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A  SURGICAL  EMERGENCY 

So a seriously injured man with squirty arterial bleeding rocks up in the middle of morning surgery. What does the poor sod of a GP do ? Picture the scene.....

 

 

Hello sir how can we help you today ? Severed limb,  no worries,...... second door on the right.  Just hold on whilst we clear Mrs Scrottle out of the room, then Dr can get out his pocket microsurgery kit.  

 

Jeez. what was the poor guy supposed to do? Nearest hospital? Grantown-on-Spey around 10 miles, that would have been the cottage hospital of course., Nearest proper hospital Inverness 27 miles.

Jokes aside, this would have been the early 1960's, major trauma is not that uncommon, and more-so back then. Between Motor accidents,  agricultural accidents and a nascent ski-ing industry, accidents would happen and a rural GP would be called to help, frequently being the first person there with even basic first aid training.

 

To summon an ambulance would not have been quick, I don't know how it worked back then but as an educated guess there may have been an ambulance stationed at Grantown and probably another at Aviemore. During the day one of them could get to The Boat in around 20 minutes so long as it was not already busy. Would there have been a local service at night, weekends etc?  Possibly a volunteer service provided they could be found, if not then would have to wait for an ambulance to come out from Inverness.  Air ambulance, I very much doubt it, though if there was a really major incident then not doubt the RAF from Lossiemouth would have pitched in.

However as to our bloke with the squirty arm ?  I suspect that the local Dr would have been expected to do whatever he could to stop the bleeding and then to get him to a hospital, which one would be a tough call.

In those days a cottage hospital did a lot more than they do now. It would still have had an operating theatre however it would be GP's who did some surgery on the side who did most of the operating, and all of the anaesthetics. They would have done the every-day bread and butter type operations, whip out an appendix or two, set a fractured arm , remove tonsils that sort of thing.  A proper surgeon from Inverness would probably have come once or twice per week and did any more complex operations, though out of hours either the GP would have to cope or the patient would have to go to Inverness.

These days the patient would be whisked to Inverness by helicopter where  vascular and orthopaedic surgeons would be waiting to put his arm back together. Back then however, vascular surgery was in its infancy and reconstructing the arteries in the arm would have been a non starter. If one artery was cut they would tie off the cut one, see if there were any cut muscles or tendons that could be stitched back together then splint the arm, close the defect as far as possible and hope that 

  1. The arm would survive on one artery.

  2. There was still a good enough blood supply to allow the severed bone, muscle etc to heal.

  3. The whole lot didn't get infected by gunk from the saw etc.

Stitching tendons back together would have been beyond the scope of a GP surgeon, so if the patient pitched up at Grantown there would be a choice to be made. Was the bleeding stopped and the patient stable enough to make a transfer to Inverness ?  If so he could have been transferred and he would probably keep a functioning arm.  If not then they would amputate at or just above the level of the saw-cut.

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