A forgotten Emergency

Someone walked into my ER this morning (I am a day’s worth of travel south of it) and handed the triage nurse flowers and chocolate for me, to thank me for “caring so much.

“Now, it’s nice to get recognised. But at the same time: I do not do much more than what needs doing, so how bad must this person have felt they have been treated before, to consider my conduct worthy of recognition?

And is it bad that I can not recall the case for the life of me? I a wracking my brain, I have been told the diagnosis, sex, age, and status of the patient, even the day.

And, still, I do not remember them. Not in the least.

I think, honestly, that this is one of the issues we have with health care these days. Patients feel like they are not being taken seriously (every single one of them is, we literally kill ourselves to make them better. We just do a piss poor job, apparently, at showing it), and patients realize that they are but blips on our radar.

People we will (and have to) forget, the second they leave our care.

This was probably one of those cases that fell into a lull in the stream of patients arriving every night (I only did nights for a long time). I probably had the time to explain to them what happened. I probably had time to listen. And I probably had time to show I cared, rather than just caring and carrying on.

This should not be my place. This should be the domain of GPs.

The advocacy role of GP is being eroded by a system that focuses on defensive and rapid medical intervention over lifelong care and support. We’re not healing, we’re fighting fires. This system kills nurses, specialists, and physicians.

In a fantasy world where strong GP/PC physicians are the champions of their patients, there would always be a physician and a bunch of nurses who do not forget. Who will watch over procedures and, very importantly, translate “hospital” to “patient” showing them, that we do care, that we do worry about them and that they do matter.

We can do better. But for this, we have to have a cohesive and coherent medical system in which the patient is not funneled from provider to provider but guided through it by one, strong, advocate.

This starts in policy and politics and does not end with addressing a toxic image of what makes a “good hard” nurse or physician. The patient isn’t the only one suffering from this, and we’d do well to do better, for ourselves and for our patients.

Franz Schmidt (1555 – June 14 1634)

A healer’s job is to heal. And this list is ordered by their birthdays. So, why would I add an executioner with no known birthday to it?

Few sentences had as much an impact on my decision to become a medic than the one attributed to Asklepios: “Sedare dolorem, opus divinum est.” — the soothing of pains is the highest (a divine) calling.

An executioner’s job in Germany of the 16th century was by no means a simple one. To become one, an apprenticeship with an established Master (“Meister”) executioner was required, a hard and thankless job of being the Master’s personal servant, then a few years in the employ of another executioner, followed by a rather involved process of Mastership, only after which one was allowed to call oneself an executioner.

Schmidt’s father did not voluntarily pick up the sword. As a woodsman, he worked for the Margrave of Kulmbach (Albrecht II, a real asshole, that guy), who had a habit of executing anyone he disliked. When his executioner refused to hang four innocent men, Albrecht forced Schmidt’s father to do the deed, damning him to a life as executioner, since the job was a one way street into societal shunning.

Franz entered as an apprentice into his father’s business at age 14. At the time, being an executioner meant to not only execute criminals but to also be jailor, advocate for the condemned, legal expert, craftsman, and more. At age 18 he finished his apprenticeship but continued work under his in Hof (Bavaria) until meeting Maria Beck, his future wife and daughter of the chief executioner of Nürnberg, whose post he inherited.

Not your basic Hangman

Being chief executioner in Nürnberg, one the richest and most prosperous cities in Europe, afforded Schmidt a wealthy lifestyle and considerable social and legal powers. Under his reign, he pushed for and turned into law the Executioner’s Right To Refuse. Remembering his father’s fate, a Margrave’s decision condemning him to a life of social stigma and state sanctioned killing, he established that “no man, not of free standing nor as an executioner, can be made to kill against his conscience.”

Medieval Nürnberg. Front and center the gallows and executioner’s hill. In today’s world, this is where the A73 highway comes down from Erlangen. Schmidt lived in the center of town, close to the cathedral.

He also became a campaigner for women’s rights with his wife who in the couple’s lavish residence in the best part of Nürnberg hosted fundraisers for women’s shelters and orphanages.

