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In the early 19th century, surgeons, and even more so their patients, still faced the major problems which had been there for centuries - pain, shock, lack of time, blood loss and infection.

It was difficult to operate successfully on a conscious patient. Speed was essential and a good surgeon could amputate a leg in under three minutes. However, many patients still died from shock or loss of blood, and even more from infection after the operation. In some London hospitals, nine out of ten people died from infection.

Robert Liston

This description is of a typical operation carried out by the surgeon, Robert Liston, in the 1830s. From it we get an idea of what surgery was like in the early 19th century.

Liston was also the only surgeon to have performed an operation with a 300 per cent mortality rate. During a high-speed amputation, he cut off his assistant’s fingers and slashed the coat of a spectator, who fainted in shock. All three died - the patient and assistant from sepsis and the spectator from shock.

It may sound as if Liston was incompetent, but he was actually highly respected and it was the need for speed which caused the deaths. In 1835, he became the first professor of surgery at University College London, and in 1846 carried out the first operation using ether as an anaesthetic in Europe.

James Simpson

In the early 19th century, scientists began to experiment with anaesthetics to put the patient to sleep.

• The first gas used was laughing gas. It was fine for pulling teeth but could not be used for longer operations.
• In 1846, ether was used first in America, and then by Robert Liston in London. It did knock patients out, but was flammable and could damage the lungs.
• In 1847, James Simpson first used chloroform successfully.

Simpson tried it out on himself and two other doctor friends. They tried different doses on each other until they were unconscious.

As a professor of midwifery, Simpson first used chloroform to help women in labour, but in no time at all it was also being used for operations. It was soon obvious that it was the most long-lasting and reliable anaesthetic. It could knock people out for longer operations and so gave surgeons more time when operating. Surprisingly, there were objections to the use of chloroform.

• Some surgeons preferred their patients awake so that they could fight for their lives.
• Many religious people felt that pain (particularly in childbirth) had been sent by God and should therefore not be tampered with.
• It was difficult to get the dose right. A 15-year-old called Hannah Greener died while having her toenail removed.

Black period of surgery

Ironically the use of chloroform initially led to the 'black period of surgery', a 20-year period when the death rate actually went up. However, this was not the fault of Simpson or chloroform. With patients unconscious, surgeons could now take their time over operations and attempt more difficult invasive surgery. Unfortunately, patients still died from blood loss or from infections picked up in the operating theatre because doctors:

• didn't bother to wash their hands
• coughed over patients
• wore bloody aprons as a badge of honour on the wards

However, chloroform was a major breakthrough and surgery improved over time.

• In the 1850s John Snow, known for his work on cholera, developed an inhaler to regulate the dosage.
• Queen Victoria had chloroform during the births of two of her children. This made chloroform more acceptable.
• Other developments, eg the use of antiseptics during surgery, reduced mortality.