Surgery

Surgery in 19th Century

William A. Graham gives present day readers some insight into his experiences with the surgical practices of the early 19th century in his diary. When he reached Philadelphia, Graham witnessed Doctor Philip Syng Physick leaving a patient’s house:  “After the Doctor had finished his surgical operations, and was retiring, a relative of the injured man followed him to ask, if he thought the patient was in much danger?”(1). Physick had just performed surgery on a man “with his skull fractured, the whole transverse suture was loose, the cranium could be moved up and down upon the brain” (1).

John Bell, a Scottish surgeon whose Discourses on the Nature and Cure of Wounds was widely studied, goes describes how a fractured skull should be treated:

Though the scalp be lacerated and throw back, and even though the skull be cut up along the scalp, he cleans it of blood, lays it down smoothly, and expects it to adhere. Though, in a narrow wound, he puts in his finger, and feels the cranium bare, though he puts in his probe, and knows that the skull is naked to a great extent, still he lays down the scalp carefully, and presses it gently, that it may adhere (1).

Catgut

Once the broken bone and blood had been cleaned and exfoliated so that it could properly heal, the doctor then closed the scalp back up with stitches. While other surgeons would delay closing the wound, Bell was in opposition to the idea of waiting and thought that if the wound can be stitched up, the sooner the better (2).   Perhaps in closing the wound, Philip Syng Physick used the new type of suture he invented.  Silk sutures were used at the time, but Physick’s new absorbent catgut sutures were preferred (3).  Catgut sutures, made of a type of cord prepared from the fiber found in the walls of animal intestines, would naturally dissolve into the body (4).

Early 19th Century amputation kit

Graham describe a surgery he himself performed, an amputation.  This occurs when Graham returns to Abingdon to set up a medical practice.  He was called in by the family of Nicholas Wassum, who was already being seen by Doctor Clements. When discussing the case, Clements “was disposed to have the arm of Wassum amputated…” while Graham  “was only disposed to amputate the finger, believing that course might answer the purpose, urging that if it did not they could then resort to the other remedy” (1).

This specific case shows disputes between doctors on how much of the arm should be amputated. Graham believes that they should save as much as possible by starting with amputating solely the finger, and should it fail, proceed to the arm. However, Clements would rather amputate the entire arm to be safe and guarantee the patient’s life. The line between choosing to amputate a limb or not depends mostly on the arteries and bones affected in the injury. If the bones are shattered and major arteries are ruptured, blood loss becomes too much of a risk to attempt to set the bones in place and save the arm as opposed to amputating it and saving the patient’s life (2).

In another case, Graham learned the consequences of amputation. He had gone to treat William Moore, who was ill with a respiratory disease, and learned that he had been a soldier in the American Revolutionary War.  Moore “had been wounded at the battle of Kings Mountain, and as consequence of a severe fracture from a ball, it became necessary to amputate his thigh” (1).  Military injuries at the time were a common reason for amputations because it was quick  to perform on the battlefield while time was limited. Graham treated Moore’s illness, but Moore also complained “of nothing but a severe pain in the leg, and toes of the leg that had been amputated” (1). This phenomenon is known today as “phantom pain” in which one believes they still feel sensation and pain in an amputated body part.

Phantom pain had first been documented in 1675 by a Belgium surgeon, Philip Verheyen. After his left leg was amputated he had it preserved in embalming fluid. When he began to experience phantom pain, he began to dissect his preserved leg to find the source of the pain (5).

The main problems presented with surgery in the early 1800s, especially in this case is the amount of pain the patient endured and infection. Surgeons had to perform their procedures very quickly because the lack of an effectual anesthesia. In this time period, doctors used alcohol such as brandy or whiskey to use as an anesthesia, but it was not fully effective.

It was not until the second half of the 19th century, past Graham’s time, that fully-functioning antiseptics were used, the first by Joseph Lister. Lister created an antiseptic from a dilute form of carbolic acid from his knowledge of its sterilizing effects on sewage: “‘The material which I have employed is carbolic or phenic acid, a volatile organic compound, which appears to exercise a peculiarly destructive influence upon low forms of life, and hence is the most powerful antiseptic with which we are at present acquainted.’” (6)

By: Crawford Cox

Works Cited

(1)  William Alexander Graham, “A Narrative [1827] of Graham’s Journeys, Medical Training and Career 1816-1819 in Lexington, Va., Abingdon, Va., and Philadelphia,” Washington and Lee University Library, Special Collections.

(2)  Bell, John. Discourses on the nature and cure of wounds. In two volumes. By John Bell, surgeon. … . Of wounds in General. Of procuring adhesion. Of wounded arteries. Of gun-shot wounds. Of the medical treatment of wounds. Vol. Volume 2.The second edition. Edinburgh, 1800. Eighteenth Century Collections Online. Gale. Washington and Lee University. 17 May 2012 <http://find.galegroup.com/ecco/infomark.do?&source=gale&prodId=ECCO&userGroupName=vic_wlu&tabID=T001&docId=CW106573930&type=multipage&contentSet=ECCOArticles&version=1.0&docLevel=FASCIMILE>.

(3)  “Catgut.” http://en.wikipedia.org/wiki/Catgut

(4)  “Biography of Philip Syng Physick.” http://www.archives.upenn.edu/people/1700s/physick_philip_syng.html

(5)  “Philip Verheyen.” http://en.wikipedia.org/wiki/Philip_Verheyen

(6) Tan, S Y. “Joseph Lister (1817-1912): Father of Antisepsis.” Medicine in Stamps. 48.7 (2007): 605-6. May 13. <http://smj.sma.org.sg/4807/4807ms1.pdf>.

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