Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Amputation

Episode Date: August 2, 2013

Welcome to Sawbones, where Dr. Sydnee McElroy and her husband Justin McElroy take you on a whimsical tour of the dumb ways in which we've tried to fix people. This week: We take the leg. Music: "Medicines" by The Taxpayers (http://thetaxpayers.net)

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, Tommy is about to books.

One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We pushed on through the broken glass and had ourselves a look around. The medicines, the medicines, the escalant macaque for the mouth Already welcome to the solvones the metal tour Miss guiding medicine I I'm just a macaron. I'm Sydney Macroight Justin I've been looking all over for you. What are you doing here? Just leave me Sydney leave me no You're you're just laying there on the grass and you're You're holding your foot. And are you bleeding?

Not yet, listen, Sid, we've had a lot of good years together, but I gotta hang nail. And I don't know, I don't know if I'm gonna, I'm gonna pull through, Sid. It's okay, no, we're getting out of this together. I'm gonna drag you back to the studio. Okay, drag me. Here we're getting out of this together. I'm gonna I'm gonna drag you back to the studio. Okay Drag me Here we go. You're dragging me

Like this is like with a lady list of car of her maybe someone's great strength Okay, you know, I was probably overreacting. It's just a hang nail. I think that there's probably a... Nope. I'm the doctor here. Let me take a look at it. Oh, uh oh. This isn't good. It's just a hang nail, Sid.

Don't be silly. No, no. This could get infected. This could ulcerate. I don't know how fast you're gonna heal. It's just a hang out. I wouldn't even heal. I think there's only one solution. I think we know what fast you're gonna heal. It's just a hangout. I won't even heal. No. I think there's only one solution.

I think we know what we've got to do. Just clip it off and then, I guess, I just move on from my life. You're right, it's got to come off. The whole foot's got to come off. No. What? That's right, Justin. The foot's got to come off.

I don't think I'm not a medical doctor. I don't know. That's right, I am. So listen to me, darn it. Okay, listen, I'm understandably a little freaked out right now. A need my foot for soccer and stuff. It's too late. It's too late for all that. Listen, okay, okay, okay, listen.

I'm gonna do it every say, I trust you, but can you can you walk me through what what just while we threw a little bit about what we're talking about to help calm me down? Like you did that first time I tried Nike will and you told me about all the chemicals in it. Okay. All right. I'll explain to you what we're doing, but we don't have much time.

I'd say we have about a half an hour. That infection could set in and and it could develop and you could lose that foot to gangrene in I mean it could be as soon as weeks. We we have a heart attack. Okay. Well, let me tell you about amputation, Justin. Please. It's the last thing I want to think about right now, but anything to take my mind off the pain. Do you know where the word comes from? Obviously not. It comes from the word amputare in Latin, which means to cut away, which comes from ambi, which means around amputare, which means to prune. Okay. So I'm going to prune around your ankle a bit. Just cut some of this

excess. May hurt a bit. Don't worry about it. It interestingly enough, the word amputare and Latin would only be used in reference to punishment for a criminal. But stealing, you get your hand cut off that kind of thing. Precisely. So it would never be used for the surgical procedure. That came much later, like the 17th century. Wow. So not a lot of, usually we're going back to a year old, ancient times with sobbing.

This is a little more, a little more recent. No, the concept of amputation, I'm giving you some history of the word amputation. You like that kind of thing. You love words. I do. That is your trade. No, the con, I mean, like the idea that maybe for some medical reason, people were removing

limbs actually probably dates back to the Neolithic times. They have found remnants of bone and something that was like a saw and rocks and said, yeah, they were probably Neolithic humans performing amputations for some reason. I don't know how they figure that out. I don't know. It was a, we're not caveman doctors. We're regular doctors. No, I am not an anthropologist. And you are not a doctor. Fair enough. Do we know?

