Amputation

Prior to the aseptic era, by far the most commonly performed major surgical procedure was an amputation, which was also one of the earliest operations depicted in medical literature.  

Saints Cosmas and Damian performing the miraculous transplantation of a leg (late sixteenth century) by Ambrosius Francken
Cosmas and Damian were prominent Arab twins who converted to Christianity and traveled about Persia, freely giving their medical services to the needy. Unfortunately, however, the brothers were tortured and beheaded during the reign of Emperor Diocletian (303 A.D.), though they subsequently became the patron saints of barber-surgeons as the legends of their medical and surgical accomplishments grew in time. They became famous following their legendary transplantation of the leg of a Moor. It seems that a Christian Roman deacon, Justinian, had a malignant growth on his leg and fell asleep while praying for a cure in the Church of Cosmas and Damian in Rome. In his dreams, the saints amputated the diseased limb and transplanted the leg of a Moor who had been brought to the church for burial. The patient awoke and gratefully observed a now healthy leg, though black in color.
amputation saw
This very primitive (Italian?) amputation saw was probably 13th century or earlier. Unfortunately there are no hallmarks for specific identification.
Feldbüch der Wundartzney (1497) by Hans von Gersdorff
In the illustration by the famous German surgeon Hans von Gersdorff (ca 1480-1540), note that the physician was using his left hand as a tourniquet to both reduce bleeding, and to compress the nerves for pain control. The man on the right of the illustration was wearing a “T,” likely indicating that he suffered from St. Anthony’s Fire, which was probably erysipelas, a Group A streptococcal infection common at the time.
A General System of Surgery (1743) by Laurence Heister
The removal of a limb was the last surgical resort, and the most dramatic surgical procedure prior to the discovery of anesthesia in the middle of the nineteenth century. The pain and fear must have been beyond description, and patients often had to be held down by several assistants.
Large (24 1/2-inch) German amputation saw (ca. 1540)
The hooks at either end of the saw would allow the surgeon to hang up his instrument in plain sight for the admiration of potential future customers.
Perrot saw (ca. 1770) by Spear & Sagnson
a later amputation saw in the same style that would have been in use by surgeons during the French Revolution
Mid to late eighteenth-century amputation saws
(top left column) exhibition bow saw by Aubry,(Richard) Butcher’s bow saw by Evans & Co., Hey’s saw by Down, serrated Parker’s Capital saw by Tiemann; (top right column) Sattertlee’s saw by Tiemann, Rust’s bow saw by Tiemann, chain saw with carrier by Aubry, lifting-back metacarpal saw with universal handle by Tiemann; Tenon saw by Evans & Wormull
metacarpal saw, ca. 1800
This decorated ivory handeled metacarpal saw is unique and may have been part of the instrument collection of a physician to royalty. It's ironic that such a magnificently handcrafted instrument was designed to remove digits.
oil on board by an unknown artist, mid nineteenth century amputation
amputation with several attendants holding down the patient and students observing the procedure
Traité complet d’anatomie de l’homme, 2nd ed. (1866–1871) by J.M. Bourgery, Claude Bernard, and N.H. Jacob
The earliest method for amputation was the circular technique, first described by Aulus Cornelius Celsus (25 B.C.-50 A.D.). Military surgeons preferred this technique because the wound healed quickly, and there was less soft tissue to be exposed to the possibility of infection. Additionally, circular amputation resulted in less operative pain, and patients could be transported with fewer complications.
Eighteenth century circular amputation knife by Price
This is an eighteenth century circular amputation knife by Price with the sharpened edge on the top of the knife. With one quick swipe of the blade, a limb could be removed in a matter of a few minutes, a blessing in the days before anesthesia was available.
British circular amputation set (ca. 1770) by Savigny
Savigny was the preeminent British manufacturer of surgical instruments in the eighteenth century.
Traité complet d’anatomie de l’homme, 2nd ed. (1866–1871) by J.M. Bourgery, Claude Bernard, and N.H. Jacob
James Yonge (1646-1721) was the first to describe the flap amputation, a later method that was faster, and was associated with less postoperative pain than the circular technique.
amputation set (ca. 1870) by Spencer and Crocker
This set could have been used for the flap or circular techniques and would have been tyical for those used by surgeons during the Civil War.
Armamentarium Chiruigicum (1655) by Joannis Scultetus
This is an illustration of an early mastectomy with the control of bleeding by cautery.
Traité complet d’anatomie de l’homme, 2nd ed. (1866–1871) by J.M. Bourgery, Claude Bernard, and N.H. Jacob
an illustration of a nineteenth century mastectomy
breast fork, mid eighteenth century
This instrument was used for the removal of a diseased breast and is extremely rare.
Heine’s osteotome (ca. 1840) by Heine
The Heine's osteotome was an early nineteenth century chain saw device used for the rapid separation of bone during an amputation. It has quite an intricate mechanism and thus not many have survived.
Traité complet d’anatomie de l’homme, 2nd ed. (1866–1871) by J.M. Bourgery, Claude Bernard, and N.H. Jacob
the use of a Heine's osteotome in amputations
Charrière's catalogue of surgical instruments
another use of the Heine's osteotome
ladie's artificial hand, nineteenth century
Early amputation was regarded as a life saving procedure and prosthetics were very popular in the nineteenth century in the presence of frequent post-operative infection complicating injuries.

