From the first trauma specialist honing his skills on wounded Roman
gladiators, to the wartime plastic surgeon's pioneering operations to save
the faces of injured soldiers, the history of surgery is full of
inspirational characters who possessed extraordinary talent and ingenuity.
Here is a whistle-stop tour of some of the key moments in what is often a
gruesome, fascinating field.
THE GLADIATOR'S SURGEON
The Roman province of Pergamum, AD157
The post of physician to the gladiators in Pergamum, or any major city of the
Empire, was a prestigious one. Celebrity gladiators required their own
celebrity surgeon, and this was the perfect position for an ambitious
showman such as Claudius Galen. Galen had studied with distinguished
physicians.
In his new role he learnt to deal with everything from minor sports injuries
to serious battle wounds. When the survivors of the contests left the arena,
he would be waiting to set bones and amputate limbs. He became an expert at
stemming blood flow and restoring the fighters to health.
As one of the first trauma surgeons, Galen was perfectly placed to study the
inner workings of the human body. An amputation revealed the bones, muscles
and tendons. He noticed how blood vessels pulsed, and that some blood was
brightly coloured.
Galen eventually became a personal physician to the Emperor Marcus Aurelius.
He hoped to be immortalised by the medical profession as someone who
understood how the body functioned. Much of what he deduced was correct,
though not everything: he saw the heart as a sort of furnace, with no sense
that the blood circulated around the body or was pumped by it.
But considering that most of Galen's anatomical experience was based on
animals, he didn't do a bad job. And after 1,500 years, our knowledge of
medicine, surgery and anatomy is still based on the writings of this
boastful Roman surgeon.
THE 30-SECOND AMPUTATION
University College Hospital, London, May 1842
The steeply raked semicircular wooden galleries of the operating theatre had
been swept that morning. The table resembled a crude workbench. The grain of
the wood was marked with deep grooves and stained brown with blood. The
first operation was scheduled to begin at noon.
The patient was in a bad way; jagged ends of broken bone protruded through the
skin of his calf. He had sustained the injury on the Great Northern Railway
when he had slipped between the platform and a moving train. The only cure
for such a compound fracture was amputation.
Fortunately, the company's terminus at King's Cross was close to University
College Hospital. This meant that he would be operated on by Britain's
finest surgeon, Robert Liston. The room goes quiet as Liston strides through
the door. “Sharp features, sharp temper” is how his colleagues describe him.
His operations are always well attended.
“Good afternoon, gentlemen,” he says to the now packed theatre. “Today I shall
be performing an amputation of the thigh in the usual manner.”
A dresser slips a tourniquet around the patient's upper thigh. Two other
assistants firmly hold his shoulders and arms to stop him struggling. Liston
turns to the galleries; everyone is leaning over the railings. “Time me,
gentlemen!”
In one rapid movement, he slices into the flesh. There is nothing theatrical
about the patient's cry. It is a chilling, horrible scream of terror.
Liston flings the knife into a tray and grabs the saw. Placing his left hand
on the bone, with his right he begins to saw with rapid, precise strokes.
With a needle and thread he then ties off the blood vessel. The operation is
over. From first cut to final stitch, the whole procedure has taken 30
seconds.
ORGAN-SWAP PIONEER
The Frenchman Alexis Carrel was the first doctor to work out how to sew blood
vessels together. This discovery alone helped to save countless lives. When
arteries or veins were damaged, his efforts meant that they could be
successfully repaired. In addition, his experiments made transplants
possible and opened up a whole new area of surgery.
While at the Rockefeller Institute for Medical Research in New York in the
late 1930s, Carrel was considered one of the world's most eminent and famous
scientists. Since winning a Nobel prize in 1912 for his work on organ
transplantation, Carrel had conducted thousands of transplantation
experiments. He had swapped the leg of a black dog with the leg of a white
dog and replaced the head of one dog with the head of another. He had
swapped skin, rearranged veins and added hearts. No animal, it seemed, was
safe from Carrel's increasingly bizarre research.
But his pioneering experiments with tissue culture gave scientists a much
greater understanding of organ and cell function. They also allowed the
investigation of conditions such as diabetes. His idea that limbs and organs
might be grown or repaired in the laboratory was decades ahead of its time.
However, for all his achievements and technical advances, Carrel kept coming
up against a major problem. Transplants of an organ between different parts
of the same animal were invariably successful, but almost every one of his
hundreds of transplants between different animals ultimately ended in
failure. Carrel concluded that he was coming up against a biological force
that he was powerless to counteract. Despite 50 years of experiments, he
failed to overcome a major obstacle to successful transplantation: rejection
- the body's reaction to foreign tissue.
