Surgery

Surgery. Surgery in colonial America was taught chiefly by apprenticeship and practiced in the patient's home. Unlike English surgeons, who formed a profession apart from physicians and apothecaries, American surgeons were distinguished from physicians neither by licensure nor societies. The establishment of hospitals and medical colleges in Philadelphia and New York City during the late Colonial Era and the resumption of European travel after the Revolutionary War offered surgeons educational options besides apprenticeship. Many prominent late eighteenth‐ and nineteenth‐century American physicians who advanced both the teaching and practice of surgery—such as Philip Syng Physick in Philadelphia, the nation's first professor of surgery; Valentine Mott and David Hosack in New York City; and Boston's Oliver Wendell Holmes Sr.—trained in European hospitals and imported European ideas and techniques. American physicians took pride in their surgical skills and in such innovations as Ephraim McDowell's 1809 ovariotomy and J. Marion Sim's 1849 vesicovaginal fistula.

After William T.G. Morton, a dentist, developed sulfuric ether as an anesthetic, John Collins Warren, of a prestigious Boston medical family, and Henry Jacob Bigelow introduced it on 16 October 1845 at the Massachusetts General Hospital. Within ten years, the surgical use of anesthesia had spread around the world, enhancing the prestige of American surgery.

Although anesthesia removed the fear of pain from surgery, surgical infections remained a problem. In 1867 the Scottish surgeon Joseph Lister announced an antiseptic method of treating surgical wounds. That same year, several American surgeons adopted Lister's carbolic acid spray—thereby touching off a twenty‐year debate over whether or not Louis Pasteur's and Robert Koch's newly announced germ theory of disease adequately explained surgical sepsis. By the 1890s aseptic surgery—performed in a germ‐free surgical area with sterilized equipment—became the norm in American surgery. William Stewart Halsted's popularization of the surgical rubber glove around 1890 proved a notable American contribution to asepsis.

In the 1870–1920 era, reforms of medical education at Harvard, the University of Pennsylvania, and especially Baltimore's Johns Hopkins University Medical School and Hospital improved the surgeon's education and professional status. Rigorous and lengthy clinical training replaced the short courses, European Wanderjahre, and apprenticeships of antebellum America. Although surgical education remained closely linked to medical education generally, surgeons began to form their own professional societies. The American Surgical Association, founded in 1880, first met in 1882, and launched a journal, the Transactions of the American Surgical Association, in 1883. A century later, several specialized associations and journals reflected surgery's diversity.

Throughout the nineteenth century, surgeons continued to operate mostly in the patient's home and limited themselves mainly to such procedures as amputations, hernia repair, and the excision of growths. After 1900, the hospital increasingly became the locus of surgical activity. The evolution of hospitals and operating rooms into complex institutions, technologically and organizationally, gave rise to ancillary disciplines such as surgical nursing, radiology, and anesthesiology and encouraged the growth of pharmaceutical and surgical‐instrument industries. Among the first surgeons to specialize were the pioneering neurosurgeons Harvey Cushing at the Harvard Medical School and the Peter Bent Brigham Hospital and Walter Dandy at the Johns Hopkins Memorial Hospital. In 1902 Alexis Carrel aseptically rejoined severed blood vessels without thrombosis; in 1905 he and Charles Claude Guthrie transplanted a dog's kidney. Although the dog died, the dream did not.

The application of ideas or inventions initially unconnected with surgery often spurred the development of the field. Karl Landsteiner's discovery of blood types in 1901 removed the theoretical barrier to blood transfusions; George Washington Crile performed the first successful transfusion between patients in 1905. When the pharmaceutical and technical problems of blood storage were solved by the end of World War II, blood loss and shock disappeared as major hurdles to surgical procedures. Advances in immunology, genetics, and pharmacology enabled Joseph Murray to accomplish the first successful kidney transplant in 1954. Thomas Starzl, using cyclosporin, developed the protocols for successful liver transplants, and Francis Moore and Norman Shumway, among others, developed them for heart transplants. Lasers transformed ophthalmic surgery, while CT (computerized tomography) scans and MRIs (magnetic resonance imaging) extended imaging technology far beyond the X ray. Helen Taussig and Alfred Blalock developed a surgical correction for the tetralogy of Fallot (“blue babies”) in 1944, using insights gained from fluoroscope images and advances on Carrel's method. If inventions stimulated surgery, the reverse was likewise true. Difficulties in thoracic and cardiac surgery, for example, motivated John H. Gibbon's invention of the heart‐lung machine during the 1940s. This, in turn, made open‐heart surgery possible, and prompted Medtronics, Inc., to develop the pacemaker in the 1950s. Orthopedic surgery grew with improvements in prosthetic devices.

The individualism and technical virtuosity of eighteenth‐ and nineteenth‐century surgery gave way in the twentieth to teamwork and a more solid scientific foundation. The Mayo Clinic in Rochester, Minnesota, for example, gained fame for its advancement of the surgical arts and for being one of the first American medical group practices. William Halsted's importance in the annals of surgery derives not only from his introduction of rubber gloves and improved surgical techniques, but also from his insistence that surgery be pursued collaboratively with the basic clinical sciences. Owen H. Wangensteen of the University of Minnesota Medical School, like Halsted, taught generations of future surgeons that surgery rests on scientific foundations. In 1952 a team at Minnesota headed by C. Walton Lillehei successfully conducted the first open‐heart surgery under direct vision, an achievement made possible by collaboration among cardiac physiologists, anatomists, and surgeons.
See also Heart Disease; Medicine; Pharmaceutical Industry.

Bibliography

Martin S. Pernick , A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteenth‐Century America, 1985.
Charles E. Rosenberg , The Care of Strangers: The Rise of America's Hospital System, 1987.
Ira M. Rutkow , The History of Surgery in the United States 1775–1900, 2 vols., 1988, 1992.
Christopher Lawrence, ed., Medical Theory, Surgical Practice: Studies in the History of Surgery, 1992.
Joel D. Howell , Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century, 1995.

Thomas P. Gariepy