Surgical History

Surgical procedures have been recorded from the earliest of times and art continues to be an important way of documenting the history of this specialty. 

Egyptian circumcision: relief on the wall of a tomb at the Sakkara cemetery in Memphis, sixth dynasty (2625–2475 B.C.)
The earliest written representation of surgery is that found in Egyptian ruins and early papyri. A number of minor procedures are noted there, including the practice of circumcision, which is the first operation ever illustrated and was the only surgical procedure mentioned in the Bible (Exodus IV, 25), when Moses’ wife Zipporah, “took a sharp stone and cut off the foreskin of her son”. This relief was found in a cemetery in Memphis at the home of Imhotep, grand vizier to King Zoser (2980-2900 B.C.).
Edwin Smith Egyptian surgical papyrus (ca. 1600 b.c.), cases 9–12
In 1862, American Egyptologist Edwin Smith (1822-1906) discovered probably the most important Egyptian medical document yet found. The Smith Papyrus was written in about 1600 B.C., and reflects medicine as practiced as far back as the thirtieth century B.C. Smith discovered the manuscript in Thebes in 1862, and JH Breasted translated it in 1938. The papyrus contains text on both sides of a fifteen foot roll, and is made up of forty-eight individual surgical cases describing examinations, diagnoses, and methods of therapy.
relief of Egyptian surgical instruments
These instruments were inscribed on the wall of the outer corridor of the Temple of Sobek and Horus built by Ptolemy VII, Kom Ombo, Egypt (181–146 B.C.).
The Code of Hammurabi inscribed on black diorite rock (ca. 1780 B.C.)
Hammurabi ruled the Mesopotamian civilization of Babylon from 1792 to 1750 B.C., and was responsible for formulating the first recorded code related to medicine. This now famous Code of Hammurabi is housed at the Louvre in Paris, and represents an early effort to form a social structure based on law.
fresco from the Casa di Sirico, Pompeii, first-century
Aeneas (between Venus and Ascanius) being treated by a physician
forceps from Pompeii, first century
Roman surgical instruments, second century
scoops, probes, scalpel, and tweezers
Roman bronze scalpel (ca. 200 A.D.)
Altasrif (thirteenth century Latin translation) by Albucasis
Al-Zahrawi (Albucasis) (936-1013) was a surgeon of Spanish/Arab descent, and became a major figure in the history of medicine with his comprehensive and systematic review of surgery, the Altasrif. It was referred to by physicians for hundreds of years, and was translated into Latin, providing the basis for all future European surgical writings. Albucasis carefully and thoughtfully described more than fifty surgical conditions, including bloodletting, midwifery, urinary diversion into the rectum, reduction mammoplasty, tracheotomy, craniotomy, and lithotomy. Illustrations of surgical instruments were the first to be seen in printed form in the Altasrif.
Ambroise Paré (1510-1590)
Ambroise Pare (1510-1590) is considered by many to be the first great modern surgeon, and he was responsible for raising his profession in France from a level of scorn and ridicule to one of admiration and esteem. He was the son of a barber-surgeon, and was thereby exposed at an early age to minor surgical procedures performed by those without a formal medical background.
oil painting by Hans Holbein the Younger (1541)
Henry VIII handing the Act of Union to Thomas Vicary, uniting barbers and surgeons
rectal repair lancet
French King Louis XIV was troubled by a rectal fistula. An instrument similar to this was used by barber-surgeon Charles-François Felix to accomplish the repair. The only other example is the instrument that was used, now located at the medical museum in Paris.
King Louis XIV
The Surgeon oil painting on canvas by David Teniers the Younger (1610–1690)
This painting illustrates some of the procedures performed by seventeenth century barber surgeons, including bleeding and lancing boils.
The Gross Clinic (1875) by Thomas Eakins
Professor Samuel Gross was one of the most prominent surgeons of the nineteenth century and was the chairman of surgery at the Jefferson Medical College from 1856 to 1882. He was an extremely important American surgeon, author, and medical teacher, and his two volume System of Surgery (1859) provided a basis for surgical techniques used during the Civil War. Unfortunately, Dr. Gross remained one of the last major medical figures of the nineteenth century to be unconvinced by the monumental discoveries earlier that century regarding asepsis, as seen in this famous painting.
The Agnew Clinic ( 1889) by Thomas Eakins
The Agnew Clinicis an 1889 oil painting by American artist Thomas Eakins showing Dr. Agnew in perfomance of a partial mastectomy in a medical amphitheater.
the scalpel held by Dr. Agnew for his portrait
Agnew Clinic
This photograph of Dr. Agnew was used by Eakins in preparation for his famous painting.

