The PioneersThe MilitaryReferences


The History of Surgery and Anaesthesia

It was also important to be aware that prior to Anaesthesia, Surgery had to be quick, and was quick, intricate procedures would not be attempted unless it was lifesaving, although there are some surgeons who did attempt a procedure that was to complex and could not be carried out safely at speed, so the patient died in agony usually owing to the pain or shock due to an blood loss.

Today the average time taken to amputate a limb would be about 90 minutes.

In the 19th century, Robert Liston, who carried out the first amputation under a general anaesthetic in this country, on a cold Monday December 21st 1846. He was known as one of the fastest surgeons in London at that time, he could amputate a limb in less than a minute. Robert Liston was 6'2" tall and was very strong. There is no doubt about it this man was arrogant, but his arrogant stems from his ability to do his job better than any other at that time. He was quick, he knew what he was doing not only did he have a sharp knife you also had a sharp mind. It was said that he never used to bother himself with minor operations as he felt this was far below his abilities. This arrogance can be seen today in many surgeons and in some cases in many anaesthetists, who feel is over the gifts should be reserved for a far more complicated procedure.

So the first major operation performed in this country was done at the University College Hospital in London. William Squire administered the first anaesthetic. William Squire, happened to be the apothecary's nephew who made ready the ether substance that was to be used.

 The patient's name was Frederick Churchill who was a butler, who had broken his leg sometime earlier and it had been left to fester and it needed to be amputated, otherwise he would have died.

“Liston is quoted as saying "This Yankee dodge, gentleman, and beats mesmerism hollow”

So it was then, the stage is set, the audience was in place and his assistant William Cadge at the ready. He commanded William Cadge, to take the artery  press on it, he is then quoted as saying to the medical audience in attendance to

“Gentlemen time me!”

It took less than a minute (it is recorded as 25 seconds) before the limb was on the floor and vessels tied off.

This speed was unnecessary because of the effectiveness of the anaesthetic, but this was the first time and it was in the nature of the surgeon at that time, he knew no other way, other than to work as expeditiously as possible. 

Overcome with joy at the success of the anaesthetic, Liston held a party at his house the night, Cadge, his assistant was anaesthetised with ether at the party. In the People's Journal which was written in January 9, 1847 there is a famous quotation which states

"Tell, happy hour that brings the glad tidings of another glorious victory. Oh what a delight for every feeling of heart to find the New Year ushered in with the announcement of this noble discovery of how to steal the sense of pain and veil the eye and memory from all the horrors of an operation. WE HAVE CONQUERED PAIN."

I have mentioned that it was also a fact; that very little surgery was done in peacetime. Yes there were some who had their boils lanced without anaesthetic or stones removed from their bladder and fractures that were closed reduced.

In most cases, however, when it was carried out, it was as a last resort, to try to save the life of the unfortunate patient. The mortality rate was high, and this was exacerbated because patients had very few reserves of strength, their bodies could not withstand the shock of the surgery. 

The reason this was is in most cases, the patient put off surgery until everything else had been tried and death was certain without it.

The fear of death today as a result of major surgery lingers in most people even with our modern equipment, excellent anaesthetic agents and the superb anaesthetists, surgeons and staff we have today.

The surgeon and anaesthetist will however impress on the patient that there is a danger of bleeding, infection and other complications that could lead to the death of the patient.

 In the days before anaesthesia the surgeon would first emphasize that you will definitely die in agony without surgery and this agony might last several weeks.

The surgeon then persuaded the patient that although the pain of the procedure will be excruciating, it would be short lived and he would be as quick as possible, he would offer to provide a substance to ease the expected agony whether that be, alcohol, opium, mesmerism or any other known substance or combined technique.

He would explain there was a very good chance that the patient will survive procedure.

The surgeons were not heartless individuals, and would genuinely want to save the life of the patient, it is however true that without experimenting, progress would not have been made, and in the early days doctors would experiment with this potion or that herb to cure a disease, and in some cases he would kill the patient instead of curing the patient.

The same applied to surgeons who would experiment with a procedure that had never been tried before and as a result either kill the patient, make things worse for the patient or in some cases make things better. In a lot of the cases it was the operator who was attempting to enhance his own reputation and the reputation of the hospital that he worked for which was the main factor, a typical example of this was the Hoo Loo operation in the 1820s by Key and Cooper. These big high profile surgical procedures would attract a very large audience of paying medics which could be quite profitable for the surgeon and the hospital.

Still, Advancement in surgery in the early years came primarily from the Armed Forces surgeons, during times of war.