An amputation in 28 seconds … surgery really has changed

An amputation in 28 seconds ... surgery really has changed

I was out and about recently when I came across an old black Mercedes. It was probably around my own vintage, from the fifties or maybe even older. Unfortunately, the owner wasn’t around so I couldn’t find out anything about its history, but I imagine it would have had a few stories to tell.

It was a beautiful looking car but as I got closer to it, I could see evidence of age. There were gaps in the doors which werenl’t closing properly and on closer inspection there were signs of home-made repairs where fillers had been used. They were rough and ready, and the patches had been hand-painted. That didn’t spoil the sense of history attached to it though. Signs of a life well lived. It was still being driven too so the engine was obviously in good nick.

It kind of reminded me of myself. A bit of mileage on the clock, some bits removed over the years and some other bits added with a few scars prove it. But the engine is ok for the moment and all the moving parts are kept in order with various pills and potions.

I’ve been very fortunate with the professionalism of my surgeons, but things might have been different if I had been born in the 19th century when Robert Liston was practising medicine. 

His career has been well documented on the Internet and he was known as the fastest surgeon of his era, not necessarily the best though.

Before the discovery of general anaesthesia, surgery was a horrific prospect with the patient fully conscious and suffering unspeakable agony with a significant risk of death. In those days surgeons had to get creative in an attempt to save lives while minimizing a patient’s pain. One of the most effective ways was to perform the surgery as quickly as possible, sometimes in under five minutes.

There was an upside to this method. The less time a surgery took, the less likely the patient was to bleed out and the less they would suffer. However, there was also a downside as accuracy would often be sacrificed in favour of speed.

Perhaps the fastest surgeon of this period was Robert Liston, who was often referred to as the “fastest knife in the west end”. He received his medical education at the University of Edinburgh, where he developed a reputation for being a very difficult individual with a caustic and arrogant personality.

He was particularly interested in anatomy and quickly built a reputation as a fast and highly skilled surgeon. He was widely disliked by his peers, and many wanted him banned from the wards because of his unpleasant attitude. Following a series of disagreements with his colleagues, he left Scotland and moved to London.

Standing six feet two inches tall, Liston was an imposing figure who was famously strong and spoke with a loud and brusque voice that would often intimidate both his students and patients. He was unusual at the time in that he would wash his hands and remove his frock coat and put on an apron to operate. Proper surgical antisepsis would not be widely accepted until the late 1800’s.

Before performing an operation, Liston would stride boldly into the surgical theatre, which was frequently packed out with spectators including visiting surgeons, all eager to witness his unparalleled surgical technique. With the presence of a true showman, he would then nod to the medical students present with their pocket watches in hand and announce, “Time me, gentlemen!”

A typical amputation would take approximately two to three minutes to perform, with his fastest amputation being reported to be an astonishing 28 seconds. 

A handkerchief would be placed in the patient’s mouth to mask his screams, a medical student would be asked to hold the limb that was being removed, and two other students would keep the patient still. Liston would then cut through the flesh with a scalpel, saw through the bone and suture the wound. Despite the speed with which he performed these procedures, his results were excellent for the time.

Between 1835 and 1840, Liston performed 66 amputations and only 10 died, a mortality rate of less than 1 in 6. The average mortality rate for amputations was 1 in 4.

In addition to his record-breaking 28-second leg amputation, Liston is infamous for some particularly remarkable cases. In another leg amputation that took a comparatively slow two and a half minutes, Liston accidentally also removed the patient’s testicles. In a more successful operation involving the testes, he removed of a 45-pound scrotal tumour, that the patient had to carry around in a wheelbarrow, in just four minutes.

Perhaps Liston’s most famous case, however, is the only operation in history with a 300% mortality rate. Robert Liston was performing a leg amputation on a patient who was lying flat on his table. As he brought down his knife, he was so focused on his speed that he took his surgical assistant’s fingers off along with the patient’s leg. As he swung the knife back up, it clipped a spectator’s coattails who collapsed and died. Unknown to Liston at the time, this death was only the first of three. The second and third deaths came a few days later, but still due to the operation. It later became apparent that the equipment Dr. Liston used was infected and not sanitized. The assistant’s finger and the patient’s amputated leg became infected, developed gangrene and both died from their wounds. The spectator who collapsed was later discovered to have died of fright.

