08 May 2012

On the History of Surgery

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Robert Liston

Atul Gawande shares a great story of the pre-anaesthesia age, in the New England Journal of Medicine.

The limits of patients’ tolerance for pain forced surgeons to choose slashing speed over precision. With either the flap method or the circular method, amputation could be accomplished in less than a minute, though the subsequent ligation of the severed blood vessels and suturing of the muscle and skin over the stump sometimes required 20 or 30 minutes when performed by less experienced surgeons. No matter how swiftly the amputation was performed, however, the suffering that patients experienced was terrible. …

Before anesthesia, the sounds of patients thrashing and screaming filled operating rooms. So, from the first use of surgical anesthesia, observers were struck by the stillness and silence. In London, [Robert] Liston called ether anesthesia a “Yankee dodge” — having seen fads such as hypnotism come and go — but he tried it nonetheless, performing the first amputation with the use of anesthesia, in a 36-year-old butler with a septic knee, 2 months after the publication of Bigelow’s report. As the historian Richard Hollingham recounts, from the case records, a rubber tube was connected to a flask of ether gas, and the patient was told to breathe through it for 2 or 3 minutes. He became motionless and quiet. Throughout the procedure, he did not make a sound or even grimace. “When are you going to begin?” asked the patient a few moments later. He had felt nothing. “This Yankee dodge beats mesmerism hollow,” Liston exclaimed.

It would take a little while for surgeons to discover that the use of anesthesia allowed them time to be meticulous. Despite the advantages of anesthesia, Liston, like many other surgeons, proceeded in his usual lightning-quick and bloody way. Spectators in the operating-theater gallery would still get out their pocket watches to time him. The butler’s operation, for instance, took an astonishing 25 seconds from incision to wound closure. (Liston operated so fast that he once accidentally amputated an assistant’s fingers along with a patient’s leg, according to Hollingham. The patient and the assistant both died of sepsis, and a spectator reportedly died of shock, resulting in the only known procedure with a 300% mortality.

In his surgical exuberance, Liston apparently had cut through the coat tails of a distinguished visitor, who thought he’d been stabbed in the vitals and proceeded to die of fright.

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Maggie's Farm

Thursday morning links…

On the history of anesthesia I’m Not Going Home With You..And Other Lies (h/t Linkiest) A book: The Moral Molecule: The Source of Love and Prosperity Why they hate Santa (the culture that is Scotland?) Gay Marriage as a Distraction The coming waves…



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