Contrary to the image of executioners in modern folklore, only a small part of Schmidt’s work revolved around executions. As the local jail’s prisoner advocate he also had the power to commute sentences and choose the means of execution. He abolished the death penalty for homosexual acts, opting for banishment instead. He also ended the more brutal forms of execution, burning, drowning, the wheel, and crushing, were commuted to an execution by sword.

One would think that such a rebel would make enemies, and that he did. By and large, however, he was not just respected but actually liked by clergy, nobility, and the common folk, for his piety and reasoning for life, his common commutations of sentences, and his work in social matters.

The “Executioner’s Bridge” in Nürnberg. A museum about medieval law and Franz Schmidt is located to the right. To the left the “Executioner’s Tower” where Schmidt had his office.

In addition to executions, Schmidt also had to carry out physical punishments, such as flogging, amputation of limbs or fingers or toes. Of these, as well as his executions (361 executions, 345 punishments), he kept meticulous records. This will become important in a second.

By 1590, Schmidt, endearingly known as “Meister Franz” across the land, had reformed his job into that of a “merciful weapon of justice.” Well liked by most, he was no less than considered a peer to jurists and upper law enforcement. He could have continued and then retired rich and happy with his wife and seven kids.

Yet, there was a second side to Meister Franz. Early in his career, he found his love for medicine. “If I am to drive out the ailments of this city, I must not start or end with the criminal element, I must also heal the human element” he wrote to his wife in one of the few surviving letters and documents (Nürnberg was heavily bombed in WWII and few things of value survived, Bamberg was mostly spared – a story for another day, also involving a physician – and some of his records were kept there).

From 1578, the start of his work in Nürnberg, to his death in 1634, he worked not only as an executioner but also as a healer. While working to reduce the pain of executions and to commute as many as possible (even Meister Franz was clear that a murderer deserved death), he also soothed the pain in those who did not meet him on the scaffolds. In his lost writings, the last one having been destroyed during the Allied bombing of Nürnberg, days before the war’s end, he described methods to set bones, establish the health of an unborn child, cure a number of fevers and other ailments, and posited the (sacrilegeous for the time) question if the fever or the cough was not the illness itself but a symptom of unseen things, too small to detect, inside a person’s body.

He wrote about sanitation, respectful medicine, reproductive health, and the value and frequent health checkups for the very young and very old.

Sedare dolorem…

When he retired in 1617, he received a royal letter of “Ehrlichkeit”, removing the last stigma of having been an executioner, from Ferdinand II, and became a medical consultant and teacher. In 1543, Vesalius’ De Humani Corporis Fabrica, the first book on human anatomy was published, and having read it before, Schmidt not only translated it into German, he also performed, against the laws of the time and under the generous protection of his reputation and letter of Ehrlichkeit, autopsies on consenting donors for young healers.

By his own estimates, he performed close to 15’000 consultations as a healer and medical consultant over his career, trained 502 young medics, and “spared the life of those condemned to suffer torment until death” a whopping 904 times.

When he died in 1634 he received a state funeral and was buried in a cemetery usually reserved for clergy and nobility. His writings persisted and were used, among other ways, as the basis of both justice and medical reform until late into the 18th century.

Schmidt’s grave in Nürnberg.

A Metal Medic

Schmidt wasn’t free to chose his occupation, having been cast into it by fate and a cruel Margrave who condemned him, trough his father, to a life that could have gone differently very easily.

But he chose to stretch and soften his impact on society, reducing executions, showing mercy more than the times would have allowed most anyone else, and by becoming a healer of more than just perceived and real societal ills. He, in everything he did, lived by that sentence attributed to Asklepios: Sedare Dolorem Opus Divinum Est.

John Snow (15 March 1813 – 16 June 1858)

If you only ever heard of John Snow, commonly known as the father of epidemiology in regards to the SARS-CoV-2 pandemic, you’d be forgiven for thinking this to be his only, and greatest, claim to fame.

But we don’t celebrate the well known in this series as much as we discover new and exciting things that make trailblazers into heroes and heroines. John Snow, for all that he did against Cholera and for epidemiology, was one of those heroes.

Born in 1813, Snow shared something with many of the heroes on this list: he was a reluctant physician. Pluridisciplinary thinking seems to be one of the great factors in what makes the good great and the great greater. Unlike many of his colleagues on this list, though, he was a thoroughly nice person, a visionary and teacher, unaffected by the antics that seem to be defining features of others.

