In the Age of Sail, surgery was a grubbie business, considered beneath the dignity of physicians, doubly so aboard sailing vessels. The task fell instead to barber-surgeons, whose sharp knives and steady hands served equally well for trimming hair, pulling teeth, or sawing off limbs broken in combat or labour.

But as intercontinental trade with the Americas bloomed, so too did the demand for ships and sailors, and even barbers came to be in short supply. Captains, desperate to fill the role, turned to professions of ever more tenuous medical ability to fill their crew. Thus was born the fishmonger-surgeons, just as likely to gut and fillet a patient than staunch a wound, followed by taxidermist-surgeons, pig-gelder-surgeons, whore-surgeons, and, most terrifying of all, gynecologist-surgeons. Their reputation among seamen became ever more feared.

Thomas Hearn was on the island of Dominica, working to fill the ship's hold with exotic mahogany, when a rope snapped, dropping a log that smashed his ribcage to flinders. As he wheezed his last breaths, the other sailors dragged his broken body below deck, into the surgeon's quarters, and laid him out on a sawdust-strewn table. As he drifted in and out of consciousness, his eyes took in the spools of silk ribbon neatly organized beside the boxes of glossy buttons. The captain had hired the surgeon to fill the vacancy at short notice, rumored to have paid the man just a few shillings and promise of a ride back to England.

The surgeon sucked air through his teeth. "Oh, dear, oh dear. Those limbs are going to have to go," he said, hefting a bone saw.

Thomas seized the man by the sleeve with the last of his strength. "... your... profession..." he rasped. "What were you... before...?!"

The man smiled. "A dollmaker."

The last of the blood drained from Thomas' face. "I choose death!" he wailed in horror, as the dollmaker-surgeon pinned him down and began to saw through his limbs. "Someone fetch me a priest-surgeon!"