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On The Table With One of History’s Most Infamous Surgeons

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Imagine lying on a table in a old-school operating room. Faces stare down on you from the viewing galleries above and your leg throbs with pain from a broken bone and an infection just starting to set in.

The door opens and three men in blood-stiffened aprons walk in, carting a collection of needles, knives and saws. Two of them grab your shoulders and arms and pin you to the table. The third picks out one of the knives from the cart.

“Time me, gentlemen,” he calls out to the gathered spectators. “Time me.”

The man grabs your leg and begins to cut just below the knee. He continues to hold onto your leg as one of his lackeys gets a tourniquet around it. To free his cutting hand, he clasps the knife, covered in your blood, in his teeth and picks up a saw.

He cuts back and forth through the bone, drops the severed part of the leg into a bucket filled with sawdust, and sews you up, to the applause of the men sitting in the wings. They’ve timed the whole bloody procedure—from first incision to clipping the loose threads on the sutures—at just two and a half minutes.

It may sound like a scene from Saw or Hostel, but this is actually just a pretty typical procedure in a Victorian Era surgical ward.* And for all the imaginary pain you just went through, you’re really one of the luckiest patients around. The madman who just flew through your amputation with reckless abandon was Dr. Robert Liston, one of the finest surgeons of the time.

Quick Cuts

Richard Gordon, a surgeon and medical historian, calls Liston the “fastest knife in the West End.” His style may have seemed careless, but in the age before anesthesia, speed was essential to minimizing the patient’s pain and improving their odds of surviving surgery. Slower surgeons sometimes had pain-wracked and panicked patients wrestle free from their assistants and flee from the operating room, leaving a trail of blood behind them. Only about one of every 10 of Liston’s patients died on his operating table at London’s University College Hospital. The surgeons at nearby St. Bartholomew's, meanwhile, lost about one in every four.

Liston’s quick hands were so sought after that patients sometimes had to camp out in his waiting room for days waiting for their turn to see him. Liston tried to see every last one of these patients, no matter their condition. He especially loved treating those cases that his fellow surgeons had dismissed as beyond help, which earned him a reputation among colleagues as showy.

Occasionally, Liston’s speed and showmanship were a hindrance to his operations. Once, he took a patient’s testicles off along with the leg that was being amputated. His most famous (and possibly apocryphal) mishap was the operation where he was moving so fast that he took off a surgical assistant’s fingers as he cut through a leg and, while switching instruments, slashed a spectator’s coat. The patient and the assistant both died from infections of their wounds, and the spectator was so scared that he’d been stabbed that he died of shock. The fiasco is said to be the only known surgery in history with a 300 percent mortality rate.

Life Beyond Surgery

Liston had more going for him than just a quick and (mostly) steady slice, though. He was a highly-regarded surgical instructor and prolific inventor. Some of his creations, like the “Liston splint” and  “bulldog” locking forceps, are still around today. He also published two medical texts, The Elements of Surgery and Practical Surgery.

Towards the end of his career, Liston made medical history and performed a surgery that made his nimble hands obsolete in Britain. From that point on, pain would no longer be a hurdle to successful surgery, and speed wouldn’t be the surgeon’s greatest asset.

In 1846, Liston received a patient named Frederick Churchill, whose right knee had been causing him terrible problems for years. None of the treatments he’d been given before had worked, and now the only option was amputation. The day of the surgery, Liston walked into the operating room and, instead of grabbing a knife and asking his audience to time him, he pulled out a jar. Ether, American dentists and doctors had recently demonstrated, could be used as a surgical anesthetic. “We are going to try a Yankee dodge today, gentlemen,” Liston told the crowd, “for making men insensible.”

Liston’s colleague, Dr. William Squire, administered the anesthesia. He held a rubber tube to Churchill's mouth so he could inhale the ether, and after a few minutes, he was out. Squire placed a handkerchief laced with more of the stuff over Churchill’s face to keep him that way, and then Liston began the operation.

A mere 25 seconds later, the amputation was complete. Churchill roused a few minutes later and reportedly asked when the operation was going to begin, to the amusement of the audience.