In that regard, he is more like Åke Senning (14 September 1915 – 21 July 2000), a reluctant physician as well, who wanted to be nothing more than an engineer and found his calling in the combination of engineering and medicine in the development of the first pacemaker. Like John Snow, he also was one of the genuinely nice people in this series.

John Snow wanted to be a mathematician. But at 14 a spot as a medical apprentice opened up and, lacking funds and connections to continue into university, Snow accepted.

Into Medicine

He performed impressively and was often left to himself to tend to patients from as early as sixteen years old. When he was 19, working as an apothecary-surgeon apprentice, he managed a local Cholera breakout largely by himself. His experience led to him adopting a teetotal life, becoming a vegetarian, and beginning to distill his drinking water. He also published a first book on Cholera management.

It also gave him valuable insights into the workings of Cholera that would become important later. His mathematical mindset led to his painstaking documenting of infection vectors and contacts, helping him to prevent hundreds of infections and resolve the outbreak quickly.

His efforts did not go unnoticed. He was invited to work as an assistant surgeon in a coal mining operation and, in 1836, at 23 years old, received an invitation to study medicine in London.

He graduated two years later. During his time in school, he had developed an interest in the first moves into anesthesia. Working as a surgeon, he graduated with an MD in 1844. In the mean time he wrote a book about asphyxiation and resuscitation in still born children, the first of its kind to like body temperature and resuscitation success.

First Anesthetist

By 1846, ether ended the barbaric days of wake surgery. However, physicians administered the ether themselves and gave as much as they could to extend their time of concentrated working on the patient. This wasn’t always a good idea.

Using his math skills, Snow first recorded and charted the optimal dose per kilogram for men and women, taking into account age and occupation. He experimented on consenting volunteers and even developed a scale to chart the “hangover” after sedation.

He published his findings in papers and never attempted to keep any of the formulae he used a secret. No patent was filed, as was the habit of those times, to ensure his dominance in the market, yet despite his openness, he quickly became the go-to person to perform anesthetic procedures for other surgeons. And just like that, John Snow became the first Anesthetist.

While working with ether, he also experimented with chloroform. While the first experiments didn’t go so well, one of his patients died after a relatively minor surgery from chloroform inhalation, he quickly developed algorithms to ensure patient survival. Unlike ether, chloroform had to be titrated, that is given slowly, and patients often cleared a little before being put back “under.” This ended the days of surgeons doing the sedation themselves and the profession of Anesthetist was truly born.

He designed masks to administer ether and chloroform and gave them away.

His greatest claim to fame, however, was his painstaking work in calculating dosages which allowed him to partially sedate patients. This was useful in obstetrics, where mothers were slightly sedated but not put to sleep. So well was this received, that he was called to perform this procedure for two of Queen Victoria’s child births. At the time, most people saw the easing of labor pains as wrong, believing that the pain of labor was God’s punishment for Eva’s sins and not to be reversed. Queen Victoria’s births, however, changed this perception and, two years later, chloroform was used routinely, using the “Snow Table” to determine doses in deliveries.

First Epidemiologist

A year after Queen Victoria’s first chloroform-assisted delivery, Cholera came to London (again).

It was not the first, and it would not be the last. Unlike some common claims, John Snow did not independently do his research, however, but was asked by the Crown and by many prominent physicians to lend his expertise.

He’d previously been a co-founder and driving force behind the Epidemiological Society of London, which surveilled and recorded Cholera and other outbreaks since 1850, four years before the Broad Street Pump outbreak.

Additionally, he’d published works as early as ten years before the Broad Street Cholera outbreak, questioning the truth behind common belief that the illness was caused by inhaling “unholy air.” Instead, he analyzed his work earlier in his career and, despite this not being common belief and germs being unknown to science, believed it must have something to do with contamination of food or water.

He set off to prove or disprove his ideas in the 1854 Cholera outbreak that made him famous. By simply talking to residents and mapping water and food sources he quickly identified the Broad Street pump as the possible culprit but could not isolate any contaminants in the water. Nevertheless, thanks to his already stellar reputation as a physician and his thorough recording and analysis of the interviews done with residents, he convinced the council to disable the pump.

