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Afet

Cutting-edge history

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The following article was published in the Financial Times, and I found it quite interesting.

I know we had a discussion previously on the history of prosthetics, but how much do we really know about the history of amputation?

This article gives a bit of an idea...

Cutting-edge history

By Stephen Pincock

I went to the oldest operating theatre in Britain last month to see what it was like to have my leg amputated without anaesthetic. It was a surprisingly informative experience. For a start, the operating theatre, now a museum, is housed in the rafters of an old English Baroque church, on a busy road near London Bridge railway station. Apparently the church roof was an ideal spot for an operating room because it adjoined the wards of St Thomas’s Hospital and offered good access to natural light.

Surgeons began working in the theatre, under a large skylight cut into the church roof, in the 1820s. Their patients were women from the nearby surgical ward who would be brought through a small door into the theatre’s bare, cramped and unheated space.

The theatre itself consists of a series of raised viewing stands with wooden arm-rails, arranged in a tight U-shape around a small wooden table. During surgery the stands would be occupied by other medics wanting to learn from the spectacle before them, which can’t have been pleasant for the poor patients.

Sadly, on the day I visited the roof was being repaired so I couldn’t explore properly. By way of compensation, Karen Howell, the curator of The Old Operating Theatre Museum and Herb Garret, offered to give me a bit of an insight into what it might have been like to be a patient back in those days.

First, she asked me to lie down on a rickety replica of a 19th century operating table and proceeded to tie a leather tourniquet around my thigh. As she was doing this, she gave me the kind of nerve-jangling lecture that would have been delivered to patients of the times.

“Are you prepared to meet your maker?” she asked. “Because illness is a known precursor to death and you ought to be ready for death.”

Then she took out a wooden box inside which several long, thin knives rested in velvet compartments. A general dullness, and a collection of nicks in the blade, told of the knives’ age. Still, they looked frightening enough.

Howell explained that these were known as Liston knives, after Robert Liston, a surgeon who had worked briefly at St. Thomas’s Hospital in the late 1800s. In fact, she said, they were a medical breakthrough.

Previous surgical knives, such as those used to amputate Nelson’s arm, had been curved something like a sickle, with the sharp blade on the inside edge, she explained. To amputate a limb, the surgeon would reach around and slice through the flesh in a single, circular sweep. Then, as someone else held the cut apart, he would go on to cut through the bone or joint. Once the amputation was achieved, the remaining skin would be sewn through and pulled together like a string purse.

The trouble with this method, however, was that it left the patient with a stump of bone covered only with a layer of tight-stretched skin. Nelson apparently suffered badly with residual pain as a result.

So Liston’s advance, which involved his straight-bladed knives, was to cut the skin and tissue so that it formed two V-shaped flaps that could be sewn over the bone stump to cushion it. The technique apparently made a big impact.

All the time Howell was describing this in graphic detail, complete with flashing blades and re-enactments of the techniques, I was lying there on the operating table wondering how anyone survived the procedure. It wasn’t until 1847 that any kind of anaesthetic was used, so the surgeons needed to be pretty quick (some could complete an amputation in under a minute).

If the shock or the pain didn’t get you, an infected wound probably would. Only in 1865 did Joseph Lister, a biologist as well as a surgeon, come to the realisation that is considered his main contribution to medicine - the idea that sterile surgery was a good thing.

While working at the Glasgow Royal Infirmary, Lister promoted the use of carbolic acid to swab wounds and insisted that surgeons wore clean gloves and wash their hands before operating. Many of his peers thought all this a laughable waste of time. These days, his name is spoken of with reverence - plus he has the added bonus of having Listerine mouthwash named in his honour.

In one sense, all this is ancient history. But what strikes me is how recently all this brutal medicine was taking place. You don’t have to go back very many generations to find someone in your family who was alive at the time.

One hundred and forty years later, things are very different. The most lauded medical advances these days revolve around our growing appreciation of the human genome. For example, one of the more exciting areas in medical science at present is the potential of an experimental therapy known as RNA interference - in which single molecules target aberrant stretches of genetic code to turn them off and halt disease.

Just last month, scientists showed that this kind of injection could stop the processes that trigger the production of bad cholesterol in monkeys. For scientists, this is a very promising sign for upcoming human trials.

In a very real sense, the human application of RNAi is what you’d call cutting-edge science. Of course, given my harrowing experiences at the old operating theatre, I now have a totally new appreciation for that term.

Taken from this page of the FT.com website.

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You know Afet - I am married to a Genealogist, and my brother had a Phd in history. Our family has always been interested in things of the past. I find your story fascinating. Compared to today, those were tough times to be alive in.

I spent two weeks in London in 1957. One of my stops was Madame Toussand's (sp?) Wax Museum. Aside from trying to "talk" to the Bobbie at the door (ha!), I was particularily enamored by the chamber of horrors exibition below.

Man's inhumanity to man, (and woman).

