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