While this is rightfully hailed as the first step into the field of Epidemiology, Snow himself wasn’t so sure that he was the savior he was called. Due to the lack of pathogens in the water and already declining numbers, he often stated, that he was unsure if he had not drawn the right conclusions but only after the water had already cleared. Declining numbers prior to the disabling of the well seem to agree.

A year later, Snow rewrote the book he had written at age 19 to include the Broad Street outbreak. In it, he popularized the use of dot maps to map outbreaks and strongly favored a primitive germ theory that heavily influenced Louis Pasteur’s work in sterilization and food safety. He was the first to recommend boiling water before use.

Sadly, unlike scientists, the council of London did not agree with Snow, replacing the pump after the outbreak. While no further cases of Cholera caused by it are known, it had been built next to a cesspit, a fecal dump, and was implicated in other illnesses and many other deaths.

It took until 1866, after Snow’s death, that one of the greatest opponents of Snow on the matter of water contamination, William Farr, observed the same issue at another pump and issued orders that all water had to be boiled before use.

Farr is also known for another scientific win. In 1867 he stated that, “although I disagree, I have calculated it myself and numbers do not lie. I do not know how, but I will advise to boil water.”

Snow had always lived a dietary life that emphasized purity. In 1840, however, he suffered kidney damage, which he attributed to his vegan lifestyle and he allowed himself a little wine for digestion and returned to eating meat a few times a month. Sadly, he never fully recovered and his hectic life as a medical celebrity and the stress of being the odd man out in germ theory, took its toll.

He died, aged 45, from a stroke.

Willem Johan (Pim) Kolff (February 14, 1911 – February 11, 2009)

Know what’s hardcore? Being an active resistance fighter against the Nazi occupation of the Netherlands, that’s hardcore. If, by the by, during that time you also start the first blood bank in Europe, build the first dialysis machine from car parts and juice cans, and hide a Jewish colleague and his son from SS officers, you’re ultra hardcore.

Meet Pim Kolff.

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Dr. Rebecca Lee Crumpler (February 8, 1831 – March 9, 1895)

Imagine being a physician in 1880 and writing a book that changes medicine as we know it. You put the pen to paper and begin:

I now present to the public a few thoughts in book form, trusting that they will be accepted on their merits alone. The following pages contain a few simple appeals to common sense, and are addressed to mothers, nurses, and women generally.

Dr. Rebecca Lee Crumpler – Foreword to to “Book of Medical Discourses”

You mean every word of this. You hope, against hope unfortunately, to always be judged on merit alone. And you feel, rightfully, that women do not get their fair share in medicine, be it as a practitioner or a patient.

Read More

Mercy Dogs, unsung canine heroes (Feb 5 1897 – June 30 1968)

Imagine you and yours saved tens of thousands of lives in a time when saving lives wasn’t just hard work, it was hell-a dangerous, too. And then be forgotten. You become a legend, something people actually won’t believe really happened.

That’s what happened to Mercy Dogs.

On Feb 5 1897 a German painter by the name of Jean Burgatz showed off something he’d been working on for a while. It wasn’t a new painting but, instead, a dog trained to rescue wounded soldiers in dangerous situations.

His “Rettungshund” was trained to use her superior senses to find wounded soldiers at night and either supply them with needed wound dressing and other aids or, if the person was alive but unable to get up, to return to her handler and lead them to the soldier.

By 1900 he had trained 29 of the dogs, six of which remained in his care, the rest was given to the Army and the Red Cross.

Another 14 years later, at the dawn of World War I, Germany had trained 6’000 of the furry paramedics. And, unlike soldiers, those dogs were held in high esteem and protected well. If the choice was between losing a Rettungshund (now renamed “Sanitätshund,” “medic dog”) or a soldier, often the decision fell against the human. Still, thanks to their use by the Red Cross, soldiers on both sides were rescued in the hundreds.

Britain’s Army did not think much of the idea, but one of its officers, Edwin Hautenville Richardson, did. After trying, unsuccessfully, to start a rescue dog (named “mercy dogs” in Britain) wing inside the medical corps, he gave his trainees to the British Red Cross, which eventually trained and used around 200 of them during the war.

After the cannons stopped, German, French, Austrian, and British dogs numbered close to ten thousand and had saved as many, probably many more, lives.

