Robert Liston was a prolific Scottish surgeon and inventor born on 28 October 1794 Ecclesmachan, West Lothian, Scotland. He was the eldest son of Scottish minister and inventor, Henry Liston, who invented the Euharmonic (enharmonic) Organ.
Robert’s father was also Moderator of the General Assembly of the Church of Scotland, which in general seems to be an assembly of all churches in Scotland. Following the assembly, Henry would represent the Church of Scotland in other events around Scotland and the world.
Henry’s diligence and ingenuity seem to have been transferred to his son, who seems to share his hard-working attitude and inventiveness.
As mentioned earlier, Robert was a surgeon during the 1800s. This time in healthcare wasn’t AMAZING for patients. Particularly due to the lack of anaesthesia.
Prior to the invention of anaesthesia, surgeries were something like a horror film. All surgeries were completed while the patient was fully awake and coherent. Just imagine the most gruesome surgery possible, and also imagine being fully awake for its completion. And if you can’t imagine that, don’t worry because we’re going to tell you about a couple.
Just before the commencement of the surgery to remove the bladder stone of a young boy, and despite having already inspected the child, the surgeon chose this ‘dreadful moment’ to re-examine him, inserting a metal sound through his urethra and into his bladder. ‘Unfortunately he could not feel the stone, till after trying in all directions, and putting the boy in excruciating pain for several minutes, he, at last, satisfied himself and gave the instrument into the hand of another surgeon, for further testimony’. This surgeon likewise had great difficulty in locating the calculus and so handed the sound to a third colleague. According to a correspondent:
"These examinations occupied a full twenty minutes, during the whole of which time the boy continued screaming and was nearly exhausted before the operation commenced … Now a great part of this painful process might be, or ought to be avoided. It is woeful to the patient, it is disgraceful to the surgeon…"
For another stomach-churning surgery, here is Claire Tomalin’s researched account of a surgery performed on Samuel Pepys to remove a troublesome bladder stone in the 1600s. Please do us a favour and remember Sam was awake the whole time:
“The surgeon got to work. First, he inserted a thin silver instrument through the penis into the bladder to help position the stone. Then he made the incision, about three inches long and a finger's breadth from the line running between scrotum and anus, and into the neck of the bladder, or just below it. The patient's face was sponged as the incision was made. The stone was sought, found and grasped with pincers; the more speedily it could be got out the better. Once out, the wound was not stitched--it was thought best to let it drain and cicatrize itself--but simply washed and covered with a dressing, or even kept open at first with a small roll of soft cloth known as a tent, dipped in egg white. A plaster of egg yolk rose vinegar and anointing oils were then applied.”
Not much can be found on Robert's very early life. But we do know that he was educated at the University of Edinburgh.
At age 24, he became a member of the Royal College of Surgeons both in London and Edinburgh. The youngest to reach this point at that time. During this time, he was hired as an anatomy demonstrator at John Barclay’s (famous anatomist) in Edinburgh. Robert was, apparently, kind of a dick to the people he worked with and he didn’t get along with John Barclay. So, he decided to leave and began teaching anatomy and surgery himself.
As a teacher, he gained an impressive reputation as a knowledgable surgical practitioner. He began to accept surgeries from random people (because apparently you could do that then). People would seek Robert out because they were suffering from ailments that other surgeons would steer clear from.
Robert would literally accept any single case that came his way. At this time, he had no official connection to the Royal Infirmary of Edinburgh, so these surgeries had to be performed in the patient’s homes, or in lodgings that he would provide them.
I suppose the Royal Infirmary of Edinburgh was the main surgical hospital in Edinburgh at the time, although Robert was still a Fellow of the Royal College of Surgeons.
Throughout these surgeries, Robert began to develop a large amount of ingenuity. He improved on many operating techniques to better assist surgical operations that other surgeons had failed or just refused outright to treat.
One striking moment of ingenuity occurred during an amputation by Andrew Russell, then Professor of Clinical Surgery at Edinburgh. An artery in the cut bone bled profusely, and couldn’t be tied in an ordinary way. With the amputation knife, Robert cut off a chip of wood from the operating table, formed it into a cone, drove it into the bleeding orifice, and immediately stopped the bleeding.
While also showing an enormous level of ingenuity, Robert also consistently improved his surgical speed (owing to his ever-increasing knowledge of amputation and anatomy). It may seem obvious, but the importance of speed during an amputation couldn’t be understated. Not only to decrease the blood loss of the patient, increasing the likelihood of survival, but to also minimize how long the patient’s pain would last.
When Liston was 40, he accepted an offer to become a surgeon of University College London. Due to his amazing proficiency with his surgery, he garnered the nickname, “The Fastest Knife in the West End”. Robert was so acclaimed for his skill and became so well known for the fact that he never turned a patient away, that his waiting rooms would often be packed with patients waiting for days at a time to be operated upon.
His survival rates were also staggering in comparison to other surgeons. Many surgeons had a mortality rate of 1 in 4, while Liston proudly held a rate of 1 in 10. Slower surgeons dealt with issues such as patients actually getting up from the operating table and trying to escape the operating room, which could easily have contributed to the high mortality rates of their patients.
As luck would have it, Robert practised directly adjacent to the invention of modern anaesthesia. On November 23, 1846, Frederick Churchill, a butler, was admitted to University College Hospital under Liston's care. Liston found Churchill to have developed septic arthritis and was sure to lose his leg. A recent discovery in America had shown that the dentists Morton and Jackson had begun researching the use of ether in their dental practices, effectively beginning the start of the anaesthetic age. Liston determined to use Churchill as a guineapig in an attempt to use this anaesthetic himself.