Liston, without doubt, made a significant contribution to the field of surgery in the pre-anaesthetic era. Years later, when anaesthesia was invented, he became the first surgeon to operate using it, and his surgery was a success.

I came close to sharks in Australia before – this time I have a plan

About ten years ago my wife and I went to visit our daughter Vicki, and her partner – now husband- Ian, when they were in Australia. They spent a few years there, came home, had a family of three boys and just recently returned to Oz for another stint.

On our visit we were based in Brisbane. My son Colin, and my mother came with us. There was no shortage of beautiful sandy beaches in the area so the gang of us stopped off at one of them one day for a picnic.

It was a quiet spot and as far as I can remember we were the only people there. I noticed a small pleasure boat anchored about two hundred metres offshore and apart from that there was no sign of life. It was a hot day too, so I decided to go for a swim. As I was swimming around, Buddy their dog was running back and forth along the shoreline barking and enjoying himself.

After the swim I went for a small walk and when I returned, the gang couldn’t wait to tell me they had a visitor. Apparently, the guy in the pleasure craft got into a smaller boat and came ashore to speak to them. He told them to be careful in the water because a few sharks had been circling his boat for some time.

I’m not sure how my legs supported me at that stage because they turned to jelly. All sorts of scenarios ran through my head and most of them involved me in a pool of blood minus a few limbs. The theme music for Jaws was ringing in my ears and for the rest of my time in that country, I refused to go into the water.

Many tried to convince me of how safe most of the beaches were and how some even had nets spread across the water to prevent sharks entering the bathing area. I didn’t care. I had been swimming in close proximity to sharks and survived that near death experience with my body intact and I had no intention of exposing it to the risk of further harm.

The experts tell us there are many varieties of shark, some more dangerous than others, but as far as I’m concerned, a shark is a shark and I never want to be close to one again. Makes no difference to me how cuddly it is. If it has a fin, I’m off.

That creates a slight problem though because I’m heading to that part of the world again at the end of the year thanks to my daughter’s migration. I’m supposed to swim regularly for my back issue, so I need a plan. One thought I had, was to take one of the grandsons to the beach with me and keep him close while in the water. At the first sign of a shark, I could offer him as a sacrifice and go like the clappers to save myself.

My daughter, selfishly in my opinion, has an issue with that idea so as an alternative I decided to educate myself on how best to deal with sharks from a defensive perspective. The first thing I discovered is that you don’t need to go to the southern hemisphere to find sharks because approximately 35 shark species have been found in the waters around Ireland, including the second largest fish in the sea, the basking shark. I didn’t know that.

Travel + Leisure magazine offer some advice on how to keep safe from sharks while swimming in the ocean. They tell us that while these creatures have been painted as heartless predators on the hunt for human blood, that couldn’t be further from the truth.

Sharks are intelligent and curious animals who are likely just as intimidated by you as you are of them. If you ever run into one, the success of your interaction largely depends on you — it’s up to you to convey that you are a predator, not prey.

They suggest that while keeping cool when nose to nose with a shark may seem impossible, it isn’t. You just need to know a little about shark behaviour and have a plan for how to react should you come across one while swimming.

The colour of your clothing matters. Sharks have monochromatic vision, so it would be smart to avoid colours like white, yellow, or neon when swimming or diving because those may stand out more brightly in a blue ocean. Sticking to darker colours, like black and blue, can minimize unwanted attention from sharks.

When you see a shark, your instinct may be to swim as fast as you can in the other direction, but this could communicate that you are prey and should be chased. When you spot a shark in the ocean, your goal is to let them know that you, too, are a predator. To do this, you must acknowledge the shark by using eye contact.

But don’t get too locked in because if there’s one shark, there could be others. So, after you make initial eye contact, look around you. Again, the key is to show the shark or sharks that you are aware of them and not prey.

The reason you want to act like a predator in the water is to tell the shark that you are not on their menu. Splashing, screaming, and causing a scene at the surface might make them think you are a sick or injured bird or fish.

Maybe so, but in my case, I’m pretty certain that staring into the eyes of a shark to intimidate him is not going to happen. Splashing, screaming and causing a scene is much more likely so maybe I’ll just have to find a swimming pool.