Further use of ether in Europe’s operating rooms revealed its drawbacks. It irritated surgeons’ lungs, caused vomiting and other side effects in patients and, in some windowless rooms where surgery was performed by gaslight, ignited and caused fires. Anesthetics would continue to improve and become more common in medicine, but Liston wouldn’t get to see much of their progress. He died in a sailing accident less than a year after Churchill’s surgery, still the fastest knife London had ever known.

*Of course, you’re not a time traveller, and this is a hypothetical operation, but the details of the scene—from the medical students timing the amputation, to Liston holding the scalpel in his mouth—are all recorded in and borrowed from one or another of Liston’s actual surgeries.

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Animals
How a Pregnant Rhino Named Victoria Could Save an Entire Subspecies
Sudan, the last male member of the northern white rhino subspecies, while being shipped to Kenya in 2009
Sudan, the last male member of the northern white rhino subspecies, while being shipped to Kenya in 2009
Tony Karumba, AFP/Getty Images

The last male northern white rhino died at a conservancy in Kenya earlier this year, prompting fears that the subspecies was finally done for after decades of heavy poaching. Scientists say there's still hope, though, and they're banking on a pregnant rhino named Victoria at the San Diego Zoo, according to the Associated Press.

Victoria is actually a southern white rhino, but the two subspecies are related. Only two northern white rhinos survive, but neither of the females in Kenya are able to reproduce. Victoria was successfully impregnated through artificial insemination, and if she successfully carries her calf to term in 16 to 18 months, scientists say she might be able to serve as a surrogate mother and propagate the northern white rhino species.

But how would that work if no male northern rhinos survive? As the AP explains, scientists are working to recreate northern white rhino embryos using genetic technology. The San Diego Zoo Institute for Conservation Research has the frozen cell lines of 12 different northern white rhinos, which can be transformed into stem cells—and ultimately, sperm and eggs. The sperm of the last northern white male rhino, Sudan, was also saved before he died.

Scientists have been monitoring six female southern white rhinos at the San Diego Zoo to see if any emerge as likely candidates for surrogacy. However, it's not easy to artificially inseminate a rhino, and there have been few successful births in the past. There's still a fighting chance, though, and scientists ultimately hope they'll be able to build up a herd of five to 15 northern white rhinos over the next few decades.

[h/t Time Magazine]

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entertainment
Why Our Brains Love Plot Twists
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From the father-son reveal in The Empire Strikes Back to the shocking realization at the end of The Sixth Sense, everyone loves a good plot twist. It's not the element of surprise that makes them so enjoyable, though. It's largely the set-up, according to cognitive scientist Vera Tobin.

Tobin, a researcher at Case Western Reserve University, writes for The Conversationthat one of the most enjoyable moments of a film or novel comes after the big reveal, when we get to go back and look at the clues we may have missed. "The most satisfying surprises get their power from giving us a fresh, better way of making sense of the material that came before," Tobin writes. "This is another opportunity for stories to turn the curse of knowledge to their advantage."

The curse of knowledge, Tobin explains, refers to a psychological effect in which knowledge affects our perception and "trips us up in a lot of ways." For instance, a puzzle always seems easier than it really is after we've learned how to solve it, and once we know which team won a baseball game, we tend to overestimate how likely that particular outcome was.

Good writers know this intuitively and use it to their advantage to craft narratives that will make audiences want to review key points of the story. The end of The Sixth Sense, for example, replays earlier scenes of the movie to clue viewers in to the fact that Bruce Willis's character has been dead the whole time—a fact which seems all too obvious in hindsight, thanks to the curse of knowledge.

This is also why writers often incorporate red herrings—or false clues—into their works. In light of this evidence, movie spoilers don't seem so terrible after all. According to one study, even when the plot twist is known in advance, viewers still experience suspense. Indeed, several studies have shown that spoilers can even enhance enjoyment because they improve "fluency," or a viewer's ability to process and understand the story.

Still, spoilers are pretty universally hated—the Russo brothers even distributed fake drafts of Avengers: Infinity War to prevent key plot points from being leaked—so it's probably best not to go shouting the end of this summer's big blockbuster before your friends have seen it.

[h/t The Conversation]

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