Technology and Safety: History of the Operating Room

Before the Operating Room: Magicians, Priests and Physicians

The development of surgery occurred in different regions at different times, in China, India, South America, Mesopotamia, Persia, Arabia and finally Europe. The early surgeons were either priests, magicians, physicians or barber-tradesmen who understood anatomy and were comfortable with the common practices of amputation and trephination.
Trephination is perhaps the oldest of surgeries that we know of. Because it involved cutting or grinding a hole in the skull, remnants are plentiful, as human skull bones have lasted for as many as 12,000 years intact. Neolithic evidence of trephination has been found in many disparate civilizations, from the pre-Incas in South America (2000 BC), to the early Europeans in France (5100 BC), to the Egyptians extending back as far back as 8,000 BC. The practice was probably originally performed for spiritual and magical reasons, and was performed by kings, priests and magician-physicians. It later was used to relieve pressure for head injuries, seizures and mental disorders such as psychosis.

Greece: The first surgical training program

“A physician is worth more than several other men put together, for he can cut out arrows and spread healing herbs.” (Iliad, Book XI) Greek surgeons were trained in semi-formal schools called Asklpieia. The result of this training resulted in a uniformity of medical and surgical practices that laid the groundwork for the modern training programs that would follow many centuries later.

Greek surgical techniques were mostly learned on the battlefield, where arrows were removed, wounds covered, tourniquets and vasculature ligatures applied and amputated limb wounds were closed. There were surgical specialists in some areas of gynecology (abortions were preformed, children birthed, infections drained), but most other surgeries did not include opening any cavities in the body, a practice that would last until the 19th Century.

Rome: The birth of the operating tent

The modern operating room is descended from the Roman military tent and hospital system that was perfected to a degree not matched again until the time of Napoleon. The first Roman Medical Corps was formed by Emperor Augustus. Medical professionals were required to train at the new Army Medical School and could not practice unless they passed stringent examinations.

The Roman military surgeon was called the “medicus vulnerarius,” the “wound doctor.” Roman military surgeons and their counterparts, the specialist arena surgeons (who maintained the health of the valued gladiators) were extremely proficient not only with their surgical techniques, but also in the organization of their infrastructure.

The medicus vulnerarius was in the field with the soldiers during battle, and managed a system that included surgery in the field, an ambulance team, and 2 receiving battlefield hospital tent systems located on opposite sides of the field. The tent system moved with the army.

Germany, France, Austria, England, America 1800 – 1900

Large, city-based charitable hospitals arose out of the medieval monetary medical care system in Europe during the late 1700's to care for the poor and indigent. Leading cities in Europe developed the operating theater as the venue for both operating and teaching. These theaters were modeled after the dissection theaters that gained fame in Padua, Leiden and other largely Italian cities. In 1822 the St Thomas’ Hospital built its operating theater, and in 1824, in Boston, what was to become known as the Ether Dome was built. These theaters remained the standard until the full acceptance of Semmelweis’ and Lister’s antisepsis regimens lead to the inclosure of the operating room and the introduction of sterile technique.

World War II and the Korean War

By World War II, the military hospital tent system was expanded to include the peripheral-style design for operating rooms that allowed for multiple patients to be operated upon simultaneously. All necessary components could be powered and supported from any location within the tent, so that a single tent had the flexibility to allow for a variable number of casualties to be operated upon at any time.
This peripheral design reached its zenith during the Korean War, with the development of the MASH (mobile army surgical hospital) concept. This format was the basis of modern operating room design, with support systems coming into the room from the periphery.

Photos of Operating Rooms through the 1900's