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Robert Liston: Speedy Victorian Surgeon

I've spent half a century (yikes) writing for radio and print—mostly print. I hope to be still tapping the keys as I take my last breath.

Before anesthetics removed the terrible pain of surgery the success of an operation was measured by the speed with which it was performed. Robert Liston is said to have once removed a limb and sown up the stump in 30 seconds from start to finish, although two minutes appears to have been his more regular time.

This 1912 painting by Ernest Board depicts Robert Liston about to amputate a patient’s leg before an admiring crowd.

This 1912 painting by Ernest Board depicts Robert Liston about to amputate a patient’s leg before an admiring crowd.

Nineteenth Century Medicine

Born in Scotland in October 1784, Liston studied medicine at the University of Edinburgh and graduated in 1818. It was a time when the practice of the physician was hampered by a poor understanding of illness.

Some doctors still believed that removing a few pints of blood from a patient would alleviate ailments despite the complete absence of evidence that it did.

Miasma was the prevailing theory of disease transmission that said some kind of noxious “bad air” carried sickness. However, the following were “listed among the general causes of illness ‘diseased parents,’ night air, sedentary habits, anger, wet feet and abrupt changes of temperature.

“Cholera, shortly to be epidemic in many British cities, was said to be caused by rancid or putrid food, by ‘cold fruits’ such as cucumbers and melons, and by passionate fear or rage” (Victoria and Albert Museum).

Rest was the usually prescribed therapy, along cleansing the body through laxatives and/or preparations to induce vomiting.

Most of the medicines available were based on folk remedies. Also, such dangerous substances as arsenic, opium, and cocaine were often prescribed. At least until the late 1840s when anesthetics began to appear, what patients in a doctor’s office dreaded hearing more than anything else was the need for surgery.

On the pharmacy counter are remedies labelled cocaine, strychnine, opium, and arsenic. The eager customers line up for bottles of “Bracer” while a sign on the wall states “The Killem' Quick Pharmacy.”

On the pharmacy counter are remedies labelled cocaine, strychnine, opium, and arsenic. The eager customers line up for bottles of “Bracer” while a sign on the wall states “The Killem' Quick Pharmacy.”

“Doctor Liston Is Ready For You Now”

Many a patient hearing those words refused to enter the operating room and left; they preferred to suffer and, probably, die than go through the ordeal of surgery while wide awake.

Those whose quaking knees delivered them to the table might find themselves surrounded by observers eager to watch the great surgeon remove an arm or tumor.

Surgeon Richard Gordon described Liston’s technique: “He sprung across the blood-stained boards upon his swooning, sweating, strapped-down patient like a duelist, calling, ‘Time me gentlemen, time me!’ to students craning with pocket watches . . . Everyone swore that the first flash of his knife was followed so swiftly by the rasp of saw on bone that sight and sound seemed simultaneous. To free both hands, he would clasp the bloody knife between his teeth.”

Robert Liston’s Accomplishments

Liston was ahead of his time with regard to operating-theatre hygiene. Unlike most of his professional colleagues he washed his hands before each operation. Another innovation was wearing a clean, new apron for each surgery.

The medical newspaper ASCO Post notes that during Liston’s time, “Surgeons actually took pride in wearing dirty bloodstained operating gowns as a display of their experience in the surgical trenches. They also believed pus was a natural part of the healing process rather than a sinister sign of sepsis. Not surprisingly, most deaths were due to postoperative infections.”

Knowing the high mortality rate among those undergoing surgery, Liston felt much as his patients must have that going under the knife should be the last option.

Even though the medical profession of his time knew next to nothing about sepsis, Liston tried to keep his hospital environment as clean as possible. And, he understood the terror his patients felt and did what little he could to ease their fear, his lightning-fast operating techniques being part of that.

Such was the quality of his work that his patients were more likely to survive than if attended to by less skilled surgeons. In 2012, general surgeon Bill Thomas noted in the Bulletin of the Royal College of Surgeons of England that Liston “performed 66 amputations between 1835 and 1840 and only 10 died―a mortality rate of 1 in 6. A little down the road at the time in St Bartholomew’s Hospital, the surgeons were sending one in four to the mortuary.”

Robert Liston.

Robert Liston.

The Hazards of Surgery

Occasionally, there was a downside to Liston’s dedication to speed. In his haste to amputate a man’s leg, he accidentally removed his testicles as well. But, there was worse.

He was removing another patient’s leg when his flaying blade took off the finger of an assistant who was holding the limb steady. The notion of sterilizing instruments was some years in the future so both the patient and assistant contracted an infection and died. A third casualty of the procedure was a man who was observing the surgery. Liston’s scalpel sliced into the man’s tailcoat, who fell to the floor, apparently dying of shock.

There are some who cast doubt on the accuracy of this story of a 300 percent mortality rate from a single operation, but it has been repeated often by usually credible sources.

A child with a neck mass was taken to see Liston. The surgeon thought it was an abscess and cut into it. Unfortunately, it was an aneurysm and the boy bled to death.

Coincidentally, it was a burst aneurysm that killed Robert Liston in December 1847. He was 53 years old.

Amputation knives; the tools of Liston’s trade.

Amputation knives; the tools of Liston’s trade.

Bonus Factoids

  • Liston also invented several medical instruments, including a splint that was still used until recently to deal with fractured femurs.
  • On December 21, 1846 Robert Liston performed the first operation in Europe using the ether anesthetic that had been developed in America. He called it “the Yankee dodge” and praised it for alleviating the excruciating pain of surgery.
  • While in Edinburgh, Liston confronted fellow doctor Robert Knox over the mistreatment of a young woman called Mary Paterson. Knox had basically pickled Paterson in whiskey and put her body on humiliating display. It turns out that Ms. Paterson has been murdered by the notorious body snatchers Burke and Hare. You can learn more about this grisly business here.

Sources

  • “Health & Medicine in the 19th Century.” Jan Marsh, Victoria and Albert Museum, undated.
  • “Time Me, Gentlemen! The Bravado and Bravery of Robert Liston.” Robert R. Nesbit, Jr., MD, et al, American College of Surgeons, May 2016.
  • “Not for the Squeamish: Surgery in the 19th Century.” Ronald Piana, ASCO Post, September 10, 2019.
  • “Robert Liston.” Undiscovered Scotland, undated.
  • “Saints and Sinners Robert Liston.” Bill Thomas, Bulletin of the Royal College of Surgeons of England, 2012.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

© 2021 Rupert Taylor

Comments

Miebakagh Fiberesima from Port Harcourt, Rivers State, NIGERIA. on April 22, 2021:

He seem to do his best for his patients as record. But good as that may be, medicine was still at a primitive stage back then. The read is interesting. Thanks.

Rupert Taylor (author) from Waterloo, Ontario, Canada on April 21, 2021:

Hi John. He seems to have been more than a bit arrogant that annoyed his peers, but he genuinely cared about his patients, particularly those who were poorer.

I am thankful that he didn't do my vasectomy.

John Hansen from Queensland Australia on April 21, 2021:

A very interesting article. Liston seems to have been ahead of his time, and despite a few unfortunate outcomes he did seem actually concerned for his patients.

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