Aidan O'Donnell

“The state of the medical art in the early 19th century was extremely primitive. Medical practice was still largely based on the classical works of Galen and Hippocrates, and harmful practices such as bloodletting were widespread. Nothing was understood about sterility. A surgeon might not trouble to remove his street clothes, or perhaps dress like a butcher, wearing overalls and a leather apron. The patient would require to be restrained by muscular assistants. The best surgeons were the quickest, and could often perform an amputation in less than a minute. Robert Liston of Edinburgh would perform amputations in front of rows of medical students, and begin with the command ‘Gentlemen, time me!’ and would clasp the bloody knife between his teeth when he needed to use both hands.”
― Aidan O'Donnell, Anaesthesia: A Very Short Introduction

“The most useful way to estimate the body’s physiological reserve is to assess the patient’s tolerance for exercise. Exercise is a good model of the surgical stress response. The greater the patient’s tolerance for exercise, the better the perioperative outcome is likely to be, though marathon-running is not required. For most patients, the ability to sustain a little light exercise, such as playing a round of golf, or carrying a heavy shopping bag up a flight of stairs, is all that is required.
When I am in doubt about my patient’s exercise tolerance, I ask them to accompany me on a short walk up the hospital stairs, which usually clarifies the matter one way or the other. It is possible to put patients on a treadmill and measure their exercise tolerance formally (so-called CPX, cardiopulmonary exercise testing), but this is time-consuming, and is therefore reserved for especially difficult cases.”
― Aidan O'Donnell, Anaesthesia: A Very Short Introduction