r/AskHistorians • u/JaBiDaRadim • Oct 06 '19
"In those days, "surgeons operated in blood-stiffened frock coats – the stiffer the coat, the prouder the busy surgeon", "pus was as inseparable from surgery as blood", and "Cleanliness was next to prudishness"" How would this make sense in the light of the miasma theory? Wouldnt everything reek?
"He quotes Sir Frederick Treves on that era: "There was no object in being clean...Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head""
I see these quotes quite often (taken from here: https://en.wikipedia.org/wiki/Robert_Liston) and it makes little sense to me. All of that should reek. If I believed in miasma, and everything I owned smelled incredibly bad, would I not believe its spreading disease? Furthermore, most doctors saw themselves as gentleman and were proud of keeping themselves clean. Why would they make an exception here?
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u/fikstor Oct 06 '19
So the answer went beyond the reddit limit for posts so it is split in to a parent comment and then it continues as a reply. I've seen this done in reddit before and hopefully I didn't fudge it.
The question is hard to answer is a straightforward manner. It had to do, as other posters have mentioned, with the need to appear respectable to the patients. Medical knowledge was lacking in several areas and while it is true that the "miasma" theory was prevalent it was not seen as the sole source of disease, for example a broken bone from a fall had nothing to do with miasmas. Thus, the miasma theory was mostly sued to explain what we would now call "infectious" diseases. Surgical treatments were prescribed for very specific diseases which might not have a "miasmatic origin" and would then not be affected by miasma or bad odours. The intersection of miasma with surgery is highly interesting and worthy of an extended post but today I shall focus on the myth of the "blood caked" coat.
By the early to mid-nineteenth century, surgery was shifting from its previous trade and artisan associations to the beginnings of a profession complete with the associated infrastructure of colleges, learned societies, qualifications and finally incorporation into standardized medical degrees. Thus, the newly acquired status of the surgical professional was a prized possession, not least because it was seen to attract potential patients and increase income.
As an aspirational profession, surgery was heavily promoted by its leading lights as one in which every practitioner was cultured, urbane and well-educated; but the very novelty of this situation meant that surgeons’ standing and status had necessarily to be constantly and consistently signaled to a public whose actual perception of surgeons’ status and activities must have hovered somewhere between that of butchers and joiners, hence the common if unflattering term for surgeons: “sawbones.” However, with the standardization of medical qualifications not being universal or necessarily expected until the end of the nineteenth century, the quacks, or unqualified practitioners, continued to rely on eighteenth century flamboyance, extravagance, exoticism and a bit of showmanship as the time-honored way to attract patients.
As a contributor to the Australian Medical Journal in 1871 noted, the image of a “quack,” as seen by the medical establishment of the period was of “[one] whose lips are oily, whose words are musical … [His] garments are faultless; his jewelry is costly and abundant; his locks anointed and he exhales an odor of frangipani” (1) As far as regular surgeons were concerned, a surgical operation was perceived as a major event for a patient and their family (or even literally, for the less fortunate, a “life passage”) and as such should be performed with reverence and dignity; so the aim of the surgeon would be to maintain his dignified persona while accomplishing a necessarily disordered procedure.
Generally, up until the nineteenth century, surgeons had performed (very infrequent) “capital” (major) operations in their street clothes with the only concession to what was, in effect, manual labor, being the removal of coats and the rolling up of shirt-sleeves, usually during a particularly physically taxing and bloody procedure such as a major amputation. This state of relative undress gave the surgeon freedom of movement, indicated vigorous and rapid activity (necessary in the days before anesthesia) and preserved his clothes from potential extensive blood and tissue spattering which would have been both obvious and difficult to remove. As J. Collins Warren noted, “The surgeon’s toilet was regarded as a post-operative ceremony” (2).
Change, however, was on the horizon for both the practice and perception of surgery: change ironically encapsulated in the somewhat anachronistic 1912 portrait of the eminent early nineteenth century British surgeon Robert Liston (Figure 1), depicted as the archetypal agile, adept and rapid eighteenth century operator stripped down to his shirtsleeves, as described above. Liston would have been much more likely to have kept his coat on and has actually been described as operating “in a bottle-green coat.”(3)
Nevertheless, this reinstating of respectability did not take into account the continuing problem of spillage and soil onto the surgeon from the operative procedures: hence the perennial surgical story of the frock coat “stiff with caked blood” (4). This story seems to have originated in the reminiscences of elderly surgeons intent on painting a grim, dirty and bloody picture of the nineteenth century surgery of their youth (5-9) . Their aim was no doubt to emphasize the progress made in surgery in the last part of the nineteenth and the early twentieth centuries and to make an obvious distinction between the two — a distinction that may not always have existed in reality, given that in any field there is always more continuity than change.(10)
However, the legend of the “blood and pus soaked” coat, so frequently mentioned in reminiscences, served well as a rhetorical marker of all that had been wrong in the bad old days of surgery. The legend of the “blood soaked” coats may also have originated, at least in part, from the time-honored habit of “downscaling” older, much worn clothes, either to others (servants or second-hand clothes dealers) or for wear on less formal occasions, rather than getting rid of them altogether. Men’s clothes in particular, before the advent of ready-towear and the “high street tailor,” were much too valuable to discard, so surgeons simply followed the general custom of utilizing their “second best” coats for their “work”; thus the coat worn for formal ward rounds or “coat tail visits” as they were referred to at the Massachusetts General Hospital in the 1880s (11), would be downgraded to the operating coat.
As J. Collins Warren noted in his nineteenth century reminiscences of surgery and surgeons in Massachusetts General Hospital, “Antiquated broadcloth coats which were no longer fit to perform their ordinary duties were used [for surgery]”(2), an observation echoed in the comment of W. T. Hayward describing surgery at Liverpool Hospital in 1871: “the [surgeons] wore frock coats … the coats had evidently done good service for some years in another capacity” (12). The matron of Prince Alfred Hospital in Sydney (later Royal Prince Alfred) also confirmed that before an operation in 1882 “the surgeon would remove his coat and don an older coat kept at the hospital for this purpose” (13).