Bones, Blood, Barbers, and Butchers: Surgeons in the 18th Century

In the eighteenth century, the record for the fastest amputation at the thigh was nine seconds, start to finish, including sawing through the bone. Are you impressed yet? Even the average, thirty seconds, was pretty damned fast.

And speed was of the essence. Let’s face it. If you needed surgery in the eighteenth century or the first half of the nineteenth, you’d better be strong and brave, because it wasn’t a doddle. Not for the surgeon, and not at all for the patient.

Patients faced three major killers

They’d solved one of the major issues that killed people who needed surgery, reinventing ligatures to tie off blood vessels so the patient didn’t bleed out on the table. Before the sixteenth century, they’d used cautery—burning—to seal any gushers, vastly adding to the pain. And, of course, closing up the wound as fast as possible helped.

And pain was the second issue. No effective anesthetics. Not until the mid-nineteenth century. The patient was awake for the entire operation, which was the main reason why speed (and some strong helpers to hold the patient down) mattered.

The biggest killer was factor number three. Germs.

Not that they knew that, of course. The prevailing opinion was that wound infections were caused by air, though how nobody quite knew. They had no way of knowing that the surgeon’s hands and clothes, the bed sheets, the surgical instruments, the dressings, and a myriad of other surfaces that would come into contact with the patient were covered with organisms too tiny to see, but that would infect the wound. Most people sickened. More than half died.

Keep out the air to keep out the contagion

Some hospitals did pretty well. Their theory was that the infective element was carried in noxious fumes; that is, if it smelled like bad air, it would be bad for their patient. Alexander Monro (Primus and Secundus), a father and son team who headed the Royal Infirmary in Edinburgh, must have run a clean operation. They managed to get the death rate for amputations down to eight percent. Given that other hospitals of the time managed rates of 45 to 65 percent, that’s truly impressive.

Most surgeons relied on speed to limit the amount of time the wound was exposed to the air, thus—they hoped—cutting down on the damage the air did to the tissues.

More butchery than medicine

So a fast surgeon was far more likely to be a successful surgeon for three reasons: less blood flow, a shorter time of acute agony, and (they thought) less contagion. No wonder that, to the rest of the human race, surgery seemed more a matter of butchery than medicine.

Naturally, as they thought at the time, physicians did not perform surgery. Physicians had, since medieval times, been university trained. They were gentlemen’s sons with a medical doctorate, highly educated and knowledgeable about the humours of the body and the appropriate ways to balance them. In theory, their superior knowledge made them the only proper people to practice medicine and oversee surgery. They did not involve themselves in physical labour, but expected rather to command those who distilled the medicines they prescribed (apothecaries) or who carried out operations they deemed necessary.

Surgeons, barber surgeons and apothecary surgeons

Specialist surgeons learned their craft on the job, working as a surgeon’s mate in the navy or the army, or as the apprentice to a barber surgeon or an apothecary surgeon.

Barbers were good men with a blade, so an obvious choice for removing some part that shouldn’t be there or performing a beneficial bloodletting. The familiar red and white barber’s pole dates from the time of the barber surgeon, representing the rod the patient held tightly during the operation and the bloodied and clean bandages used. When washed and hung to dry, they would twist together in the wind, forming the spiral we see today.

Apothecary surgeons had won a landmark case in the first decade of the eighteenth century, when an apothecary was taken to court by the Guild of Physicians for compounding and administering medicines without the benefit of a physician’s advice. The Physicians won, but the Society of Apothecaries appealed to the House of Lords, who were unimpressed with the argument that allowing apothecaries to care for the sick would:

“Deprive the gentry of one of the processions by which their younger sons might honourably subsist and be a great detriment to the Universities.”

The Lords reversed the judgement.

The rise of a profession

By the eighteenth century, surgeons were giving physicians a run for their money, some attending university as well as learning their craft by apprenticeship. However, they seldom had any formal qualifications before the Royal College of Surgeons was founded in London in 1800. They were ‘Mister’ compared to the physician’s more prestigious ‘Doctor’, though the brilliant work of a plethora of eighteenth century surgeons raised their status and the work of medical teaching hospitals such as the Royal Infirmary mentioned above raised their knowledge.

By the time Victoria ascended the throne, the confidence of surgeons, and the income they could command, had risen to the point that the cheeky surgeons made the former insulting honorific into a badge of honour. In the UK, Eire and New Zealand to this day, surgeons are called ‘Mister’ rather than ‘Doctor’.

