Early surgery relied upon 'surprise and speed'. Prior to the development of anaesthesia, the patient was held down and loose limbs pinioned. Straps alone were not enough to hold down a half-crazed man so the handler became skilled in the where and how of holding the patient down without causing further harm.
In the History of Moorfields Eye Hospital, Treacher Collins writes of Sir William Lawrence "In those days, since all eye operations had to be performed without anaesthetic, at least four or five assistants had to be employed to hold the patient down. The division of labour was as follows: One assistant to fix the patient's head, one to depress the lower eye lid and fix the chin, one to confine the arms and upper part of the body and one to secure the legs and lower part of the trunk".
Sir Edward Morris writes in his history of the London Hospital; "There are still ghastly relics in the hospital of those terrible days; the great wooden operating table with its straps; the bell which was sounded before an operation to call assistants to hold down a patient, a bell whose terrible clang could be heard by every shivering patient in the building, including the patient, often a little child; a bell with a voice loud enough and harsh enough to make all Whitechapel shudder".