Blood and Guts Read Online Free PDF Page A

operation already have their pocket
watches ready.
    In one rapid movement, he slices into the flesh, and a dresser
immediately screws down the tourniquet to stem the rhythmically
spurting fountain of blood. Drawing the blade under the skin
with the grain of the muscles, Liston pulls it towards the hip, down
to the bone, then sweeps it around the leg and back towards the
knee to leave two U-shaped incisions on the top and bottom of
the thigh. There is nothing theatrical about the patient's cry. It is a
chilling, horrible scream of terror. He is weeping now, struggling,
mewling, whimpering.
    Liston flings the knife into a tray and grabs the saw. His assistant
puts his hand into the cut, fingers reaching right the way down to
the bone. He pulls back the mass of skin, muscle, nerves and fat
towards the hip to expose as much bone as possible. Liston places
his left hand on the exposed bone and, with his right, begins to saw
through it with rapid but precise strokes.
    The student supporting the leg is concentrating so much that
he barely realizes when he's holding its full weight. He looks down
with a shudder, kicks the box of sawdust towards him and drops
in the severed limb. It lands with a thud, sending up a small cloud
of bloody sawdust.
    The saw falls to the floor and, with his assistant still holding back
the flesh of the stump, Liston bends close to tease out the main
artery in the thigh – the femoral artery on the underside of the leg.
The stump begins to ooze as Liston's bloodied hands reach for the
needle and thread. He ties off the blood vessel with a reef knot. A
'good, honest, devilish tight and hard knot,' as he will later tell his
students. He notices other, smaller, blood vessels and knots the ends
together, holding the thread in his mouth at one point to make sure
it is really tight.
    Liston shouts at a dresser to loosen the tourniquet. A gently
flowing stream of blood meanders between the ridges of the blanket
to drip into a pool on the floor. But the pool is small, not large
enough to be life threatening. The assistant allows the flesh he has
pulled aside to spring back so that the bone is once again covered
and protected by soft tissue. The two U-shaped flaps of skin are
pulled together over the stump. A thin line of coagulating blood
seeps between them.
    The operation is over. From first cut to final stitch, the whole
procedure has taken only thirty seconds. Thirty seconds of remarkable
dexterity, flashing blades, rapid movements and brilliant
showmanship. Thirty seconds of such pain that few patients are ever
able to put it adequately into words. The memory of those thirty
seconds will haunt them for the rest of their lives. If they live.
    Fortunately, the mortality rate from Robert Liston's operations
was remarkably good. Between 1835 and 1840 he conducted sixty-six
amputations. Ten of his patients died – a death rate of around one in
six. About a mile away at St Bartholomew's Hospital, surgeons were
sending one in four patients to the mortuary, or 'dead house', where
the all too frequent post-mortems took place.
    Given that many surgeons were appointed through patronage
or, more usually, nepotism, there was a large degree of surgical
incompetence even in the most renowned hospitals. Surgeon
William Lucas at Guy's Hospital in south London was generally kept
away from the operating theatre for everyone's safety. In one thigh
amputation he cut the U-shaped flaps of skin the wrong way round
leaving a raw stump and a dismembered limb with two excess
flaps of skin. His botched operations (the word 'botched' became
synonymous with failed surgery) were notorious. They were thought
to be the main reason that a young dresser at Guy's, John Keats,
abandoned the surgical profession to become a poet.
    In rural areas the local physician was expected to carry out his
own operations. The medical literature of the day is littered with
accounts of attempted surgical procedures and their consequences.
Martin A. Evans, a