Abstract
In their interesting article on the future of surgery, 1 the authors state: ‘With increasing knowledge of internal organs, from the mid-19th century, surgeons were able to consider entering body cavities … yet little surgery was performed within the abdominal cavity because of the risk of introducing infection …’
This is wrong. The reason why the abdominal cavity was ‘out of bounds’ was because the patient was, until Morton’s demonstration of ether anaesthesia in October 1848, not only awake, but usually writhing and screaming. Anyone who doubts this only need to read Fanny Burney’s account of her awake mastectomy in 1811. 2
It was the extraordinary rapid uptake of safe anaesthesia over the next few years (with deep ether also providing muscle relaxation) that led to the golden age of abdominal surgery, with many of the great eponymous operations being pioneered over the next 25 years.
It is not unusual for surgeons to forget or downplay the role of the anaesthetist but in the context of this paper it might behove Hughes and Macintyre to remember that even when they have been replaced by a robot, the patient will still need the skill of a competent anaesthetist to ensure safety and insensibility when undergoing the traumas of surgery.
