Surgery in hospitals (and homes)

As surgeons separated from barbers, took anatomy classes, practiced dissection, and joined hospitals, their expertise increased.  Surgeries happened in both hospitals and homes.  They were not done for repair, but for issues that could be visibly seen, such as cancer and gangrene, or when the pain got to be unbearable, as in bladder stones.  Not many people died from bladder stone surgery, which was called "cutting for the stone."  Bladder stones were common due to poor access to good water (the Thames River was filthy), drinking alcohol, and not having the correct diet.

English amputation saws
surrounding
French amputation knife
Wellcome Museum, London
14 October 2012

It was not uncommon to amputate a whole limb due to gangrene, but more people chose to die of the gangrenous infection rather than to have a surgery that would lead to infection. Sixty percent of patients got "wound fever," which was thought to be a bad reaction to the surgery by the patient, catching something from the other patients, or from miasma [noxious and poisonous fumes]. The fact that bacteria was transmitted from the surgeon's dirty clothes or dirty hands, or from the multitudes of students and general public watching, was completely unknown. If the patient made it 5 days post-surgery, his or her outlook was pretty good (Mathias).



Surgery to remove a malignant armpit tumor
in Dublin drawing room, 1817
(Wellcome Library)

Again, you can see the patient above being held down for the surgery, since he was awake for it.  Fanny Burney (1752-1840) wrote of her own mastectomy on 30 Sepetember 1811,
"When the dreadful steel was plunged into the breast - cutting through veins - arteries - flesh - nerves - I needed no injunctions not to restrain my cries.  I began a scream that lasted unintermittingly during the whole time of the incision - and I almost marvel that it rings not in my Ears still! so excruciating was the agony.  When the wound was made, and the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp and forked poniards [slender and small knives], that were tearing the edges of the wound - but when again I felt the instrument - describing a curve [around the breast] - cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose and tire the hand of the operator, who was forced to change from the right to the left - then, indeed, I thought I must have expired.


Fanny Burney
www.pbs.org/wgbh/masterpiece/
wives/writers/burney.html

" ... [P]resently the terrible cutting renewed - and worse than ever, to separate the bottom, the foundation of this dreadful gland [the cancer] from the parts to which it was adhered - Again all description would be baffled - yet again all was not over - Dr Larrey rested but his own hand, and - Oh Heaven! - I then felt the Knife rackling against the breast bone - scraping it! - This performed, while I yet remained in utterly speechless torture, I heard the Voice of M. Larrey ... in tone nearly tragic, desire every one present to pronounce if any thing more remained to be done; The general voice was Yes, - but the finger of M. Dubois - which I literally felt elevated over the wound, though I saw nothing, and though he touched nothing, so indescribably sensitive was the spot - pointed to some further requisition - and again began the scraping! - and after this, Dr Moreau thought he discerned a peccant* attom** - and still, and still, M. Dubois demanded attom after attom ..." (Hemlow, Joyce, et al. (ed.) The Journals and Letters of Fanny Burney (Madame D'Arblay), vol 6 1975, 596-616, quoted by Old Operating Theatre and Herb Garret Museum.)

English amputation saws
Wellcome Museum, London
14 October 2012

 Is it any wonder that lots of patients ran away from the hospital the night before surgery? (Mathias.)

*peccant = "1. guilty, criminal. 2. Ill-disposed; corrupt; bad; offensive to the body. 3. Wrong; bad; deficient; unformal" (Johnson).
**attom [atom] = "1. Such a small particle as cannot be physically divided. 2. Any thing extremely small" (Johnson).