What surgery was like

Surgery at Great Ormond Street began from the most limited beginnings.

Founder Dr Charles West thought that there was little special surgery worth doing on children. There was a horrific truth in this, because surgery was so primitive, there were few operations worth risking. Nevertheless we soon had a surgeon working with us, and the field of paediatric surgery gradually expanded.

When GOSH was founded in 1852, anaesthetics had just been introduced. But surgeons still worked at high speed, as they did in the days before chloroform and ether.

Not all operations used anaesthetics – it was not possible to do cleft lip and palate repairs unless the patient was conscious and able to help the surgeon! In the 1860s a new anaesthetic delivery gag allowed operations on unconscious children, and the modern practice of operating young began.

There was no real understanding of infection. The Victorian obsession with cleanliness helped, but many children must have died after surgery from infected wounds. A graphic description of a kidney stone operation made it clear the surgeon routinely put his unclean fingers into the wound. Lister wrote his famous article in the Lancet in 1867 advocating carbolic acid as an antiseptic, but it was not until 1877 that we learn it was being used at GOSH.

Then as now, GOSH did not have an accident and emergency service. The most common operations were things like tracheotomy, kidney stones, cleft lip and palate, and operations on tuberculosis of the bones. Even by 1885, it would surprise us to see how little surgery was done. Opening the abdomen or chest, let alone the skull, would not be contemplated.

One modern aid to surgery arrived in 1903 – our first X-ray machine. This is now just one of the techniques used to see inside the child and to plan an operation.

Sir Denis Browne, the first surgeon to work exclusively with children, joined us in 1926. He was a constant innovator and patented an anaesthetic device known as the Top Hat.

From 1945, David Matthews applied plastic surgery techniques developed on Allied airmen injured in the war, to children.

Heart surgery really dates from the 50s (a dedicated cardiothoracic ward opened 1955). It was at this time that techniques were developed to stop the heart and allow more complex surgery. Now we run a substantial heart transplant programme, and corrective surgery on heart defects is regularly carried out on babies of a few weeks old.

Interventional radiology is reducing the need to cut patients open. A long catheter is inserted into the child’s vein, allowing repair work on blood vessels or the heart itself. Perhaps these new techniques will make some current surgery redundant.

Our heart surgeons are playing a leading role in studying medical error, the subtle ways that an operation can go wrong. They are bringing in experts from industry to show how we can make operations even safer.

Our Neurosurgery unit opened in 1953 and was according to Mr Kenneth Till, "the first fully equipped and staffed neurosurgical department in a children’s hospital". Mr Till joined us for the start of the unit and was a consultant 1956-1980.

Neurosurgery is another field that would have astonished our founders, with operations to reduce epileptic seizure or to remove brain tumours. The brain is, obviously, encased in the skull but MRI scanning allows the surgeon to see inside the child’s head. The neurosurgeons can ‘see’ smaller lesions using MRI than they could with the naked eye, which requires even greater accuracy. GOSH was the first UK children’s hospital to use a computer assisted navigation system and new techniques are being developed to further refine the surgery.

Surgeons today emphasise how much it is a team effort. Improvements in diagnostics, radiology, anaesthesia, intensive care and medicine have contributed enormously to the improvements in surgical results. For example it is improvements in pain relief and anaesthesia, allowing far more surgery to be done on a day-care basis, even compared with five years ago.

Another development is minimally invasive surgery, laparoscopy (often called ‘keyhole surgery’). GOSH is conducting a major research project into whether this form of surgery has long term benefits. It is already known to reduce the time children need to spend in hospital and the trauma from an open wound. Operations for reflux, mending hernias, removing spleens and correcting bowel disorders can be done laparoscopically.