It probably we are we do have evidence from it in the in the Vedas texts, the Sanskrit texts from India from 3500,800 BC. There were definitely amputations. Then Queen Vishwa had a leg amputated in battle, and they made her an iron leg to replace it. God, that's hardcore. Isn't that hardcore? That's really boss. That's just begging for like a Robert Rodriguez movie.

It made about it. It's gotta be heavy. It is. But it was really in Greece. That tends to be where a lot of our episodes land, right? In Greece, where we start to see the idea of performing this procedure for a medical indication, knowing why we're doing it, not just randomly or guessing as to what old texts may be referencing. We start to see the process of amputation for reasons other than traumatic. Other than your leg got crushed by a rock and we've got to leave it behind.

Like what kind of stuff are we talking about? Largely infection. At the time, we didn't have antibiotics, of course. We didn't have any way to fight infection other than your own immune system. So if you had a horrible ulcer or something, some kind of infection in your extremity and your foot or your hand or your leg or your arm, then it would continue to spread and spread until you died.

You became septic and died. Oh, man. Why don't want that? No, nobody wants that. So that's when they began to come up with the idea that you could amputate a limb. You could intentionally remove it in order to prevent the infection from spreading.

Right, because I think that the idea of spreading is in itself kind of an advanced idea when you when you look at how we saw the human body back then, right? Because we didn't see it correctly from wrong as you don't need prompting to I'm sure, but no, no, no, no, don't worry about that. We weren't seeing the body as systems in the way that we do today, right? Absolutely. Well, we didn't know, when we knew that infection spread, I need to clarify that we didn't know the word infection

or what infection was. We knew that redness and heat and then, you know, dying tissue tended to keep spreading, but we didn't know what caused it. And we certainly didn't know that there was a circulatory system that was spreading it. So we don't know. Well,. And we certainly didn't know that there was a circulatory system that was spreading it. So we did. Or a lymphatic system or anything else.

But we did see, we saw something spreading, so we knew we had to cut it off. We knew at least that it seemed to be progressing in a linear fashion and that eventually, it would make a person so sick that they would probably die. And so, you know, that's kind of a simplistic solution. So that part seems to be bad. The rest of them seems to be okay.

Let's just remove that part. Which is still, I guess, has some grounding and, you know, reality, right? Oh, yeah, there's still, I mean, hopefully we're more scientific about it now. But yes, there's still call for this. And it's, I think it's a testament to the 5th century Greeks

that they figured this out. We're next. Well, it's interesting because as we date back to Celso who would have, he would have operated around year zero, essentially. With my man, Jay-Zo. Exactly around the time Christ was born. He was describing amputations, writing about amputations that he was performing.

And he was actually one of the, he was the first one to recommend ligating the blood vessel. Do you know what that means, Justin? Absolutely not. So when you cut a blood vessel, as you may imagine, blood comes out. Blood comes out. Good job. Yeah, it's from the blood, like I've said. So I'm going to come in a minute, direct, when it comes to making people believe. That's true.

So he was the first one to advise tying off those blood vessels to stop them from leading. That seems... You've mentioned that to me before I'm passing that that happens. That seems so intricate. I don't even know how you do that. It is very intricate. You use very small thread and dexterious, dexterous, dexterity, dexterity.

Dexterity. You need good fingers. You need good fingers. You need good fingers. Yeah. You practice. I mean, you take a lot of practice. Yeah, med students actually have to.

Special knots. Med students actually have to. Special knots. Med students actually have to open their arms for at least two other students to let them practice on their veins. I heard. Precisely. My arm has been cut off and sewn back on several times. You know that that actually does happen in a dental school.

They practice giving shots to each other. In their mouths? Yeah, I, a friend of mine went to the dentist. He said that his dentist told him that she used to get at minimum two shots every day for, for a while. That sounds horrific. She said it never gets any better. They, it's comforting.

