Before the 19th century in France, physician and surgeon were treated as two different professions. Whereas physicians were granted their degrees after a formal, expensive, and highly theoretical education, surgeons had typically been trained by apprenticeship from the Middle Ages roughly until a 1768 royal decree mandated training at the Collège de Chirurgie.1 The era of the "barber-surgeon" officially ended in the 18th century, but the social disrepute of the surgeon—rather like the stink of his craft—hung in the air for decades after. When the Faculté de Médecine at the University of Paris reopened after the French Revolution, steps were taken to eliminate the historic gulf between medicine and surgery: all kinds of doctors and surgeons would be trained at the same institutions, be given the same education—one that emphasized hands-on, practical training in hospitals—and be granted the same degree.2
Surgery was always an extreme measure. It was dangerous, so a patient had to be certain that the potential benefits of surgery would outweigh its substantial risks. Surgeons had to work deftly and quickly, lest their patients die from blood loss or go into shock from the pain. The interior of the body was generally considered beyond the surgeon's reach—attempts at abdominal and thoracic surgery usually resulted in the death of the patient. Amputations (which a skilled surgeon could perform in under one minute) and external tumor removals were the most common procedures.3 Inhalable anesthesia, first demonstrated in 1846, made surgery less painful for patients and less strenuous for doctors and staff.4 More invasive, radical surgeries became possible in the second half of the century, and new theories and practices in antisepsis sharply reduced mortality for postoperative infections. Blood loss remained a problem though, and so-called "bloodless" surgical techniques—like those involving galvanically-heated cauterizing instruments, or loops and écraseurs ("crushers") capable of cutting off blood supply to a tumor or cyst before removal—were valued.5 Later, in the early 20th century, the discovery of blood groups finally made transfusion safe and feasible, further extending the amount of time a patient could spend on the operating table.6
- Ellis, A History of Surgery, 55; Gelfand, Professionalizing Modern Medicine, 3-5, 67-8, 92-97.
- La Berge and Hannaway, "Paris Medicine: Perspectives Past and Present," 1-2.
- Gawande, "Two Hundred Years of Surgery"; Fitzharris, The Butchering Art, 5-8; Ellis, History of Surgery, 73.
- Ellis, History of Surgery, 81-87.
- Mosucci, Gender and Cancer, 62-64.
- Ellis, History of Surgery, 144-5.
- Ellis, Harold. A History of Surgery. London: Greenwich Medical Media Ltd, 2001.
- Fitzharris, Lindsey. The Butchering Art. Scientific American/Farrar, Straus and Giroux: 2017.
- Gawande, Atul. "Two Hundred Years of Surgery." New England Journal of Medicine 366 (2012): 1716-1723. DOI: 10.1056/NEJMra1202392.
- Gelfand, Toby. Professionalizing Modern Medicine: Paris Surgeons and Medical Science and Institutions in the 18th Century. Greenwood Press, 1980.
- La Berge, Ann and Caroline Hannaway. "Paris Medicine: Perspectives Past and Present" in Constructing Paris Medicine, edited by Caroline Hannaway and Ann La Berge. Amsterdam: Rodopi, 1998.
- Moscucci, Ornella. Gender and Cancer in England, 1860-1948. Palgrave Macmillan, 2017.