The US was late to the party but, both owing to the success of dogs in WWI and pressure from the American Red Cross, a program was started that remained civilian and in the hands of the ARC. While Europe used mainly German Shepherd’s for this task, the US, both due to anti-German sentiment and for practical reasons, used pointers and setters.

Only during WWII did America, starting in 1942, add mercy dogs to its repertoire. Unlike the Red Cross dogs, which were trained to rescue anyone who was wounded, US dogs were trained to bring back an item of clothing or similar to ascertain the wounded was indeed American.

One such dog was made famous by being promoted into the rank of Sergeant after holding a German soldier captive until his unit arrived. He became a cause célèbre in the United States with most Americans idolizing and celebrating him, while others felt, that promoting a dog made a mockery of the system. Sgt. Stubby of the 102nd Infantry, 26th (Yankee) passed away on March 16 1926 at 10 years of age (80 in dogs) and is part of a non-public collection at the Smithsonian Institute.

After the war, rescue dogs declined in numbers. A similar program was used by America during the Korean War, but remained smaller in numbers and was more aimed at recovery (dead) than rescue (alive).

But, still, during the first half of the 20th century, these heroes with fangs and paws rescued tens of thousands of wounded.

Elizabeth Blackwell (February 3, 1821 – May 31, 1910)

On Jan 22 1849, aged 28, Elizabeth Blackwell, born in Britain, became the first female physician in the United States of America.

Having been rejected from every medical school she applied to, she finally turned to a small, private, school, the Geneva Medical College (in Geneva, NY, not Switzerland). Blackwell walked in, ready to be denied, but an all male student representation voted to admit her, forcing the chancellor to turn the school (which was financed by said male student’s rich families) to admit Blackwell and open its doors to female students.

Today, Geneva is known as SUNY and rightfully proud of that day.

That day, her admission to medical school, didn’t come easy for Blackwell. Her father lost his fortune in sugar refining in a blazing fire that destroyed their home in Bristol, UK. Out of most of his money, he moved his family to NYC to become an abolitionist, unknowingly shaping Dr. Blackwell’s future at the dinner table in discussions around slavery, women’s rights, and child labor.

The Making of a Metal Medic

She became a teacher at age 17, weeks after her father died, working in education reform soon thereafter, but found herself more and more drawn into medicine. The needed impetus happened shortly after her twentieth birthday, when an acquaintance mentioned that she would have probably not suffered as much, had a female physician cared for her.

She converted to Unitarianism, a more liberal form of religion, not as judgmental about females working in traditionally male jobs, and moved to North Carolina to teach music. There she met and moved into a room at the Reverend John Dickinson’s house. Dickinson had been a physician before becoming a minister and opening a school. He was more than excited to see Blackwell interested in this career. He lent her his books and taught her privately. She learned as much as she could, only leaving the library to run a Sunday school for former slaves.

After Dickinson lost his own school, she moved to Charleston to live with his brother, a physician. Sam Dickinson pushed her to apply in Philadelphia, promising to lend her the missing money to do so. A friend of Dickinson’s, Dr. Allen, boarded her for free and privately taught her anatomy while she applied to medical schools, carrying references from all three men, each well regarded as experts in their field… no one wanted her.

Medical School

In the fall of 1847, having been turned away at many schools, Blackwell applied to Geneva College. Here, the Chancellor and Dean disagreed, the Dean finding the though intriguing, the Chancellor fully opposed. As was the rule for such cases, a panel of 150 student representatives was polled. Unlike other events, however, this time, the Chancellor insisted, one vote against her would cause her denial.

The student body voted, unanimously, to accept her.

Between the two terms of her time in medical school, she returned to Philadelphia, working in a hospital for the poor. She graduated, 19 months later, on January 22, 1849.

The Dean, Dr. Charles Lee, who had voted to admit Blackwell conferred her degree, then bowed deeply. As did the President. To thunderous applause.

No Break

Life didn’t get much easier for Dr. Blackwell. She moved to Europe where, no matter the country or hospital, she was treated as a nurse, not a full physician. Only when she arrived at La Maternité and met Paul Dubois, one of the greatest Obstetricians of his time, did she receive training. At the conclusion of her time with him, Dubois made it clear, in writing, that she was probably slated to be the best OB in the United States, male or female.