EENT

Alas! How could I declare the weakness of a sense which in me ought to be more acute than in others...

                                                Ludwig van Beethoven (1802) 

Ophthalmology and otolaryngology are fairly modern medical specialties, though physicians have always been faced with the challenge of treating patients with disorders of the head and neck.  Early therapy for the loss of vision and hearing was largely ineffective, and barber-surgeons did their best to repair the consequences of trauma in battle.  It was not until the middle of the nineteenth century and the discoveries of anesthesia and aseptic techniques that physicians began to take a special interest in this area of the body since they could finally offer their patients a reasonably painless experience with some hope of survival.

(Chapter Sections below, additional Pictures left)  

Exposition anatomique des organs des sens . . . (1775) by Jacques Fabien Gautier D’Agoty
color mezzotint of the Circle of Willis
Traité complet d’anatomie de l’homme, 2nd ed. (1866–1871) by J.M. Bourgery, Claude Bernard, and N.H. Jacob
the external and internal ear

Obstetrics and Gynecology

Where they save one, they murder many.

                                                    Dr. William Hunter (1718-1783)

It was only within the last several hundred years that the study and treatment of conditions affecting women were considered appropriate for review by the established medical community.  Even into the 19th century, Victorian prohibitions and gender bias prevented an accurate and thorough evaluation of women’s diseases.

(Chapter Sections below, additional Pictures left)   

Anatomia Uteri Humani Gravidi (1774) by Dr. William Hunter
a famous illustration of the gravid uterus

Trauma Surgery

Vertigo, vomiting, stupidity, haemorrhage, loss of sense, either partial or total, are the symptoms of this kind of mischief...

                                                        Percival Pott (1778)

Warring nations have always given physicians both the obligation and the opportunity to find new ways in which to treat trauma. Despite the fact that invasive surgery was not possible prior to the nineteenth century discovery of anesthesia, many important surgical innovations resulted from the desperate efforts made by military physicians whose wards were suddenly overrun with battered troops.

(Chapter Sections below, additional Pictures left)   

Feldtbüch der Wundartzney (1517) by Hans von Gersdorff
This is an illustration of some of the many types of wounds inflicted during battle for thousands of years and the challenges they presented to military physicians.

General Surgery and Anesthesia

     He must begin first in youth with good learning and exercise in thys noble arte, he  also must be clenly, nimble handed, sharpe sighted, pregnant witted, bolde spirited, clenly apparailed, piteful harted, but not womanly affectionated to wepe or trimble, when he seeth broken bones or bloodies woundes, neither muste he geve place to the cries of his sore patiente, for soft chyrurgians maketh fowle sores. Of the other side, he maie not plaie the partes of a butcher to cutte, rende or teare the bodie of mannekynde. For although it be fraile, sore, and weake, yet it is the pleasure of God, to cal it his Temple, his instrument, and dwelyng place. 

                                                                      William Bullein (1579)  

 

For thousands of years, those who practiced surgery were perceived more as craftsmen than as professionals, and it was not until the last few hundred years that surgeons were considered “physicians.”  

(Chapter Sections below, additional Pictures left)

The Gross Clinic (1875) by Thomas Eakins
Professor Samuel Gross was one of the most prominent surgeons of the nineteenth century and was the chairman of surgery at the Jefferson Medical College from 1856 to 1882. He was an extremely important American surgeon, author, and medical teacher, and his two volume System of Surgery (1859) provided a basis for surgical techniques used during the Civil War. Unfortunately, Dr. Gross remained one of the last major medical figures of the nineteenth century to be unconvinced by the monumental discoveries earlier that century regarding asepsis, as seen in this famous painting.
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