Harmony Hunter: Hi, welcome to the podcast. I’m Harmony Hunter, sitting in this week for Lloyd Dobyns. Today my guest is Sharon Cotner, who is a medical historian at the Pasteur and Galt Apothecary.

Sharon, I’ve asked you here today to talk about 18th-century surgery – kind of a grisly topic. Would you start by telling me what the word “surgery” means in the 18th century? What would that encompass?

Sharon Cotner: The word originally comes from the ancient Greek language. It translates as “hand work.” Putting on a bandage, taking out a splinter, even giving a massage under medical circumstances would be considered surgery. Operations are only going to be a small part of the whole surgical field of medicine. The operations would be strictly involving some sort of cutting into the body or removing a piece of the body.

Harmony: When I imagine an 18th-century operation, my assumption is that this would be primitive, kind of crude by today’s standards. Would I be wrong in assuming that?

Sharon: Yes and no. There are a variety of operations performed, and many of them are really very similar to the way we operate still today. It’s not so much the actual procedure – the technicalities of the procedure – but it’s the conditions under which the surgery is performed that would be crude: the fact that you don’t have anesthesia and the fact that you won’t be using sterile techniques.

But if I’m going to, you know, cut off a leg, it’s still a knife and a saw today. Yes, your saw might be motorized, but it’s a saw nonetheless. And that’s how you’re going to do it in the 18th century: knifes and saws. There’s no change in the procedure.

Harmony: This makes me feel like my leg is going to fall off just thinking about it. How do you begin? It just sounds horrifying to begin the process of removing a limb without anesthesia.

Sharon: Well first of all, I would point out to you that part of the reason you’re horrified about this is because you have ways to relieve the surgical pain, and you know of those ways. There’s a certain level of psychological pain threshold that is involved in all of this. They’re going to try and lessen the pain as much as possible by doing their operations as quickly as possible.

That also is going to limit some of the operations that they can perform, based on speed. How fast can you actually do it? When you’re dealing with an amputation, which would be one of the most common major operations performed, it’s an average of one to three minutes from the time when you started to cut through the flesh to severing the bone from the body.

Harmony: That is surprising, I would not have imagined you could do it that quickly. How do you learn a skill like that?

Sharon: Practice. Many young men who were going to train to be surgeons – and strictly surgeons, doing no other form of medical work – would have joined the military. They would have gained many of their skills from battlefield surgery.

Harmony: Battlefield surgery is probably going to be a different animal than going to the surgeon in town. How do those differ?

Sharon: Well, it’s like today. There’s a certain level of triage, figuring out which procedures you can do with success, and which patients really, even if you tried the procedure there wasn’t much chance or hope of them surviving. So you start with helping those that you can to the best of your ability.

In a private practice where I might be able to set a broken bone that might be multiple fracture or a compound fracture, in a battlefield situation, you might look at that and say, “Well, I’ve got 15 other patients lined up, so the best thing to do in this situation is simply amputate.” Yeah, you make some choices based on that.

I think one of the biggest problems with battlefield surgery isn’t just figuring out what procedures that you can do to success, but also the simple fact that in those circumstances, your body is simply going to be exposed to more infection and have less chance of recovering afterward.

Harmony: Infection is a pretty big problem, I would imagine, since you don’t have antiseptic, you don’t have antibiotics. How much are they aware of with infection, and what are they doing to try to prevent it?

Sharon: Well let’s first of all get rid of the word “infection,” because it would not be employed in medical use. Infected with what? There is no concept of germs, bacteria, microorganisms causing disease. You can say that a wound becomes foul, putrid, morbid. You can use a lot of terms, but you will not use that term “infection” or “infected.”

When you’re trying to dress a wound, you want to approach it with the idea of what can you apply that will make the wound heal better and faster? So the medicines were often referred to as “healing-promoters” versus infection preventers. The lack of sterilization prior to an operation is an issue, but your body does have an immune system. It is there to try and fight off infection.

So how strong is your immune system is ultimately the biggest challenge. Many of the medicines that were applied as dressings to the wounds to heal and promote healing were natural antiseptics: camphor, myrrh, even alcohol was listed as a dressing for a wound. But nothing that you have will be antibiotic in nature.

Harmony: So we’ve talked about surgery -- what about other things that fall under that category of sort of operations?

Sharon: Well, bloodletting is probably the most common, technically, of the surgical procedures. Bloodletting would be performed as a treatment for diseases. The main purpose behind bloodletting is to relieve and control inflammation. Since inflammation is a common symptom of both disease and injury, it’s obviously going to be a common treatment.

The main method for providing the bloodletting treatment is with a knife, known as a lancet. It’s used to puncture the vein. The main veins that were punctured were those in the middle of the arm, just as they are today. Then there are also those infamous leeches. Leeches really were recommended as a substitute for a lancet to used on smaller children where veins were too small or delicate to find and puncture.

Harmony: Can you explain a little bit about behind what the thinking is behind that practice?

Sharon: Well, I mentioned that the main purpose behind the treatment is to relieve inflammation. Most people have the older historical view of bloodletting, where we are bleeding to balance the humors, or remove bad blood. That way of thinking is going out in the 17th century with new knowledge of the body.

Blood, of course, is red. And you can see through the skin, it is transparent, so we’re going to start to see some of that redness. When you start putting pressure against the nerves in that part, as the blood is building up, you develop pain. With that blood still continuing to push in behind it, these particles are rubbing one against the other, thus you have friction, friction results in heat. Redness, swelling, pain and heat: those are the four properties of inflammation.

So I have now logically described why you have inflammation. What do you do when you get too much water behind a dam in a riverbed? You let out the water. Well that’s what I’m trying to do with bloodletting. I’m trying to let out some of that blood to relieve the inflammation.

Harmony: And of course now I suppose we know that a loss of blood like that would probably weaken the body.

Sharon: Not necessarily. First of all, you’re not necessarily taking that much blood. The amount of blood that would be taken would depend on the individual: their size, their age, their sex, their general health and constitution, time of life, kind of illness, location of the body. All of these are factors into how much blood would be taken out.

For a feverish disorder, trying to treat a male of approximately 150 pounds, an average amount of blood that might be removed is 12 ounces. Well if I go to give blood to the Red Cross in modern times, I’m giving 16. Just because you give up some of your blood doesn’t necessarily make it harmful to you. But in addition, there are studies to show that some bloodletting can actually be of benefit. So it might not have been all a bad thing.

Harmony: So bloodletting is not as backwards as we might think.

Sharon: That’s correct.

Harmony: What else are they doing in the 18th century that we’re still doing today?

Sharon: Oh, when we’re talking about surgical procedures, the simple, obvious things where you have to pull a tooth, or you have to amputate a limb because of gangrene sets in. They removed bladder stones, they removed cataracts from the eyes, they cut out cancerous tumors.

Sharon: What I find about medicine is that we always want to view ourselves as better than it used to be. And of course, as technology improves, we do get better. But that’s not to negate the value of what happened in the past. Because without what happened in the past, we can’t continue to move forward.

Harmony: Thanks so much for being with us today, I know I’ve learned a lot.