A few days later, while treating an infant with conjunctivitis, she contaminated her own eye, losing sight in it shortly thereafter. This ended her aspirations in surgery.

She returned to the US shortly thereafter, opening her own practice, but still faced sexism, leading to few patients. Female medical practitioners were seen as abortionists and little more, so no one came for other complaints lest the neighbors would talk.

Dr. Blackwell teaching (1870)

She started lecturing in 1853 and began to personally mentor the few women who had begun to study medicine after Blackwell had kicked open the door. She opened, together with one of those students, a clinic for Women and Children in 1857. Among her mentees was Elizabeth Garrett Anderson, the first female physician, mayor, and medical school dean in the UK.

When the Civil War broke out, she once again faced adversity in her plans to train female nurses for the front lines, but ultimately succeeded in establishing a training clinic for Union nurses. She and her nurses are credited with saving thousands of lives over the course of the war.

Later Life

A lifelong close friend of Florence Nightingale, the two had a falling out over the role of women in wars. Blackwell saw them as physicians, Nightingale as nurses, both insisting their respective professions being the better suited to treat and heal.

Financially now stable from a number of investments, Dr. Blackwell turned towards mentorship, the setup of women-run medical schools, and societal change in Britain.

She became a campaigner against contraceptives, premarital sex and any counseling in this regard by physicians, and turned into a fervent vaccine opponent.

In 1907, she fell down a set of stairs, leaving her physically impaired and with declining mental health. She died on May 31 1910 in Britain, her headstone can be found in Kilmun, Scotland. She was the first female to receive an obituary in the Lancet.

Robert Liston (28 October 1794 – 7 December 1847)

In our list of Heroes, Robert Liston is somewhat of an anti-hero. An important tale, nevertheless, and so he appears here.

Liston was a brash, arrogant, and entitled man. A peacock, more concerned with his pursuits (both as a womanizer and as a braggart in the surgical theater) than his patients.

He was tall, balding, and of “unimposing looks,” yet had a temper to make up for it and assert his dominance and presence at every moment. He also had a soft side, an ear for the sick, and a need to be liked. But to understand Liston, we have to understand surgery in the 1820s.

A round theater was often packed with paying visitors from all manners of high society. Surgery was a spectacle, a sideshow, and a business, not officially associated with medicine as a healing art but with anatomy, a mechanical and practical one. It wouldn’t be until the 1840s that anesthesia, mostly driven by John Snow (15 March 1813 – 16 June 1858), would enter the operating rooms, and thus surgeons had to work fast and with extreme accuracy if they wanted to finish their handiwork in time for the patient to not flail or die from blood loss. Surgery, as we know it today, did not exist, all surgical moves were amputations.

He was 24 when he became a surgeon at the Royal Infirmary of Edinburgh. But even before that time, he had already left his mark on the discipline, writing under a pseudonym for a number of anatomical magazines. His descriptions of heroic surgical endeavors were all fables, yet they bred a new kind of surgical braggadocio, the competition for faster and faster completion of complicated amputations.

Surgery was, unlike medicine, a lucrative endeavor. Selling seats at the theater, advising and training new surgeons, as well as the cost of the procedure itself made many of the star surgeons very rich. Not rarely did practitioners even perform the operation for free or pay their patients to ensure a constant stream of theatrical stages that sold out to packed rafters. Within the operating theater most surgeons worked surrounded by ascending, concentric standing and seating areas, not unlike that of a coliseum. Many of those rooms were open to the sky to let in light and to vent out the smell of blood and other fluids that dripped down onto a sawdust covered floor.

An old operating theater, later 19th century.

Closest to the surgeon were his assistant(s) and the patient. The first circle contained colleagues who came to gawk and cheer, interspersed by students of higher means who also made up the following standing rings. Behind those, a number of seating rings were reserved for the very rich, followed by poorer students and the rabble that could afford a ticket to the show.

Liston was a surgeon of the purest sense. He abhorred the “finicky and affected” ideas of medical practice, seeing himself as a provider of services that were neither spiritual nor elegant, a mercenary in the service of surgery.

