Less than one hundred and fifty years ago a surgical operation was a sensational event often attended by several hundred curious onlookers. Every surgeon of the early nineteenth century was a pioneer. With no diagrams to guide his operations, no anaesthesia. to kill pain, and no knowledge of the prevention let alone cause of infection, he tackled almost every kind of operation in this specialized field. The casebook of one well-known surgeon dating back to the 1830’s includes records of amputations, operations for breast cancer, circumcisions, the tying of a subclavian artery for the first time in history, and the removal of a plum stone by excision from the trachea of a nine year old girl.