I would, well, I would imagine. They used to practice, uh, taking blood from each other in medical school, but we don't do that much more because, uh, much these days because, uh, physicians, honestly, at least in the U.S. don't take that much more because much these days because physicians honestly at least in the US don't take blood very often We're not personally responsible for phlewotomy No, some still do but most don't so they were like it so he was like getting blood vessels This seems like not a big deal, but it's a huge deal because it's stopped bleeding effectively Now it's still we still had the problem with infection. So, you

know, the process of amputation is pretty easy. It's probably as simplistic, well, I bet even Justin could guess how it's done. Sauradov. That's right, Justin. You saw it off. You saw it off. So, if you want to remove a leg, you very simply. Put this on. You make the saw back and forth. Uh-huh. Just wait for the screaming to stop. You cut through the skin.

You cut through the muscle. You in all the tissue beneath. You cut through the bone. You're not to lose your nerve. You do have to pull up vessels. You bandage it, probably covered in some vinegar at the time. Oh, that's good. Good job, guys.

And pray to the gods you believe in that it does not get infected. Which it will. Which it, which it almost certainly will because you're in the olden days and everything got infected all the time. By a hundred AD our our chiginies our chiginies and heliotrists began to they were two more Greeks Romans two more Greeks, Romans. Lemurias. Romans. It began to use the same procedure for other processes, other than just infection, although we didn't know what it was at the time. Also for ulcers that weren't healing on lower extremities, so deep wounds, ulcerative

wounds for tumors, although again, they didn't understand the concept of cancer, but they knew something was growing there that shouldn't and would eventually kill the patient, so they could remove a limb for that, and then other deformities, you know, problems, congenital problems, or traumatic problems that would cause someone to not be able to use the limb. They also developed the technique of circumferential compression, meaning that they would tie something. Brack, break that down for me. So circumferential going all the way around. Okay.

And compression, applying pressure. Okay. So like a turn-a-kick, kind of idea. Dig. So they would apply, now wasn't a turn-a-kick yet, not yet, but they would apply pressure around the top above the blood vessels so that they wouldn't bleed as much. And they continued to like a vessels, which is a big deal in Galen, who we have spoken of many times.

Galen, I always remember that. He also advocated this procedure and wrote about the importance of using material that wouldn't rot or decompose easily to tie off the blood vessels, acknowledging that if the patient survived, the material would be there for a while. But Galen later admitted, that's a pretty big if they're probably not going to. You don't really need to worry about that too much. And that's absolutely true. Most of these patients did not survive.

This became even more true when I, okay, something happened in the middle ages. King Arthur. Again, I have referred to the... Well, the majesty of camel. The majesty of camel, it occurred. There was magic. There was magic and singing. There were talking squirrels.

There was much dancing. And then everyone forgot every smart thing they'd ever learned. Well, that was all the magic. Everyone smelled bad. Everyone was making stinky poltuses to put other stinky places. You know, stinky poltuses was the name of my death metal band when I was a college. We didn't play out much. And somehow we completely forgot about that really great idea about like any blood vessels.

That seemed that seemed pretty on point, especially for old dudes. It was a really, really important idea and we just stopped. And instead, we would use coterie, which means like burning the vessels to stop the bleeding. So a piece of heated metal, just stick it on there after you've removed the limb, which was probably just as painful as it sounds. Are dumping a pot of gold on their head to prove the supremacy of the dothraki? Is that some kind of cultural reference? A little game of thorns.

Humor for everybody. Oh, okay. I was about to call it that nurture, but then I realized that all of our listeners would turn on me. 100%. Never mind. Keep on keeping on. I actually only had the Game of Thrones Justin. Game of Thrones Justin. They call me at the office.

