‘Modern’ Surgical Scene, Circa 1945

The Anesthesia Era: 1916–1945

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The operating room was a sterile environment, even hermetically sealed off from the audience, and the audience had changed from physicians to nurses.

A Century of Progress

The text and photographs on this page are excerpted from a four-volume series of books titled Oncology Tumors & Treatment: A Photographic History, by Stanley B. Burns, MD, FACS. The photos below are from the volume titled “The Anesthesia Era: 1916–1945.” To view additional photos from this series of books, visit

The performance and professionalism of surgery dramatically changed between 1845 and 1945. Each advance in medicine created changes in the personnel of the operating room and its observers. At the beginning of this era, surgery was a public event; anyone who could tolerate watching was permitted entrance, and, in the preanesthesia era, some were even enlisted to help restrain the patient.

Women were only allowed in the operating room as patients until the 1870s, when female nurses were granted access, but only to assist the patient. It wasn’t until the end of the century that nurses began to help prepare the operating rooms and assist physicians in some institutions. By the 1920s, the role of the female nurse had been extended to include passing instruments and administering anesthesia. Until then, the least senior man of the operating team normally performed these responsibilities.

Only major hospital centers had dedicated anesthesiologists. At the turn of the century, the surgeon assumed center stage as the hero of emerging surgical specialties, and the audience now was comprised of only physicians and medical students. They were usually seated in a hierarchical assemblage; the most revered, senior members in the front rows and the students in the top rows.

With each passing decade, starting in the 1870s, the medical community gained increased awareness of the critical nature of sterile protocols in the operating room. The operating dress of the physician graduated from a black “Prince Albert” long coat and street clothes, to sterile operating garb from head to foot. However, it was the sterility concerns in the operating area that experienced the most dramatic alterations. In the 1840s, most operations, especially those of the wealthy and middle class, were performed in the home using the kitchen table as the operating arena. Hospitals were certainly not viewed as “the heart of healing,” but as the last resort, a place to die.

By 1905, the emphasis of medical photography had turned its focus to the physician’s ability to conquer disease, and photographs of operating rooms decorated the walls of hospitals and physicians’ offices to reflect the “professionalization” of an institution. When this photograph was taken, in the mid-1940s, hospitals had acquired a new image as a sacred place to save lives. The operating room was a sterile environment, even hermetically sealed off from the audience, and the audience had changed from physicians to nurses. The style and format of this photograph was popularized in the 1940s to convey the sterile conditions of the operating room and the education of nurses. As medicine continues to advance, nurses and ancillary personnel continue to undertake more positions and procedures, which, a generation earlier, were the sole sacred domain of physicians. ■

Excerpted from Oncology: Tumors & Treatment, A Photographic History, The Anesthesia Era: 1916–1945, by Stanley B. Burns, MD, FACS. Photographs courtesy of Stanley B. Burns, MD, and The Burns Archive.