I was pleased to read Janet Smith’s recent review of the state of SA surgery and how it continues to be world class. Though I wonder what it might be like in a few years’ time now that medical students are no longer selected on merit.

It cannot possibly be as bad as it was in my grandmother’s time.

This was brought home to me when I heard of an exhibition in New Jersey containing three vertebrae from the body of President James A Garfield, assassinated in 1881. My granny was born about then.

The bullet lodged harmlessly in some fatty tissue. Today Garfield would have been out of hospital in a jiffy. In 1881 he didn’t stand a chance though he clung to life for three months. Garfield’s doctors failed to find the bullet despite a dozen of them digging into the wound, often with unsterilised instruments. Sterile techniques were considered fastidious.

No anaesthetics either.

Helpful letters from citizens poured in – one suggested turning the president upside down to see if the bullet fell out. Medicine has come a long way since.

Garfield was fed rectally with whiskey and drops of opium. The assassin’s defence was that Garfield’s doctors killed the president. “I just shot him,” he said. He was hanged all the same.

But out of morbid fascination let’s go back another 200 years… We are in Charles II’s time and he is bedridden.

He has a kidney complaint and is surrounded by the finest medical brains in England.

They bled some of his royal Stewart blood, that being a stand-by cure for just about anything in those days. Except, one supposes, haemorrhaging. A dozen doctors scarified his flesh; cut off his hair; blistered his scalp; smeared tar mixed with pigeon dung on the soles of his feet; blew powder up the royal nostrils to induce sneezing to release “the humours in the brain”; poured concoctions down his throat to make him throw up; and purged his bowels.

He was given “spirit of human skull” from a hanged man’s skull; frequent gargles and tonics and ale, broth, cowslip (which is quite poisonous), manna, mint and bezoar (from a hairball in a goat’s stomach). Mercifully doctors decided against the “stomach brush” – a bottle brush on the end of a long wire which patients swallowed with lots of water and which was then worked up and down Roto Rooter fashion.

On day five Charles did the intelligent thing – he expired.

Charles was lucky that he did not require surgery. Surgeons were something else. Until the decade in which my maternal grandmother was born they were generally uncouth and cynical.

Even today I have heard the typical orthopaedic surgeon described as “strong as an ox and twice as smart”.

Surgery evolved partly from barbers who traditionally lanced boils, pulled teeth and did the occasional amputation. (“Like a little trimmed off the sideburns while we sharpen the saw, sir?)

Their universities were usually the battlefields where they learnt that quick amputations were important, there being no anaesthetics.

Barely a century ago James Simpson’s invention of anaesthetic (chloroform) enabled surgeons to work at a more reasonable pace but the survival rate remained low. This was because almost within living memory surgeons operated in their street clothes or wearing a jacket crisp with blood from previous operations.

When, in the 1890s, sterile techniques were introduced, many scorned it in the operating theatre just as some had scorned anaesthetics. In fact when a pioneering young English surgeon wore a white coat and rubber gloves to an operation, those looking on laughed and laughed.

Pure theatre it was.