Credit: Wellcome Library, London. Wellcome Images

Jean Baptiste Marc Bourgery and Nicholas Henri Jacob, ‘Iconografia d’anatomia chirurgica e di medicina operatoria,’ (1841), Florence. Ligature of an artery in the inguinal region, using sutures and a suture hook, with compression of the abdomen to reduce aortic blood flow. (all images courtesy Wellcome Library, London/Wellcome Images)

In 1811, nearly four decades before the advent of anesthesia, the English novelist Fanny Burney underwent a mastectomy for breast cancer. Later, Burney wrote a long letter to her sister, Esther, describing this battlefield-style operation. Her account remains one of the most famous and gut-wrenching descriptions of pre-anesthesia surgery ever written:

When the dreadful steel was plunged into the breast – cutting through veins – arteries – flesh – nerves – I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision – & I almost marvel that it rings not in my Ears still? so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp & forked poniards, that were tearing the edges of the wound.

To learn his surgical technique, Dominique-Jean Larrey, the revered French military doctor who performed Burney’s operation, referred to some of the first medical illustrations ever printed in widely disseminated instructional textbooks. Now, a vast collection of these grotesque but strangely beautiful Victorian illustrations are compiled in Crucial Interventions: An Illustrated Treatise on the Principles & Practice of Nineteenth-Century Surgery, a new book by medical historian Richard Barnett.

Pancoast, 1846. Surgery to correct strabismus, involving the division of the internal rectus of the right eye

To a modern viewer, these surreal drawings might look like torture porn or illustrations for a horror novel. Glaucoma patients’ eyelids are held open with metal clamps, reminiscent of that famous scene in A Clockwork Orange ; harelips are sutured with corset-like stitches; step-by-step diagrams illustrate how to amputate arms, fingers, legs, and feet — and those are among the least graphic images. Though they look primitive now, in the 19th century, these highly detailed color drawings represented the beginning of a revolution in the art and science of surgery. Surgeons transformed from scalpel-slinging cowboys in a medical wild west into near-divine heroes.

“The greatest challenge in telling the story of surgery lies in its very nature,” Barnett writes in the book’s introduction, “The Thinking Hand: Surgery as Craft, Art, and Science.” “Like ballet dancers or center-forwards, surgeons rely on forms of expertise gained through experience and observation, which cannot be easily articulated. The images collected here provide a magnificently rich resource with which to think about the visual, tactile, and sensual aspects of surgery.” In a series of essays accompanying the drawings, Barnett traces the fascinating history of surgery from the work of Renaissance anatomist Hieronymus Fabricius to today.

Bourgery and Jacob, ‘Traité complet de l’anatomie de l’homme’ (1840). Incision and two procedures for caesarean section (click to enlarge)

Thanks to anesthesia and antisepsis, modern medical practices allow patients a clinical remove from the bloody business of surgery. The drawings in Barnett’s book are a reminder of how new and how manufactured this privilege of clinical distance is. Well into the 1840s, surgery took place in “noisy, dirty, crowded spaces called operating theaters,” as Barnett writes. Surgeons dressed in street clothes operated on patients screaming in agony. They worked as quickly as possible to minimize blood loss, pain, and shock. Mortality rates were high. Eighteenth century anatomist John Hunter described surgery as “a humiliating spectacle of the futility of science.”

But in the middle of the 19th century, after new medical schools were established and textbooks became more widely available, operating rooms started to resemble the cordoned-off, laboratory-like settings of today. Surgery became a treatment patients might actually choose instead of a horrific last resort. “Surgeons entered culture and literature as High Victorian heroes, and they also entered the aristocracy,” Barnett writes. And as surgery changed, especially after the advent of anesthesia, social understandings of the human body, illness, and mortality changed with it. No longer did patients have to feel “the knife (rack)ling against the breast bone — scraping it,” as Burney wrote in her graphic description of her mastectomy.

The meaning of pain itself changed, too. As Barnett puts it, “for surgeons at the end of the century, ‘If [pain] had a purpose it was to teach people, especially poor people, to be grateful to medicine, not God.’”

An early European anatomical dissection, from Johannes de Ketham’s ‘Fasciculus Medicinae’ (ca. 1493). A learned physician reads from a treatise while a surgeon carries out the dissection.

Pancoast, 1846. Surgery for cancer of the tongue

This scene from an Arzneibuch (a compendium of surgical techniques and medical recipes), compiled around 1675 for a Franciscan monastery in Germany or Austria, shows surgery for lacrimal fistula being performed on a nun. (click to enlarge)

Thomas Johnson, ‘The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French’ (1634). The frontispiece to Thomas Johnson’s English translation of Ambroise Paré’s works

Hand-colored illustrations of a prosthetic nose from Ambroise Paré’s ‘La Methode Curative des Playes, et Fractures de la Teste Humaine’ (1561)

Bourgery and Jacob, ‘Traité complet de l’anatomie de l’homme, vol. 3’ (1844). Vertical cross section of the human brain

Bourgery and Jacob, ‘Iconografia d’anatomia, vol. 1’ (1841). Resection of the lower jaw

Bernard and Huette, 1848. Musculature and blood supply of the wrist and hand

Pancoast, 1846. Sites for ligature of arteries in the lower arm and resection of the arm at the elbow joint

Pancoast, 1846. Compression of arteries in the arm and leg to reduce blood loss during surgery.

Bernard and Huette, 1848. Anatomy of the armpit, and the ligature of the auxiliary armpit

Maclise, 1856. Dissection of a seated man, showing the aorta and the major arteries of the thorax and abdomen.

Bernard and Huette, 1848. Dissection of the thorax, showing the relative position of the lungs, heart and primary blood vessels.

Bernard and Huette, 1848. Surgical anatomy of the large intestine (front view, left) and surgical anatomy of the large intestine (rear view, right).

Bourgery and Jacob, ‘Iconografia d’anatomia, vol. 1’ (1841). Surgical saws, knives, and shears for operations on bone

Bourgery and Jacob, ‘Iconografia d’anatomia, vol. 1’ (1841). Amputation of various toes, and amputation of the toes at the metatarsals

Richard Barnett’s Crucial Interventions: An Illustrated Treatise on the Principles & Practice of Nineteenth-Century Surgery is available from Thames & Hudson.

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Carey Dunne

Carey Dunne is a Brooklyn-based writer covering arts and culture. Her work has appeared in The Guardian, The Baffler, The Village Voice, and elsewhere.