“Gentlemen, This Is No Humbug”

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In the early 1840’s a visiting surgeon approaching the main building of Boston’s Massachusetts General Hospital, an imposing granite structure designed by Charles Bulfinch, could consider that he was about to enter one of the foremost temples of his art. From a parklike garden he ascended a flight of stone steps that led him through a portico of eight towering Ionic columns, then continued his climb inside the building up a gracefully winding cantilever staircase. On the fourth floor he entered the surgical amphitheater, located in the great dome with which Bulfinch had capped his architectural achievement. Here, in terms of facilities, he was virtually at the top of the surgical world.

On a sunny day the dome, consisting largely of skylights, provided clear, bright light for the surgeon’s work. A hundred or so observers, sitting in a steeply rising bank of seats, could see everything being done. One of these left us an impression of an “operating table covered with linen of snowy whiteness, rarely seen elsewhere, and for which the Hospital was noted” and of “handsome cases, in which artistically arranged surgical articles of every description, and adapted to any and all emergencies, were conspicuously placed.”

The same observer noted the presence of other and more ominous objects: “hooks, rings and pulleys inserted in the walls” for the attachment of powerful traction devices, and, standing in one corner in an upright sarcophagus, a mummy from ancient Thebes. The mummy may have been placed there to add a touch of scientific tradition, but for many patients who entered that room, its blackened, shriveled face and ghastly grin must have stood for something else: the chamber of horrors that this and all other operating rooms were in those days of pre-anesthesia surgery.

Reminiscing in 1897 about some of the scenes they had witnessed under that dome before anesthesia, a group of elderly physicians could only compare them with what they had heard about the tortures of the Spanish Inquisition. As one put it, “No mortal man can ever describe the agony of the whole thing from beginning to end.” At Massachusetts General Hospital surgical patients were not often tied down; they were held by strong attendants, but sometimes even the strongest were not able to cope with the spasms produced by cautery and the knife. One doctor remembered an operation performed by the hospital’s senior surgeon, Dr. John C. Warren, in which the cancerous end of a young man’s tongue was cut off by a sudden, swift stroke of the knife; then a white-hot iron was introduced into the mouth to cauterize the wound. Driven almost insane by the pain and the sizzle of his searing flesh, the patient burst out of his restraint, and a bloody struggle ensued.

Almost as bad as the cutting operations were those in which dislocations had to be reduced against the resistance of muscular contraction. The muscles could be relaxed by bleeding the patient to the point of extreme weakness, by administering tartrate of antimony, or by injecting a strong infusion of tobacco into the rectum. These crude procedures, however, were not completely effective, and so it was often necessary to attach straps to the body and affected limb and to apply traction by means of a block and tackle. The same aged physician who had been present at the tongue operation recalled with equal vividness seeing a poor wretch literally put to the rack for half an hour in an attempt to reduce a dislocation of the thigh, with the only results being outbursts of “yells and screams, most horrible in my memory now, after the interval of so many years.”

The good surgeon was the quick one. In any very lengthy operation, it was thought that the excruciating pain could cause the patient to die of shock. Limbs sometimes came off in less than a minute. But then it was still not over. Vessels had to be tied. The wound had to be sewed up. One surgeon of the period later observed that patients seemed to suffer as much in this stage of the operation as they had during the cutting. So the ligation and suturing, too, were done as rapidly as possible.

Under these circumstances there was little opportunity for the sort of careful observation aitd study that might have contributed to improvement of the surgical art. The fact that surgery, in spite of this, had made a considerable advance since the Middle Ages, when it grew out of the barber’s skill, was due mainly to increasing knowledge of anatomy and to experience gained in operating on victims of accidents or war. There was very little elective surgery, and even then it represented only a last desperate resort. Typically, in the five years prior to the introduction of anesthesia, operations at the Massachusetts General Hospital averaged about three a month.

During these years of limited surgical progress, many things had been tried as a means of inducing insensibility. About the best that had been found by the beginning of the 1840’s was opium—a large dose of laudanum given before the operation. But it was not enough to deaden the piercing pain of the knife. Another expedient was to make the patient “dead drunk.” It was not a success. Cold was applied, to numb the nerves, and various drugs were administered through the stomach, but they were inadequate.