Horror stories from the history of surgery

Sometimes, it's a little mind blowing when you remember just how recently medicine passed from the world of art/magic/tradition and into the realm of science. There's plenty of reason to argue that the transformation still isn't complete today, but I'm really mesmerized by stories from the 19th century, when every surgery was something of an experiment and the same, cutting-edge doctor could vacillate between modern techniques and medieval bio-alchemy in his treatment of the same patient.

Until that time, the prevalent method of cataract treatment was “couching,” a procedure that involved inserting a curved needle into the orbit and using it to push the clouded lens back and out of the line of sight. Warren's patient had undergone six such attempts without lasting success and was now blind. Warren undertook a more radical and invasive procedure—actual removal of the left cataract. He described the operation, performed before the students of Harvard Medical School, as follows:

"The eye-lids were separated by the thumb and finger of the left hand, and then, a broad cornea knife was pushed through the cornea at the outer angle of the eye, till its point approached the opposite side of the cornea. The knife was then withdrawn, and the aqueous humour being discharged, was immediately followed by a protrusion of the iris."

Into the collapsed orbit of this unanesthetized man, Warren inserted forceps he had made especially for the event. However, he encountered difficulties that necessitated improvisation:

"The opaque body eluding the grasp of the forceps, a fine hook was passed through the pupil, and fixed in the thickened capsule, which was immediately drawn out entire. This substance was quite firm, about half a line in thickness, a line in diameter, and had a pearly whiteness."

A bandage was applied, instructions on cleansing the eye were given, and the gentleman was sent home. Two months later, Warren noted, inflammation required “two or three bleedings,” but “the patient is now well, and sees to distinguish every object with the left eye.”

That's from an amazing essay on the history of surgery published last month in the New England Journal of Medicine.

The article is absolutely fascinating. I recommend reading it all the way through. If for no other reason than to get a better understanding of the fumbling way medical innovation happened. It wasn't like everybody woke up one morning and decided to adhere to the scientific method and the germ theory of disease. Instead, there were debates, and failures, and horrible things that happened as doctors tried to expand the number of illnesses they could treat before they necessarily had the tools (or the mental paradigms) to solve those problems. But, it was through making all those mistakes that the actual solutions started to form.

Among the more-interesting points in this piece: The advent of anesthesia didn't just make surgery more pleasant for the people experiencing it. It also enabled surgeons to slow down and practice surgery with a great deal more care. For instance, prior to anesthesia, a good surgeon could successfully amputate a leg in less than a minute. That's the surgery you can see being performed in the image at the top of this post.

Read "Two Hundred Years of Surgery" at the New England Journal of Medicine

Via Maria Popova and The Daily Beast


  1. “The knife was then withdrawn, and the aqueous humour being discharged, was immediately followed by a protrusion of the iris.”

    Reading this was nearly followed by an immediate discharge of my lunch.

    1. I would find this less disturbing if it didn’t describe the experience of one of our patients c. 1982.

  2. “Sometimes, it’s a little mind blowing when you remember just how recently medicine passed from the world of art/magic/tradition and into the realm of science.”

    Agreed!  Though I would modify your formulation slightly….

    “from the world of art/magic/tradition and into the realm of science/magic/tradition”

  3.  I feel quite sure that future generations will look on our current medical arts with the same revulsion as we view those in the past.  This occurred to me yesterday, reading about that poor girl in Georgia having her limbs (and part of her torso) amputated to get rid of the flesh eating bacteria.  I understand why that had to be done, but would venture a guess that at some point we will come up with a better way.

    1. I think that–for this particular condition, at any rate–we will eventually learn to simply not have flesh-eating bacteria. Perfectly easy to avoid, as they are very small and easily crushed.

    2. “What grandpa? You guys didn’t just grow new teeth? You would screw fake ones in your head or something? What do you mean ‘if you could afford it’?”

      Also, more on topic of what you were saying. I read up on the poor girl. I guess if something doesn’t happen that often it legally doesn’t have to be documented. So the flesh eating condition she has is essentially being ignored compared to many other medical oddities. I find this odd, and a bit alarming. What if it evolves to the point of an outbreak one day? I feel like something that scary should at least a bit more attention payed to it, regardless of how infrequent it is.

  4. It is my opinion that even nowadays medicine has not entered completely into the realm of science. Modern medical practice is still grounded in tradition and some treatments (chemotherapy, gastric bypasses, cortisone) are as gruesome as the one above. Furthermore millions of dollars are thrown away every year in useless treatments (homeopathy, Bach flowers, faith healing) certified only by quackery and recommended even by some “scientific” physicians. I’m not saying that medical advances are not important or that the medical science can be dismissed but that we still have horror medical stories and medical practice is still very unscientific. 

