17. Surgery in the 19th century was no place for women – though some enterprising females got around this institutional sexism in ingenious ways.
One reason why surgery was so risky was that the profession was made up of a small group of people – wealthy men. Women were all but excluded from almost all areas of medicine, but above all from surgery. Indeed, in England, the first female surgeon, a pioneer by the name of Louisa Aldrich Blake, only graduated from the London School of Medicine in 1877. This ‘macho’ approach to surgery undoubtedly cost countless lives. Many men reveled in being as tough, brutal and bloody as possible, even risking their patients lives for the sake of their own reputations.
Famously, one female surgeon found an unlikely way around this institutional sexism. Dr. James Barry was a respected British Army surgeon credited with saving numerous lives in field hospitals throughout the first half of the 19th century. Dr. Barry even rose through the ranks to become the Inspector General of Britain’s military hospitals. It was only after the skilled surgeon’s death in 1865 that the truth was revealed: Dr. Barry was actually a woman, born Margaret Ann Bulkley. They had lived as a man for several decades, deciding this was the only way to get into medical school and then into the field of surgery.
16. Instead of being a warning sign of infection, pus was seen as a good thing and proof that a wound was healing.
Victorian-era hospitals were smelly, messy places. And that’s an understatement. Strangely enough, the surgeons themselves reveled in the conditions. It wasn’t just blood they loved to see, however. According to the wisdom of the time, pus was also a welcome sight. That is, seeping wounds were seen as healthy, a sure sign that they were healing. As Robert Liston, one of England’s most famous surgeons of the 19th century, noted “pus was as inseparable from surgery as blood”.
Of course, these days, you don’t need a medical degree to know that pus is a sure-fire sign of infection. Back in the 19th century, however, some surgeons referred to it as the “laudable pus” and would regard a seeping wound with approval, confident that they had done a good job. Far from being a sign that a surgical wound was healing, however, this was an unmistakable sign of infection. This ignorance was the reason why so many patients died and continued to die even after medical pioneers like Joseph Lister started to warn about the mortal dangers of infections.
15. Far from taking their time whilst operating, surgeons loved to work fast and could even amputate an arm in under 30 seconds.
These days, a patient undergoing surgery would want their surgeons to take their time. Back in the 19th century, however, the opposite was true. Speed was of the essence. After all, patients went under the knife without modern-day anesthetics to dull the pain. They wanted it all over as quickly as possible. Moreover, a fast amputation was easier to patch up, significantly reducing the likelihood of a patient bleeding to death. It was even said that the amount of time spent on the operating table was directly collated to the likelihood of a patient making it out of the theater alive.
When it came to swift amputations, nobody could beat the Scottish surgeon, Robert Liston. Writing in a medical journal in 1837, he advised that “operations must be set about with determination and completed rapidly”. It was said he could amputate an arm within 28 seconds, while a leg took just over 2 minutes. According to the legendary nurse Florence Nightingale, he demanded that his assistants time him and even clasp bloodied knives between his teeth so he could have both hands free to yank off rotten limbs without losing a second.
14. Surgeons took a perverse pride in their bloodied aprons – the dirtier a smock was, the better (and the more deadly).
In 1902, Sir Frederick Treves saved King Edward VII’s life. His heroics helped establish him as one of the era’s most famous – and most distinguished – surgeons. But even Sir Frederick had some questionable attitude to cleanliness and hygiene. For much of the 19th century, surgeons like him took pride in their bloody gowns and smocks that they wore over their everyday clothes while in theater. Indeed, a clean gown was seen as the sign of an idle surgeon, while an apron covered in the blood, guts and pus of numerous patients the sign of a busy man.
Famously, Sir Frederick once remarked: “There was no object in being clean…Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head.” He was not alone in believing this. In 19th century operating theaters, surgeons would routinely hang their gowns on a rack by the door, leaving them for weeks without washing them. They would then simply put them on over their normal, everyday clothes, when it was time to get to work. Unsurprisingly, such an approach led to many patients catching infections and dying as a result.
13. Early attempts at putting patients to sleep were often unsuccessful – patients sometimes woke up or never woke up at all.
Before modern anesthetics, surgeons used a variety of methods to try and reduce a patient’s pain. In many cases, the patient was simply given large doses of gin or whisky in the hope that they would pass out from drunkenness. Other surgeons preferred to try a range of herbs or even narcotics, such as opium imported from the East. While alcohol was usually ineffective, opiates sometimes were too effective – indeed, instances of patients dying from a drug’s overdose having only gone into hospital to have a limb amputated were shockingly commonplace.
