Amputation in 28 seconds
Early surgical amputations by Quentin Smith
(Published as 'Robert Liston: A musing' in Today's Anaesthetist 2009 Vol 24[2])
If your injured leg became infected in the days before antibiotics you would almost certainly die. If you lived in the early 1800’s and Robert Liston was your surgeon, then you might have had a slim chance of surviving such an injury. But more about Robert Liston later.
Even though amputation itself carried a 50% mortality before the appreciation of the need for antisepsis (Listerian antisepsis was only realised in the 1870’s), such drastic surgery was often the only chance of survival. It truly was a grim time to be a patient. If you didn’t die from the injury, or surgery, infection would get you.
And there were no anaesthetics back then either. Amputation was preceded only by some cheap brandy (cognac if you were a private patient), and perhaps a few biscuits to rebuild your strength. This was regarded as resuscitation for shock. The ringing of a bell (imagine the subsequent nightmares induced by that!) summoned a few burly gentlemen who would restrain the patient allowing the surgeon opportunity to hack off the injured limb quickly, and staunch the inevitable flow of blood. Speed was everything in the humane interests of reducing suffering and blood loss. The eventual advent of anaesthesia did little to help the patients as the use of chloroform and ether increased the mortality from amputation.
The danger of anaesthesia in traumatic injury was something the military learned to its cost in the Crimean Campaign, where chloroform is believed to have finished off countless soldiers who were shocked from their injuries. These deaths moved an army surgeon to record: “the smart of the knife is a powerful stimulant, and it is better to hear a man bawl lustily than to see him sink silently into the grave”. (This remark has been unfairly attributed to be the origin of the current surgical ethos that “no patient should be allowed to die without being operated on first”).
So even in the early days of anaesthesia many surgeons preferred to amputate limbs without it. Speed, not finesse, was the mark of an accomplished surgeon (no change there). Between 1818 and 1847 Robert Liston embodied everything both good and bad about fast amputations. His reputation was made on being able to remove a leg and stitch the end back up in 28 seconds. Needless to say, he was a bit of a showman.
Liston is infamously remembered for the unfortunate complications of his flashy surgery. He once accidentally removed a patient’s testicles in his eager pursuit of the sub-30 second amputation. It is not clear from his records whether he charged the patient for an orchidectomy as well as an amputation.
But Liston’s most infamous operation was one in which he achieved a 300% mortality. He not only amputated the patient’s leg, and the coat-tails of a spectator, but also several of his assistant’s fingers. The patient died from gangrene, as did his assistant, and the horrified spectator suffered a fatal heart attack. A 300% surgical mortality has never been equalled in 200 years (though the efforts of many have come close).
Early surgical amputations by Quentin Smith
(Published as 'Robert Liston: A musing' in Today's Anaesthetist 2009 Vol 24[2])
If your injured leg became infected in the days before antibiotics you would almost certainly die. If you lived in the early 1800’s and Robert Liston was your surgeon, then you might have had a slim chance of surviving such an injury. But more about Robert Liston later.
Even though amputation itself carried a 50% mortality before the appreciation of the need for antisepsis (Listerian antisepsis was only realised in the 1870’s), such drastic surgery was often the only chance of survival. It truly was a grim time to be a patient. If you didn’t die from the injury, or surgery, infection would get you.
And there were no anaesthetics back then either. Amputation was preceded only by some cheap brandy (cognac if you were a private patient), and perhaps a few biscuits to rebuild your strength. This was regarded as resuscitation for shock. The ringing of a bell (imagine the subsequent nightmares induced by that!) summoned a few burly gentlemen who would restrain the patient allowing the surgeon opportunity to hack off the injured limb quickly, and staunch the inevitable flow of blood. Speed was everything in the humane interests of reducing suffering and blood loss. The eventual advent of anaesthesia did little to help the patients as the use of chloroform and ether increased the mortality from amputation.
The danger of anaesthesia in traumatic injury was something the military learned to its cost in the Crimean Campaign, where chloroform is believed to have finished off countless soldiers who were shocked from their injuries. These deaths moved an army surgeon to record: “the smart of the knife is a powerful stimulant, and it is better to hear a man bawl lustily than to see him sink silently into the grave”. (This remark has been unfairly attributed to be the origin of the current surgical ethos that “no patient should be allowed to die without being operated on first”).
So even in the early days of anaesthesia many surgeons preferred to amputate limbs without it. Speed, not finesse, was the mark of an accomplished surgeon (no change there). Between 1818 and 1847 Robert Liston embodied everything both good and bad about fast amputations. His reputation was made on being able to remove a leg and stitch the end back up in 28 seconds. Needless to say, he was a bit of a showman.
Liston is infamously remembered for the unfortunate complications of his flashy surgery. He once accidentally removed a patient’s testicles in his eager pursuit of the sub-30 second amputation. It is not clear from his records whether he charged the patient for an orchidectomy as well as an amputation.
But Liston’s most infamous operation was one in which he achieved a 300% mortality. He not only amputated the patient’s leg, and the coat-tails of a spectator, but also several of his assistant’s fingers. The patient died from gangrene, as did his assistant, and the horrified spectator suffered a fatal heart attack. A 300% surgical mortality has never been equalled in 200 years (though the efforts of many have come close).