A SHATTERED FACE REBUILT
It was difficult to look at Lieutenant William Spreckley without experiencing
a feeling of utter revulsion. He had been passed from the trenches at Ypres
to casualty station to hospital before finally ending up in Sidcup.
Spreckley could remember a bright flash but, strangely, experienced little
pain. He knew his face was damaged, but the nurses refused him a mirror.
Instead of a nose he had an ugly, gaping hole.
When Queen's Hospital opened in Sidcup in the summer of 1917, Harold Gillies -
now Britain's foremost plastic surgeon - was appointed to run it. He was
ready to put his vast knowledge of plastic surgery to the test.
Spreckley was one of the first patients to be admitted to the new hospital.
Because the officer's nose was missing, Gillies planned to re-create the
skin and the cartilage supporting it.
The first part of the operation is ingenious and involves removing a small,
rectangular piece of cartilage from the soldier's ribcage. Once Gillies is
confident that the cartilage is the right shape, he slices open a flap of
skin on Spreckley's forehead and transplants the cartilage under the
surface. Gillies is, in effect, growing Spreckley a new nose in the middle
of his forehead.
Several weeks later, once Spreckley's forehead is fully healed, Gillies begins
the next operation. Cutting carefully, to leave the cartilage intact, he
slices a flap of skin from the forehead. He twists the skin around to form a
new nose. The cartilage keeps the structure from collapsing, although the
resulting protrusion is hardly attractive.
He has gone from having no nose to having a swollen, comic representation of a
nose.
The operations continue. He shapes the nostrils and defines the shape of the
new nose, cutting or pulling in excess skin. By the time Spreckley is
discharged his face is almost as good as new.
The transformation is truly remarkable.
HOPE FOR BURNT AIRMEN
The Queen Victoria was the Second World War equivalent of Harold Gillies's
Queen's Hospital at Sidcup, and most severely burnt airmen ended up there.
With aviation fuel burning at temperatures of about 700°C, the surgeons
faced an enormous challenge. There was a never-ending stream of new
admissions to East Grinstead.
By 1944 the procedures were well established, the hospital well equipped and
the staff well versed in caring for the victims of severe burns.
But, above all, they relied on the waltzing tube pedicle. Instead of grafting
flat pieces of skin which were prone to infection, the skin, still connected
to the body and so with its own blood supply, was rolled into a tube
providing it with an infection-resistant cover. After a couple of weeks, the
skin had grown on to the affected area, and was ready to be shaped.
The airmen called themselves the Guinea Pig Club, produced their own magazine,
had a little emblem (a guinea-pig with wings) and even their own anthem.
THE FIRST HAND TRANSPLANT
Anyone who saw Clint Hallam's hand would remember it for ever, perhaps in
their nightmares. Hallam recalls sitting in an aircraft next to a nice old
lady. They got talking. Then she happened to glance down at his right hand.
Recoiling in shock, she summoned the flight attendant and asked to be moved.
She said she had nothing against him personally, only she could not bear
sitting next to someone who was wearing a dead man's hand. The recipient of
the world's first hand transplant was beginning to realise that many people
found his new hand repulsive.
Hallam underwent surgery in September 1998 at the Edouard Herriot Hospital in
Lyons, France. The operation was a success but Hallam struggled to overcome
his disappointment. It wasn't just the mismatch between his new arm and the
old one, so much as the practicalities. The new arm did not work very well.
There was only limited movement: he said that he was almost more crippled
with the hand than if he had been left with a stump.
To avoid the limb being rejected by his immune system, Hallam had to take a
cocktail of drugs. The pills were keeping his arm alive, but they were also
having other effects. Hallam had started to develop diabetes and found that
he was growing breasts. By 2001, he had lowered his dosage and in February
his hand was amputated by one of the surgeons who had helped to attach it.
Any transplantation involves overcoming a psychological barrier. What is the
effect of having a dead man's hand? It certainly bothered that woman on the
plane. The surgeons had failed to overcome the final obstacle. Consciously
or not, it was Hallam himself who had rejected the hand.
© Richard Hollingham 2008. Extracted from Blood and Guts, A History of Surgery
(Ebury Publishing, August 7, £18.99).
The book is available at £16.99, free p&p, from Times Books; tel:
0870 608080, timesonline.co.uk/booksfirst
Blood and Guts: The History of Surgery, starts on BBC Four, August 20, at 9pm
