From Gruesome to Good -The evolution of Surgical practice
“we don’t have a recipe for surgery, it can go wrong and change in unexpected ways ,what we need is a team that can work together and handle the unexpected”
— Atul Gawande, General and Endocrine surgeon Mass General Hospital.
“The operation was hundred percent successful”, you might have come across these words if you’ve ever encountered a situation where you were waiting in the stressful hall outside the operating room , gazing the door of the OR, looking for the surgeon to walk out and convey the final verdict .
Surgery today is even a worrisome situation as its results are always at stake, however it has evolved remarkably inconsistent to the past.
Till the early 19th century , medical knowledge around the world was limited. Limited enough that there was little understanding of even basic diseases and infections, healthcare outcomes for women and children were insanely poor, cancer the ghost epidemic was hardly recognized as few people lived long enough to develop it, life expectancy was low and surgery was unsanitary performed without anesthesia.
Surgery was a in fact a brutal and terrifying practice. It was taken as the last resort, to be done only in the matter of life and death. Patients were to be inebriated with alcohol and other substance before being operated and then screams of those struggling under the knife would mingle discordantly with the everyday noises drifting from the streets around. As spectators and students would often refer “Big Jacky”(otherwise known as Death) to be hovering over the beds of those being operated.
A French philosopher Jean-Jacques Rousseau said of the experience, “What a terrible sight an anatomy theater is”
Operation theaters were in fact a gateway to death.
So, how did this intimidating practice became so subtle?

Yet as ever before, medical pioneering was at its peak. Researches and practitioners continued to search for a possible solution and it was in 1846, William Morton a Boston dentist came up with a possible solution.
Morton who already had performed a successful tooth removal on one of his patients using his magic potent persuaded Dr.Jacob Bigelow and Dr.John Collins of the Massachusetts General Hospital, one of the most renowned surgeons of the time to use Ether as source to turn patients subconscious before operations. Morton administrated ether to a patient using a glass vial and a breathing tube, Johns Collins removed a tumor from a Boston laborers neck and it was the miracle of medicine that when the patient woke he proclaimed to have felt only a few scratches and no pain.
Ether , Morton’s magic potent laid the basis of modern day anesthesia.

Surprisingly the properties of ether were known for more then a century but the reason it wasn't brought into practice was because Surgery was considered to be essentially painful and the relief of pain was not seen as the dominant goal.
Ether anesthesia soon inspired enough surgeons making it a standard practice and opened up the possibility of working on the body and inside the body in ways that just weren't possible.
Despite of the remarkable discovery post surgical outcomes came with trouble as mortality rates were still high. Patients would have an operation that may be successful but would die of infection. This lead to a new debate in the medical world about what caused the patterns of disease. Some would refer it as a disease in the air while others claimed it to be in the body.
In 1847, a Hungarian Physician Ignaz Semmelweis made a breakthrough in the battle against infection. He discovered that in childbirth, if obstetricians and midwives washed there hands they could prevent child birth fever, one of the biggest killer of mothers in childbirth delivery in hospitals.
However being unable to offer a reasonable scientific explanation Semmelweis’s theory was rejected by his peers.
Being unable to publish his research Semmelweis was left unrecognized.

About a decade later French chemist, Louis Pasture presented his research on fermentation arguing that microorganism in the air caused infection establishing the “germ theory of disease”
In 1865, British surgeon Joseph Lister learned from Pasture’s paper that certain chemical agents killed microorganisms . Lister recognized that carbolic acid lowered the bacterial count extrapolating that if we put it on our hands it could reduce the risk of infection. His idea was even rejected as some called him to be “deeply mistaken” as it held surgeons responsible for bringing in the infection.

Although Lister’s idea took two to three decades to be recognized but it eventually led to a shift from antiseptic to aseptic surgical practice ,making it the paradigm of surgical practice today.
