In 1888 the great American surgeon Rudolph Matas saved the life of a patient who had been shot in the arm. The operation was a significant moment in the evolution of vascular surgery, since it introduced an entirely new technique for dealing with aneurysm – a condition in which an artery wall is weakened and balloons outwards.
What astonishes me about this operation – apart from Matas’s surgical genius – is the nature of the equipment available to him. Very little of it was even designed for use in the operating theatre.
Two years earlier Robert Tuttle Morris had written a short textbook about antiseptic surgery, aimed at those practitioners (there were many) unfamiliar with its basic principles. He includes details on suitable equipment and where to procure it. Much of his advice has a charmingly ad-hoc feel to it:
Place a small table and a chair near the operating-table. On the small table put a roast-beef platter for large instruments; a large bowl for clean sponges; a small platter for small instruments, and two or three saucers for catgut, needles, etc.
After discussing the use of silk thread, which he suggests is better than catgut for suturing where fine stitching is required, he observes that
Dealers in fishing tackle have silk-worm-gut on hand.
But my favourite is the section on sponges, which were used as surgical swabs are today. Synthetic sponges were still unknown, so Morris is referring here to the marine animal:
For ordinary surgeon’s purposes use selected reef sponges. Buy them by the pound. They do not cost much, and the surgeon can throw them away after employing them once.
He then explains how they are to be bleached with potassium permanganate and hydrochloric acid, rendering them aseptic.
Put them where they will become very dry. Hire a boy to beat out the sand. Put what sponges are wanted for use in the near future into fruit jars filled with 1-30 carbolic-acid solution.
Matas’s biographer Isidore Cohn, who was somewhat prone to poetic flights of fancy, claims that a ‘Negro boy’ was indeed employed to beat the sand out of the great man’s surgical sponges with a mallet.
Modern surgeons would certainly balk at the suggestion that these surgical sponges be reused:
Wash out blood and other contents as thoroughly as possible. Put the sponges in a vessel of water. Set the vessel in a warm place. As soon as decomposition has broken down the fibrin which was entangled in the sponges, they are to be washed in clean water and then put through the original bleaching process.
To be fair to Morris, he makes clear his disapproval of this practice. And like many medics he has an enjoyably dry sense of humour:
I have seen an absorbed operator allow the silk for an abdominal ligature to trail across a leucorrhceal vulva, supposing that towels were so arranged as to prevent the silk from squirming around into any unclean place. The patient died of septic peritonitis; but then several drops of perspiration from the operator’s face, three or four hairs from an unshaven mons veneris, and part of the contents of an ovarian cyst, went into the abdominal cavity along with the silk ligature.
The abdominal cavity in this case was carefully cleaned after the operation with a sponge, which had fallen on the floor only once. The operator is not convinced that antiseptic precautions offer great advantages over simple cleanliness, as he states in an article relating to the subject.
Patients go from great distances to this surgeon and allow him to start botanical gardens on their insides.