They also would use hot oil for this process. I would think that between your choices, see, like, all things considered molten metal doesn't sound that bad. I mean, like, obviously- Oh, it doesn't? No, I mean, obviously painful, but it seems like as far as, like, cauterization and stuff, that would be, I mean, hot oil would just bring you to a delicious golden brown. It would make you some sure, as I don't think that it would get the job done

in terms of cotterization, right? Well, I mean, if you burn and clot the end of the vessel, that we still use cotterine today, let me clarify. In surgical procedures, cotterine, the use of heat to stop bleeding, the use of electricity and heat is still used. We burn blood vessels. Right, but I'm just talking about the disparity

between hot oil and hot metal, which hot metal you got kind of a giant chameleon vibe I'm into it, but it seems like that would be a good solution. I'll be at a bad one. Well, why don't I try both on you later and we'll see which one hurts more? Fair enough. I mean, I know they're both gonna hurt. I'm just saying that hot metal, it seems like we do the job of cotterization. Now, of course, the problem with all this is that we didn't have any anesthesia. Oops. So people, I will say this, in the 13th century, they did try to come up with something. They would soak sponges in opium and mandric root, and then just hold it over the patient's face until they went to sleep.

And then at the end, you could revive them with vinegar. Now, my guess is that they probably woke up when you... Hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey, hey I mean, again, we're talking about a lot of procedures that were probably done as a last resort, you know. They knew that patients were going to either die of the, you know, blood loss from the procedure, the shock of the procedure or infection. So this was a really like life or limb scenario. Literally. Now, in the, in the 1400s, things got serious because gunpowder wasn't invented. Ah, humanity. You're going so well with the magic consort. The Mandrake root. It's really the history of amputations is somewhat parallels the history of warfare. Because that was where we really learned how to do amputations and how to do them more

effectively was because of the invention of gunpowder the use of guns and the The havoc that that has wreaked on the human body So by necessity we were doing more and and I think that with anything right you if you do it enough some of these advances are bound to to become To emerge from that absolutely And in a general sense, you know, you have to give the military throughout history, not just the United States military credit for coming up with a lot of cutting edge medical procedures and treatments and ways to manage conditions out of necessity. Because they created them.

Well, I think that's a little presumptuous. How do we patch out the people that we got shot? Well, that's true. In the 1500s, with more invitations being done, they began to be kind of codified procedures were described. You would, at first they thought, well, maybe it would be a good idea to kind of apply a band of pressure above and below where you're cutting everything off. And then, but they were still doing weird

things like putting egg white, stippdicks on the wound. Why not to stop the bleeding? We're just guessing after all, it's just cutting off a limb. It was really why not put an almond on there? Sure. We don't know. I don't know. I don't know.

We got lots of those. We got lots of chickens. Not the yolk. What are you crazy? Just white. Take a chicken, what are you crazy? Just white. Take a chicken, strap it to your plague, bubo, and then take the egg and pour it on your leg after you. Not the whole egg.

Just the white. I got cholesterol issues. I can't eat the yolk. I'm sure we'll have an episode that tells you what to do with the yolk. Yeah, that'll be something else. It's feeling too rocky, so you can be to follow up greed. Now there was a French army surgeon in the mid-16th century who really Ambrose Perre, who was really instrumental in coming up with how we're going to do amputations. He brought

back ligation. He actually, yes. So again, we started tying off blood vessels, which we should have been doing all along. And he also started creating more prostheses. The idea of a prosthetic wasn't very popular prior to this simply because most patients didn't survive. So if somebody did, you would make one out of whatever you had, you know, wood or bronze or iron or whatever, but he started creating prosthetics because people might actually survive the procedure. And we got even better at it when in 1616 we discovered how blood circulates.

Come, miraculous actually that we have gotten this far without that knowledge. It really is. The idea that we knew how to stop bleeding before we knew what direction blood was going and what carried blood wear and how that whole circulatory system worked. So what next? So after that, the tourniquet was invented. It was not. Help me understand.

You talked about how in the middle ages, we were tying off above and below, we were going to make the cut, right? What differentiates that from a tonic? What really differentiated it was the idea that this is, okay, this is something that we are actually applying above the site of the incision. So, you know, closer to the heart, then, you know, the incision is going to be. And it is tight enough to actually stop blood flow, you know, because there's a difference between just applying pressure to the area and actually applying a tourniquet.

