Surgery can be viewed as one of several potential means of providing medical therapy to patients. Stone age finds reveal that relatively complicated surgery has been performed on humans for a long time. Trepanation is probably the most well-known ancient surgical method, which was used to exorcise evil spirits and relieve pain of a more medical nature. Put simply, trepanation means cutting, sawing or drilling a hole in the patient’s skull.
In the 17th century, Swedish surgeons had formed a guild that assigned them the privileges of craftsmen. Most surgeons were German, mainly acting as barber-surgeons in the army during times of war.
Seen through the eyes of the 17th century period of Enlightenment, traditional medical practitioners like healers, midwives and barber-surgeons were viewed with considerable skepticism, while the representatives of theoretical medicine, concentrated at the medical faculty at Uppsala University, gained in confidence and power. The education provided by the faculty was highly theoretical and the demonstration of instruments was as close as it got to practical surgery.
At the same time, the government was interested in addressing the misery created by the many injuries and disabilities resulting from protracted wars, as well as wanting to alleviate social tensions. This eventually led to the establishment of the College of Physicians, Collegii Medici, as the governing body and predecessor of the Swedish Medical Products Agency.
By 1739, it was concluded that a hospital was desperately needed in Stockholm. Thirteen years later, in 1752, the Serafimer Hospital opened with eight beds, four each for internal and external medicine respectively. A royal decree determined that no one could be appointed district medical officer or barber-surgeon without a minimum of six months’ practice at a hospital where he would learn the basics of surgery and medical procedures. This constituted the first formal stipulation that physicians should acquire both theoretical and practical skills.
The head of the Serafimer Hospital, surgeon and professor Olof Acrel, held lectures, demonstrated surgery and published scientific articles. One of the problems he identified was the design of surgical instruments: “Those of a more sensitive nature may become easily dismayed, when shown the dreadful drawings of all the superfluous, damaging and useless tools, which have been left to us by our predecessors, alongside their reasons for using them. The field rifles kept in arsenals could not instill more dread in the beholder than those instruments found in the surgical armory”.
By the beginning of the 19th century the medical corps had already been divided into two categories: medical doctors and master surgeons. Even as recently as 1850 there were no more than 200 medical doctors with surgical training in Sweden.
In 1839, the status assigned to surgery was described as follows: “Although some surgical cases are certainly in merit of care, on the grounds of colic, hemorrhoids and wolf bite, apart from setting broken limbs and the most primitive barber-surgeon incisions, there is not much to be deemed worthy of the name surgical procedure. It remains uncertain to what extent the surgical instruments of hospital physicians can really be put to practical use”.
The rivalry between surgeons and medics was again highlighted by the experiences from the wars in the second half of the 18th century, and surgeons became the scapegoats of the 1788 war against Russia. Not only had there been too few barber-surgeons, but their training was still far from adequate.
In addition, the operations they performed—despite being relatively uncomplicated by today’s standards—were extremely painful and risky for both patient and doctor. Alcohol was the only available anesthetic and the substantial infection risk represented a serious problem.
Surgeons worked without surgical masks or gloves and used unsterilized instruments. They went straight from autopsies to childbirths without changing their clothing or cleaning their instruments. But as the cause of infection remained obscure, experimentation offered the only hope of a solution to the problem. Either attempts were made to avoid the supposedly harmful effect of air by refraining from changing dressings or attempts were made to remove the supposedly bad air by opening windows and creating a draft.
Two discoveries led to wider acceptance and approval of surgical methods and medical science. The first was anesthesia, partly in the form of the medical application of nitrous oxide as advocated by the English chemist Davy and partly in the form of ether anesthesia as advocated by Swedish chemist Berzelius. The second discovery was Pasteur’s theory of bacteria, which originated in studies carried out in the French wine and brewing industry. On the basis of Pasteur’s findings, instruments began to be sterilized in carbolic acid, which reduced the risk of infection to both patients and surgeons. All that remained for therapeutic surgery to really break through was the suitability of instruments.