Changes in Surgery

Surgery underwent significant changes between the years c.1800 and c.1900, with pivotal advancements in pain relief and infection control. Two of the most important figures in this transformation were James Simpson, who pioneered the use of anaesthetics, and Joseph Lister, who introduced antiseptic techniques to reduce the risk of infection during surgery.

Surgery in the Early 19th Century

In the early 19th century, surgery was a highly risky and painful process. The operations performed during this period were often life-threatening, with amputations and removal of growths being among the most common procedures. Due to the lack of effective anaesthetics, patients had to endure immense pain while undergoing surgery. Surgeons had to work as quickly as possible, not only because of the pain but also to minimise the risk of death from shock or infection, which were widespread in surgical environments.

Operating theatres were often unsanitary, and infections could easily spread due to the lack of proper hygiene practices. Death rates from infections and complications after surgery were high, and patients could easily die from what might now be considered routine procedures.

James Simpson and Anaesthetics

In the early 19th century, various chemicals were experimented with to find an effective anaesthetic. Initially, nitrous oxide (laughing gas) was used, but it was ineffective in completely numbing pain. Similarly, ether was tested but had unpleasant side effects, such as irritation to the eyes and lungs, causing coughing and nausea.

The breakthrough came in 1847 with the discovery of chloroform by James Simpson, a professor of midwifery at the University of Edinburgh. Simpson was searching for a better way to ease the pain of women during childbirth, and in an experiment with his colleagues, he discovered that chloroform could effectively anaesthetise a patient, rendering them unconscious during surgery.

Simpson described the moment in a letter:

“I poured some of the fluid into tumblers... Before sitting down to supper we all inhaled the fluid, and were all 'under the mahogany' [the table] in a trice [very quickly], to my wife’s consternation and alarm.”

Simpson quickly shared his findings, allowing other surgeons to incorporate chloroform into their practice. Despite this breakthrough, there was some resistance to the use of chloroform:

• Some surgeons preferred patients to stay conscious so they could fight for their lives during surgery.
• Religious groups believed that pain was a natural part of human existence and that it should not be avoided, especially during childbirth.
• A tragic incident in which a woman, Hannah Greener, died after receiving too much chloroform during a toenail operation led to further concerns about its safety.

In 1848, John Snow, who had previously identified the link between cholera and contaminated water, created an inhaler to more accurately measure the dosage of chloroform administered to patients. In 1854, when Queen Victoria used chloroform during the birth of one of her children, the practice gained wider acceptance, and it became more commonly used in surgeries thereafter.

The 'Black Period' of Surgery

With the advent of effective anaesthetics, surgeons were able to perform more complex and longer operations. However, this led to new challenges. Longer surgeries resulted in increased risk of infection and greater blood loss, and many patients died during these procedures. The introduction of anaesthetics thus coincided with what is known as the ‘black period’ of surgery, from the 1850s to the 1870s, when mortality rates remained high despite improvements in pain relief.

Surgeons were still unaware of the importance of sterilisation, and many continued to operate in unsanitary conditions. Infection remained a significant risk, and the lack of proper hygiene practices in hospitals contributed to the continued high death rates during surgery.

Joseph Lister and Antiseptics

The next breakthrough in surgery came with the work of Joseph Lister, a surgeon who studied Louis Pasteur’s germ theory. Pasteur's work had shown that microbes caused infection, and Lister applied this theory to surgery, realising that the spread of bacteria was a key factor in post-surgical infections.

In 1867, Lister discovered that carbolic acid (also known as phenol) could kill bacteria in open wounds. He recommended the following antiseptic practices to reduce the risk of infection during surgery:

• Doctors and nurses should wash their hands in carbolic acid before performing any operation.
• Bandages and ligatures (tied-off blood vessels) should be soaked in carbolic acid to prevent the growth of bacteria.
• A carbolic spray should be used to disinfect the area surrounding the operation.

Lister's methods were initially met with scepticism, but over time, they proved to be highly effective. By introducing carbolic acid to his surgical practices, Lister was able to significantly reduce the death rate from infections in his surgeries, dropping from 46% to 15%.

Aseptic Surgery and Further Developments

Lister's work laid the foundation for aseptic surgery, which emerged by the late 19th century. Aseptic surgery aimed to create an entirely germ-free environment in the operating theatre. This involved a series of rigorous measures to ensure that no bacteria entered the surgical area:

• Operating theatres were thoroughly cleaned before and after each surgery.
• Sterilised surgical instruments were used, often heated in steam to kill any potential bacteria.
• Surgeons wore sterilised gowns, masks, and gloves to prevent the transfer of germs.
• The overall cleanliness of the hospital was improved to reduce the spread of infections.

These measures helped to dramatically lower the risk of infection, making surgery safer and more effective. The introduction of aseptic techniques, alongside anaesthetics, revolutionised surgery and led to higher success rates in operations by the end of the 19th century.

Conclusion

The period from c.1800 to c.1900 saw remarkable improvements in surgical practices, primarily driven by the work of James Simpson and Joseph Lister. Simpson's discovery of chloroform as an anaesthetic allowed for longer and more complex surgeries, while Lister’s introduction of antiseptics and the development of aseptic surgery helped reduce infections and improved patient outcomes. These advancements were pivotal in the development of modern surgery, paving the way for even further progress in the 20th century.