And then, there was his soft side. He’d often leave his post at the Infirmary, even turning down lucrative surgeries, to perform smaller surgical tasks at the houses for the poor and infirm in and around Edinburgh. He gave copies of his books, then considered required reading, to those who could not afford them, and there are a number of documented cases of him taking on young surgeons without the means, even paying them a modest salary.

Or that time he punched out a colleague for displaying the naked body of a young female murder victim in whiskey for three months before a planned gruesome show autopsy. It later became clear, that the victim, Mary Patterson, had been murdered by infamous body snatchers Burke and Hare and sold to Dr. Knox “still warm, almost breathing.” Patterson had been a medical socialite, having sexual relationships with many surgeons and students, and was well known, thus drawing thousands to pay and gawk.

Knox’ complicity in this is almost guaranteed, he’d started showing “dissection of the very recently deceased” months before and performed up to two autopsies a day in some weeks. An anatomist like him would not have missed the signs of murder in those bodies brought before him by Burke and Hare.

Liston arranged to have the body inspected for sings of foul play and then buried in a small ceremony.

But Liston’s true rise to fame did not come from his charity or even his brash nature. His frequent bar fights with fellow surgeons, his lavish parties during which he bedded young impressionable socialites, or his books were nothing compared to his alleged feats in the OR. None of those are well documented, through the last one is to some extent on account of the persons involved.

During surgery he started a fight with another surgeon that culminated in them disagreeing about the nature of a mass in a boy’s neck. To prove it was not an aneurysm but a tumor Liston stabbed it. It was an aneurysm and the boy died in seconds. Rather than becoming apologetic, Liston removed the artery and had it prepared for display.

Another time, in a rush to finish surgery faster than one of his opponents who’d done one in two minutes and forty seconds, he accidentally amputated his patient’s testicles as well. These, too, were prepared for display. He also beat his colleague by nine seconds.

Finally, to beat his record of two minutes and 31 seconds from this event, he worked so fast, he amputated three of his assistant’s fingers and, during the final flourish, nicked the coat tails of another colleague standing in the spectator row. The patient and assistant died of gangrene three days later, the spectator, believing he’d been slashed, from shock an hour after the surgery.

The London Operating Theater. Banisters were added in the 1870s to prevent troubles like the ones experienced in Liston’s record case.

That day, Liston not only achieved the record in fastest surgery but also in most people killed during one: three.

But why then include Liston in my list?

Liston’s antics were numerous and woven tightly into the fabric of a changing medicine and surgery. His brush with Knox and the Burke and Hare murders, his publication of books that informed a new generation of surgeons and ultimately led to the inclusion of surgery into the medical field, and, finally his students…

Remember his charity? One of those charitable students whom Liston took on for free and even paid a small stipend was Joseph Lister, who later told that his presence at that fateful triple death surgery inspired him to pursue his studies into the aseptic technique and the development of methods to combat post-surgical infectious deaths.

Another of his students present that day was James Young Simpson, who, again inspired by what had transpired that that fateful surgery, worked at finding ways to numb patients to allow for more time in surgery. He experimented with anesthetics and laid the groundwork for sedated and unconscious surgeries that, in concert again with John Snow (15 March 1813 – 16 June 1858), made modern surgery possible.

He also invented a number of surgical tools still in use today.

But, as long as mankind is more attracted to blood and gore, Liston will be remembered as the record holder in speed surgery and most deaths following a procedure.

He died of an aneurysm himself, aged only 53 years, while performing surgery. His grave is small and unassuming, faded writing that is almost illegible today is the last that remains of a once larger than life figure.

Nachgedanken zum BarCamp München (#bcmuc)

#bcmuc war toll.

Jetzt ist’s also vorbei, das Wochenende. Und, wie bei jedem BarCamp, gilt mal wieder: für jeden alten Bekannten macht man drei neue Freunde. Zum ersten Mal Nils und Johannes Mairhofer IRL getroffen, und dutzende andere tolle Menschen. Vom „Vorglühen“ am Giesinger Bräu bis zur Abschlußveranstaltung war hier alles spitze und super gut organisiert.

