I often joke that The Chirurgeon’s Apprentice is all about ‘the horrors of pre-anaesthetic surgery’ and yet, I’ve never written an article which focuses primarily on the patient’s experience before the widespread use of ether beginning in the 1840s. Suffice-to-say, it was not a pleasant affair.
In 1750, the anatomist, John Hunter, colourfully described surgery as ‘a humiliating spectacle of the futility of science’ and the surgeon as ‘a savage armed with a knife’.[1] He was not far from the truth. Surgery was brutal and only to be undertaken in extreme circumstances. In 1811, Fanny Burney had a mastectomy after being diagnosed with breast cancer. She later recorded the incident vividly for posterity:
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—& I almost marvel that it rings not in my Ears still!
Fanny (pictured right) went on to depict her own terror as one that ‘surpasses all description’. The agony, she said, was ‘excruciating’. So terrible was the operation that her surgeons decided to limit her anxiety by choosing a day at random and giving her only two hours notice before they began.[2]
Fanny was one of the lucky ones. Not only did she survive surgery, but she also went on to live for another 28 years. Others were not so fortunate. When Stephen Pollard underwent an operation to remove a bladder stone in 1828, he did so under the gaze of 200 spectators. What should have lasted 5 minutes ended up taking almost an hour. The surgeon, Bransby Cooper, fumbled and panicked, cursing the patient loudly for having ‘a very deep perineum,’ while the patient, in turn, cried: ‘Oh! let it go; —pray, let it keep in!’[3]
Pollard died the next day.
Pain was not just an unavoidable side effect of surgery. Most surgeons operating in a pre-anaesthetic era believed it was a vital stimulant necessary for keeping the patient alive. This is why opiates and alcohol were used sparingly, and typically administered shortly before (not during) a procedure, as the loss of consciousness was considered to be extremely dangerous.
Today, patients are laid flat on an operating table. Before the latter half of the 19th century, however, patients were often sat upright in an elevated chair. This prevented them from bracing when the surgeon’s knife began to dig into their flesh. Unsurprisingly, they were also restrained, sometimes with leather straps. The operating chair depicted on the left is not dissimilar to ones which would have been used during these earlier periods.
The patients weren’t the only ones who felt anxious before an operation. Surgeons, too, were apprehensive about cutting into living bodies. The Scottish surgeon, Charles Bell (1774 – 1842), was described by one colleague as having ‘the reluctance of one who has to face an unavoidable evil’.[4] John Abernethy (1764 – 1831), a surgeon at St Bartholomew’s Hospital, confessed to shedding tears and being physically ill before or after a particularly terrible operation. He described the walk to the operating room like ‘going to a hanging’.[5] And William Cheselden (1688 – 1752) once remarked that ‘no one ever endured more anxiety and sickness before an operation…’[6]
Surgery was a last resort, and one which brought with it considerable risks. During an operation, patients could die from the sheer amount of blood lost during a procedure. In hospital operating theatres, a wooden box was placed under the patient to catch blood and pus during the surgery. Additionally, sawdust was placed under the floorboards to catch the overflow. Even if a patient survived the traumatic ordeal, he or she might die from post-surgical infection.
Surgeons, of course, were aware of these risks, and went to great lengths to avoid operating. The historian Stephanie Snow argues that because of these dangers, ‘an elaborate etiquette of medical consultations developed’ before a decision was made to operate.[7] Indeed, only a handful of surgeries took place each month at most of the major London hospitals in the first half of the 19th century. Robert Liston—known as ‘the fastest knife in the West End’—lost 1 in 10 patients in the operating theatre at University College Hospital during this period. His success rates were fairly good. Surgeons at nearby St Bartholomew’s lost approximately 1 in 4.[8]
This does not account for the number of patients who died later of complications.
Very few people who underwent surgery recorded their thoughts for posterity. They either did not have the resources to do so, or the inclination to write about their painful experiences. George Wilson—a Professor of Chemistry at Edinburgh University—underwent a foot amputation in 1842. He remembered ‘the fingering of the sawed bone; the sponge pressed on the flap; the tying of the blood-vessels; the stitching of the skin; and the bloody dismembered limb lying on the floor’. Later, he wrote that these memories were not ‘pleasant remembrances’ and were ‘never welcome’.[9]
When reading descriptions like these, it is easy to understand why so many patients’ voices are now lost to us. All too often, their memories, like the surgeries they suffered, were simply too painful to endure.
1. Quoted in P. H. Jacobson, ‘Dentistry’s answer to “the humiliating spectacle'”, Journal of the American Dental Association (1994), p. 1576.
2. The full description of this surgery can be found in Fanny Burney, Selected Letters and Journals, ed. Joyce Hemlow (1986), pp. 127-41.
3. Druin Burch, Digging up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon (2007), p. 26. A fuller description of this incident can be found in an earlier article I wrote here.
4. J.M. Arnott, quoted in Gordon Gordon-Taylor & E.W. Walls, Sir Charles Bell: His Life and Times (1958), p. 82. Originally quoted in Peter Stanley, For Fear of Pain: British Surgery, 1790 – 1850 (2003), p. 205.
5. George Macilwain, Memoirs of John Abernethy, 2 vols (1854), Vol II, p. 203. Originally quoted in Stanley, For Fear of Pain, p. 204.
6. William Cheselden, The Anatomy of the Human Body (1741), p. 334. Originally quoted in Lynda Payne, With Words and Knives: Learning Medical Dispassion in Early Modern England (2007), p. 79.
7. Stephanie Snow, Blessed Days of Anaesthesia (2008), p. 4. I am hugely indebted to Snow for pointing me to some of the sources cited in this article.
8. Matt Soniak, ‘”Time Me, Gentlemen”: The Fastest Surgeon of the 19th Century’, The Atlantic (24 October 2012).
9. Jessie Aitken Wilson, Memoir of George Wilson (1860), pp. 296-7. Originally quoted in Stanley, For Fear of Pain, p. 276.