Attarniquet's idea is to stop blood flow. So you don't just want to willingly apply a tourniquet. If I put a tourniquet on your arm and don't do anything about it, eventually that arm is going to die. It's not going to work anymore because of lack of blood flow. So applying a tourniquet and applying pressure different concepts. With the surgeon Petit in 1718, he came up with the idea of a tourniquet

and then actually kind of revolutionized the incision-making process. So the way that they used to make incisions was what was called the classic circular cut. It was one very fast because your patient was awake. And unhappy. And unhappy and in pain. So you moved as quickly as possible. You made one big circular cut through as quickly as possible, sawed through the bone and you were done. He was the

one to say, you know what, we really need to cut the skin first and then cut through the muscle so we can leave perhaps some extra skin to maybe cover things up at the end. And eventually that gave way to a three stage circular cut where you would cut through the skin and then you would cut through the muscles. So you would cut through the skin and then peel back the skin a bit? Peel it back a bit so that you could leave a little extra skin and then actually cut the bone.

Eventually when we got to the point where we're making three stage cuts where we could saw the bone off a little bit higher up so that the bone was not as long as the skin and the muscle around it. Retroactyl Apologies to anybody trying to eat a ham sandwich where they enjoy our program. I do apologize about that. Yeah, if you have a week's stomach, well then why are you listening to our show? Sydney actually can't, we watch, anytime we watch something gross on TV,

we've been in situations before where I've been, we've been eating and she'll just be happily eating watching somebody get dismembered. She has a very high tolerance for that sort of thing. It really, once you've spent a few months in anatomy lab, you really just don't, you know. I'm just a big sack of bones and meat to you, aren't I? Well, I, I mean, I wouldn't say that on the air.

Fair enough. It's interesting. During the Napoleonic Wars, there were as a surgeon and great-grandmother and Guthrie and L'Arée in France, who both made great advances with amputation, again through necessity, you know, war equals more amputations. And they both realized that it was better at the time prior to this, they thought it was better to wait a while before you cut like a damage or infected limb until it was absolutely

the last possible option. And they both realized that it was better to cut a little sooner. And they performed many amputations and wrote papers on them and actually began to improve the survival rate. Still not great, but better than before. And they were both recognized for that. But it really wasn't until 1846 that saying things started getting good for patients who unfortunately had to go under going petations. Good of course being irrelevant if time. In 1846 the idea of anesthesia with

ether was finally introduced. You're welcome you man. So in Massachusetts the first surgery using ether was done. And obviously this revolutionized the idea of amputations because now we could put a patient to sleep before we you know removed a limb. It says here on your your information that Lister developed the antiseptic technique is this Lister of Listerine fame? This is Lister of Listerine fame. I got around, huh? As he began to, and he did play on the ideas of, I have to mention, when we talk about antiseptic techniques, there were predecessors who began to advocate this such as, um, semilvice, the father of handwashing.

Sure. Hero of mine. There is a father of handwashing, semilvice, was the first one to say, hey, you notice how after we do autopsies and then we go and deliver babies, the women that we delivered their babies get really sick, maybe we should wash our hands in between. It's revolutionary. He was drummed out of every medical society for it.

Wow, really? Yeah, he was greatly criticized because he insinuated that physicians could transfer disease, which of course they can. Absolutely. But that was not a popular idea at the time. So Lister developed in the late 1800s antiseptic technique and then patients of all surgical persuasions began to really stand a chance because we could put them to sleep so they could undergo the procedure. You didn't have to move quite as fast because your patient wasn't screaming

and pain. We knew how to like it. Blood vessels. Oh, are you doing that there? Yeah. We knew how to like it. Blood vessels. So your patient can I might have a low glyinocytic or a gas? What's the other one? General. General. So gas and I mean, and this was ether, and then chloroform, so you would just, you know, knock your patient out. And it was good that we had this because what came soon, and I think when a lot of people want to hear about

