378 | ANNUAL REPORT SMITHSONIAN INSTITUTION, 1946 
wounded that they were unable to move along with the advancing 
troops were put to the sword. The able-bodied but wounded soldier 
who fell into the hands of the enemy could only expect to be insulted 
or mutilated, if not killed. During the Middle Ages some men of 
doubtful qualifications made it their trade to treat soldiers for a meager 
stipend just as mercenary soldiers took up warfare as a business. 
Field hospitals were introduced by Isabella of Spain around 1487, and 
they were later reintroduced by her grandson at the siege of Metz in 
the sixteenth century. There Ambroise Paré was a central surgical 
figure. He was responsible for abolishing the custom of applying 
cautery or boiling oil to wounds. In the seventeenth century the 
regimental surgeons were still referred to as staff barbers and that is 
about what the great majority of them were. 
The development of surgery was hampered by the lack of means 
for controlling pain and it was plagued by the high mortality which 
attended it. Such surgical deaths were due to hemorrhage, traumatic 
shock, and infection. Infection was a concept wholly unfamiliar be- 
fore the nineteenth century. A favorite method of procedure of 
eighteenth-century surgeons, as well as of those who preceded them, 
was to probe wounds. The probes were not sterilized and often were 
not even washed. The surgeons themselves wore their oldest frock 
eoats in the operating room. To these coats, often heavily encrusted 
with dried blood and pus, some surgeons even attached an aura of 
superiority. 
Surgery in the eighteenth century consisted of the setting of broken 
bones, the probing and suturing of wounds, the amputation of crushed 
or gangrenous limbs, and the opening of abscesses. No one dared to 
attempt abdominal surgery. Operations for gall-bladder disease, 
thyroid disease, and cancer, which make up so large a part of a sur- 
geon’s work today, were unknown. Appendicitis had not been 
recognized. 
It was at the turn of the eighteenth century that one of the many 
dramatic events in the history of surgery took place. In Danville, 
Ky., on Christmas Day, 1809, Ephraim McDowell performed in his 
own home an operation such as had never been done before. This was 
the removal of a large abdominal (ovarian) tumor, without the benefit 
of anesthesia, and without the aid of adequate methods for stopping 
hemorrhage or for preventing infection. Since her life depended on 
it, his stalwart patient agreed to undergo the ordeal. McDowell’s fel- 
low citizens also knew that the operation was experimental, and it is 
told that a crowd gathered outside of his house with the intention of 
hanging him if his patient should die. Fortunately for McDowell, 
and for the progress of surgery, the operation took no more than 25 
minutes and the patient recovered completely. 
