Steve Borthwick performed emergency surgery on his starting line-up as he ripped up his England team for Saturday's clash with Italy. In a brutal cull, Borthwick has made nine changes to his XV plus three positional tweaks as his patience ran out following crushing defeats to Scotland and Ireland.

Two of the changes were enforced with scrum-half Alex Mitchell and centre Ollie Lawrence injured but the total of nine is the most ever made by an England coach in the tournament. That eclipses the eight made by Brian Ashton, after another mauling by Ireland in 2007, and a major change of direction for Borthwick.

George Ford, Henry Arundell, Freddie Steward and Fraser Dingwall have chopped from the 23 entirely as Borthwick highlighted physicality, discipline and attack as England's major problems.

He had given a raft of players a second chance after the 31-20 loss to Scotland but the 42-21 hammering by Ireland has seen him reach for the axe.

Borthwick said: "There are certain things that, to me, are unwavering. Unfortunately, in the last two games we've not met those standards. I am going to hold them to those standards. The intensity, we've looked at that. Then we've got to make sure that we have 15 men on the pitch.

"We've played games where we have long periods where have had 14 men, where people have had to do extra work. This has been a team that had built a very good disciplinary record. That is something that needs to change. And we've got to take our chances and make sure the opposition are not getting as many."

Fin Smith has been given the No.10 berth ahead of Ford and hooker Jamie George, lock Alex Coles, flanker Guy Pepper, scrum-half Ben Spencer, wings Cadan Murley and Tom Roebuck plus centre Seb Atkinson and full-back Elliot Daly are all in.

Tommy Freeman is the only back to make the cut from the Ireland debacle - and he has been switched from wing to centre - whilst Ben Earl and Tom Curry have moved places in the back row with Earl set to win his 50th cap at No.8.