Before anesthesia, speed was essential to minimizing pain and improving odds of survival.
Imagine lying on a table in a old-school operating room. Faces stare down at you from the viewing galleries above, and your leg throbs with pain from a broken bone -- infection is just starting to set in. The door opens and three men in blood-stiffened aprons walk in, carting a collection of knives and saws. Two of them grab your shoulders and arms and pin you to the table. The third picks out one of the knives from the cart.
"Time me, gentlemen," he calls out to the gathered spectators. "Time me."
The man grabs your leg and begins to cut just below the knee. He continues to hold onto your leg as one of his lackeys gets a tourniquet around it. To free his cutting hand, he clasps the bloody knife in his teeth and picks up a saw. He cuts back and forth through the bone, drops the severed leg into a bucket filled with sawdust, and sews you up, to the applause of the men sitting in the wings. As promised they've timed the whole procedure -- from first incision to clipping the loose threads on the sutures -- at just two and a half minutes.
The man who just flew through your amputation with apparent reckless abandon was Dr. Robert Liston, one of the finest surgeons of the time.
Dr. Richard Gordon, a surgeon and medical historian, calls Liston the "fastest knife in the West End." His style may have seemed careless, but in the age before anesthesia, speed was essential to minimizing the patient's pain and improving their odds of surviving surgery. Slower surgeons sometimes had pain-wracked and panicked patients wrestle free from their assistants and flee from the operating room. Only about one of every 10 of Liston's patients died on his operating table at London's University College Hospital. The surgeons at nearby St. Bartholomew's, meanwhile, lost about one in every four.
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Liston's quick hands were so sought after that patients sometimes had to camp out in his waiting room for days waiting for their turn to see him. Liston tried to see every last one of these patients, no matter their condition. He especially loved treating those cases that his fellow surgeons had dismissed as beyond help, which earned him a reputation among colleagues as being showy.