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There are some stories that act like fractals. They contain intricate patterns that zoom down into finer and finer detail, so that in the end, what first seemed like a simple concept actually contains an entire world. We have found one such story.
Dr. Nicholas Tilney, professor at Harvard Medical School and transplant surgeon at the Brigham and Women's Hospital, wrote a book on the history of surgery in Boston, focusing on one woman in 1913 named Mary Agnes Turner. Tilney joined Radio Boston co-host Meghna Chakrabarti to talk about his book, "Invasion Of The Body: Revolutions In Surgery."
- Dr. Nicholas Tilney, transplant surgeon at the Brigham and Women's Hospital, author of "Invasion Of The Body: Revolutions In Surgery"
Meghna Chakrabarti: The book really has to do with the entire history behind the art and science of surgery. Something that Tilney knows a lot about.
The kind of major organ transplants Tilney used to perform were totally unimaginable in Mary's time. But that doesn’t matter because Mary is unique.
Dr. Nicholas Tilney: She did something rather unusual at the time, which was Jan. 22, 1913. She went across the street to the new hospital.
Back then, it was the Peter Bent Brigham Hospital, an institution dedicated to the “care of sick persons in indigent circumstances in the county of Suffolk.”
Mary had varicose veins, most likely caused by a lifetime of work as a maid in one of the great houses on Beacon Hill.
Trundling up and down stairs carrying things and living basically a miserable existence
Plus, she’d given birth to five children. So, Mary ends up in terrible pain from the swollen, serpentine blue veins running down her legs.
She goes to the doctor.
She seemed a little bit brave to me.
Because for the past century and a half, the poor only went to the hospital as a last-ditch measure of desperation, never expecting to come out.
But brave Mary Agnes, she went in...
And the surgeon she consulted, David Cheever...
Cheever’s as blue-blooded as they get. Harvard College grad. Family full of doctors going back to battle surgeons in the Revolution. Dr. Cheever says, “Mary Agnes, you need surgery.”
Now, since she’d spent so long as a domestic servant, maybe it just didn’t occur to her to question the patrician dictates of a powerful male doctor.
I think that was common until well into the 1950s and 1960s.
Which is the first hint about why Mary Agnes is so special. Her relationship with Dr. Cheever is unlike anything we have today.
Now, there’s much more skepticism about doctors, about medicine, about opinions.
But not Mary Agnes. She says, “Yes, Dr. Cheever.” And is admitted for the first every surgery at the Brigham. This was in 1913.
But get this. She’s admitted three days before her surgery. Three long, luxurious days before to get blood and urine tests, to get to know the staff.
And then, the day comes. She’s lifted out of her bed by a gentle giant of a man.
The orderly was a huge factotum of a man named Adolf. Adolf Watska. And Adolf didn’t say anything, but he used to carry the patients in his arms to the operating room.
And he does this, tenderly, for Mary Agnes. He lays her down on the table. And then steps back into the shadows. Everyone else in the operating room wears face masks except Adolf.
Around the turn of the century, maybe a little bit before, masks came in.
But they don’t become mandatory in operating rooms until after WWI. So for Mary Agnes’ operation, the chief surgeon, Harvey Cushing, doesn’t make Adolf wear a mask.
And apparently Adolf said he never breathed — he never breathed — or spoke, while in the room. Cushing somehow allowed him to get away with it.
The operating room itself was brand new.
The floors were polished wood.
The furniture was cast iron. A couple electric bulbs dangled over the operating table. But most of the light came in through a big window in the outside wall.
This sounds totally primitive. Could you imagine performing surgery like that?
Then how did they do it?
I mean in our view, in our context now, it’s incredibly primitive. But then it was really the top of the drawer.
We’re talking state of the art here, 1913 cutting edge. There are no surgical scrubs in Mary Agnes' operating room. No latex gloves. No autoclave instruments or red bio-hazard disposal bags.
Well, that was the way it was for a very long time, until well after WWII. And in Mary Agnes’ time, at the end of each case, a nurse was directed to gather up the blood-soaked sponges off the floor. She collected the rubber gloves, she collected the gowns, she washed them all, or had somebody wash them all.
For later use?
In fact, when I was a college student, one of my jobs was to wash and powder gloves for reuse. This was in the 50s. We didn’t have all the disposable stuff. I’m sure cotton was expensive. So they just used them over and over and over again. Just wash and wash and wash.