I was asked to write a piece about living near the coast. Here’s my effort

If you want to experience what it’s like to live in a coastal town, you could do worse than spend some time in Cobh. It’s a great spot, full of history and like any place surrounded by water, it has seen its fair share of tragedies. But plenty of good times too.

The sea has always played a large part in our family life. My mother was born and raised on Spike Island and her father worked on the Department of Defence boats operating around Cork Harbour. My grandmother was a midwife based on Spike and she, like all the other inhabitants, had to rely on a launch to get to Cobh. When labour called, she had to travel in all hours of the day and night and in all types of weather.

When the weather was too bad, travel was impossible, and the islanders had to sit tight. A teacher travelled to the island every day from the mainland to run the little school. I remember my mother telling me that she often prayed for a storm when she didn’t feel like going to school because the teacher would be stranded, and the kids would have a day off.

The family left Spike Island and moved to Cobh in the early forties which was in reality changing one island for another. They settled in a terraced house on top of a hill on the eastern part of the town with unrestricted views of the harbour and that’s the house I grew up in.

In those days there was very little light to be seen around the harbour at night. Street lighting was practically non-existent so the surrounding areas of Whitegate, Spike Island, and Haulbowline were really dark. As a child, I can remember the trawlers coming into port as darkness fell and they looked sinister with their black sails, and I imagined we were being invaded by pirates.

When I got older, my friends and I used to play down by the seashore. We would pick periwinkles at low tide and fill potato sacks which we kept submerged in the water to keep the winkles fresh until the guy came to collect them in his van. He had a weighing scale and would give us a few pence per stone in weight.

We’d bring some home to the parents too and they would boil them in a pot of water and drain them into a bowl. The winkles would be picked out of their shell with a pin and straight into the mouth. They didn’t last long.

There was no shortage of fish either. Word would spread when the mackerel were breaking and everyone charged to the seashore, armed with fishing rods or a line of feathers. Fresh fish were always welcome at home and when the spoils were good, the neighbours were looked after too.

As we got older, we had a punt, a small rowboat, and we would spin around the harbour during the summer holidays. On a good day we’d have money to put petrol into the outboard engine, failing that we had to use elbow grease and pull the oars. That was ok when rowing with the tide but a much different story when pulling against it. Progress was slow.

We had no fear of the sea. We were all competent swimmers which was just as well because I’m sure we didn’t have a single life jacket between us. But in those days, there was lots of activity around the harbour and always plenty of people to keep an eye on us. They were great carefree times.

Sometimes when you’ve grown up in a place, it takes an outsider to remind you of what you have on your doorstep like IrishCentral, an Irish website in North America which spreads news of all things Irish.

It reminds us that if you claim Irish descent there is a good chance that your ancestors left Ireland through Cobh. It was the departure point for 2.5 million of the six million Irish people who emigrated to North America between 1848 and 1950.

Like Annie Moore, the first immigrant to pass through the Ellis Island immigration facility in New York Harbour on Jan 1, 1892. A statue of her and her two brothers stands outside the Heritage Centre and that centre is a must see for any visitor to the town. You can learn about the arrival of the railway in Cobh in 1862 that facilitated the mass emigration of people from Cork Harbour.

It’s well known by now the Titanic’s last port of call was Cobh and a visit to the Titanic Experience is essential. On April 11, 1912, that ship dropped anchor off Roche’s Point at the entrance to Cork Harbour and picked up 123 passengers who were brought to the ship from Cobh. Four days later it struck an iceberg and almost 1500 souls were lost.

In 1915, the Lusitania was sunk off the Cork coast by a torpedo fired by a German U-boat. 1,198 people perished and that tragedy also had a connection with the people in Cobh as the dead, injured and bereaved were brought to the town. Of the 289 bodies that were recovered, 169 were buried in the Old Church Cemetery just outside the town. 

These days, sea farers visit the town in happier times. Thousands of passengers from over one hundred cruise ships disembark in Cobh every year and they bring a lot of life to the town as do the visitors from around the country who come to see the liners.

The scenery changes every day when you live on the coast and there’s something very relaxing about watching the slow-moving activity of the various boats moving about the harbour. There’s always something new to see.

Trapping and eating birds was a way of life in Cyprus during hard times

The island of Cyprus is a rest stop for songbirds as they migrate between Europe, Africa and the Middle East. A place where they can rest up and catch their breath before continuing on their journey. It hasn’t always been a happy haven for them though. Many have found themselves on the menu in Cypriot restaurants instead.

