The Mölnlycke Health Care blog
The O.R.: Then and now – How much has really changed?
It is vacation time (in the northern hemisphere at least), which means that I start to get postcards from friends on their holidays. Some are of delightful views, some are comical and a good few are of steam engines...
This year, I received quite an unusual one (my friends know me). It shows a leg being amputated in 1775 – 1776 at Old St Thomas’s Hospital, London UK. Initially I was struck by how entirely different the environment and procedure are to what we expect to see now. There is no anaesthetic, absolutely no suggestion of aseptic procedure, no overhead light and there is – watching the “entertainment” – a big audience (well, it is theatre!), which includes Omai, a Polynesian invited to England following Captain Cook’s second voyage, in the front row.
Some things have not changed at all, though – have a look at the instruments laid out for use, especially the bone-holding forceps! Surgeons in the United Kingdom are also still called “mister” rather than “doctor”. Doctors were members of a Royal College, charged fees in gentlemanly guineas (£1.05) rather than the more common pound (£) and considered themselves to be scientists. Surgeons were not nearly so well regarded. Though respected today (by some of us anyway – I am a former theatre scrub nurse!), in the early 1800s they had yet to live down their origins as mediaeval barbers. More numerous than doctors—in 1815, there were only 14 physicians attached to the Royal Navy, compared to 850 surgeons and 500 assistant surgeons—they were not looked on as true professionals but as technicians, sawbones who treated the distasteful aftermath of accident and infection.
Things are somewhat different now though, aren’t they? Surgeons are now considered to be part of medical profession and are qualified as doctors before they then carry on to train as surgeons, reverting to mister, missus or miss when they complete that training – and there is another difference. Thankfully we now have female surgeons, which would have been unthinkable even 100 years ago. The operating room, or theatre, is now clean and segregated – we know about bacteria and infection thanks to Pasteur, Lister and particularly the man considered to be the founder of modern bacteriology, Robert Koch (December 11, 1843 – May 27, 1910). This means that we appreciate the importance of asepsis and how to create and maintain the sterile field using antiseptics, surgical gloves, drapes and gowns, clean air suits and laminar air flow, etc. As more and more antibiotic-resistant bacteria strains emerge, the importance of stopping them entering the surgical site increases. We now have sophisticated anaesthesia, which is a medical speciality in its own right, and of course, unlike the old days, our patients usually live...
So, things are very different – or are they? We still talk about operating theatres – even though audiences no longer clap and cheer – and our most significant enemies are blood loss and infection.
By being diligent in our practice, by ensuring that we choose the right tools for the job and by keeping up to date with advances in the field, we can all do our bit to ensure that we are not compromising infection control – while taking the best from the past.