In 1845, British surgeons first tried to use nitrous oxide as a general anesthetic. The scientist who discovered ‘laughing gas’, Humphrey Davy, learned that, as well as giving him and his assistants the giggles, it also made them feel less pain. However, the very first time it was tried on a patient undergoing surgery, the patient woke up mid-procedure. The idea was quickly abandoned. Some years later, James Simpson pioneered the use of chloroform. This was administered by inhalation and was used to knock patients unconscious. It remained in use until the 1920s. While often effective, however, patients sometimes still woke up screaming in agony.
12. The introduction of ether as an anesthetic in the mid-19th century may have been a breakthrough, but fatality rates actually went up!
In December 1846, surgeons gathered in the operating theater of University College London to witness medical history. Dr. Robert Liston, famed for the speed of his amputations, promised to demonstrate the latest surgical advance, imported into England from the United States. The patient was laid down on the operating table and made to inhale ether. He was knocked out. The days of surgeons struggling to hold squirming patients down were over. Indeed, many medical professionals heralded the introduction of ether as a true landmark, bringing the ‘age of agony’ to an end.
However, in hindsight, this wasn’t an entirely good thing. Up until the 1840s, surgeons were required to carry out procedures as swiftly as possible. With their patients unconscious and unable to squirm in pain, surgeons felt more confident. Far from just cutting sickly limbs off, they attempted more complex procedures. However, advances in anesthesia hadn’t been accompanied by advances in hygiene. As a result, rates of infections soared. Indeed, at the Massachusetts General Hospital, the records show that mortality rates for amputations increased from 19% to 23% directly after the introduction of ether.
11. Victorian-era surgeons usually used their own tools and would mark notches on their saws for every limb they hacked off
In one account of master-amputator Robert Liston, the master surgeon made a show of pulling out a special bone-cutting saw. He opened a long case and removed a straight amputation knife of his own invention. The saw, with which Liston could hack an arm off in under 30 seconds, had a wooden handle with a number of notches in it. According to the legend, Liston would carve a notch for every limb he amputated (whether the patient survived or not!). And he wasn’t the only one to have his own tools of the trade.
Most surgeons had their own scalpels and saws which they used to carry out a wide range of operations – often having heeded the advice of respected surgeon William Gibson, who recommended surgeons practice their bone-sawing techniques at home with old pieces of wood! While Liston and other expert surgeons may have taken pride in their instruments, such an approach was highly problematic. In many cases, surgeons carried scalpels, knives and even saws on their person. They were never even washed, let alone sterilized. In fact, many surgeons brandished their blood-encrusted instruments with pride – the bloodier a saw and the more notches, the better!
10. During the 19th century, leech therapy enjoyed a remarkable comeback and many surgeons swore by it.
Bloodletting by leeches wasn’t just performed by ancient cultures. It enjoyed a boom during the 19th century, with physicians and surgeons seeing ‘leech therapy’ as the cure to a number of ailments. For the most part, the procedure was carried out by barber-surgeons; indeed, in England, leeching was one of the few procedures they were allowed to perform following the establishment of the Royal College of Surgeons. However, from the 1830s onward, even elite surgeons became convinced of the benefits of leeches. And French leeches were seen as being especially effective.
The surge in demand for the creatures was inspired by Dr. Broussais, a surgeon in the Napoleonic army. He used leeches whilst performing emergency surgery in field hospitals and shared his success stories far and wide. In his 1809 monograph on the topic, Broussais declared “the benefits of the leech for man are so great that all doctors should be aware of them.” Before long, the swamps of France had been swept clean of leeches and surgeons and physicians in America offered huge sums of money to anyone who could successfully breed the European leech on that side of the Atlantic.
9. Mistakes in the operating theater were common, often comical, and usually fatal.
Surgery in the 19th century was fast, brutal and often took place in dirty and cramped rooms. Mistakes were inevitable. Indeed, looking at the records from the time, the shocking errors made by the self-proclaimed medical elite almost outweigh their successes. Above all, “the fastest knife in the West” Robert Liston was responsible for a catalog of errors. And if they weren’t so tragic, most of his errors would be comical, including the infamous occasion he scored an unprecedented ‘300% mortality’ rate in one operation alone.
On that occasion, Liston was due to perform a routine leg amputation. He approached the procedure with his usual speed and bravado, asking his assistant to time him as he raised his scalpel. Unfortunately, in his haste, he managed to cut two of his assistant’s fingers off. Then he swung his knife back, slashing the coat of a spectator. That man dropped dead of a heart attack, while the stumps where Liston’s assistant’s fingers used to be soon became infected, with fatal consequences. Needless to say, the patient also died. And that was just one botched operation! Liston also famously chopped off a man’s testicles whilst trying to take off his leg, and he was still seen as one of Britain’s finest physicians.
