[Surgery in the last 40 years: looking back in wonder].

Much has changed in surgery in the last 40 years: From the fifties, new findings were introduced, such as antibiotics, anticoagulants, cytostatics, cardiac and pulmonary surgery, artificial respiration, osteosynthesis, arteriography, synthetic fibres and image intensifying in the clinic. The average hospital stay in the surgical ward used to be 21 days, mortality 6-7%. Owing to the long hospital stays, nurses, physicians and interns grew familiar with the pre- and postoperative courses. In the sixties, reconstructive vascular surgery became possible, where earlier limbs had to be amputated. The first pacemakers were inserted. There was widespread lung surgery because of tuberculosis, and owing to the great poliomyelitis epidemic of 1953, there was ample expertise of artificial respiration. Surgical treatment of fractures took off, and the first hip prostheses were introduced. The average hospital stay shrunk to about 14 days and the mortality to less than 2%. A turning point in surgical management came in 1961. In that year, the free Saturday was introduced, marking a transition from austerity to luxury. The medical successes were overtaken by the patients' needs, expectations and claims. Physicians started to work fixed hours, rather than when required. The seventies saw the beginning of intensive care and great progress in paediatric surgery; organ transplantation came in the eighties. The recent years were marked by formalization and protocolling of treatment and information. The growing influence of the government and of bureaucracy, and the encroachment upon the surgeon's social position and income interfere with his work with the patients.