that the operating room was located as high as possible not because of lighting difficulties but so that the yells and imprecations of patients undergoing operative surgery could not reach the ears of the rest of the occupants of the institution.
In the Principles and Practice of Modern Surgery written as late as 1847 by Robert Druitt, of England, the only reference to the care of the patient during operation is, "there should be a sufficient number of assistants to restrain the patient's struggles, to administer cordials, and a bed or table with pillows or cushions to make the patient's position as easy as possible." And further, "the operator should always cut the skin as speedily as possible, for it is the most painful part of every operation."
And these surgeons had speed. Sir Clifford Allbutt (1837-1925) wrote, "When I was a boy, surgeons operating on the quick were pitted one against the other like runners on time. He was the best surgeon, both for patient and on- looker, who broke the three minute record in an amputation or lithotomy."13 Baron Dominique Jean Larrey, Napoleon's famous surgeon, was known to perform a shoulder-joint disarticulation in one minute, and the leading surgeons of that day were equally rapid in their manipulations. Robert Liston (1794-1847), one of the best-known Scottish surgeons of the first half of the nineteenth century, was noted for operative speed and dexterity, and he advised his associates to make rapid skin incisions and become ambidextrous. In the American editions of his text-books, although he was a forceful writer, he says very little about caring for the patient during the operation and nothing about avoiding pain. John Collins Warren14 was a more deliberate surgeon. Observing a visiting doctor pull out his watch just as he was about to start an operation, he remarked, "You may put up your watch; I do not operate by time."
