Blood and Guts Read Online Free PDF

physician in Galway, recorded a typical example
from his casebook in the Lancet medical journal of 1834. His patient
was forty-five-year-old Martin Conolly, whose leg was crushed by
falling timber. Having persuaded the man that amputation offered
the only chance of survival, Evans conducted the surgery, but his
account gives little detail about the procedure itself, except that it
was 'done by circular incision without assistance'. It is unlikely to
have been as quick and efficient as Liston's operation, but was
performed 'in the usual manner'.
    As soon as the limb was removed Conolly reported feeling
better and stronger, but in a few moments became faint and gradually
weaker. 'He died,' reported Dr Evans, 'without having lost
four ounces of blood during the entire process.' Evans attributes
this not to any surgical failure resulting in massive internal
bleeding, but to the patient. 'He had been a strong man, but was
fearful of consequences, the only cause to which I can attribute
his sudden dissolution.'
    Patients had every reason to be fearful. Liston usually operated
on reasonably fit young men or women with strong constitutions,
and considered long operations cruel. That his were speedy affairs
helped minimize blood loss and reduced the risk of disease. Liston
also believed in keeping wounds clean. After the skin had been
stitched together – with stitches known as 'sutures' (from the Latin
word meaning 'to sew') – he advocated dressing the wound with
sheets of lint dipped in cold water. These were to be frequently
changed as the wound suppurated, with warm poultices applied to
reduce the swelling and 'encourage discharge'.
    Not for Liston the filthy bandages and straps of some of his
rivals. These, as he was fond of saying, only encouraged 'putrefaction,
fermentation, stench and filth'. It wasn't unusual for surgeons
to reuse bandages and dressings already stiff with blood. For
convenience, one surgeon proudly kept a drawer of 'plasters' passed
from patient to patient over the years. Well, he and others reasoned,
why waste them?
    Liston would also wash his hands before operating and always
wore a clean apron. Or at least it started off clean at the beginning
of the day. Other surgeons took pride in conducting operations in
the same frock coats they had used for years. The blood and pus that
had built up into a hardened crust of material were regarded with
respect. Surgeons were, after all, respected members of society; they
had almost the same standing as doctors.
    Liston and most of his contemporaries could, with some justification,
claim to save lives. They had a firm grasp of anatomy, knowing
with some certainty the name and position of every bone, muscle
and organ in the body. They also knew broadly what each organ did,
even if they had only a limited understanding of the underlying
mechanisms. Crucially for Liston's generation of surgeons, they had
also developed the skills and dexterity to stop their patients from
bleeding to death on the operating table.
    The decision to operate was determined by the pain the patient
could withstand. In some quarters pain was seen as a prerequisite for
a successful operation – a stimulant to the body's natural powers of
recuperation. Perhaps the Galway patient had not been in enough
pain? Many operations took far longer than the few seconds required
for a basic amputation. Liston considered some of these too cruel. A
mastectomy, for example, would take several minutes, the breast
being slowly dissected 'with all due caution and deliberation'.
    Neither was there any understanding of infection – what it was
or how it was spread or prevented. Although Liston chose to operate
in a clean apron with relatively clean hands, instruments and
dressings, these practices owed everything to his sense of cleanliness
and common sense rather than any theory of disease or how it
was controlled.
    The speed with which he conducted his operations, which
included the removal of tumours and