Robert Liston

Robert Liston (28 October 1794 – 7 December 1847) was a pioneering Scottish surgeon. Liston was noted for his skill in an era prior to anaesthetics, when speed made a difference in terms of pain and survival.

He was the son of the Scottish clergyman and inventor Henry Liston, whose father—Robert Liston—was the Moderator of the General Assembly of the Church of Scotland.[a]

Liston received his education at the University of Edinburgh, became first 'The Great Northern Anatomist' of Blackwell's Magazine, and in 1818 became a surgeon in The Royal Infirmary of Edinburgh. In 1832/3 he is listed as living at 99 George Street in the centre of Edinburgh's New Town. He lived from 1840 to 1847 at No. 5 Clifford Street, off Bond Street in Mayfair, in a building and indeed area now of some historical significance, hence Richard Gordon's specific mention of this address in his section on Robert Liston.

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.

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

Robert Liston, photograph circa 1845 by Hill & Adamson

Richard Gordon describes Liston as "the fastest knife in the West End. He could amputate a leg in 2 1⁄₂ 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; he is said to have been able to perform the removal of a limb in an amputation in 28 seconds.[c]

In Florence Nightingale's Notes on Nursing, she states "there are many physical operations where ceteris paribus 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".[b]

Gordon described the scene thus:

He was six foot two, and operated in a bottle-green coat with wellington boots. 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 from the iron-railinged galleries. 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.

Gordon's talent for 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".[a] 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 very 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 an attractive 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 whiskey for three months before dissection, during which time she was essentially on voyeuristic display. Liston's response is documented in a letter from him

According to Liston, he saw Mary Paterson's body in Knox's rooms and immediately suspected foul play. He knocked Knox down after an altercation in front of his students – Liston assumed some students had slept with her when she was alive, and that they should dissect her body offended his sense of decency. He removed her body for burial.

Liston's firsts

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 also performed the first operation in Europe under modern anaesthesia using ether, on 21 December 1846 at the University College Hospital. His comment at the time: "This Yankee dodge beats mesmerism hollow". This is clearly a reference to the first use of ether by doctors in the US. The first operation using ether as an anaesthetic was by William T. G. Morton on 16 October 1846, in the Massachusetts General Hospital. See the History of general anesthesia.
• He invented see-through isinglass sticking plaster, the 'bulldog' locking artery forceps, and a leg splint used to stabilise dislocations and fractures of the femur, and still used today.

Liston's most famous cases

Although Richard Gordon's 1983 book pays tribute to other aspects of Liston's character and legacy as noted elsewhere in this article, it is his description of some of Liston's most famous cases which has primarily made its way into what is known of Liston in popular culture. Gordon describes Liston's four most famous cases in his book, as quoted verbatim below.

Fourth most famous case

Removal in 4 minutes of a 45-pound scrotal tumour, whose owner had to carry it round in a wheelbarrow.

— Richard Gordon

Third most famous case

Argument with his house-surgeon. Was the red, pulsating tumour in a small boy's neck a straightforward abscess of the skin, or a dangerous aneurism of the carotid artery? 'Pooh!' Liston exclaimed impatiently. 'Whoever heard of an aneurism in one so young?' Flashing a knife from his waistcoat pocket, he lanced it. Houseman's note – 'Out leaped arterial blood, and the boy fell.' The patient died but the artery lives, in University College Hospital pathology museum, specimen No. 1256.

— Richard Gordon

Second most famous case

Amputated the leg in 2 1⁄₂ minutes, but in his enthusiasm the patient's testicles as well.

— Richard Gordon

Liston's most famous case

Amputated the leg in under 2 1⁄₂ minutes (the patient died afterwards in the ward from hospital gangrene; they usually did in those pre-Listerian days). He amputated in addition the fingers of his young assistant (who died afterwards in the ward from hospital gangrene). He also slashed through the coat tails of a distinguished surgical spectator, who was so terrified that the knife had pierced his vitals he dropped dead from fright.

That was the only operation in history with a 300 percent mortality.

— Richard Gordon

• "Cases of Aneurism; Fracture of the Femur; Case of Aneurism", The Edinburgh Medical and Surgical Journal, 16: 66–74, 212–215, 348–352, 1820, retrieved 16 July 2010 
• "Spontaneous Mortification – Case occurring in the upper extremity", The Lancet, Lectures Delivered at the North London Hospital, by Robert Liston, Esq., Lecture IX, 1: 846–851, 14 March 1835, doi:10.1016/s0140-6736(02)96871-6, retrieved 18 July 2010 
• "Observations on Some Tumours of The Mouth and Jaws", Medico-Chirurgical transactions for 1836, Royal Medical and Chirurgical Society of London, 20: 165–199, 1837, PMC 2116728, PMID 20895635 Also via Google books (Note: The volume listing for Google is incorrect, as evidenced by the first page which clearly states "volume the twentieth").
• Practical Surgery, with One Hundred and Twenty Engravings on Wood. London: John Churchill & Henry Renshaw. 1837. Retrieved 24 October 2009.  Full text at Internet Archive (archive.org)
• American edition (1838). Practical Surgery, with Notes and Additional Illustrations by George W. Norris, one of the surgeons to the Pennsylvania Hospital. Philadelphia: James Crissey. Retrieved 24 October 2009.  Full text at Internet Archive (archive.org)
• Elements of Surgery. (2 ed.). London: Longman, Orme, Brown, Green & Longmans. 1840. Retrieved 24 October 2009.  Full text at Internet Archive (archive.org)
• American edition (1842) from the 2nd London edition. Elements of Surgery. Philadelphia: Ed. Barrington & Geo D. Hasswell. Simultaneously published in: New York, by J. & H.G. Langley; Charlestone, S.C., by WM. H. Berrett; Richmond, V.A., by Smith, Drinker & Morris; Louisville, KY, by James Maxwell, Jr. Retrieved 24 October 2009.  Full text at Internet Archive (archive.org)
• "A Course of Lectures on the Operations of Surgery, and of Diseases and Accidents Requiring Operations: Lecture IX", The Lancet, 2: 65–68, 12 October 1844, doi:10.1016/s0140-6736(02)64540-4, retrieved 18 July 2010 
• "On Fracture of the Neck of the Femur", Dissertations by Eminent Members of the Royal Medical Society, Paper read on 1820, Edinburgh: David Douglas, 1892, retrieved 16 July 2010  See also BiblioLife reproduction via Google