Many factors limited the number of surgical operations performed in those days. Lack of successful anesthesia and measures to prevent infections barred the study of living pathology so that the profession could not know of the great fields of human disease which could be relieved by surgical treatment. As an example, consider appendicitis. Today laymen ask what was done about this disease before it was learned that it could be cured by operating. The present writer does not think appendicitis was as frequent one hundred years ago as it is today, because of difference in diet in the two periods; but undoubtedly the disease did exist, as did other affections of the digestive system which now are amenable to surgery. Therefore operative pain delayed the knowledge of pathological conditions in the abdomen, and without this knowledge surgeons could not advise laparotomy. Even had surgeons been reasonably sure what was going on in the abdomen, the dread of pain would have deterred patients from submitting to operation; and so people continued to die from undiagnosed abdominal lesions. When operating was done, as Trent15 writes: "For all patients the experience entailed severe nervous shock and a long period of depression to follow, conditions which interfered seriously with the healing of operative wounds, and greatly protracted convalescence."
Expressions like "It takes nerve and a steady hand to be a surgeon" originated in pre-anesthetic days, when there was truth in such a declaration. Operating without anesthesia, with a struggling, groaning, or yelling patient as a subject, even if one were absolutely sure of his anatomy, he must be extremely careful lest his hand might "slip," and cut something which did not require surgery. The often-quoted sentence from the American surgeon, Valentine Mott, indicates the difficulties under which the surgeon of pre-anesthetic operations labored: "How often, when operating
