The Medical Background

Early 19th Century Medicine

In these days of modern antibiotics and antiseptics, we often forget that, if you had been born in the 1850's, you lived in a world where your chances of surviving an operation, a severe wound, or problems of childbirth were very small.

In 1842, a "gentleman" might have lived to his late 30's in a city like Manchester, or to 52 in the rural countryside of Rutland. A labourer, or tradesman would be lucky to get out of their 20's if they lived in one of the fast growing cities. Compare this to modern life expectancy when men can expect to live to more than 80 years (figures for life expectancy 2012).

Understandably, for the general population, going to the doctor was an activity of last resort.

Early 19th Century Surgery

Surgery was no better. Although surgeons of the first half of the 19th century are often portrayed as little better than butchers, they were frequently both skilled and knowledgeable. In 1842, Sir Robert Liston, the foremost London surgeon of the day demonstrated the amputation of a leg in 30 seconds to a packed crowd of medical students in the wooden galleries that surrounded the operating room at Universty College, London.

The problem was survival. When it came to surviving surgery, there was a pretty good chance that if the pain of pre-anaesthetics surgery didn't get you, then the infection that followed almost certainly would.

Breakthroughs in Surgery and Nursing

Victorian Britain of the 1840's and 1850's was to provide the breakthroughs that transformed surgery and your chances of survival. The adoption of anaesthetics, which started with Simpson's first use of chloroform in 1847 solved one problem. An unconscious patient at least meant that he or she stayed still while the surgeon did his work. This meant that a surgeon could take more time as the patient was not thrashing around. Potentially, it also meant more invasive and deeper operations because the surgeon had more time to assess his progress.

Nursing and medicine were taking their first steps towards professionalisation. Florence Nightingale received her training at the first nursing school at Kaiserwerth in Germany,  established in 1846 and went on to establish the first British nursing school at St Thomas and to prove the value of professional nursing in the Crimean War. The professional nursing register ifollowed in 1858, along the pattern of the founding of the BMA in Worcester in 1838 and the Royal Charter of The Royal College of Surgeons in 1843 in England.

The Black Period

However, what followed the increasing use of anaesthetics is known as the "Black Period" of surgery. From 1846 to 1870, death rates as a result of operations actually went up rather than down as surgeons undertook more complex operations without the corresponding improvements in hygiene and cleanliness that were needed to prevent infection.

Little wonder when surgeons routinely hacked and cut in their normal day clothes and then went on the use the same equipment on the next unfortunate patient who was brought to the table. Little wonder too that so few patients survived. You have only to read "Notes on the surgery of the war in Crimea" by George McCloud to understand a world where surgeons still believed in "bad air" as the source of infections.

Antiseptics - Joseph Lister

The real breakthroughs started with Joseph Lister, whose pioneering work in antiseptics and the use of carbolic acid to clean hands, equipment and later bandages saw the first real advances in decreasing mortality rates. These plummeted from 46% between 1864 and 1866 to 15% between 1867 and 1870. Further advances came in the application of sterilisation and in the creation of aseptic operating environments.

This hard evidence of the fall in infection rates as a result of clean hands, sterilised equipment and the increasing adoption of aseptic surgical environments was the background into which John Lionel Stretton qualified as a surgeon in 1881.