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operations
meant that patients were 'under' for only a few minutes at most,
yet the possibilities the successful relief of pain offered were endless.
Operations no longer had to be so fast. Surgeons could take their
time; they could attempt more complicated procedures. Robert
Liston would not live to see the full potential of anaesthetics
realized. He died in a sailing accident less than a year later. But
by then his era of lightning-quick surgery was over.
THE MEDICAL STATE OF THE ART
----
    While surgeons were saving lives with new techniques, medical
science was struggling to catch up. The work of doctors had barely
advanced since the Middle Ages, and if surgery was an inexact
science, then Western medicine was more akin to a faith, a bit like
astrology – scientific method built on foundations of sand.
Treatments had changed little over the proceeding centuries and
were limited in their scope. There were few cures available to
doctors, and fewer genuinely effective drugs. Apothecaries boiled
up all sorts of weird mixtures with varying results. A typical example
from Guy's Hospital includes 'bath of herbs and sheep heads'
prescribed to a woman suffering from an 'unknown illness'. How
marinating the poor lady in offal was going to cure her was anyone's
guess. Still, she probably paid handsomely for the privilege.
    At best, all doctors could hope to do was to assist the natural
process of healing. This might work for influenza, but would be
completely ineffective against tuberculosis, syphilis or a heart condition.
Even in the 1840s, the work of the physician was still firmly
rooted in superstition. When you called on a doctor to attend you –
and they did not come cheap – you might reasonably expect some
sort of treatment. But the physician's options were limited. Medical
practice was still based on the theory of the four humours developed
by Galen. It was the job of the doctor to balance the bodily
fluids of yellow bile, black bile, phlegm and blood.
    As the understanding of anatomy had advanced over the
centuries, most Victorian doctors knew this view of physiology no
longer made sense. Yet the treatments available remained largely
unchanged. Doctors could prescribe drugs. Some were effective for
pain relief but others, such as mercury, were downright dangerous.
Physicians would induce vomiting or diarrhoea in the patient to
purge the body. They could also drain away excess blood. All these
treatments made sense if you accepted the idea of the humours.
They made no sense at all if you looked at the growing scientific
evidence against them.
    Bloodletting was as important to early Victorian medicine as it
had been for almost two thousand years. Draining blood allowed
doctors to remove 'morbid' matter from the bloodstream. This, the
logic went, would be replaced by new healthy blood. Doctors carried
scalpels or lancets (hence the name of the medical journal) to cut
the skin and allow the blood to drain into shallow bowls. Others
employed 'cupping' techniques, where small glass bowls were
heated and placed over the lanced area of skin. The bowls cooled,
forming a vacuum which helped to suck blood from the body. *
    * Cupping also proved effective for pain relief, and was in common use in hospitals until the 1950s.
    Some doctors preferred using leeches rather than cups. When
leeches are attached to the skin they secrete a chemical that
prevents the blood from clotting. This anticoagulant is so effective
that even when the leech is removed, the wound will continue to
bleed for another three to four hours. Leeches were particularly
useful for bleeding sensitive areas of the body, such as the gums or
around the eyes. American leeches were said to have a less irritating
bite than British ones. The received wisdom was that leeches should
be kept in a tub of river water with some peat or turf. It was best to
rinse them before application.
    For the modern physician who wanted to keep up with cutting-edge
medical advances, scarifiers