In 1811, nearly four decades before the advent of anesthesia, the English novelist Fanny Burney underwent a mastectomy for breast cancer. Later, Burney wrote a long letter to her sister, Esther, describing this battlefield-style operation. Her account remains one of the most famous and gut-wrenching descriptions of pre-anesthesia surgery ever written:

When the dreadful steel was plunged into the breast – cutting through veins – arteries – flesh – nerves – I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittingly during the whole time of the incision – & I almost marvel that it rings not in my Ears still? so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp & forked poniards, that were tearing the edges of the wound.

To learn his surgical technique, Dominique-Jean Larrey, the revered French military doctor who performed Burney’s operation, referred to some of the first medical illustrations ever printed in widely disseminated instructional textbooks. Now, a vast collection of these grotesque but strangely beautiful Victorian illustrations are compiled in Crucial Interventions: An Illustrated Treatise on the Principles & Practice of Nineteenth-Century Surgery, a new book by medical historian Richard Barnett.

To a modern viewer, these surreal drawings might look like torture porn or illustrations for a horror novel. Glaucoma patients’ eyelids are held open with metal clamps, reminiscent of that famous scene in A Clockwork Orange ; harelips are sutured with corset-like stitches; step-by-step diagrams illustrate how to amputate arms, fingers, legs, and feet — and those are among the least graphic images. Though they look primitive now, in the 19th century, these highly detailed color drawings represented the beginning of a revolution in the art and science of surgery. Surgeons transformed from scalpel-slinging cowboys in a medical wild west into near-divine heroes.

“The greatest challenge in telling the story of surgery lies in its very nature,” Barnett writes in the book’s introduction, “The Thinking Hand: Surgery as Craft, Art, and Science.” “Like ballet dancers or center-forwards, surgeons rely on forms of expertise gained through experience and observation, which cannot be easily articulated. The images collected here provide a magnificently rich resource with which to think about the visual, tactile, and sensual aspects of surgery.” In a series of essays accompanying the drawings, Barnett traces the fascinating history of surgery from the work of Renaissance anatomist Hieronymus Fabricius to today.

Thanks to anesthesia and antisepsis, modern medical practices allow patients a clinical remove from the bloody business of surgery. The drawings in Barnett’s book are a reminder of how new and how manufactured this privilege of clinical distance is. Well into the 1840s, surgery took place in “noisy, dirty, crowded spaces called operating theaters,” as Barnett writes. Surgeons dressed in street clothes operated on patients screaming in agony. They worked as quickly as possible to minimize blood loss, pain, and shock. Mortality rates were high. Eighteenth century anatomist John Hunter described surgery as “a humiliating spectacle of the futility of science.”

But in the middle of the 19th century, after new medical schools were established and textbooks became more widely available, operating rooms started to resemble the cordoned-off, laboratory-like settings of today. Surgery became a treatment patients might actually choose instead of a horrific last resort. “Surgeons entered culture and literature as High Victorian heroes, and they also entered the aristocracy,” Barnett writes. And as surgery changed, especially after the advent of anesthesia, social understandings of the human body, illness, and mortality changed with it. No longer did patients have to feel “the knife (rack)ling against the breast bone — scraping it,” as Burney wrote in her graphic description of her mastectomy.

The meaning of pain itself changed, too. As Barnett puts it, “for surgeons at the end of the century, ‘If [pain] had a purpose it was to teach people, especially poor people, to be grateful to medicine, not God.’”

Richard Barnett’s Crucial Interventions: An Illustrated Treatise on the Principles & Practice of Nineteenth-Century Surgery is available from Thames & Hudson.