(Hitler and Tojo were behind bars and wire cages to keep people from taking out their vengence on them. Like I said, this was 1957)

Thank you for the article. It reminds me of stories that I have read about conditions during our civil war over here.

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Thank you for the article. It reminds me of stories that I have read about conditions during our civil war over here.

You're welcome Jim. I'm glad you liked it. I found it fascinating too. Seems we all have to be grateful to Mr. Lister ;)

I spent two weeks in London in 1957. One of my stops was Madame Toussand's (sp?) Wax Museum. Aside from trying to "talk" to the Bobbie at the door (ha!), I was particularily enamored by the chamber of horrors exibition below.

Oh, tell me about it! I went there back in 2004, during my 16 months of deafness. We also went down into the Chamber of Horrors .. OMG, never again! :blink::blink:

I don't know how it was for you, but when we went there, there were loads of 'people' there. They'd fool you into thinking they were a waxwork, then they'd pounce on you! :o Scared the life out of me, though I don't usually scare easily at all :blink:

Because I couldn't hear, I relied solely on my sight to figure who was real and who was a waxwork, WHILST hanging onto hubby for dear life. In the end, I just avoided eye contact with everyone - waxwork AND human - and tried to find the exit FAST! :ph34r:

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Hi Jim & Afet

This thread reminded me of some of the medical museums I visited whilst I was in London. Many of the museums have restricted access to the general public, but I've found a link to London's Museums of Health and Medicine - there's a map of the museums on the website & I think they organise or co-ordinate guided tours.

Lizzie :)

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Hi,

during and after the Battle of Borodino in 1812, Dominique Larrey, the most famous of Napoleonic

surgeons, performed 200 amputations within 24 hours!!!

Mind you - without the benefit of anaesthetics, morphines or antibiotics!!!

One wonders how many of those poor wretches managed to survive.

That anybody should have survived is testament to the toughness, power of resistence

and tolerance of pain displayed by our ancestors.

Kind regards,

Mike RHD

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Interesting stuff, years ago I was given the US army medic's field book on battlefield amputation. It was originally written during the Civil war. It has been updated but was still used in Vietnam! I will try to scan it and post it on line for those interested.

I think I'm right in saying that there were 15 amputations carried out onboard HMS Victory, during the Battle of Trafalger by one surgeon a Mr William Beatty. http://www.nelsonsnavy.co.uk/battle-of-trafalgar.html

He only lost 2 patients!!

PJ :rolleyes:

Interesting stuff, years ago I was given the US army medic's field book on battlefield amputation. It was originally written during the Civil war. It has been updated but was still used in Vietnam! I will try to scan it and post it on line for those interested.

I think I'm right in saying that there were 15 amputations carried out onboard HMS Victory, during the Battle of Trafalger by one surgeon a Mr William Beatty. http://www.nelsonsnavy.co.uk/battle-of-trafalgar.html

He only lost 2 patients!!

PJ :rolleyes:

Muz will know more, I think he sailed with Nelson? ;)

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Hi all

In my last post I mentioned a well known book carried by US Battlefiels surgeons, have managed to locate it on the net, have a read it's facinating if history of amputation is your thing! :rolleyes:

Anyhow here it is:http://www.behavmedfoundation.org/pdf/amputeeguide.pdf

PJ :)

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Interesting stuff, years ago I was given the US army medic's field book on battlefield amputation. It was originally written during the Civil war. It has been updated but was still used in Vietnam! I will try to scan it and post it on line for those interested.

I think I'm right in saying that there were 15 amputations carried out onboard HMS Victory, during the Battle of Trafalger by one surgeon a Mr William Beatty. http://www.nelsonsnavy.co.uk/battle-of-trafalgar.html

He only lost 2 patients!!

PJ :angry:

Interesting stuff, years ago I was given the US army medic's field book on battlefield amputation. It was originally written during the Civil war. It has been updated but was still used in Vietnam! I will try to scan it and post it on line for those interested.

I think I'm right in saying that there were 15 amputations carried out onboard HMS Victory, during the Battle of Trafalger by one surgeon a Mr William Beatty. http://www.nelsonsnavy.co.uk/battle-of-trafalgar.html

He only lost 2 patients!!

PJ :unsure:

Muz will know more, I think he sailed with Nelson? ;)

... Noah. Cheeky Git :D

If I remember correctly many of the amputees from HMS Victory continued in Naval service afterwards.

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It always seems amazing, particularly to those of us who've undergone the surgery with all the modern advantages, that amputation was so successful. Even under the horrendous conditions of the American Civil War (that's The Late Unpleasantness to those of you south of Mason-Dixon) 75% of amputees survived if their limbs could be removed within 24 hr. of injury. After 24 hr this dropped to 50%. This was a tribute to the relative youth of many of the patients and the speed plus simplicity of the surgery, reducing the amount of time the wound was open to infection, blood loss, and surgical shock. Nobody liked the disfigurment of amputation, but as barbaric as it seemed it saved many lives.

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