surgery was done by Joseph Lister. He also discovered more about germs. In 1867, Lister insisted on two points: germs caused infections; and infection and pus-formation were not inevitable, still less beneficial, stages in wound healing. Lister learned that so many patients who underwent surgeries and amputations were dying from sepsis. The mortality rate dropped after using his antiseptic spray. The effects of the antiseptics and having a new understanding of bacteria and germs, drastically improved surgery. Porter also explained how by 1900 doctors prevented the risks of infection by wearing protective wear like gloves, gowns, and masks.
Many developments throughout the evolution of surgery led to this understating of bacteria. Surgeons and barbers did their best with the knowledge they had. It makes sense that there were more deaths after the increase in surgery. They did not have the knowledge at the time to know how to prevent infections. This part in the history of medicine and surgery is very important. All of these deaths are what led to the discovery of bacteria and prevention of infection. It is these deaths that led people like Joseph Lister to strive for an answer to what was causing these infections. The discoveries of anesthetics, like ether, and antiseptics, allowed for surgery to continue to develop. All of the negative outcomes that occurred were experiences to learn from. It is incredible that these people could discover all of these things with the resources they had.
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