Jude Knight’s writing goal is to transport readers to another time, another place, where they can enjoy adventure and romance, thrill to trials and challenges, uncover secrets and solve mysteries, delight in a happy ending, and return from their virtual holiday refreshed and ready for anything.

She writes historical novels, novellas, and short stories, mostly set in the early 19th Century. She writes strong determined heroines, heroes who can appreciate a clever capable woman, villains you’ll love to loathe, and all with a leavening of humour.

A Raging Madness is out May 9th. Stop by our sister blog today to see surgery in action in a new excerpt and enter two giveaways!

On The Famous Voyage: Finding London’s Lost River

the fleet by samuel scott

The Fleet River. Samuel Scott, 1750.

London’s major river is, of course, the Thames but, as the capital’s antiquarians will tell you, there are more than a dozen ancient tributaries hidden beneath the surface of the modern metropolis. The largest of these smaller rivers is the River Fleet, which flows from the largest stretch of common green in London, at Hampstead Heath, to Blackfriars Bridge, where it enters the Thames. This is a journey, not just from North London to the River, but also through the history of the City from Ancient to Modern times, marking some colourful characters and encompassing some bewildering changes along the way.

Cities are typically built along rivers to provide drinking water, transport, defense, and sewage removal. The Fleet has served all of these functions over London’s long history. As place-names along its banks (Brideswell, Clerkenwell) suggest, many wells were built along the Fleet in Roman and Saxon times, although, as we shall see, the purity of its waters were not set to be a defining feature as London grew.

The Fleet (‘tidal inlet’ in Anglo-Saxon) initially provided a waterway which served London from the North and, in a later incarnation as the New Canal, was part of the network which brought coal from the North of England to fuel the rapidly industrializing London of the seventeenth and eighteenth centuries. Even after the canals were superseded by road and rail and entirely covered over in the later eighteenth and early nineteenth centuries, the valley carved by the Fleet continued to form the basis for some of London’s modern arteries, such as Farringdon Road and the Metropolitan Railway line (although it resisted having an underground railway line–that which would become the Jubilee Line–lain beneath it by repeatedly flooding tunnels).

Defensively, the Fleet has a rather inglorious history. It is unclear how the Fleet was utilized by the Romans and it seems rarely to have been called upon subsequently. A second century boat carrying ragstone (possibly intended for building the city wall) was discovered in 1962, sunk at the mouth of the river.

Much later, the Fleet’s banks were built up into earthworks during the Civil War, when London was very much a Parliamentarian (‘Roundhead’) stronghold. The Royalist armies, however, never threatened the capital, with Charles II’s return to the City being by invitation rather than by conquest. During one of the great crises of the restored king’s reign in 1666, desperate Londoners were hopeful that the Fleet would provide an effective break against the Great Fire as it reached its third day. Here the Fleet proved as ineffective as the civic defenses and the Fire jumped the Fleet ditch, ultimately allowing it to claim St Paul’s Cathedral.

Of course, the most serious modern military threat to London came from the air in the form of the Luftwaffe. The old river beneath Fleet Street could offer no protection when Serjeant’s Inn, one of the oldest legal precincts in England, was destroyed during the Blitz.

It is with the removal of sewage and other waste, or at least with its failure to do so effectively, with which the Fleet is most famously associated. As London grew, the Fleet increasingly became a repository for whatever the city’s inhabitants wanted to get rid of. The medieval meat markets which grew up to feed the expanding population soon became problematic and in 1290 the Carmelite monks complained that the offal deposited in the river by butchers at a nearby market (the delightfully-named Shambles, at Newgate) was constantly blocking what was, at this point, a stream.

Copperplate_map_Fleet

The southern end of the Fleet, 1550s.

Although all manner of industries poured waste into the Fleet, it was the offal and dead animals in various forms which seemed to catch the imagination of early modern satirists of the capital. Ben Jonson’s (c. 1612) mock-epic poem which lends its title to this article was a litany of classical references intertwined with toilet humour and social satire and described the diverse pollutants of the river with considerable gusto:

Your Fleet Lane Furies; and hot cooks do dwell,
That, with still-scalding steams, make the place hell.
The sinks ran grease, and hair of measled hogs,
The heads, houghs, entrails, and the hides of dogs:
For, to say truth, what scullion is so nasty,
To put the skins, and offal in a pasty?
Cats there lay divers had been flayed and roasted,
And, after mouldy grown, again were toasted,
Then, selling not, a dish was ta’en to mince them,
But still, it seemed, the rankness did convince them.
For, here they were thrown in with the melted pewter,
Yet drowned they not. They had five lives in future.

