Robert Liston
Known for being the fastest surgeon of his time, Robert Liston once amputated a patient's leg so recklessly that he not only killed his patient but also two bystanders. He could amputate a leg in under leg 30 seconds.
Before the advent of anesthesia, speed was key to patient survival and comfort. But Liston was so focused on his speed during the amputation that he accidentally cut off the fingers of his assistant along with the patient's leg. And when he swung the knife back up, he accidentally slashed into the coattails of a spectator, who fainted on the spot.
Liston's legacy comprises both that which has made its way into the popular culture, and that found primarily within the medical fraternity and related disciplines.
In 1837, he published Practical Surgery, arguing the importance of quick surgeries; "these operations must be set about with determination and completed rapidly."
Liston's image has been preserved in both bust and portrait form. Following Liston's death, a meeting was held of his friends and admirers, who "unanimously resolved to establish some public and lasting Testimonial to the memory of this distinguished surgeon". A committee of some 78 people was formed, which resolved that the testimonial should consist of a marble statue to be placed in some designated public spot, and the inauguration of a gold medal, to be called the "Liston Medal", "and awarded annually, as the Council of University College, may decide".
Reputation
Richard Gordon describes Liston as "the fastest knife in the West End. He could amputate a leg in 21⁄2 minutes". Indeed, he is reputed to have been able to complete operations in a matter of seconds, at a time when speed was essential to reduce pain and improve the odds of survival of a patient.
In Florence Nightingale's Notes on Nursing, she states "there are many physical operations where ceteris paribus (all else being equal) the danger is in a direct ratio to the time the operation lasts; and ceteris paribus the operator's success will be in direct ratio to his quickness".
Gordon's prose is more than just caricature. He describes how the link between surgical hygiene and iatrogenic infection was poorly understood at that time. At an address by Dr Oliver Wendell Holmes to the Boston Society for Medical Improvement on 13 February 1843, his suggestions for hygiene improvement to reduce obstetric infections and mortality from puerperal fever "outraged obstetricians, particularly in Philadelphia". In those days, "surgeons operated in blood-stiffened frock coats – the stiffer the coat, the prouder the busy surgeon", "pus was as inseparable from surgery as blood", and "Cleanliness was next to prudishness". He quotes Sir Frederick Treves on that era: "There was no object in being clean...Indeed, cleanliness was out of place. It was considered to be finicking and affected. An executioner might as well manicure his nails before chopping off a head". Indeed, the connection between surgical hygiene, infection, and maternal mortality rates at Vienna General Hospital was only made in 1847 by Vienna physician Dr Ignaz Philipp Semmelweis from Hungary, after a close colleague of his died. He instituted the hygiene practices exhorted by Holmes, and the mortality rate fell.
Such was the era in which Liston lived. Gordon states that Liston was "an abrupt, abrasive, argumentative man, unfailingly charitable to the poor and tender to the sick (who) was vilely unpopular to his fellow surgeons at the Edinburgh Royal Infirmary. He relished operating successfully in the reeking tenements of the Grassmarket and Lawnmarket on patients they had discharged as hopelessly incurable. They conspired to bar him from the wards, banished him south, where he became professor of surgery at University College Hospital and made a fortune".
In writings on Liston, he is portrayed as a man of strong character and ethics, which was the source of some of his confrontational style. In one case, he confronted a medical colleague (Dr Robert Knox) over the treatment of a young woman (Mary Paterson) who it later transpired was murdered (see Burke and Hare murders), with Knox thought complicit in the murder. She was in Knox's dissecting rooms within four hours of her death, and kept in whisky for three months before dissection, during which time she was essentially on voyeuristic display.
While Liston's pioneering contributions are paid tribute within popular culture such as Richard Gordon, they are best known within the medical fraternity and related disciplines.
- Liston became the first Professor of Clinical Surgery at University College Hospital in London in 1835.
- He performed the first public operation utilizing modern anaesthesia, ether, in Europe on 21 December 1846 at the University College Hospital. His comment at the time: "This Yankee dodge beats mesmerism hollow", referring to William T. G. Morton's experimentations with ether as an anaesthetic for extraction of teeth. See the History of general anesthesia.
- This left a lasting impact on two of Liston's students: James Simpson, who would go on to be a pioneer of chloroform's use as an anaesthetic; and Joseph Lister, who pioneered aseptic technique.
- He invented see-through isinglass sticking plaster, bulldog forceps (a type of locking artery forceps), and a leg splint used to stabilise dislocations and fractures of the femur, and still used today