And you thought your doctor was bad

kw: book reviews, nonfiction, medicine, podcasting, humor

When we need an operation, it helps to know a surgeon's success rate, not that you can easily find that out! Perhaps more importantly, for serious work, what is the surgeon's death rate (or survival rate)? Just to show how low the bar can be set, consider Dr. Robert Liston, who performed the first surgical operation under anesthesia in England in 1846. This was shortly after the miracle of ether was first demonstrated in the U.S. It was also just a year before he died. But prior to that, what was his death rate?

According to biographer Richard Gordon, quoted by Dr. Sydnee McElroy and her husband Justin McElroy in The Sawbones Book, in one case, that rate was 300%! To quote (from p. 101 in Sawbones):

"…Liston amputated a leg in two-and-a-half minutes. The patient died in the hospital from gangrene, but that happened a lot in the days before antibiotics. …[during the operation] Liston also amputated four fingers of an assistant… [and] managed to nick a doctor observing the surgery…"

The observing doctor, fearing a mortal wound (some nick!), died of fright on the spot. The assistant caught gangrene from his wounds and also died. One surgical operation, three deaths. Has anybody else you know of had a bad day that bad? Not even your doctor, right?

The book's full title is The Sawbones Book: The Horrifying, Hilarious Road to Modern Medicine. It is based on material from the podcast Sawbones. Having listened to an episode, I find that the book's portions (hard to call them chapters) follow the style of the podcasts: Sydnee tells a story while Justin interjects humor, and draws some from her also. Five of the items are biographical vignettes in the "Misguided Medicine Hall of Fame"; witness a blurb from Pliny the Elder: treat bloodshot eyes with a woman's milk in combination with honey and a bit of daffodil or powdered frankincense. Yowza!

Even though most of the stories range from tragicomic to entirely tragic, there are a few bright spots. While surgeons such as Dr. Liston had to learn to operate very fast to minimize a patient's agony, they learned a lot of practical anatomy. And in fairness, most were more careful than Liston and had a death rate well below 100%. Rampant experimentation did turn up things that could help: honey was prescribed for just about everything you can imagine (and a few you'd do better not to imagine!), but is usually ineffective. However, it is effective as a drying agent and germ barrier for open wounds. Another supposed universal cure: Urine. It doesn't cure anything. But if you are healthy, it is a sterile fluid, and if you get a cut and have no other source of sterile water, you can safely pee on the wound to wash it out. It'll sting, of course; there's a little salt! (and if you're not healthy, you could make things worse…) Finally, the last item is about the development of polio vaccine, which was actually a competition between Dr's Salk and Sabin, and their different approaches. Both succeeded, and both vaccines are still in use and almost 100% effective. That's a good story.

Sawbones is good reading and great fun, if a bit gross at times (for instance, you learn how to quickly exhume that corpse Dr. Frankenstein needs for his experiments). So don't read it while having breakfast. Any other time ought to be fine.