Surgery entails the physical manipulation of a bodily structure to diagnose, prevent, or cure an illness. The sixteenth century French surgeon Ambroise Paré stated that surgery “eliminates that which is superfluous, restores that which has been dislocated, separates that which has been united, joins that which has been divided, and repairs defects of nature.”1
From the beginning, all surgeons have had to deal with three issues—bleeding, pain, and infection. Early attempts at suturing cuts, amputating mangled limbs, and draining and cauterizing open wounds were for the most part futile as one of the three issues reared its ugly head. Surgery was painful and surgeons were encouraged to be as quick as possible to minimize patient suffering. Brute, efficient force was the norm. There wasn’t time for anything else. Surgeries were mainly amputations and removal of external growths. An amazing patient-centered account came in 1811 from the novelist Fanny Burney, who, after being diagnosed with breast cancer, underwent a mastectomy:
When the dreadful steel was plunged into the breast—cutting through veins—arteries—flesh—nerves—I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of my incision—and I almost marvel that it rings not in my Ears still! So excruciating was the agony.2
One can imagine the temperament a surgeon needed in this era—detached, oblivious to the blood-curdling screams of their patients, and the ability to come back again and again despite poor outcomes.
In the 1840s, ether emerged as the anesthetic of choice and allowed for the first entries into successful intricate operations in the internal regions of the human body. The added time this afforded allowed for attention to bleeding and minimization of pain. However, increased surgery led to the realization that though patients survived their operations, they were undone by the emergence of dangerous postoperative infections. Overcoming this barrier surprisingly came from two sources—the introduction of meticulous hand washing in 1847 by the Hungarian doctor Ignaz Semmelweis, and the concepts of sterilizing surgical instruments and preventing bacteria from entering the wounds at the time of surgery by Joseph Lister in the 1860s. Lister later implemented the use of sterile gloves to effectively complete his tasks.3
With the combination of effective anesthesia and antisepsis, the tide turned. Surgeons began to achieve success in interventions in the body and curing disease. Prestige naturally followed success, and the God-complex began. The public, celebrating successful outcomes where previously there had been none, now embraced surgeons irrespective of their character flaws. The reality, however, was that surgeons were still dealing with life-and-death situations. And in this familiar chaos, historic attitudes prevailed—detachment, confidence bordering on arrogance, and intolerance for the imperfect.