Wednesday, April 22, 2009

Surgery in the time of THE ELEPHANT MAN

What kind of a cinematologist would I be if I didn't reference the surgery scene at the top of The Elephant Man? A mediocre one, I'd say.

As it happens, just for fun, I've been reading The Greatest Benefit to Mankind, a history of medicine by the late (great!) Roy Porter. The Greatest... can get a little encyclopedic, but Porter's other book, Blood & Guts: A short history of medicine has a lot of entertainment value, especially the chapter in which Porter describes catheterizing a penis with mercury as a cure for syphilis. Off topic I know, but the book is fascinating.

Where was I? Oh yes... When Fredrick Treves met J. Merrick in 1884, Treves was a surgeon at London Hospital. At the beginning of the film we see him (Anthony Hopkins) performing surgery on a man who has apparently been in an "industrial accident." In graphic black and white we see the man's open bloody abdomen rising and falling with his breath as the hospital staff work to save his life. The surgeons wear smocks, with cuffs protecting their shirtsleeves. They are bare-handed, they aren't wearing masks, and their breath and their hair can go anywhere, including into the patient's abdomen. Come to think of it, the patient's own hair from his chest or abdomen can get in there too. Brrr! If the man doesn't bleed to death, he still has a good chance of dying from infection.

By the 1880s, in Glasgow, Joseph Lister (think Listerine) had been working out his theories involving bacteria and aseptic(1) practices, but the idea of doctors being a source of infection themselves (via transmission of microorganisms) was still controversial.

At this point in history, nurses had been trained (by Florence Nightingale and others) to scrub every surface within an inch of its life. But, there was still a popular idea held by doctors and nurses alike, that miasma caused infection and death, not bacteria. Many medical people were willing to believe in bad air, but not in invisible little creatures like bacteria which could be on a seemingly clean surface or even blown around on the breath.

We can hope that in this surgery scene from the movie, some form of antiseptic(2) practice is in place. But at this time, it was common practice to roll up your shirt sleeves and don a surgical smock that was stiff with blood, having been worn by other surgeons previously and not laundered. Facemasks didn't come into vogue until the late 1890s. Rubber gloves were popular in dissection, but didn't get a grip in surgery until the late 80s or early 90s. Antiseptic and aseptic practices were also inconsistent. Lister sprayed carbolic acid all over himself, the patient, and his surgical team to cut down on germs, but he didn't make it a practice to scrub his hands, just dip them in carbolic.

Here we see a shot in the scene with a breathing mask and what we must assume is chloroform, since ether was used in the 1840s for surgery, but replaced by chloroform pretty quickly. Apparently the stuff is safer to use, but I don't know why.

Can you believe that before the 1840s, surgeries (when they were done) were done without anesthesia??? Tumor removal, amputations, gallbladder and bladder stone removal, mastectomies... my various body parts are shrinking at the thought of getting cut into without the benefit of pain killers stronger than gin.

Treves calmly takes a hot poker and cauterizes the patient's arteries, as needed. I thought the smoke in the scene particularly well done. I imagine there would have been a substantial smell to the procedure. I imagine there still is a smell, however these days I believe cautery is performed with an electrical charge or some kind of chemical on a stick, depending on the type of surgery, its location, and the amount of bleeding.

All in all, David Lynch managed to stay true to his own dream state trippy-ness and layer some very interesting medical history into a very poignant story. I highly recommend it.

I've had a request from one of my students: he asked me to describe the mechanism by which Spider-Man can squirt web out of his wrists. Young men and their curiosity about sticky palms! As we all know(3) Peter Parker in the comic strip had a mechanical web-squirting device. In the movie Peter is an organic squirter, so... Look out! ... Here comes the Spider-Man!

1. Asepsis means to exclude all microbes. Something that is sterilized has nothing at all living on it. As a colleague of mine often points out to his students, there is no such thing as partial sterilization.
2. Antisepsis means to prevent microbes from multiplying and getting out of hand, but they are still present, sometimes in a weakened condition.
3. Thanks to my cartoonist husband, R. Sikoryak.


  1. Yum! This makes me crave some barbecue!

  2. I always get hungry for skirt steak or barbecued ribs when I'm teaching a lesson on respiratory musculature. Gruesome, but true.