Robert Liston at the Edinburgh Infirmary
Robert Liston was born in Ecclesmachen in West Lothian, Scotland, on the 28th of October 1784. He lost his mother, Margaret, when he was six years old and was raised by his father, Henry, a minister and inventor.
He attended Edinburgh University and studied under acclaimed anatomist John Barclay. He then trained and, in 1818, qualified as a houseman (a junior doctor) at the Edinburgh Infirmary, but while doing so, he earned a reputation for being arrogant, sharp-tongued and unpopular. He barked and others quaked. His height of 6 feet 2 inches or 1.8 metres made him even more formidable to his colleagues.
His colleagues advocated removing him from the hospital wards because of his diabolical bedside manner. After a series of disagreements with his superior, Dr. George Bell, and his fellow physicians, he was dismissed in 1822, but he was reinstated in 1827. Within a year, Liston was promoted to the position of operating surgeon.
He was praised for his capabilities as a quick-handed surgeon in an age before anesthetic; he was able to complete a limb amputation within three minutes. Speed made the significant difference between a patient's life or death outcome and the pain they experienced.
"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."
— Royal Surgeon Sir Frederick Treves (1853-1923) on the subject of medical hygiene in Liston's era.
The Showman Surgeon: "Time Me Gentlemen!"
In 1833, he missed out on a promotion at the Edinburgh Infirmary and sought a new challenge. He relocated to London, and in 1834, he was elected as Professor of Clinical Surgery at the new North London Hospital in Camden, promptly renamed (not by him) the University College Hospital.
Hygiene was not deemed as important as it is in today's hospitals, so when Liston strode into the operating theatre and, surprisingly for that era, removed his frock coat, washed his hands and put on an apron prior to operations, he was set apart from his peers who happily hacked away at patients in blood-soaked sleeves. Very often, his work was watched by an eager crowd of spectators, which he loved. He was a showman at heart. He would frequently ask his audience to time him.
His still-conscious patient was afforded the luxury of a handkerchief to bite down on or to scream into as the surgeon performed his task. For an amputation, Liston was aided by one assistant or medical student who held the limb due to be amputated and another two medical students who ensured that the patient remained still on the operating table as the scalpel and saw cut through flesh and bone.
Liston's 28 Seconds Operation
His fastest operation was a staggering or terrifying twenty-eight seconds long.
During another of his rapid operations, Liston removed a forty-five-pound scrotal tumour from a man in just four minutes. The patient had been carrying the tumour around in a wheelbarrow prior to the procedure.
He completed an amputation and removed a patient's testicles within a two-and-a-half-minute procedure. Sadly, the testicles were not supposed to have been removed, but Liston's haste ensured that the man left his care without more than he'd anticipated.
Liston's mortality rate was one in six for the sixty-six amputations he carried out between 1835 and 1840. That was an improvement on the nearby St. Bartholomew's Hospital, which averaged one in four operations resulting in death.
A 300% Mortality Rate From a Single Amputation
Robert Liston is remembered for the swift operation that resulted in a 300% mortality rate. At first, it was a standard procedure for Liston. He carried out an amputation within two and a half minutes. However, as he wielded his scalpel, he cut through the coattails of a spectator who was terrified that he was injured and so he dropped dead. Liston also managed to cut the fingers off his assistant, who had been holding the limb during the amputation. The assistant and the patient died from infections within a few days.
As word got out about Liston's errors in haste, his theatre spectators and medical students aimed to be as far back as possible while observing his work. It was better to be safe than sorry.
There remain questions about whether this event occurred because no eyewitness accounts, if there were any, have survived. Truth or fiction, Liston's record of a 300% mortality rate has never been beaten. Let's hope that it never is.
Robert Liston's Legacy
On 21st December 1846, Robert Liston carried out the first ever publicly observed operation using ether at University College Hospital, London. He is also remembered as a medical writer and as the inventor of a thigh splint for use when the limb was dislocated.
Robert Liston believed that a good surgeon knew when not to operate and that surgical procedures had to be considered the last possible treatment options.
Aged fifty-three, he died from an aneurysm on the 7th December, 1847.
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