    1. Flower essences may be useless to you. I don’t find the Bach brand to be especially powerful. But I have tried other flower essences that have had very obvious effects on myself and others. Don’t knock it just because it’s not popular and you don’t understand it. 
      They are not meant to be medicine as we think of , they are much more  subtle and affect the energy systems of the body.  With the exception of Bleeding Heart Flower (Dicentra), which causes a very strong emotional reaction in many who have tried it.

        1. Very easy to criticize and make fun of I am sure, you like to hit easy targets I see. Your loss, not mine. Even if they stop selling them in stores, I know how to make my own. I can’t say that I don’t understand your POV. I lived much of my life with a closed mind. I was lucky enough to have it cracked open against my will
          Btw, subtle energy definitely exists. As Einstein put it, energy that is present, but not fully understood.

          1.  OK, I’m sorry for being sassy, but not for criticizing.  Have you read the wikipedia entry on flower remedies?  http://en.wikipedia.org/wiki/Bach_flower_remedies

            I agree, energy that is subtle exists.  Dark energy certainly meets the criteria for subtlety. http://en.wikipedia.org/wiki/Dark_energy 
            In fact, because it is so subtle, it has no practical influence on human scales.    That’s why physicists have to work so hard to see it’s effect.  On biological time scales, eark energy is irrelevant and chemical energy (electromagnetic) dominates.  Here, the subtle is a synonym for irrelevant.  What do you mean by “subtle energy?”

          2.  The only part of the wiki article on flower remedies that matters:  Systematic reviews of clinical trials of Bach flower remedies found no efficacy beyond a placebo.

            In other words, it will work about as well as praying to the FSM. 

    2. Try having a baby in America.  Fucking ridiculous how much “medical guidance” is based in superstition or “tradition”.  I ended up doing quite a bit of research to parse the genuine concerns from the quackery.

  5. I find it equally mind-blowing when I remember just how quickly medicine passed from the world of art/magic/tradition into the realm of science — and from there into the realm of commerce. Ka. Ching.

    As for the “science” available at this point, I agree with Bones.  Compared with what we should/
    ought/need to know, we’re still in the Middle Ages.

  6. The gruelling horror film “Corridors of Blood” is mostly hard to take, not because of the body-snatching or murders, but because of the historically accurate portrayal of a pre-anaesthetic hospital.  From IMDB:

    Dr. Thomas Bolton fights for the use of anesthetic in surgery and uses himself as a guinea pig but soon finds himself addicted.

  7. Okay, just hold it right there. I’ll have this drawing of your mutilated leg finished in about 45 minutes…

    Now that we’ve hacked away all that meat, let me get one of the bone. Doctor, pull back the flesh with this handkerchief.

  8. “The eye-lids were separated by the thumb and finger of the left hand, and then, a broad cornea knife was pushed through the cornea at the outer angle of the eye, till its point approached the opposite side of the cornea.”
     I think I have seen the film of this operation.

  9. I remember reading something in Karl Shaw’s book ‘Gross’ about surgery; it was about amputation during the Napoleonic wars. Apparently Napoleon’s chief surgeon could remove a leg in 15 seconds or so. The ‘fact’ referred to a British surgeon whose personal record was something similar but in his haste he accidentally also removed two of his assistant’s fingers and one of the patient’s testicles.

    Edit: Should have RTFA before commenting.

  10. It’s worth noting that the author of the article is none other than Dr. Atul Gawande, which is one reason why it’s so succinct and generally awesome.  Just about anything he writes is worth reading.

  11. Robert Liston, nineteenth century “surgeon”, could amputate a leg in 2 1/2 minutes, but there was no anesthesia in those days, so the patient would thrash about violently.
    In one infamous instance, Liston inadvertently severed his assistant’s fingers (gangrene killed him soon after) and slashed a distinguished spectator who dropped dead right there, at the sight of blood and fright that his organs had been “compromised”.

    Add to that the fact that the patient ALSO died of gangrene while in the recovery ward, and you get this humdinger of a quote:  “The only operation in history with a 300 percent mortality rate.”

    Ah, the good old days…

    1. “Ah, the good old days…”

      Yeah… they just don’t operate anymore like they used to. *sigh*

      1. Also along the lines of… they just don’t NOT disinfect and sterilize the way they didn’t use to.  Or something like that.

  12. “City of Dreams” by Beverly Swerling has some surgeon characters in Nieuw Amsterdam in the 1600s. While their dedication to their craft is admirable, the descriptions are appalling (although they, unlike the physicians, actually do some good.) A description of an experimental breast cancer surgery nearly made me vomit (but of course, was fascinating.) There is also a description of a diphtheria epidemic in that series that everyone who thinks vaccines are unnecessary should read…

Comments are closed.