8. The richer you were, the more likely it was you would survive surgery – mainly because you were treated at home instead of in a filthy hospital.
Throughout the 19th century, hospitals were dreaded places. So much so that most sane people only went into a hospital as a very last resort. In Britain, the wealthy preferred to stay at home and have a physician come to them. Surgical procedures were also carried out in the homes of the wealthy. This shielded the rich from the dirt, germs and general unpleasantness of the average hospital, as well as from the risks posed by being surrounded by sick people. As a result, patients who had surgery at home usually fared better than those unfortunate souls who had to go into hospital.
The finest surgeons of the age would often be summoned to mansions or even palaces to carry out emergency surgery. Most famously of all, in 1871 eminent surgeon Joseph Lister was called to Balmoral, the Royal Family’s home in Scotland. He was instructed to perform surgery on an abscess located in the armpit of Queen Victoria herself. It was, probably correctly, assumed that, left unattended, this could be fatal. Lister’s actions at Balmoral, including his insistence on a clean room and on sterilizing his instruments, won him the Queen’s thanks and made him one of Europe’s most famous doctors.
7. Despite their limited knowledge and rudimentary skills, many 19th century surgeons were happy to perform extremely complex – and risky – operations.
Even at the end of the Victorian era, surgical techniques were rudimentary at best. But that didn’t stop the surgeons of the 19th century attempting some mind-bogglingly ambitious and intricate procedures. They didn’t just do amputations all day. Making full use of the latest anatomical research and text books, surgeons operated on the tongue, the ear, face and even the eyes of their desperate patients. For instance, one textbook advised surgeons on how to correct abnormal alignment of the eyes. This required splitting the muscles holding the eyeball in place in two – often without giving the patient anesthetic first.
Other ambitious surgical procedures involved the removal of tumors or cancerous growths. Surgeons would peel back the whole face in order to get access to the jaw or the back of the tongue. In some cases, large parts of the jaw were removed, again without the aid of anesthetic. Some surgeons even attempted brain surgery, though they usually made a patient’s condition worse rather than curing them. The Wellcome Collection in London is home to the world’s finest – and most gruesome – collection of Victorian medical illustrations, showing the wide range of procedures the era’s surgeons tried to perfect.
6. Many patients simply bled to death on the operating table, though burning wounds with red-hot irons was designed to stop this.
Amputations were far more commonplace back in the 19th century than they are today. Quite simply, if a fractured bone pierced the skin, the chances are that whole limb would need to be chopped off. The surgery was brutal, painful and very dangerous, especially since the odds of bleeding to death were so high. Victorian-era surgeons did have some methods they used to stop bleeding – and they were the same methods employed by physicians in Ancient Greece or on a Medieval battlefield. Suffice to say, when it came to stemming blood loss, very little progress had been made.
The most common method to stop a patient bleeding to death was to cauterize the stump of a limb. The discarded arm or leg would be tossed into a bucket of sawdust, usually right next to the patient who would get a gory close-up view of their own amputated limb. Then the surgeon would plunge a red-hot iron into the stump, burning the veins and arteries, closing them up for good. This would have been agony for the patient, especially if they had been given zero pain relief. It was also very smelly – indeed, accounts from Victorian-era hospitals often remark on the disgusting smell of burned human flesh.
5. Surgeons would often fight among themselves, with many violently opposed to the idea that they should wash their hands!
As if being a patient in the 19th century wasn’t bad enough, Victorian hospitals were often run by egocentrics, with fighting among vain surgeons commonplace. And, as the century progressed, one topic divided opinion more than any other: that of germ theory. In the UK, the main proponent of antiseptic surgery – which included calling for surgeons to ‘scrub up’ – was Dr. Joseph Lister. Working at the Glasgow Royal Infirmary in Scotland, he demanded that his colleagues use carbolic acid to sterilize their equipment and to clean wounds so as to reduce the hospital’s shockingly-high mortality rates.
Unsurprisingly, many of his fellow surgeons didn’t like being told what to do. Dr. Lister made many workplace enemies – and there’s plenty of evidence to suggest that this professional difference of opinion cost patients’ lives. For instance, the American surgeon, Dr. Samuel Gross, was one of Lister’s fiercest critics and would deliberately ignore the Scot’s advice. The records show he would simply close the door of his operating theater and declare: “There! Mr. Lister’s germs can’t get in anymore.” Then, as one famous painting shows, he would perform surgery while still wearing his dirty street clothes and would stick his unwashed hands into open wounds.