amputation, this is what they're referencing. What came soon after this was the Civil War. Where are they against, brother? And that's my thing I say about the Civil War. It's estimated that there may have been 50,000 amputations performed in the Civil War. Where they're against the Brutal. And that's my thing I say about the Civil War. It's estimated that there may have been 50,000 amputations performed in the Civil War. That is the same size as the population of the town we live in, for perspective, for people who live in the same town as us. It really, the problem was that a lot of gunshot wounds would result in just shattering

limbs. And there was no way to piece anything back together at the time. And inevitably, the limb would become infected, and the safest thing for the patient was to remove it, if you wanted to save their life. So that was where we kind of get this. I think the image a lot of people have of amputation, which is like the battlefield amputation. The Civil War, their bullets flying, men are screaming, there's a tent. And you've got that.

That's always, that's always key. And you have a guy whose leg has just been destroyed by gunfire, cannon fire, whatever, and you knock him out with some chloroform, and you move quickly, you make a cut through the muscle on the skin, and then you saw right through the bones, and it's from the Civil War that we get the term, saw bones. Oh yeah.

Yeah. That's where that comes from. You would like the blood vessels, you leave a little hole in the skin, you'd sew the skin back up over top, leave a little hole for all the fluid to drain out because inevitably there's going to be fluid in the tissue there. And almost everybody got an infection in there. Hey, sorry Civil War. Sorry.

Hey, sorry. They were Sorry. Hey, sorry. They were doing the best they could. Yeah, with the caveman level knowledge that they had of habitating things, but a whole there. Some stuff's going to come out, I guess. There is some important advances in prostheses at the time as well, largely because of the need. There was a need for prosthetics.

So as prosthetics date back to probably 300 BC, they found a leg in Capri, Italy that was probably, it was an iron and wood leg that was probably used as a prosthetic. Can I have an iron wood leg after you take my foot? Well I wouldn't know how to design it because the leg was housed in England and was lost when Britain was bombed. So now we'll never know what that leg looks like. God, you know, you think you think wars don't have a cost and then you hear something like

that that I'll never. The Capri leg is gone forever. I'll never have my wooden and iron leg. But there were in the 1500s, they started making prostheses with joints and then by the 1800s and then after the Civil War, they started making more functional ones that would seal to the stump, and they began making more functional prosthetics.

And as time goes on, as we go to World War I and World War II, we become much better performing amputations, and our skills at making prosthetics also greatly improve. and our skills at making prosthetics also greatly improve. Now, said sadly, this is still performed today. It obviously my hang nail is not going to merit, but what are some of the reasons that we would have for amputating today? Today, and I would be so quick to say sadly,

because again, it's still a life saving procedure, and this is something that, if you're as a physician, considering recommending this course to a patient, you sit down and have a lot of conversations about the risks and the benefits either way. And a lot of the time, you're doing this because it is the best option. Vascular disease, so if there's no more blood flow to the limb and it's going to be a side of infection or non-healing wounds Certainly disease, you know like that can lead to infection of the bone osteomyelitis and that could be a reason Trauma can be a reason if there's just nothing we can do a crush injury

Cancer that certainly can be life-saving it with some bone and musculoskeletal tumors, and then congenital malformations. Usually, the amputation has just occurred naturally in the womb, but that can correct and give people more function. Are procedures evolved, too? I would imagine, right? Absolutely. The basic idea is still pretty similar. The general thing that has improved is that we, you know, we sever it, we cut through

the skin and we cut through the muscle and we, and of course we cut through the bone using an electric saw, but we reform the muscle around the bone so that we, you know, prevent any kind of rubbing against the prosthesis that we, you know, that will be there later. And we also cut nerve endings higher and sew them into the surrounding tissue to try to limit the phantom limb pain that can result in some of the neuromas, kind of little balls of nerve tissue

that can form, that can cause a lot of pain and problems post-op. So, and obviously we try to limit joint involvement because a joint will always make it easier to use the prosthetic and we We use an antiseptic techniques in anesthesia now of course much the delight of a very one receiving Sinia we want to let our listeners go, but first we We have to talk about this guy which is the guy that I think makes this entire topic worth

Talking about so as I was makes this entire topic worth talking about. So as I was putting together our topic, one of our listeners, Eric West, tweeted that we should talk about a fellow named Robert Liston. And he was absolutely right, we should talk about Robert Liston. So this was a scotish lived from 1794 to 1847. He's famous for, well, many things, but he was the first surgeon in Europe to use anesthesia after it had already been used in the USA first. What, what?

