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-- pathological anatomy provides basis on which surgeons and physicians can collaborate

-- common basis for understanding disease and its treatment
-- medical conditions understood in terms of local lesions

-- i.e. reinforces an important shift in thinking about and identifying medical conditions

-- from generalised disruption of the whole body, and treatment of the whole person
-- to localised lesions, to be identified and treated by physical and surgical means

CONTINUING RISE OF SURGERY

-- continuing growth of hospitals esp. in new industrial towns
 
 -- inc. specialist surgical hospitals during C19

-- surgeons now entering ranks of generalist elite

-- i.e. laying claim to knowing all of medicine

-- pathological anatomy reinforces surgeons’ ambitions to expand their practice

-- now begin to attempt more invasive operations, inc. penetrating the abdomen

OVARIOTOMY

-- i.e. surgical removal of ovaries for treatment of ovarian cysts and tumours

-- 1809 Ephraim McDowell first excises an ovarian cyst

-- publishes in 1817

-- first British trials early 1820s

-- over 130 tried in Britain by 1851, mortality c. 50%
-- much controversy at this time

-- mortality reduced to 10-15% by the 1870s

-- now increasingly deemed acceptable

-- other operations follow

-- removal of gall bladder 1879
-- appendectomy for appendicitis in 1880s
-- surgery for brain tumours from 1880s
 

WHY OVARIOTOMY?

-- alternative treatments are available for ovarian cysts

-- medication
-- paracentesis
--> controversy in 1850s/60s over best methods of treatment

-- women as domestic animals

-- John Hunter 1750s and “spaying” of women
-- ovariotomy likened to vivisection
-- women’s bodies as acceptable site for surgical experimentation

-- women identified with their reproductive functions

-- ovariotomy used for other gynaecological complaints inc. dysmenorrhea, period pains, and sexual “problems” inc. masturbation and nymphomania
-- development of other gynaecological operations -- cancers, fibroids, hysterectomies

-- gynaecology as a site for surgical specialisation through the development of dramatic form of surgical skill
 

ANAESTHESIA

-- William Morton, American dentist, uses ether for extraction of teeth in mid-1840s

-- used at Harvard for excision of a neck tumour 1846

-- chloroform used by Edinburgh surgeon and obstetrician James Young Simpson 1847

-- becomes popular in surgery and childbirth
-- used by Queen Victoria

-- why now?

-- effects of ether, nitrous oxide already known by later C18
-- other controls already used for e.g. amputations
-- https://www.51lunwen.org/englishpaper.htmlanaesthesia makes more delicate operations possible -- esp. operating in the abdomen
-- i.e. not pain relief so much as technical control