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A SURGICAL REVOLUTION

Surgery in Scotland, 1837–1901

by Peter Jones

Introduction

During the sixty-four years of the reign of Queen Victoria (1837–1901), there were many outstanding industrial and scientific developments, among which must be counted the transformation of the practice of surgery.

Many have heard of Joseph Lister; they may use Listerine, and associate the name with the use of antiseptics. Relatively few know of his life, or the remarkable details of the discovery of the Antiseptic Principle. Even less is known of Lister’s Scottish friends – Ogston, Macewen, Thomas Keith and James Simpson. Yet it is not too much to claim that their work was at the very forefront of ‘a surgical revolution’.

In 1837 there was no general anaesthesia for the surgical patient. Only a few patients could bring themselves to face the pain of an operation and surgeons felt there had to be compelling reasons to inflict it. Moreover, there was no reliable way of preventing infection of the wound, which could frustrate the exercise of their skill. These hard old practices came to an end with the two great advances of the nineteenth century – general anaesthesia, and the conquest of surgical sepsis.

In 1846 ether was first used in New England to relieve the pain of dental and surgical operations, and in the following year Simpson in Edinburgh introduced the use of chloroform, which rapidly became a popular general anaesthetic. Surgery lost many of its terrors, but it was still not safe because so many surgical wounds, quite unpredictably, became septic, and this could leadto serious illness.

Then, twenty years later, in 1867, Joseph Lister was working in Glasgow, on ideas suggested by Pasteur, which would enable him to publish the results of two years of work which established the ‘Antiseptic Principle in the Practice of Surgery’. When he moved to Edinburgh in 1869 Lister showed that observance of these principles allowed surgical operations to be performed cleanly and safely. They enabled William Macewen, Lister’s student, to operate safely in the 1870s on some 300 Glasgow children who were crippled by bowed legs or knock-knees, restoring them to happy, healthy mobility.

At the same time, another friend of Lister’s, Alex Ogston in Aberdeen, was pursuing the actual cause of surgical sepsis. Working in his laboratory, in a shed in the garden of his house in Union Street, he was able to isolate and identify the germ Staphylococcus aureus.

In the late nineteenth century abdominal surgery was generally considered to be unsafe, yet its potential was to be revealed by Thomas Keith, a general practitioner in Edinburgh. Working in the whitewashed attic of his house, he operated on 300 women to relieve them of the burden of carrying a large ovarian cyst: in the final group of 100 patients only three died. It is important to study and appreciate the work of these pioneers in the light of the prevailing climate of opinion in which they lived. Each man had to place his trust in a new set of principles, and face a critical group of colleagues. Lister could only trust in his own recognition of the researches of Pasteur: when he dared to treat severe compound fractures conservatively with carbolic acid, rather than the customary amputation, he took a lonely, vulnerable path.

These were pioneering individuals, often working in unfavourable conditions, yet achieving remarkable results with simple instruments and apparatus of their own devising. The details of their lives which they left in their notes, letters and papers and in the recollections of their friends, present many memorable stories. In this account it is hoped that they will come to life in a straightforward narrative for non-medical readers, supported by full references to satisfy the medically qualified.

Progress in medicine has always been international. As will be seen, a major contribution to progress in surgery was assembled in Scotland during the reign of Queen Victoria.