That's right. Attica is the red, white and blue baby. But he was known as the fastest knife in the West End. So his what he was known for other than his I think his personality was for being able to amputate a leg in two and a half minutes. Now speed of course was important because the patients weren't asleep. So getting through the procedure quickly had some value, but it's obviously not the only concern. And Robert listened could attest to that as he in one case and he cited his four best cases. And he knew what he was saying when he said best. So, you know, he had a sense of humor about himself. And one, he accidentally amputated the patient's testicles along with his leg.

Yikes. But he did it in two and a half minutes. Still, I mean, that's great timing. It's sort of like when pizza brings it in under, pizza brings it in under 30 minutes, but other fan showies on it. It's the same sort of problem. I don't think it's like others and showies on it.

I think it's like instead of opening a box and finding a pizza with anchovies, you open the box and find a human head. You open a box and find your testicles in there. Yeah, I was going to say, I mean, he cut his testicles off. And you have to know they couldn't sew those back on. Not then. Another case he cited as one of his best. The other, this is his best case of all time. So during the procedure, he accidentally amputated his surgical assistance fingers. And as he was wildly slashing about, as all I can imagine, he also sliced through the coattails of one of a wealthy observer who had paid to come witness,

the search witness, the fastest knife in the western and the observer uh... upon being attacked with the scalpel actually dropped dead on the site fantastic now the patient on whom he was amputate on whom who's operating went on to die from gangrene as did many patients at the time and the surgical assistant whose fingers he sliced off also died of gangrene

so this was probably the only surgery in history that had a 300% mortality. There's a great quote here, if I may. Please, please. He was six foot two and operated in a bottled green coat with Wellington boots. He sprung across the blood stained boards upon his swooping, sweating strap down patient like a dualist, calling time time me, gentlemen, time me to students graining with pocket watches from the iron railing galleries.

Everyone swore that with the first flash of his knife was followed so swiftly by the rasp of saw on bone that sight and sound seem simultaneous and to free both hands. He would clasp the bloody knife between his teeth. This is a surgeon. An awesome surgeon. I know who I'm going for is Halloween. So Robert Liston, if you're listening, which you're not, we salute the effort. Yeah,

a forever. And we definitely will be reading more about you, sir. Another person I want to give an a forever is you, our dear listener, for sticking with us through another grizzly episode. Our medical history program, we sure hope you've enjoyed it. And don't worry, Justin's going to make it. I'm going to pull through. He's just wimpy. If you have a minute, if you could go to iTunes search for solbons and leave a

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Moat Wollin, Teraan, Palio Arx, Deityo Sam, Hey Mary high, surprise by kitten Delwina, cutology, Axiom 22, Darren 505, bubbles 41. My favorite, Med historian, who is an actual medical historian. Yeah, let me tell you, bud, when we checked out that I had a review by Med historian, I got pretty nervous, so I'm thrilled that you enjoy it. So head on over to iTunes and we'll read your name on the air.

On Twitter, you can follow us at sawbones. You can go to maximumfund.org and listen, all the other great max fun shows like Jordan Jesse Go, Judge John Hodgerman, stop podcasting yourself. My brother, my brother and me. One bad mother and Thank you to you the listener. Yeah, thanks so much for tuning in it means a lot We love your comments. We love your reviews and keep on giving us suggestions of things you'd like to hear more about you can email us

Sawbones at maximum fund org. Just tweet at saw bones Thank you so much again for listening make sure to join us again next Friday for another episode of Sawbones. I'm Justin McRoy. I'm Sydney McRoy. As always, don't. Drilla. I'm coming for you.

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