An Eye for War.

This wasn't the post I was planning to write, I had one planned about leprosy, - but I can never resist a story about a good Australian doctor, so hopefully you can all wait a little longer for that tale.

Today we are going to talk about the wonderfully named Sir Charles Snodgrass Ryan who was born on Killeen Station in Victoria on the 20th September 1853.  He studied at the University of Melbourne and then completed his study at the University of Edinburgh (Australian medical degrees were not wholly awarded in Australia until well into the 20th century - in fact up until very recently, most Australian doctors would complete at least some of their training in the United Kingdom).  He then undertook further postgraduate training as a surgeon in Italy and Austria. 

Sir Ryan at the time of his enlistment (public domain image sourced from the Australian War Memorial Collection)

Ladies Man

In 1809 a young man named James Barry began his medical studies at the University of Edinburgh.  He graduated in 1812 and went on to train at the combined hospitals of St Thomas and Guy's, going on to pass his exams and recieve admittance to the Royal College of Surgeons.  Following this he joined the Army, qualifying as a regimental assistant.

Barry was described as irascible and prickly.  Standing only five foot tall, with a high pitched voice, he responded angrily to the frequent taunting that was a part of Army life.  In fact he fought at least two duels over insults - shooting an opponent in one and being injured in the other.  He was also quite eccentric, travelling with his Jamaican manservant, John, his dog and a goat for milk.  He also was always dressed in full regimentals, including cavalry sword and was noted for wearing 3 inch lifts in his shoes. 

John Barry, his servant John and his dog, circa 1850

(public domain image sourced from Wikipedia)

Carousing will catch up with you

The Huns were a nomadic people who are though to have originated in Central Asia.  By 370 AD they had migrated into Europe.  They formed a unified empire for the first time under the rule of a single King in 447.  That King's name is still synonomous with brutality today - Attila the Hun.

Attila ruled from 433 until his death in 453.  Orginally his brother Bleda ruled half the tribe and Atilla the other, until Bleda's death in 447 when Atilla became the sole King.

 

(Public domain image sourced from Wikipedia)

Attila was known as Flagellum Dei by the Romans (Scourge of God).  He spent much of his reign waging war across Europe, burning and pillaging in his wake.  His actions are partially behind the fall of the Roman Empire.  At its height Attila's empire stretched from the Ural river to the Rhine.

However it's Attila's death which is of interest today.

Three Hundred Per Cent

As a doctor currently training in the fabulous speciality of obstetrics, (with a background in the even more fabulous specialty of General Practice) your correspondent stands on the hallowed ground halfway between medicine and surgery.

In that while she performs a great deal of surgery in her day to day life, she still has the ability to mock surgeons (gently of course, as they are her rather friendly and useful colleagues).

Thus how the following adventurous tale of Dr. Robert Liston first came to her ears.

Dr. Liston was a Scotsman, born in 1794 and from his description sounds like quite a character.  In a pre-anaesthetic era speed of surgery was a patient's only hope to avoid pain and infection.  Liston was famous for removing a 20 kilogram scrotal tumour in 4 minutes.

Rather than try to describe the man myself, I will let his contempory, Dr. Richard Gordon, do so for me:

"He was six foot two, and operated in a bottle-green coat with wellington boots. He sprung across the blood-stained boards upon his swooning, sweating, strapped-down patient like a duelist, calling, 'Time me gentlemen, time me!' to students craning with pocket watches from the iron-railinged galleries. Everyone swore that the first flash of his knife was followed so swiftly by the rasp of saw on bone that sight and sound seemed simultaneous. To free both hands, he would clasp the bloody knife between his teeth."

Liston was an imposing and acerbic fellow.  He left Edinburgh, where he had trained and practiced throughout his early career, in 1834 principally because he was so unpopular in the medical community there.  Not least of that was due to knocking down the infamous anatomist Dr. Knox in front of his students.  He assumed that some of the students had slept with the young woman being dissected while she was alive and that their behaviour was voyeuristic.  (As it turned out there was even worse foul play at foot!)

However, his somewhat abrasive personality was not always in the best interest of patients.  In one of the most famous cases associated with his name, Dr Liston was involved in an argument with a junior doctor about whether a mass on a boy's neck was a carotid artery aneurysm (a large swelling of a blood vessel) or an abscess (an infection).  Dr. Liston proceeded to settle the argument by removing his scalpel and lancing the mass there and then. The young boy bled to death in a matter of minutes. 

The remainder of Liston's career was spent in London, where he pioneered some amazing accomplishments, including the first British operation under anaesthesia in 1846.  A leg amputation, performed in 28 seconds, which of course makes one wonder if anaesthesia was required at all.

(in this photo Joseph Lister is actually the gentleman on the top left - I may be geeking out slightly.)

He also invented the Bulldog artery forceps.  I used a variation of them the other day. 

But this is, of course, not why I am telling this story.  

Legend has it that one day Dr. Liston was performing an amputation.  He proceeded to do so in his usual 2 and a half minutes but in his enthusiasm also amputated the fingers of his young surgical assistant, and cut through the coattails of a distinguished spectator who had leaned in too close.  

The spectator perished from fright instantly, the patient a few days later from overwhelming infection, and the assistant a few days after that, also from infection.

It remains the only operation in history with a three hundred percent mortality rate.  

As I tell my surgical colleagues - they've got a lot to live up to ;).