4. There was no such thing as privacy and many operating theaters were packed full of students and even gore-loving members of the public.
According to the medical historian Lindsey Fitzharris – author of The Butchering Art – operating theaters were sometimes known as “gateways of death”. But, far from keeping people away, such a morbid moniker actually attracted huge crowds. Indeed, most surgical operations were public events, and some of the Victorian era’s leading surgeons would draw massive crowds, especially in London. It wasn’t just fellow surgeons who would be keen to watch the gory action. Medical students and even members of the public would also crowd the floor hoping to see blood and guts. Some hospitals even have special ‘theaters’, with crowds of seats above looking down on the operating table.
Of course, this was highly dangerous. The records show that surgeons sometimes had to battle for space with the crowds. Such distractions undoubtedly cost limbs, and probably even lives. However, the biggest risk came from the dirt and the germs such crowds brought into the operating theater with them. For much of the century, nobody washed before going into a hospital and almost everyone kept their street clothes, including their dirt and grime-covered overcoats, on when they watched an operation. Even despite the warnings of the pioneering Dr Liston, this continued right up until the end of the 19th century, meaning many patients lost an arm but got a deadly infection.
3. It wasn’t just grim for the patients; spare a thought for the poor surgeons of the 19th century who had to endure blood, guts and death on a daily basis.
Surgery wasn’t just traumatic for the patients. It was also highly demanding for the surgeons themselves, in more ways than one. For starters, surgeons needed to be physically fit and strong, mainly so that they could hold their patients down. Robert Liston, famed for his extra-quick amputations, towered above his colleagues, standing six foot two, and he was said to use one his huge arms to clamp a flailing limb down while using his free hand to saw it off. However, having a strong arm wasn’t enough. A surgeon needed to have a strong stomach too. Many trainees simply couldn’t handle it and passed out whilst watching experienced surgeons at work.
Silas Weir Mitchell, was one of America’s most influential physicians and made a name for himself as a pioneer in the field of neurology. As a young man, however, he wanted to become a surgeon – that is, until he witnessed the gruesome reality of an operating theater for himself. In his memoirs, Mitchell recalled a female patient under the knife. In particular, he remembered “the terribleness, the screams, the flying blood jets”. Like many other young men, Mitchell quickly abandoned his careers plans, preferring the relative calm of a physician’s life instead.
2. The indignity didn’t end if you died on the operating table – your body may have been used for dissection by inept medical students.
The gruesomeness of Victorian-era surgery didn’t even end with the death of a patient. As if the indignity of being cut open, screaming in agony due to a lack of proper anesthetic and then bleeding to death on an operating table in front of a crowd of students and passers-by jostling for a better view of your demise wasn’t bad enough, your dead body would then be cut open some more. In England, the passing of the Anatomy Act of 1832 made digging up corpses a criminal offence. So medical surgeons and anatomy professors had to look elsewhere for specimens – and those poor individuals who never made it out of surgery alive offered the perfect solution.
From the late-1870s onward, advances in embalming meant that bodies could be stored for several months before being used for anatomy classes. These cadavers would also be used for practicing surgical procedures – again, often in front of baying crowds. Though grim, significant advances were made during the 19th century, especially when it came to understanding anatomy. In 1858, the first edition of Henry Gray’s book Gray’s Anatomy was published. The work, which is still referred to today, was based on the dissection of dozens of unclaimed bodies from London’s mortuaries and workhouse morgues.
1. It may still have been brutal and risky, but surgery in 1900 was a long way from the grim realities of surgery in 1800
In the field of surgery, as with medicine in general, a lot of progress was made over the course of the 19th century. Indeed, you’d be far happier going under the knife in 1900 than you would in 1800. Above all, thanks to the pioneering work of Joseph Lister in particular, doctors became increasingly aware of the risks posed by infections. Significant progress was made in the area of antiseptic surgery, with surgeons coming round to the idea of sterilizing their tools and scrubbing their hands before performing any operation. What’s more, advances in anesthesia allowed surgeons to perform longer and more complex operations.
By the 1890s, surgeons were wearing clean white robes rather than simply covering their everyday clothes with blood-stained aprons. And surgical instruments had become better, too. Wooden-handled saws had been replaced with saws made out of a single piece of steel, significantly reducing the risk of germs. In operating theatres, watching audiences were out and smooth, easily-cleaned surfaces were in. So, when the Spanish-American War of 1898 broke out, American hospital ships were clean, well-equipped and even fitted with X-ray machines – advances that undoubtedly saved the lives of countless soldiers.
Where did we find this stuff? Here are our sources: