Many of us recall our high school history courses as painful memorizing of timelines: empires rising and falling, wars, plagues, names of kings and queens, etc. No doubt the thought crossed our minds at least once: why do I need to know this stuff?
Then along came the History Channel, with vivid documentaries filled with dramatic special effects and lively actors that brought to life what our teachers had tried to drum into us. Suddenly we were captivated! And the really good documentaries found ways to transform something previously meaningless into lessons we could relate to today’s issues.
The history of surgery
I recently read an excellent 7-page article published in the New England Journal of Medicine in 2012. Though composed of the written word rather than video, “Two Hundred Years of Surgery”[i] by Atul Gawande, MD had enough vivid descriptions of surgical gore and agony in its early days, as well as historical illustrations, to hold attention as well as any History Channel program. In less time than it takes to sit through an hour TV show, 200 years of dramatic medical evolution flew by in a way that I could not stop reading.
Before I give a very condensed version of Gawande’s work, I thought I’d include a sample of the visual power of his writing, some of which requires a strong stomach! Take this description of leg amputation before the discovery of anesthesia. While orderlies held the patient down, a tourniquet was applied to the upper thigh to keep the patient from bleeding to death. Then,
Surgeons using the circular method proceeded through the limb in layers, taking a long curved knife in a circle through the skin first, then, a few inches higher up, through the muscle, and finally, with the assistant retracting the muscle to expose the bone a few inches higher still, taking an amputation saw smoothly through the bone so as not to leave splintered protrusions. … Before anesthesia, the sounds of patients thrashing and screaming filled operating rooms.
Almost as revealing as a movie, right? Gawande’s article is filled with quotes and tales that graphically illustrate the virtual butchery that characterized surgical procedures before the advent of “knockout” gases. Yet all the pain and gore in the first half of the article serves to deepen our appreciation of the advances, starting in the mid-19th century, that transformed surgery from agony and death into today’s safe, lifesaving procedures. In fact, its evolution can be seen as the foundation for our own advances with Magnetic Resonance Imaging (MRI).
Remarkable advances and innovations
As you might imagine, surgery was an agonizing horror until the 1846 breakthrough of anesthesia. Prior to that, surgeons had developed speed-before-precision techniques to keep patient suffering as short as possible during the hacking and sawing. Although met with much initial skepticism, the merit of “putting patients under” soon became evident, with the added bonus of eliminating surgical blunders by being able to slow down. However, another problem remained: 50% or more of patients who survived the knife succumbed to fatal infections introduced into their surgical wounds during nonsterile cutting.
In 1867, Joseph Lister published a series of articles on antisepsis (anti = against, sepsis = infection). Did you know that Listerine mouthwash, with its slogan “Kills germs that cause bad breath,” was named after him? Admittedly, the practice of disinfecting surgical tools and surfaces took longer to catch on than anesthesia did, but eventually the elimination of most post-surgical infection was its own reward.
Thus, heading into the 20th century, surgery was significantly more pain- and infection-free. Another improvement was the introduction of drugs to manage pain during recovery. The early 20th century saw hospitals less used as housing for people convalescing from sickness to safe places for surgical intervention and recovery. Improvements in technology made previously untreatable areas accessible: abdominal organs, the heart, the lungs and the brain could now be approached with a scalpel.
The second half of the 20th century brought the rise of scientific advances that began to share center stage with surgery. In addition to vaccines, antibiotics, and chemotherapies, the use of noninvasive radiation to tackle tumor cancers redefined entering the body. During the past 50 years, the trend has decisively pushed surgery toward scopes and robotics. At the same time, the use of minimal-to-noninvasive ablation (destruction of tissue) is competing in the surgical space. The trend pulling us into the future of physical interventions is decidedly toward freedom from cutting, puncturing or piercing skin, and toward the elimination of pain during and after procedures.
Dr. Gawande reminds us that today, surgery is an essential tool in the art and science of treating disease. At the same time, all of medicine continues to evolve. Research into nanotechnologies is bringing us ever closer to diagnosing and treating internal diseases on a cell-by-cell basis. Immunotherapies bring the promise of harnessing and directing the body’s natural healing resources. As Gawande declares, “The possibilities are tantalizing.”
Meanwhile, our Sperling Prostate Center, Medical Group and Neurosurgery Associates are proud to be part of forward-looking clinical methods that use noninvasive magnetic resonance imaging (MRI) to guide detection and therapies into the body. We owe a debt of gratitude to the 200 years of surgical progress that has paved the way to where we are today.
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diagnostic or medical advice. Talk to your doctor if you are experiencing
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