Amazing Sessions

Dana’s „Mein Körper 2.0“ war ein spitzen-Vortrag. Auch wenn ich mich persönlich und beruflich manchmal mit dem Thema der Transsexualität beschäftige, bin ich als Cis-Mann doch nur ein Besucher in dieser Welt. Es passiert, daß uns ein Fenster in die Problematik und Herausforderungen der Transition geöffnet wird, Dana jedoch tat mehr: sie öffnete die Tür und bot uns an, in ihre Welt zu treten. Wir brauchen mehr Danas auf BarCamps.

Hannah erzählte mutig von ihrer Depression und dem Werdegang bisher. Ihre Session war nicht nur informativ, sie gab auch Anderen den Mut, sich mit einem „ich bin das auch“ an die Gruppe zu wenden. Wir brauchen mehr Hannahs auf BarCamps.

Zudem gab’s Interessantes aus der Welt des Bahnfahrens (wie man’s billiger macht), über Nahtod-Erlebnisse mit Schlaf-Apnoe, und mehr. Das Essen war toll, auch wenn nicht genug veganes für die Veganer unter uns da war, und die gesponserten Getränke rockten.

Die Beate Mader machte Sketchnotes von den Sessions auf denen sie war. Hier sind sie, zusammen mit einigen Beobachtungen. Martin Emmerich benutzt Freemind, auch toll, und hier sind seine Notizen als PDF. Auch die MindMap Datei kann man auf seinem Blog finden.

Meine Session(s)

Nachdem die „Programming your Brain“ Session am Samstag gut ankam, wurde ich gebeten auch eine am Sonntag zu machen, was dann auch passiert ist („Brain Wars 2: The Medulla Strikes Back“). Ich denke, wir hatten Spaß, ein paar Errata und Links zu meinen Sachen sind auf meinem GitHub Profil zu finden. Für #bcbs17 denke ich mir, daß ich eine Session mit Experimenten anbiete.

Besonders happy macht mich die Adoption des Wortes „Schwurbel“ für alle Versuche, Behauptungen ohne evidenzbasierte Beweise aufzustellen.

Die Sketchnote des zweiten Vortrags kann man auf Beate’s Seite finden.

Vorschläge und Ideen

Gleich neben/hinter dem Microsoft Campus ist das Ibis und Novotel Gebäude. Mit etwas Geschick hätte man hier eine schöne #bcmuc Rate erarbeiten können, was Zogroasten es etwas einfacher gemacht hätte, auch nach dem schon sehr frühen Schluß (17:30) noch Anschluß zu finden.

Der Microsoft Campus war toll, aber so richtig „Gelassenheit“ konnte, schon wegen der notwendigen Sicherheitsmaßnahmen und zeitlichen Limitierung nicht aufkommen. Ich finde Microsoft’s Engagement super, frage mich halt aber auch, ob — wenn man so eine Location nimmt — es nicht besser wäre, auch eine fixe Afterparty Location gäbe. Weil…

Hotel-Lobby Tracks machen Spaß.

Im Allgemeinen verbinde ich mit „Camp“ immer noch 48 Stunden durchgehende Action. Die 11:30-17:30 Session blocks sind ja, eigentlich, nur der Aufhänger für die richtigen Events. Da brechen dann aber leider die Gruppen wieder in Zugroaste und Lokale, Cliquen, und Vorbekanntschaften auseinander. Das Schönste und Wichtigste am BarCamp ist das Kennenlernen neuer Menschen und Ideen, das Vertiefen von Sessions, und das ist leider halt mit dem Format so nicht wirklich möglich.


Die morgendlichen Einleitungen waren, meines Erachtens nach, zu lange. Bietet stattdessen eine „Welcome auf dem BarCamp“ Session für die „Neuen“ an, ganz am Anfang des Tages, legt Planungs- und Ideen-Sessions auf den selben Slot, und macht danach die Session-Planung. Erarbeitet mit den Neuen einen Session-Vorschlag, erklärt „Bring Yourself“ und „We Talk about BarCamp“, etc. Sponsoren-Bauchpinseln ist besser über den Tag verteilt, denen gefällt es auch besser, wenn sie nicht am Morgen als notwendiges Übel sondern durch den Tag als kompetente Partner wahrgenommen werden.


es war spitze. Danke an die Orga, die Menschen die gekommen sind, die tollen Sponsoren, etc. So muß BarCamp sein!