Murdering Medical Myths – no surgery has a greater mortality rate than 100%

 This post previously was printed in the newsletter of Central Jersey Sisters in Crime. Membership in the organization offers an opportunity to learn the writer's craft and to discuss an author’s writing problems with friends who write mysteries. Support your local Sisters in Crime.  

Today, I offer proof that a single surgery can have a mortality rate of over 100%.

Dr. Robert Liston’s colleagues venerated him. In 1835, he became the first Professor of Clinical Surgery at University College in London. In 1846, he performed the first surgery in Europe using ether anesthesia. Prior to that, surgical patients were put under hypnosis to reduce pain. You felt it, but you did not remember how bad the pain was - post-hypnotic suggestion. He was famous for his surgical techniques, and inventing surgical tools. He was a man of many talents.  

Germs, however, were not his concern. They were too small to register on his radar. One of his students, Dr. Joseph Lister, who graduated University College in 1846, championed antiseptic technique and carbolic acid’s use as a disinfectant. We can thank him for Listerine, fresh breath, and survivable surgery.     

At that time, people judged a surgeon’s quality by his surgical speed. No greater authority than Florence Nightingale in Notes on Nursing offered that quickness in surgery was paramount to good surgery. In theory, the surgeon went so fast, the germs could not catch up and infect the patient. Just kidding. I imagine, speed diminished the amount of time the patient suffered from acute pain. 

Dr. Liston, the Ricochet Rabbit of surgeons, worshipped speed over accuracy.    

His surgeries became classroom demonstrations for his colleagues. He was faster than the funny cars at Englishtown during the Grand National Championships.        

In this pre-Listerian age, infection was the chief cause of death. Post-operatively the patients were sent to the public ward, which was essentially a warehouse of deadly microbes. Using the New York City grading system for restaurants, the ward would not qualify for an "F" rating. 

Caregivers did not wash hands between patients, becoming the Angels of Death (transporting infection from patient to patient – like a tick carrying Lyme disease). The rotting and dying patients’ festering wounds were agar plates for fatal germs. The old patients served up the fatal infections to the arrivals via the nursing staff and physicians. The lack of antibiotics or disinfectants made the ward’s infection rate higher than the number of individual Zooplankton in the Caribbean.     

Routinely, surgeons performed operation in front of street-clothed spectators. The physicians and associated medical personnel would encircle the surgeon to see his techniques. Their proximity to the surgeon made contact inevitable - farther contamination. Neither surgeon nor spectator wore a mask, as they formed a scrum about the patient. Their huddle further diminished the dim light available to the surgeon. The operations were performed in a 19th century dungeon.    

In this environment, Dr. Robert Liston amputated a patient’s leg in two and one-half minutes. Post-op, he shipped his patient to the public ward where he died from infection. (100% mortality).

Dr. Liston moved so swiftly that he accidentally amputated three fingers from his assistance hand. The assistant was treated and ... sent to the public ward to recover. Infection killed him. (Mortality 200%).

In addition, during the surgery, Dr. Liston inadvertently slashed the waistcoat and coat tails of an elder surgeon-spectator. The gentleman’s shock and fear caused an acute myocardial infarction (a heart attack). He died immediately. (300% mortality).

The surgery set a world’s record mortality rate. Dr. Liston holds the record for speed of a surgical amputation, 28 seconds, as documented by the Guinness book of records.

By today’s standards, he was a surgical Jack the Ripper, a serial killer in the OR. Dr. Liston routinely sacrificed accuracy for speed. In another under three minutes leg amputation, Dr. Liston accidentally amputated his patient’s scrotum with the leg. Oops, but that took a lot of balls.        

Thank you for your kind attention. 

-- L.A.Preschel

references: 
https://en.wikipedia.org/wiki/Robert_Liston
https://en.wikipedia.org/wiki/Notes_on_Nursing
https://en.wikipedia.org/wiki/Florence_Nightingale
https://en.wikipedia.org/wiki/Joseph_Lister
https://en.wikipedia.org/wiki/Louis_Pasteur