The live spectacle of public surgery – and the origin of the operating ‘theatre’ – began with dissections for paying audiences in the 16th century. Lizzie Enfield uncovers the drama, and the developments that eventually sent surgical extravaganzas behind sterile closed doors.
The original drama of operating theatres
Words by Lizzie Enfield
- In pictures
![Black and white illustration of a dissection, showing a corpse on a table being cut open by a man wearing a hat and robes. There are dogs laying on the floor in front of the table and three people stood behind the anatomist, two of whom are recoiling in apparent disgust. In the semi-circular seating surrounding the table, people are shown watching and talking. A skeleton stands on a plinth to the right of the image. The plinth is engraved with the words "Laceros ivvat ire perartus", which appears to mean something like "go prepared".](https://images.prismic.io/wellcomecollection/b0939d8f-79b8-406b-897f-7120b53ac81f_01+ny5m3ajp+-+Tabulae+anatomicae+-+crop.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
Anyone who has ever watched a medical drama involving surgeons will know that operating theatres are clean, pristine, limited-access places. While we might enjoy the drama of someone being cut open on our TV screens, the word ‘theatre’ to describe the rooms where surgery takes place seems a little paradoxical. But 500 years ago, surgery took place in very different circumstances, performed to packed crowds in public spaces.
![Black and white photocopy-like image of one of Leonardo da Vinci's sketch pages, showing lots of illustrations of a dissected hand with the musculature beneath the skin, surrounded by da Vinci's characteristic mirror-writing.](https://images.prismic.io/wellcomecollection/47a8bb51-7199-4905-b418-fd1244d66b10_02+hps7bvzq+-+Leonardo+da+Vinci_+the+anatomist.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
The study of human anatomy flourished in the 16th and 17th centuries, in part prompted by Italian artists wishing to enhance their portrayals of the human figure. Michelangelo and Leonardo da Vinci are both known to have undertaken anatomical dissections, and their work set a new standard in the portrayal of the human figure.
![Black and white illustration showing a woman's body on a table with its abdomen cut open and a bearded man's hand reaching inside. A skeleton with a scythe stands at the head of the table beside the corpse's head. The room is packed with people, some watching, some reading, some appearing to brawl. A dog and goat are also in the room, and a monkey with a harness has escaped its holder and is shown biting someone on the hand.](https://images.prismic.io/wellcomecollection/3ee4aded-a7f0-4de7-ba44-dd3c4430d9a7_03+mv74d54w+-+De+humani+corporis+fabrica+libri+septem+-+tone.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
One of the men most closely associated with the understanding the human body was Andreas Vesalius (1514–64), who published what is widely regarded as one of the most influential works of anatomy, ‘De humani coporis fabrica’.
![A black and white engraving showing a scene with an allegorical depiction of justice at the top, with her sword and scales. To the left, a figure representing fame blows a trumpet, and to the right, a two-faced woman is shown in classical-style robes representing deceit. Below, doctors are shown conducting an autopsy on a body, surrounded by onlookers. The plate has the lettering "Et fama fallax ... fallunt et oculi" (fame is deceptive ... and the eyes also deceive). The autopsy scene bears the lettering "Nusquam tuta fides" (trust is nowhere safe), apparently meaning that the people attending cannot be entirely confident in the findings of the senses.](https://images.prismic.io/wellcomecollection/562479f7-bfec-4e08-999c-5151035f31f9_04+tdfwyw2g+-+The+fallibility+of+the+senses-+above_+justice%2C+fame+and+deceit-+below%2C+doctors+conducting+an+autopsy+on+a+cadaver%2C+surrounded+by+onlookers.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
Vesalius argued that anatomy should not be confined to medics but should be studied by all educated Christian men. His influence spread, and dissections, using the bodies of executed criminals, began to be held in public. Ticketholders could watch doctors performing autopsies by candlelight and often with accompanying live music.
![Colour lithograph depicting dissections in a black-ink drawing with a colour wash. Three bodies are being dissected in a room lit by skylights and decorated with human and animal skeletons and, along the right wall, a bust on a console and an illustration of a skeleton tacked on the wall between a list of dissection room rules and one of prices for male, female and infant cadavers.](https://images.prismic.io/wellcomecollection/83492cb1-9b6d-4bd4-aab4-1eb4f0300a2c_05+y98zkrxu+-+Three+anatomical+dissections+taking+place+in+an+attic.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
By the 18th century, live dissections had become an important part of medical training. As the popularity of these performances boomed, medical students had to compete amongst rowdy crowds to get a good seat, so closed sessions were held in private anatomy schools for medical students only. The proliferation of medical schools created shortages of cadavers, which led to grave-robbing.
![Black and white etching showing five people. On the top, against a white background, three people are shown from the shoulders up with electrical apparatus attached to them and disembodied hands operating the equipment. On the bottom, against a dark background of curtains and drapes, two recumbent corpses are attached to similar equipment positioned on a table beside their beds, also with disembodied hands operating it.](https://images.prismic.io/wellcomecollection/c6ad78fa-52d5-4dbd-ae76-38e34451694d_07+shwpkszx+-+Essai+the%C3%B3rique+et+expe%C5%95imental+sur+le+galvanisme_+avec+une+se%C5%95ie+d%27expe%C5%95iences+faites+en+pre%C5%9Bence+des+Commissaires+de+l%27Institut+national+de+France.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
One example of medical theatre that left a lasting impression was the attempt in 1803 by Giovanni Aldini to bring back to life the body of a convicted murderer by charging it with electricity. Astounded onlookers reported that the corpse’s eyes opened, his hand raised and fist clenched, and his legs moved.
