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THE OPERATION WITH A 300% MORTALITY RATE
BY PROFESSOR CONOR MAGEE MD FRCS, CONSULTANT SURGEON
Surgery is safe. It is not risk-free but by and large it is safe. The
greatest fear for any surgeon (and patient) is that of operative
mortality - dying as a direct consequence of surgery. limb into the surgical bucket (fondly called the Limb Bin). In those days
surgery was literally a spectator sport - the patient a terrified actor in a
real-life Grand Guignol performance.
For many operations mortality can be measured in fractions of a percent,
for complex operations mortality may reach 5-10%. This means that the
chance of dying is between 1 in 20 and 1 in 10. A hundred percent
mortality means the operation kills you, no ifs or buts, you die. But where Dr Liston has earned his place in medical history is the
unfortunate leg amputation where it all went wrong. As with all his
other cases the patient was brought in and placed on a wooden table-
the leg probably broken and infected (the records are unclear). No
white coats or bright halogen lights - just Dr Liston wearing an apron
caked with body fluid and one, maybe two assistants. And knives and
saws- sharpened to perfection to slice through unforgiving skin, muscle
and bone.
So - how can an operation have a 300% mortality? You can only die
once, surely.
Let me take you back to University College Hospital, London, 1864.
Now it’s fair to say that 19th century surgery was not quite the safe,
aseptic, cool, controlled surgery we perform today. Back then there
were no antibiotics, no real knowledge of infection- very little in the
way of anaesthesia. In fact pain relief was a combination of alcohol
and burly men restraining you as you bit down on a piece of leather to
control your screams.
Unsurprisingly speed was a surgeons greatest asset- if you have to
endure agonies, best make them as short as possible. Not only that but
the longer the operation the greater risk of infection and death.
Enter Dr Robert Liston - reputedly the fastest surgeon of his time. A
man whose ability to perform limb amputation was so quick that “only”
1 in 10 of his patients died, compared to his 1 in 4 of his contemporaries.
Such was Dr Liston’s renown he would often begin an amputation with
a shout of “Time me, Gentlemen”. Now speed is not often accompanied
by skill - indeed there are reports that testicles often accompanied the
Time me Gentlemen, indeed. Liston’s assistants pin the patient down-
sweating and reeking of Gin, wriggling desperately to avoid the
inevitable. Liston slices through the thigh - blood arcs everywhere,
warm blood enveloping the hand he uses to hold the thigh. There is
pus visible now - its cloying odour makes the audience gag. The patient
jerks with the pain and the assistant’s hand slips- Liston catches it in his
knife. A howl from the assistant as the pus covered, bloody knife cuts
a finger off.
A member of the audience screams in horror and collapses to the floor-
killed immediately by a heart attack. Liston - ever the professional-
perseveres and a rotted limb is dumped in the bucket while his assistant
nurses his wounded hand. Within a week both the patient and the
assistant have died from infection.
One operation. Three deaths. A three hundred percent mortality rate.
Professor Conor Magee is Consultant Surgeon at Spire Murrayfield.
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