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Surgery Past and Future

da-vinci-healthcare.jpgImagine how a single operation with a 300 percent mortality rate would appear on NHS Choices. In the 19th Century John Liston—proud of his ability to amputate the limb of an unanaesthetised patient in less than 30 seconds—accidently amputated an assistant's fingers along with the patient’s limb. Patient and assistant died of infection and an observer of shock.

Blood and Guts by Richard Hollingham is a pithy and readable history of surgery that does not hold back on the successes and the botches. One of the most amusing anecdotes became known as the “night of the pigs” and takes place in the National Heart Hospital in London in 1969.

Surgeon Donald Longmore waits for a delivery of pigs. He plans to graft a pig’s heart and lungs into a patient to keep him alive. One pig has other plans and makes its escape onto Wimpole Street, pursued by gowned, capped, masked and booted theatre staff.

The pig, now secured, is taken to the mortuary to be put to sleep, but the anaesthetist assigned to the task is Jewish. Another anaesthetist is found, but there is another problem: the patient is also Jewish and now unconscious so unable to take any decisions for himself. Mr. Longmore calls a rabbi who in fits of laughter gives the go ahead for a genuine attempt to save the patient’s life. Unfortunately, the operation fails in its final stages owing to an unforeseen reaction of pig heart to an injection of calcium.

Also described is the sad life of Ignaz Semmelweis who drastically reduces cases of puerperal fever among postnatal women in Vienna General Hospital by insisting doctors wash their hands in a chlorinated lime solution before entering the ward and with soap and water in between patients. Ironically, an embittered Semmelweis, whose findings were rejected by many experts, himself dies as a consequence of an infected wound two weeks after he is committed to a mental institution. A doctor’s touch could mean death.

In an interview on BBC Radio 4 Lord Winston debates the future use of robots in healthcare with Professor Noel Sharkey. One of Winston's main arguments is that patients need human contact and the healing touch. I wouldn’t disagree, but I do not think that precludes an increased use of medical robotics. The two go together. Certainly, as discussed before research in Cognitive Based Therapy indicates computer software is at least as effective as human practitioners.

For me one of the most noticeable aspects of the Radio 4 debate is the mismatch of the views of doctor and roboticist. In the history of surgery, robotics will not be the first innovation to have been resisted by established experts, though, as Hollingham reminds us at the end of Blood and Guts, modern surgery is based on brilliant, courageous and misguided individuals who were prepared to have a go. Sometimes they succeeded; sometimes they failed, but their efforts have helped future patients to live.

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