The hope of life
Because this one, for once, sounds so much better in French – l’espérance de vie – than the English ‘life expectancy’.
The life expectancy is just a statistical index, whereas the ‘hope of life’ makes it a poetic one, even touching.
Touching because it conveys one of the universal truths of humanity. Namely, once they are born, the vast majority of people wish, and hope, to live as old – and healthy – as possible.
And in fact, this index is not that old. It dates back to the 17th century, and we know very well who was the first person to take an interest in it. It was an English man, a London merchant named John Graunt; Tony P. wrote a blog post about him a few months ago. Click here to read it.
So in the 1660s, John Graunt compiled plenty of data about people who had died in London, and he made very neat, very thorough Excel-like tables.
And according to his figures, in London, in the mid 1660s, life expectancy was 17 and a half years.
That’s not great, not great at all. It’s not impressive.
Why is this index so low? Well, first of all, because of children. Sadly, about one third of them would die at birth or in infancy.
But the second factor was…
Doctors!
Before the 19th century, doctors were terrible. I mean, really, really terrible.
You have to realise that at that time, according to this newly created statistics, aristocrats had a shorter life expectancy than the rest of the population.
And why is that? Well, because they had enough money to pay them, and thus were the only ones who had access to doctors! And back then, being treated by a doctor was more dangerous for your health than not being treated at all.
Well let’s consider the cutting edge treatments of the time, with the very real, not fictional at all case of
The Demise of the Earl of Kent in 1702
The Earl was playing bowls with friends, when he suddenly collapsed, unconscious and apparently dead (no pulse, no breath, it sure is a hint, but I am not a doctor, what do I know?)
Luckily a prominent London physician, Dr Charles Goodall, was at the scene, and left nothing to chance in his efforts to save his patient.
He started by removing half a pint of blood from his arm – just the standard emergency procedure. (CPR would only make its debut in 1958)
He was given antimonial wine, to provoke sneezing and/or coughing and/or vomiting, to shock the Earl back to life, which too was a standard medical practice of the time.
That didn’t work either, so there was more bloodletting, blistering, some more toxic drinks were poured down his throat, and at that point some more doctors joined to help Dr Goodall and suggested to apply a red-hot frying pan on his head… (which they did, why not)
Tobacco remedies were injected into his body too, under various forms, but to no avail, and finally he was put to bed … with the bowels of a freshly-killed sheep wrapped around his abdomen – in a (desperate? Useless?) rather gross attempt to warm him up.
Spoiler alert: it didn’t work, but one mystery remains: what killed him? The (maybe) heart attack he suffered in the first place, or one of the subsequent treatments?
I summarised greatly, but if you want the complete account of this unfortunate event, you can read it here.
And that makes me feel like telling you more about the profession of surgeon.
Surgeon: Mr Doctor?
Well. As a foreigner it can be quite surprising, maybe a bit frightening according to circumstances, to realise that in this country, a surgeon is called ‘Mr’ or ‘Ms’, and not ‘Doctor’.
This practice, unique to the UK, has historical roots that date back to the 18th century, when surgery was considered a trade rather than a profession. Physicians, who practiced medicine (no cutting, amputating etc), were typically awarded the title “Doctor,” whereas surgeons, who performed surgical procedures, were addressed as “Mr.” This distinction was formalised by the Royal College of Surgeons of England in the 19th century. (until the 19th century, there were officially no female doctors or surgeons)
Over time, the lines between medicine and surgery have blurred, and even if surgeons hold both medical and surgical degrees, the tradition of addressing them as “Mr.” or “Ms” has persisted in the UK, as a mark of respect for the historical legacy of the profession.
The Interesting Case of Mr Robert Liston (a surgeon, then)
Born in Scotland, Robert Liston was a highly skilled surgeon of 19th century London. He had a very low patient mortality rate, with only one in ten of his patients dying. The average rate was one in four, the patient dying either on the table or later from infection.
Well, Mr Liston washed his hands, his aprons and his cutting utensils between 2 patients, which we know now is a good idea, but was a novelty at that time)
But we are at a time when operations are done without anaesthesia, the patient is conscious, and to minimise panic and blood loss, the surgeries need to be performed as fast as possible.
And Liston was fast. Very fast. It is said he could amputate a leg in only two and a half minutes.
Surgeries at that time would often be performed in an operating theatres, a room in a hospital or university where spectators – medical students – could watch.
The theatrical reference is not a coincidence, and the influence of the stage began to infiltrate the medical world.
This burgeoning of surgical theatres made showmen out of surgeons like Robert Liston, who in addition to his celebrated dexterity, was also reputed to perform his speedy amputations with a knife clutched between his teeth.
Before each surgery, he would challenge the audience to “time me, gentlemen!”, putting his legendary speed to the test.
But Mr Liston’s speed was a double-edged sword (pun intended). On the one hand, it helped many patients survive. On the other hand, it also led to some high-profile mishaps.
In one case, he accidentally castrated a patient while amputating his leg, which is already a bad enough blunder, but another one allegedly made him the only surgeon in known history to have a 300% mortality rate from a single operation.
Legendary! But How?
According to the story, Liston was swiftly performing an amputation when he accidentally cut off two fingers of one of his assistants (you know one of the guys who were supposed to hold the patient tight during the procedure, and probably do the bandage after that). That’s for one, but then as he brought his knife back up, he slashed the coat of a spectator. The spectator fell over the railing, dying immediately of fright.
The assistant and the patient both survived the procedure, but both died of infection a few days later.
That’s a very good story, isn’t it? However there is no first-hand account of the event, and it might be just an urban legend.
And although it put Liston’s name in the history of medicine forever, it is important to note that Liston’s successes far outweighed his failures. He saved far more lives than he lost, and he was a pioneer in the field of surgery. He was the first surgeon to use anesthesia during surgery, and he invented several medical tools that are still in use today (the aptly named Liston knife)
If you want to see more in London you can visit the Royal College of Physicians Museum, to see the ‘delightful’ Antimony cup I showed you earlier, the Hunterian Museum, which traces the history of surgery from ancient times to the latest robot-assisted operations, or the Old Operating Theatre, where you can see well, the old operating theatre of St Thomas Hospital, but so much more (I really love the herb garret).
‘Housed in the attic of the early eighteenth-century church of the old St Thomas’ Hospital, this atmospheric museum offers a unique insight into the history of medicine and surgery. The original timber framed Herb Garret was once used to dry and store herbs for patients’ medicines and in 1822 an operating theatre was included. Predating anaesthetics and antiseptics, it is the oldest surviving surgical theatre in Europe.’
From the Old Operating Theatre Website
Helene