So, there is Mary Agnes Turner, lying on a cast iron operating table, covered with a thin blanket, staring up at a newfangled electric light bulb, pouring her focus into that one, small point of light. Holding on, because she’s about to hand over her body, her soul, her consciousness, to a bunch of men she hardly knows. I mean, Dr. Tilney, when you think about it, Mary Agnes had to be scared.
Well, it’s total terror, to tell you the truth!
But is it really that bad? No. In fact, Mary Agnes is lucky. She’s having her varicose veins removed just after one of the most spectacular developments in modern surgery.
And this was a revelation.
Mrs. Turner indeed received anesthesia. Anesthesia of course came in 1847, at the Massachusetts General Hospital with the use of open drop ether.
But going under isn’t exactly a walk in the park.
Well, you felt as if you were suffocating.
So to stop her from fighting against the feeling, doctors have to hold Mary Agnes down as she loses consciousness. But, if you think that’s bad, consider what the alternatives were.
Throughout human history, surgery had been a torture chamber.
How bad was it?
During the 16th and 17th century, to make things even worse, blood was controlled with red-hot cauteries and/or boiling oil. So you can imagine the absolute anguish.
And it doesn’t get much better when you hear what standard operating procedures were for, say, an amputation in the 18th century British Navy.
The patient was tied to a table. He was doped up with wine and laudanum. He was bled to make him weak. They got a drummer to drum a beat in his ear presumably to keep his mind off of what was happening down below. It was absolutely horrible.
It sounds beyond awful. But Mary Agnes doesn't have to suffer like that. She gets anesthesia, and loses consciousness. Her body goes limp. And the doctor is ready to make the first cut.
He used a new technique called internal stripping.
But, let’s hit pause for a second and zoom in on that bright, flashing, steel scalpel. It’s got a magnificent story all its own. A history within a history.
The scalpel is 8,000 years old. Back then humans used flint to knock open their skulls to relieve melancholy and epilepsy.
If someone was acting a little crazy, they would in fact pierce through the skull with a saw or knock a hole in it with a flint.
And then we go from flint, to bronze (the Romans), to iron (the Middle Ages) and then to steel (the American Civil War, lots of amputations), and then...
The modern scalpel really came from Mr. Gillette, of the razor blade company.
The best a man can get. He perfects the detachable, disposable safety razor. And by 1915, just after Mary Agnes has her surgery, the modern scalpel is perfected and its basic design has been in use ever since.
The story of the scalpel tells us something else. It tells us that much of modern surgery as we know it today comes as the result of experiment, or happenstance, or war.
The very fact that doctors even understood that Mary Agnes’ varicose veins were caused by malfunctions in her circulatory system, even that kinda happened by accident, because In the 17th century, an English physician named William Harvey had a patient — a young nobleman — who had a huge, infected wound in his chest.
Harvey was able to stick his fingers in the hole and feel the heart beat.
A warm, live, human heart, beating and pushing and pumping blood.
He also confirmed this in animals and also in other dissections.
And voila! The discovery of the vascular system. But, as things often go with radical discoveries, Harvey’s own fellow surgeons bellow most loudly against his discovery.
Surgeons are people who are very much take-charge people, and I think like most of us, they don’t like change, even though it seems incredibly obvious.
But science finds a way. The knowledge sticks.
And now we return to Mary Agnes Turner, the domestic servant with varicose veins, the first surgical patient at the Brigham in 1913.
Surgeons strip the distended veins from her legs. They tie it off with cat gut, sucher up the wounds, and then wheel her to the ward, where she enjoys a gentle 10-day post-operative recovery.
Probably not because she had to be there, but she was the first patient, they liked her, they took care of her, and she went home after 10 days completely healed. And it was a thoroughly satisfactory experience for her.
She had a good time?
Well, I think she didn’t have a bad time.
And how much did this all cost her?
Wow. Now, Mary Agnes' story has one last surprise for us. It’s been 98 years since she checked into the Brigham.
Since then, there’s been a burgeoning of medicine, there’s been a burgeoning of pharmacology, there’s been a burgeoning of surgery.
Surgery has, in fact, become so ambitious and so common that there are 85,000 elective cases done every week day in this country.
And that’s per day?
Per weekday. I mean, isn’t that staggering?
It is. And this is where Dr. Tilney shakes his head in wonder and disbelief. He says no matter how ubiquitous or technological or routine surgery gets, there’s something about it that does not change. It’s this idea that to fix, we must cut. That in order to heal a body, we must invade it. And that remains as spectacular and audacious an act today as it was when Mary Agnes Turner first checked into the Brigham Hospital in 1913.
This program aired on November 10, 2011.
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