Not So Long Ago

Manhattan doctors have seldom had a more instructive account of modern progress in surgery than they got recently in the frank, gay, gossipy reminiscences of one famed surgeon. They got it from dapper, renowned little Dr. John Frederic Erdmann, 78 (who still operates and teaches), who just for fun of it got up at Post-Graduate Hospital and told them about surgery as he has known it.

In Bellevue Hospital's Surgical Clinic in 1884, Dr. Erdmann as a medical student saw "Dr. Alexander Mott, dressed in his Prince Albert coat, the sleeves of the coat turned up to show his white cuffs. He made no attempt to clean his hands as we do today but used just enough water from an old basin to lubricate them. There was no anesthesia. The physiology table used for animal demonstrations was his operating table. Mott would put the scalpel in his mouth and possibly several strands of waxed silk or linen. His sponges were the ordinary reef sponges and these he would rinse in an old japanned basin, changing the water in the basin only when it became too bloody to return the sponges relatively clean. The instruments he used were taken out of a mahogany box, the old Civil War carrying case which is now antique, and when he had finished with them they were wiped off and replaced in the velvet-lined box for the next victim."

Patient, Old Style. Dr. Erdmann merrily recalled the trials of the oldtime patient. When asepsis finally came into fashion washing began in good earnest.

The area to be cut was prepared for several days by "scrubbing and wrapping in bichloride solution or carbolic-soaked towels." Later on, the style was to scrub the patient off & on all day with green soap, then soak his skin the evening before the operation with a poultice of the soap. Finally, in the middle of the night, when he might have rested for the ordeal, he was "entertained" by being scrubbed, and the site of the operation was bathed in alcohol and dressed with a wet, sticky poultice to be kept on until the operation. Internal cleanliness was achieved by purging and preoperative starvation--which had the unfortunate effect of producing painful amounts of gas in the intestinal tract.

After the operation the unlucky patient continued to starve. His room was kept dark, and no one approached the bed except when absolutely necessary for fear of shaking it, causing an artery or vein to become untied--"how, I do not know."

Surgeon, Old Style. From tail coats, surgeons progressed to shirt sleeves and rubber aprons, not to protect the patient but to protect the surgeon's clothes. One man wore longshoreman's boots, another "butcher's boots which he never cleaned." Only by gradual stages was the present top-to-toe sterile white achieved.

Dr. Erdmann gives credit for the invention of rubber gloves to the late Dr. W. S. Halsted of Johns Hopkins, who thought them up to protect the hands of a pretty nurse he later married. The hand-washing then in vogue took the skin off doctors and nurses alike. Bichloride and carbonate of soda were used. "There was no question of the liberation of chlorine, nor was there any question of destruction of hands and laundry nor of the corrosion of plumbing." Surgeons worked in cotton gloves.

There was still superstition in the surgeon's lore. "We were taught that a northeast wind was provocative of erysipelas."

Equipment, Old Style. An operation in those days was often performed in a patient's house. The surgeon sent nurses ahead to prepare a room, the surgeon brought his instruments in a metal case to be sterilized on the stove, the family doctor gave the anesthetic. Dr. Erdmann once removed a large gallstone and an ovarian tumor from a large, 70-year-old woman in her home by the light of kerosene-burning auto lamps.

When Lister's ideas of cleanliness came into vogue, style was to keep everything wet with carbolic. Instrument tables were covered in towels wet with the acid, sponges were kept in it, the room was sprayed with carbolic acid until foggy. In those days catgut came in a five-foot coil to be soaked and sterilized by the doctors and "horsehair was obtained by going out to the ambulance stable and pulling out a handful from the tail of one of the horses."

Anesthetics, Old Style. Anesthesia has progressed from chloroform to cyclopropane and local and spinal anesthesia. Dr. Erdmann remembers giving anesthetics for the afternoon clinics during his internship when "most of our patients were truck drivers, wharfmen and the like with strong whiskey, gin or tobacco breaths. We would clap a bootleg cone or a lamp-chimney cone over the face and push the anesthesia until the patient was deep blue. .. .

"Our favorite indoor sports in those days were operating for hernia, breaking legs and thighs for bow legs, knock-knees, tying off hemorrhoids, opening psoas [loin] abscesses, subcutaneously operating for varicose veins, scarifying and chiseling osteomyelitis, traumatic amputations, trephinings [skull operations] for injuries, lifting breasts off for carcinoma and putting up fractures.

"Caesarean sections were done three times during my 18 months in the service with 100% fatality. . . . Thyroid operations were preceded by doses of opium or digitalis or both. In many cases a resection [removal] of the entire gland was done. I, personally, plead guilty. . . . The operation was a very easy one--a complete resection of both lobes and isthmus, with the usual speedy outcome--death within 24 hours."

In the summer of 1893, when the country was in the midst of the free silver debate, President Cleveland secretly had a cancer removed from his upper left jaw. Dr. Erdmann went along. "The yacht Oneida, owned by the late E. C. Benedict, was anchored off the Battery landing. Under cover of darkness the President went aboard, followed by Dr. Joseph Bryant [the operating surgeon]. Major O'Reilly of the Army Medical Corps, a dentist and [three other doctors]. We sailed all night down Long Island Sound, anchored in Plum Gut, and the operation was performed the next morning. It was done in the salon of the yacht, the President sitting upon a chair. ... On this occasion we put our aprons over our street clothes but we did boil the instruments." Cleveland lived for 15 years, died of something else.

Technique. The man who related this surgical back-fence gossip with such gusto did his first operation alone--he thinks it was for hernia -- on a woman at Blackwell's almshouse (now New York City's Welfare Island). He made his fortune during many years of operating on five or more patients a day, becoming the grand old man of Manhattan surgery. His limousine, with driver and red setter in front, the doctor and his sociable wife in back, is a familiar sight on tree-lined 70th Street where he lives.

He owes his popularity as a surgeon to the so-called Erdmann technique, which is not a technique at all, but an amazing speed in operating attained through practice, great anatomical knowledge and never-ending study. There is no Erdmann operation--the doctor never concentrated exclusively on any one area. He would as soon cut off a leg as go after an appendix, is at home in the skull and the thorax. He teaches surgery, but has never been able to teach the Erdmann technique.

One piece of Erdmannia he did not relate: around 1930 Vanity Fair heard of the "technique," readily got permission for famed Photographer Edward Steichen to photograph it in action. Came the day, and Steichen disposed his assistants high in the amphitheater with flash bulbs. The patient, a woman, had hardly arrived on the scene when Erdmann opened up her abdomen from top to bottom with one neat slice. Suddenly, in the rafters, the photographer's assistants lost their lunches and their balances. Steichen gave up for that day. Next time he fortified himself with troops who had been "blooded." After Erdmann's usual greetings to the assembled throng--he always gives a special greeting to the doctor who has referred the patient--he opened the abdomen of the patient, another woman. Then Dr. Erdmann proceeded to probe about in her vitals for a long--in his case a sensationally long--20 minutes. Then he looked up brightly and confessed without embarrassment, "Dammit all, I can't seem to get oriented here." Vanity Fair ran a full-page spread.

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