Robert Liston was a Scottish surgeon known for the incredible speed with which he would
attempt surgery.
This wasn't just a coincidence of his skill, Liston intentionally tried to complete surgeries,
including amputations, as fast as possible - even asking his students to time him before
he began.
The speed at which he went about hacking up his victims, er, patients, led to some mishaps,
including his credit as performing the only surgery in history to have a 300% mortality
rate!
Born in Scotland in 1794, Robert Liston was an intimidating man standing at six foot 2.
He was also regarded as domineering and argumentative, and he fell out with his tutor, the famed
anatomist Dr John Barclay while studying in Edinburgh Medical School in 1816.
This led to Liston opening his own anatomy class, and marked the start of a long career
as a medical practitioner who just kind of did his own thing, in spite of the prevailing
practices of the time, and one who was often at odds with his peers, frequently expressing
his disaproval of surgeons he did not respect and thought to be inferior.
Liston moved around from position to position for a while, sometimes spurred by disagreements
with more senior surgeons, until he accepted an appointment as professor of surgery at
the newly-opened University College Hospital in London.
He was only 34 at the time, and would remain there for the rest of his life.
His stand-offish personality made Robert Liston widely unpopular among his co-workers, although
no one could deny his skill in surgery.
He would make a point of performing rapid surgery to galleries of onlookers, proclaiming
"time me, gentlemen, time me!"
before operations.
He would go about amputations so quickly that the flash of his knife could be missed by
onlookers entirely, before he had already moved onto the bone saw, clutching the bloodied
knife between his teeth to save time.
Now I'm no doctor but I don't think a surgeon should really be putting any of their instruments
in their mouth during an operation, or in any other cavity for that matter.
But this was a different time, and Robert Liston actually had more consideration for
hygiene than most surgeons, being one of the few to wash his hands before operating.
He would also wear a fresh apron for every operation, at a time when a surgeon's bloodied
apron was a sign of experience.
The stiffer the apron, the prouder the surgeon.
A good surgeon wouldn't need to hang up his apron because it could stand up by itself,
and a true veteran would walk to work side-by-side with his apron.
It was recorded that Robert Liston could ampute a whole leg in 2 and a half minutes, and he
could amputate the leg below the knee in just 30 seconds.
This amazed his onlookers and earned him the nickname, "The Fastest Knife in the West End".
This didn't do much to ingratiate him to his detractors though, who saw this only as a
sign of his arrogance.
But showmanship aside, Liston did actually have good reason to do this.
In an era prior to anaesthetics, speed made a huge difference both in terms of how much
pain the patient would be subjected to, and their chances of survival.
Imagine you had to get your leg amputated without anaesthetic, and some big Scottish
fella says he can do it in 2 and a half minutes.
Well, first you should probably make sure he is indeed a doctor and not just your average
Glasgow hurt merchant.
But if he has a medical license, and it's got to be done, then let it be done quickly,
right?
Now, sometimes Robert Liston was a little over-zealous in his speed.
He once took off a patient's testicles along with their leg.
If you're going to make a mistake like that I'd rather you accidentally cut off my head
to be honest.
Another story says in a flurry of knife cuts he lopped off an assistant's fingers as they
were holding down a limb.
Then in his rush to switch instruments he slashed a spectator's coat.
The spectator was so shocked and afraid that they'd been stabbed that they dropped dead
of shock.
And the patient and assistant both died of gangrene afterwards, making it the only operation
to have a 300% mortality rate.
This is a very popular story and you may have even heard it before, but it may not be true,
as no primary sources confirm this surgery ever took place.
The story may just be legend or rumour stemming from Liston's speed and the fact he wasn't
very well liked.
Even his own students feared him, as he would harshly berate any mistake or failure to meet
his standards, infront of crowded galleries.
If you've ever had a boss chew you out infront of your co-workers you know it's not the greatest
feeling in the world, and by now you're probably thinking; "this guy sounds like a real arsehole!"
Perhaps he was, but he was also a very principled man.
The same students who had felt his wrath were often invited to his home for a plentiful
dinner.
He took pride in operating on patients that other infirmaries had deemed "untreatable".
This once again was seen as a sign of his arrogance, but Liston tried to help every
patient, no matter their condition; and his skill meant his surgeries had a mortality
rate of 1 in 10.
For comparison, surgeons at nearby St. Batholomew's lost about one in every four.
Another example of his ethical nature, is a confrontation he had with his colleague
Dr Robert Knox.
Knox was a central figure in the famous story of Burke and Hare.
The two were a pair of murderers who sold the corpses of their victims to Dr Knox for
dissection.
Mary Paterson was a woman who had been murdered by the two, and Knox had her kept in whiskey
for months before her dissection.
Liston was suspicious of foul play, and upon seeing Paterson's body on voyeuristic display,
became enraged and phsyically confronted Knox, knocking him to the ground and retrieving
the body for burial.
So it seems Robert Liston's reputation for being abrasive and argumentative perhaps stems
from his confrontational style when his principles were offended.
Maybe he wasn't liked because he was one of the few sane people in a world full of dolts.
As mentioned, he often did things that were seen as silly at the time, but were actually
very forward-thinking, like promoting cleanliness.
His operating style makes him sound like a bit of a butcher, but he actually considered
the patient's emotional state to be of crucial importance.
Understanding the agony and distress that surgery caused, he would try his best to put
a patient's mind at ease, and would cancel or postpone operations when a patient was
overcome with fear.
He also believed that a successful surgery was just the first step to recovery, saying
"he must consider his labour only begun when the operation is finished; the patient is
yet to be conducted, by kindness and judgment through the process of cure".
As skilled a surgeon as he was, he thought it was equally if not more important, to know
when not to operate, saying; "Who will question, that there is more merit in saving one limb
by superior skill, than lopping off a thousand with the utmost dexterity?"
But he wasn't just ahead of his time in his thinking, he was a true visionary, inventing
numerous medical implements, like the bulldog forceps that held arteries together to control
bleeding, and a leg splint used to stabilise dislocations and fractures of the femur.
These are still used to this day!
He also performed the first operation to use modern anaesthesia in Europe, in 1846.
From a bottle of ether, Liston placed a tube that led to his patient's mouth, knocking
him out shortly after.
An assistant held a handkerchief doused in ether to the patient's mouth while Liston
amputated his leg.
The patient woke up after the leg had been removed and asked "when are you going to begin?".
The gallery erupted in laughter, which confused and distressed the patient, who shouted "take
me back - I can't have it done!".
Assumedly they said ok and let him walk off.
Two of Liston's students present at this operation were greatly impacted by the display.
James Simpson, who was only 16 at the time, went on to pioneer chloroform's use as an
anaesthetic, and Joseph Lister developed aseptic technique and antisepsis, combating infection
that was poorly understood at the time and frequently resulted in patients' deaths.
A year after this surgery, Robert Liston died of an aneurysm.
He was 53 years old.
With his contributions to modern medicine, it's really a shame he's known to the public
mostly by a story that paints him as a butcher, and probably isn't even true!
His reputation is somewhat tarnished by the fact he was disliked by many of his peers,
and it's hard to say if that's because he really was hard to get along with or because
he was so unflinching in his commitment to go against everyone else's thinking with ideas
that weren't popular at the time but would ultimately prove to be the best way forward.
As is usually the case, it was perhaps a combination of the two.
Well, if you liked this video I have plenty more in a similar style, and plenty more in
dissimilar styles - so I have something for everyone, unless you just don't like me.
If that's the case, remember, lots of people didn't like Robert Liston either, but look
at him now, dead.
God I wish that were me.
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