For centuries, Cypriots have trapped and eaten migrating songbirds, as part of their normal diet. But over recent decades, the consumption of them became a lucrative commercial business and the level of slaughter reached industrial levels.

Millions of birds were killed each year as trappers employed new technologies to attract and capture them. The methods used by the trappers are illegal under both Cypriot and EU law and in the last few years, both the Cypriot authorities and environmental groups have been fighting back, dramatically reducing the number of birds being trapped.

I came across bird trapping for the first time while I was serving in that country with the United Nations in 2014. Part of our duty involved the prevention of this activity and in the course of that work I encountered many bird traps. They weren’t hard to find once you knew what to look for.

The trappers basically used two methods, glue sticks and netting. Glue sticks were very basic. They simply made a paste from the berries of a local tree and put the glue-like substance on thin sticks which were then placed on the branches of trees. Any birds that perched on them were stuck there until the trappers returned.

The trappers removed the sticks, detached their prey, then replaced the sticks for the next feathered visitors. Netting was more sophisticated. Metal poles were placed strategically around the trees and light netting was then attached to the poles. When the unsuspecting birds came into land, they got tangled up in the netting.

Some systems used electronic recording devices attached to speakers to lure the birds with mating calls. These took time and money to arrange but were very effective. The trapped birds were stuck there until they were recovered by their captors.

The birds were considered a delicacy and could fetch serious money on the black market. They were plucked, boiled and eaten whole, bones and all. While it doesn’t sound particularly appetising to me, it was, and maybe still is, a popular dish here.

Diners were prepared to pay well for the privilege of eating these miniature creatures. The dish was called ambelopouli and it would never appear officially on a menu, so diners had to know where it was available and who to ask for it.  

BirdLife Cyprus had a report on its website in 2020 describing trapping as the indiscriminate and large-scale killing of thousands of birds every year, with the worst year, since their records began, being 2014 with an estimated 2.5 million birds killed. That was the year I was working there so maybe I saw the worst of it.

Cyprus’s Game and Fauna Service, in charge of the fight against poaching, says the illegal trade is worth about 15 million euros a year. The campaign against illegal bird trapping is one of their most important long-term activities and the problem will only stop with a ‘zero tolerance’ approach. BirdLife Cyprus is determined to carry on fighting, but they have their work cut out for them.

When we came across bird traps, the protocol required us to report the finds to the authorities but in my experience, the police had little interest in getting involved. We dismantled the traps ourselves and made sure they could never be used again. It didn’t stop the trappers though. They simply replaced the equipment and headed for new ground.

It was a game of cat and mouse and occasionally we could see the trappers observing our activity from a distance. They had their side of the story too. Trappers defended their activity as traditional Cypriot food gathering and an important source of protein for the natives for thousands of years. 

Historically, trapped birds were a food supplement for the mostly poor island inhabitants living off the land. Trapping in Cyprus has been recorded in historical documents from the Middle Ages and even earlier times, but things are changing.

Last year, Cyprus Mail reported that bird trapping with nets had almost halved in Cyprus when comparing autumn 2022 with the previous year. The figures reveal a 49 per cent reduction in bird trapping with nets between autumn 2022 and autumn 2021, while the numbers since 2002 showed a 91 per cent decrease.

This encouraging decrease is due to the ongoing collaboration between environmental organisations and the competent authorities. High fines from €2,000 up have also helped.

The problem persists in certain areas across Cyprus, where large-scale organised trappers continue unhindered in the absence of the effective action of the Cyprus police anti-poaching unit, which was disbanded in November 2019.

The relaxation in fines from €2,000 to €200 for the killing of up to 50 birds using lime sticks, make penalties neither punitive nor deterrent. According to BirdLife Cyprus this has indirectly decriminalised this trapping method and has resulted in an increase in lime stick use recently.

Environmental groups have called on the government to reinstate the anti-poaching unit. They have also called for a change to the law, returning the fines to €2,000 for all birds, regardless of killing method or bird species. Only then, according to the experts, will Cyprus be able to deliver the final blow to the scourge of illegal bird trapping.

On the other hand, a recent demonstration organised by “Active Citizens Movement of United Cyprus Hunters” urged the government to lower the fines and to legalise spring hunting and bird trapping. So, this story is far from over.