Sometimes, it’s a little mind blowing when you remember just how recently medicine passed from the world of art/magic/tradition and into the realm of science. There’s plenty of reason to argue that the transformation still isn’t complete today, but I’m really mesmerized by stories from the 19th century, when every surgery was something of an experiment and the same, cutting-edge doctor could vacillate between modern techniques and medieval bio-alchemy in his treatment of the same patient.
Until that time, the prevalent method of cataract treatment was “couching,” a procedure that involved inserting a curved needle into the orbit and using it to push the clouded lens back and out of the line of sight. Warren’s patient had undergone six such attempts without lasting success and was now blind. Warren undertook a more radical and invasive procedure—actual removal of the left cataract. He described the operation, performed before the students of Harvard Medical School, as follows:
“The eye-lids were separated by the thumb and finger of the left hand, and then, a broad cornea knife was pushed through the cornea at the outer angle of the eye, till its point approached the opposite side of the cornea. The knife was then withdrawn, and the aqueous humour being discharged, was immediately followed by a protrusion of the iris.”
Into the collapsed orbit of this unanesthetized man, Warren inserted forceps he had made especially for the event. However, he encountered difficulties that necessitated improvisation:
“The opaque body eluding the grasp of the forceps, a fine hook was passed through the pupil, and fixed in the thickened capsule, which was immediately drawn out entire. This substance was quite firm, about half a line in thickness, a line in diameter, and had a pearly whiteness.”
A bandage was applied, instructions on cleansing the eye were given, and the gentleman was sent home. Two months later, Warren noted, inflammation required “two or three bleedings,” but “the patient is now well, and sees to distinguish every object with the left eye.”
That’s from an amazing essay on the history of surgery published last month in the New England Journal of Medicine.
The article is absolutely fascinating. I recommend reading it all the way through. If for no other reason than to get a better understanding of the fumbling way medical innovation happened. It wasn’t like everybody woke up one morning and decided to adhere to the scientific method and the germ theory of disease. Instead, there were debates, and failures, and horrible things that happened as doctors tried to expand the number of illnesses they could treat before they necessarily had the tools (or the mental paradigms) to solve those problems. But, it was through making all those mistakes that the actual solutions started to form.
Among the more-interesting points in this piece: The advent of anesthesia didn’t just make surgery more pleasant for the people experiencing it. It also enabled surgeons to slow down and practice surgery with a great deal more care. For instance, prior to anesthesia, a good surgeon could successfully amputate a leg in less than a minute. That’s the surgery you can see being performed in the image at the top of this post.
Read “Two Hundred Years of Surgery” at the New England Journal of Medicine
Via Maria Popova and The Daily Beast