![Black and white etching depicting Dr Frankenstein and his creature. The creature lies on the floor, its legs astride a skeleton. In the left foreground, an open book. In the background, electrical and chemical apparatus, and a bookcase on top of which are skulls. An astrological chart is stuck up on a wall. Frankenstein leaves hastily through a door on the right.](https://images.prismic.io/wellcomecollection/8829eba5-d1ba-4cbd-9dfb-e2ac67497bc4_08+p67zzz4d+-+Victor+Frankenstein+observing+the+first+stirrings+of+his+creature+-+crop.jpg?w=1041&auto=compress%2Cformat&rect=&q=100)
Aldini’s ‘act’ provided inspiration for Mary Shelley’s novel ‘Frankenstein’. Shelley would have been familiar with the auditoria of surgery and experimentation, and drew on this as she created her own fictional scientist and surgeon.
![Photogravure of surgeon Ernst von Bergmann operating in an amphitheatre. The artist shows the instruments on a tray ready for use. On the right-hand side a Schimmelbusch drum takes a prominent place. Everybody involved in the operation wears white surgical gowns, which creates a contrast to the dark tones of the background. There are no surgical gloves shown, nor are masks or hats worn in this image. The scene is set in a semi-public operating theatre. The operation takes place in front of an audience of interested colleagues in street clothes.](https://images.prismic.io/wellcomecollection/0dec9797-3d17-4bd4-b6a4-fb1a6ddd3c1f_08a+dtcqxsfw+-+Ernst+von+Bergmann+operating+in+an+amphitheatre.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
By the early 19th century, surgery on live patients, such as amputations, also began taking place in front of a live audience. The design of the hospital operating theatre was indeed theatrical and the audience view was considered: surgical theatres were based on the anatomical theatres where corpses were dissected to demonstrate and teach anatomy.
![Black and white photograph of a painting depicting Robert Liston operating, surrounded by an audience of men in dark coats and white breeches. Liston has his white shirt-sleeves rolled up and is holding a knife and leaning over a body that is covered in a sheet. Liston and one other man facing away from the viewer wear aprons.](https://images.prismic.io/wellcomecollection/01aeacbe-68df-4b0e-a138-85fb74ac705b_06+cyxsxmxc+-+Robert+Liston+operating.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
As surgical theatre burgeoned, the influence of the stage began to infiltrate the medical world. The operating theatre of Jefferson Medical College in Philadelphia was known as the ‘pit’, like the area in which orchestral musicians performed. Surgical theatre made showmen out of surgeons like Scotsman Robert Liston. He was celebrated for his speedy amputations and was reputed to have operated with a knife clutched between his teeth.
![Coloured chalk drawing of an operating theatre with seven women medical staff around a patient whose face and body are not visible under blankets.](https://images.prismic.io/wellcomecollection/59f2dbb1-fbeb-47b0-8d6d-d20d1d11c9e9_08a+zapjwh3p+-+An+operation+for+appendicitis+at+the+Military+Hospital_+Endell+Street%2C+London.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
For a long time, the woman being cut open on the table would have been the only woman in the operating theatre. Many male medics were horrified by the idea of women witnessing surgery, and one even argued that it would “change their very nature”. Elizabeth Garrett Anderson is probably the first woman in Britain to have experienced an operation as a future surgeon, in 1860; her fellow (male) medical students moved aside to give her a better view. She went on to establish a hospital entirely staffed by women.
![Sepia photograph of an operating theatre in a small tool with various cabinets and apparatus in the background and five medical professionals wearing robes, gloves, and with their faces and hair covered.](https://images.prismic.io/wellcomecollection/5310efa1-cb7c-4da3-86f4-acd368cc56ff_09+ts5tstcm+-+Wotton+Lodge_+Gloucester-+operating+theatre+and+staff.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
By the beginning of the 20th century, operating theatres with audiences had all but disappeared, for two main reasons. The introduction of anaesthetics and subsequent realisation that speed was not of the essence reduced the drama of the spectacle. But more importantly, doctors now understood that spectators brought with them germs and put patients at risk of deadly post-surgical infection.
![Colour photograph taken through a round window looking into an operating theatre, where staff in blue scrubs, hair covers and masks can be seen preparing the room.](https://images.prismic.io/wellcomecollection/46968cb8-ba0e-432a-9736-ec6de5657374_09+sk54mje9+-+Window+view+into+an+operating+theatre_+UK.jpg?w=1338&auto=compress%2Cformat&rect=&q=100)
The days of the old-style operating theatre were numbered as they were replaced by the scientific, sterile and secluded rooms that we think of today.
About the author
Lizzie Enfield
Lizzie Enfield is a journalist and regular contributor to national newspapers, magazines and radio. She has written five novels, and had her short stories broadcast on BBC Radio 4.