Medical knowledge improved steadily during the 18th century owing to a better understanding of human physiology, assisted by the popularity of anatomical dissections in medical amphitheatres as a means of tuition for medical students. The use of anaesthetics, infection control and asepsis, although accepted as normal today, remained alien concepts to doctors well into the 19th century, meaning that even basic surgery could be excruciatingly painful and potentially fatal. Speed was often the order of the day. Amputation of damaged or infected limbs could be made in a matter of seconds (usually without anaesthetic, but with a tot of brandy instead), with the excise of cancers, bladder and gall stones and even the removal of cataracts fairly routine procedures by 1800. Distinctions between surgeons and physicians remained. General medicine was practised by the physicians who limited their work to diagnosis and the administration of drugs, while only members of the College of Surgeons were considered qualified enough to undertake operative interventions.
The most prominent surgeon of the age was John Hunter, a Scotsman by birth who studied in London at the Chelsea and St Bartholomew’s Hospitals before becoming a house surgeon in 1756. Hunter is associated with new scientific discourses and the dissemination of surgical knowledge in a number of fields. After time spent in the Army, Hunter was an early exponent of asepsis, refusing to expose battlefield wounds to dissection through fear of infection. Hunter’s wide-ranging knowledge extended to an astonishing number of specialities and subjects: dentistry, the digestive and lymphatic systems and child development. He also built up a huge collection of medical and animal specimens. Today, he is regarded as the father of ‘scientific surgery’.