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Christmas 2009: Anaesthesia

Painless amputation: history of a discovery that wasn’t made

BMJ 2009; 339 doi: 10.1136/bmj.b5202 (Published 9 December 2009)
Cite this as: BMJ 2009;339:b5202

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  1. Sam Shuster, emeritus professor of dermatology
  1. 1University of Newcastle upon Tyne, Newcastle upon Tyne, NE2 4??rest of postcode?
  1. sam{at}shuster.eclipse.co.uk

    Sam Shuster ponders on why his retrospective discovery of tourniquet anaesthesia wasn’t made earlier, when it would have mattered

    My realisation that using tourniquet ischaemia in the pre-anaesthetic era could have made amputation painless led to the idle thought of why it hadn’t been discovered, and then, to the even more idle thought of whether looking at why discoveries aren’t made would help us understand how they can be made. Because this could be answered only by a study of the history of amputation that looked for the ambience of ideas and practices rather than their chronology, that is where my idleness ended—with a new reading of the original documents on amputation procedures from the 16th century onwards, written by surgeons who had used or developed them, in addition to historical reviews.

    The pain of pre-anaesthetic amputation

    The horror of amputation without anaesthetic is revealed by contemporary accounts, of which this by James Cooke in 1685 is typical1: “Dismembering is a dreadful Operation; yet necessary, that the dead part may not injure the living, nor procure death . . . let one man be at the Patients back holding him, and another before him, holding the upper part of the limb; and a Third holding that Part that must be taken off . . . you are to make strong Ligature with broad Tape . . . about three inches above the Place you intend to incise . . . and let him that has the Gripe haul up the Muscels tort . . . This done (and the Man having had a Spoonful of Cordial to cherish him), you must with your dis-membring Knife, take two large Slashes round the part in the form of half rounds, and let one meet the other as evenly as possible, and let them be deep …

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