Columnists
Let's Reminisce: A brief history of surgery
By Jerry Lincecum
Oct 5, 2020
Print this page
Email this article

Here’s a maxim that might have been voiced by my ancestor Dr. Gideon Lincecum (1793-1874): “A chance to cut is a chance to cure.” Confidence in the powers of surgery extends back to the most ancient roots of the field of medicine. There are Neolithic skulls dating from 6500 B.C. with holes that testify to trepanation, a treatment that involved drilling through the cranium, presumably to let out malign spirits.

For much of Western history, however, surgery lay somewhat apart from the practice of medicine. Hippocrates was leery of it, writing, “He who wishes to be a surgeon should go to war” reflecting the idea that the crude practices of the battlefield were seen as “the work of hand not head.” This suspicion bred an enduring medical division of labor, in which many healers viewed surgery as inferior. Well into the modern era, surgical procedures were the province of the barber, along with pulling teeth.

But in the eighteenth century the discipline made its first steps on a journey toward respectability. This progress was accelerated by a number of developments. Surgeons picked up new ideas in schools of anatomy, as they dissected cadavers. Since the nineteenth century, anesthesia has made operations more feasible. Hand washing and the sterilization of instruments dramatically reduced the rate of infection from procedures.

By the late 1800s, surgeons did the unthinkable: Instead of just operating on people at the point of death, they began the practice of elective surgery. Progress boosted the stature of surgeons from the lowliest to the recognized. Once dismissed as little more than butchers, surgeons became so trusted that patients with conditions that were merely inconvenient, annoying, or even just ugly felt secure enough to go under the knife.

In the 20th century, the discovery of antibiotics further reduced the risk of fatal infections after surgery, and a host of other innovations have brought the discipline to the point where brain surgery is a byword for something sophisticated and difficult. Ultrasound, CT scans, and MRI scans now make it possible for surgeons to see what they will cut before the patient is even on the table. When I suffered a torn cartilage in my right knee as a football injury, we did not hesitate to have it surgically repaired and there were no complications.

Nowadays some surgeons are known for their success in the replacement of entire joints, especially shoulders.  We are looking toward a time when surgery will mostly involve not the extraction of diseased tissue but the placing of an artificial body part or other device within the patient.

In this country today, joint replacement is commonplace, increasingly just another rite of passage in aging. Consider the numbers: In 2014, surgeons replaced 522,800 hips, 723,100 knees, 90,000 shoulders, 15,000 elbows, 16,000 finger joints, 12,000 toe joints, 2,000 ankles, and 2,000 wrists—a total of nearly 1.4 million procedures. By 2030, according to one estimate, there will be some four million a year. Along with metal and plastic implants, there are electronic implants, such as cardiac pacemakers; biological implants, such as a transplanted heart or liver; and organic ones, in which a patient receives a graft of sterilized non-living tissue, such as bone or a hamstring, from a deceased donor.

Implants such as pacemakers and cardiac stents are clearly lifesaving, and joint replacements, by keeping us mobile, also extend and improve our lives. But the benefits of other devices are more questionable. Some have even proved to be life-threatening, yet implants continue to be marketed with scant oversight.

In 2015, the F.D.A. received around sixteen thousand reports of deaths associated with medical devices. What’s more, a study by the Government Accountability Office estimated that 99% of such “adverse events” are not reported in the first place, and noted that the “more serious the event, the less likely it was to be reported.”

The root of the problem, of course, is money. In medicine, progress is driven by innovation, and, in our society, innovation is driven by profit. “Among implant manufacturers,” one expert writes, “market analysis drives research and consideration of device innovation.” When we submit to being cut, and to having something implanted in our body, we should have a right to feel some level of confidence that it has been shown to be safe and beneficial, meaning that it has a chance to cure.

Jerry Lincecum is a retired Austin College professor who now teaches classes for older adults who want to write their life stories.  He welcomes your reminiscences on any subject: jlincecum@me.com