Jonson’s influence and the continued assault of the Fleet upon the senses continued into the eighteenth century: Jonathan Swift’s “Drown’d Puppies” and “Dead Cats” of 1710’s A Description of a City Shower, floating amongst the offal and turnip-tops, were echoed by Alexander Pope’s “large tribute of dead dogs to the Thames” in 1728’s Dunciad.

The enthusiasm of these men for describing the sewage, of which the Fleet’s waters seemed largely comprised, was hardly less. Jonson’s ‘voyage’ was taken down a river where “Arses were heard to croak, instead of frogs”. His Fleet contained the contents of every ‘night-tub’ from an overcrowded metropolis, where “each privy’s seat/ Is filled with buttock” and the very “walls do sweat Urine”. This state of affairs is compounded by the diet of a city where “every clerk eats artichokes, and peason, Laxative lettuce, and such windy meat”. In 1700, Thomas Brown has his narrator, an ‘Indian’ revealing the strange “Manners, Customs, and Religions” practiced by the various “Nations” of London to his readers, shove an impudent rag-seller into the kennel [1] in the centre of the street with the words:

Tho’ I want nothing out of your Shops, methinks you all want good Manners and Civility, that are ready to tear a New Sute (suit) from my Back, under pretence of selling me an Olde one; Avant Vermin, your Cloaths smell as rankly of Newgate and Tyburn, as the bedding to be sold at the Ditch-side near Fleet-Bridge, smells of Bawdy-House and Brandy.

Brown’s tone is lighthearted and playful, but some of the associations he makes are telling. The visceral nature of these accounts certainly reflected a literal reality but they also had a metaphorical dimension in which it was the excesses and vices of London itself which were clogging up its abused waterways. The writers were playing, not just on the Fleet’s role in waste disposal, but also on the reputation of those who occupied its banks. In Jonathan Swift’s A Description of a City Shower, in particular, a storm washing through London links the different areas and strata of the city together through its flow.

The Fleet flowed past Bridewell and the Fleet prisons and through areas such as Clerkenwell, notorious for sheltering heretics, thieves, and prostitutes from the arms of the law. Here the bodies floating downstream alongside the unfortunate cats and dogs might be human. The industries around the river were messy and disease was known to cling to its slums. The Dunciad plays on the Fleet’s use as an open sewer by having the hack-writers, who are one of the principal subjects of Pope’s ire, swim in it. The implication was as clear as Pope’s Fleet was ‘muddy’. Much later, Charles Dickens’ child-warping pick-pocket, Fagin, would have his den alongside the Fleet.

From the early attempts by the Carmelites to keep the river unblocked to the late seventeenth and early eighteenth century attempt to make it serve as a canal, the smell and the constant need for dredging could not be overcome. So impossible was it to contain the flood of effluent that, even after the river was paved over during the later part of the eighteenth and early part of the nineteenth centuries, the build-up of trapped gas exploded near Blackfriars in 1846, taking out three posthouses and a steamboat in the process. It must have seemed as though the truth would not be hidden beneath the streets. Eventually, however, the Great Stink of 1858 preceded a concerted effort to enclose the city’s sewers and a London more familiar to us today emerged.

Dr. J.V.P. Jenkins is a historian and freelance editor from London. He earned his BA, Master’s, and Doctorate at Swansea University. He is the new co-editor of Dirty, Sexy History and sometimes tweets @JVPolsomJenkins.

Sources

Brown, Thomas. Amusements serious and comical, calculated for the meridian of London (1700)
Dickens, Charles. Oliver Twist (1839)
Jonson, Ben. On The Famous Voyage (c.1612)
Pope, Alexander. Dunciad (1728)
Swift, Jonathan. A Description of a City Shower (1710)
Ackroyd, Peter. London: The Biography (Anchor; New York, 2003)
Brown, Laura. Fables of Modernity: Literature and Culture in the English Eighteenth Century (Cornell U.P., 2003)
Gray, Robert. A History of London (Taplinger; New York, 1979)

[1] An open gutter, running down the middle of the street. The 1671 Sewage and Paving Act had prescribed moving the kennel from the center of the street to an open side drain set off by a raised pavement. The main thoroughfares were also to be cambered (built up in middle for drainage and paved) but these measures were not instantly applied to all streets.