On December 19, Liston visited Dr William Squire and told him of the great news from America which a Dr Boott had received from a Dr Bigelow of Boston. This news was that on October 16 of that year an amputation had been carried out entirely painlessly under the influence of ether, vaporized on a sponge and inhaled from a glass vessel. Liston and Squire decided to attempt to repeat the American success on Churchill in two days' time. However, Squire would need to obtain some slight experience in the use of ether as an inhalation anaesthetic before attempting the amputation on Churchill. The test subject was a patient in need of a tooth extraction. The extraction was carried out to everybody's satisfaction, and all was set for the following Monday.
On the afternoon of December 21, at 2 o’clock, Squire decided to carry out a preliminary trial of the anaesthetic before commencing the operation. The surgical theatre porter was asked to be the subject of this initial trial. However, he was a large man so he was not able to be anaesthetised deeply enough and was able to escape the operating room screaming obscenities.
Although a bit of a goof-um-up, the surgery still went ahead. Here is a description of the scene by Dr F William Cock:
'The well of the theatre is now almost full; it is 2.15 p.m. A firm step is heard, and Robert Liston enters - that magnificent figure of a man, 6 ft. 2 in. in height, with a most commanding expression of countenance. He nods quietly to Squire, and, turning round to the packed crowd of onlookers, students, colleagues, old students, and many of the neighbouring practitioners, says somewhat drily, "We are going to try a Yankee dodge to-day, gentlemen, for making men insensible". He then takes from a long narrow case one of the straight amputating knives of his own invention. It is evidently a favourite instrument, for on the handle are little notches showing the number of times he had used it before. His housesurgeon, Ransome, puts the saw, two or three tenacula and the artery forceps, named after the operator, on to a chair close by, and covers them with a towel, then threads a wisp of well-waxed hemp ligatures through his own buttonhole.
"Ready, Mr. Ransome?". "Yes, sir". "Then have him brought in."..... the patient is carried in on the stretcher and laid on the table. The tube is put into his mouth, Wm. Squire holds it and the patient's nostrils. A couple of dressers stand by to hold the patient if necessary, but he never moves, and blows and gurgles away quite quietly. Liston stands by, trying the edge of his knife against his thumb nail, and the tension increases; the patient's breathing gets deeper, more ether is dropped on the sponge. Squire looks at Liston and says, "I think he'll do, sir". The tube is removed and a handkerchief laid over the patient's face. "Take the artery, Mr. Cadge," cries Liston.
Ransome, the house surgeon, holds the limb. "Now, gentlemen, time me," (Liston’s catchphrase) he says to the students. A score of watches are pulled out in reply. The huge left hand grasps the thigh, a thrust of the long, straight knife, two or three rapid sawing movements, and the upper flap is made; under go his fingers, and the flap is held back; another thrust, and the point of the knife comes out in the angle of the upper flap; two or three more lightning-like movements, and the lower flap is cut, under goes the great thumb and holds it back also; a touch or two of the point, and the dresser, holding the saw by its end, yields it to the surgeon and takes the knife in return - half a dozen strokes, and Ransome places the limb in the sawdust. "Twenty-eight seconds," says Wm. Squire. "Twenty-seven," says Buckell, a student still living.
"Twenty-six," echoes yellow-haired Russell Reynolds. "Twenty-five seconds, sir" says proud Edward Palmer, the dresser, to his surgeon, who smiles in reply. The femoral artery is taken upon a tenaculum and tied with two stout ligatures, and five or six more vessels with the bow forceps and single thread, a strip of wet lint put between the flaps, and the stump raised. Then the handkerchief is removed from the patient's face, and, trying to raise himself, he says, "When are you going to begin? Take me back, I can't have it done!" He is shown the elevated stump, drops back and weeps a little; then the porters come in, and he is taken back to bed. Five minutes have elapsed since he left it. As he goes out, Liston turns again to his audience, so excited that he almost stammers and hesitates, and exclaims, "This Yankee dodge, gentlemen, beats mesmerism hollow."'
Robert Liston had worked for years to become the fastest surgeon known to history and he died exactly at a time when speed became obsolete in surgery. (How unfortunate.) The University College London is where Robert would spend the remainder of his years (1 year, to be exact) before passing away at the age of 53 due to an aneurism.
We may have alluded to this earlier, but Liston was a bit of a dick. He was also very pompous, knew how much skill he had, and really like the applause he would receive. He was kind of a Jeff Bezos of surgery. Sometimes, this pompousness would get the better of him.
Robert was one to know when and when not to operate. He was a believer in nature running its course, and would not use surgery as an end-all for all medical issues. However, all surgeons make mistakes sometimes, and Liston was a bit too eager to operate in one particular case.
One day as Robert was doing the rounds on his ward with his house Surgeon, Mr Bucknill, he was shown a case of a young boy with swelling in his neck over the carotid artery. (For those that don’t know, it’s the main artery that runs through the neck.)
Mr Bucknill told Robert, “The tumour pulsates and I can detect a bruit in it.” This meant that Bucknill believed the boy was suffering from an aneurysm, which is a weakening in an artery wall that creates a bulge.
Liston replied with, “Pooh! Whoever heard of an aneurysm in a boy so young?” And, without much warning whatsoever, he reached into his right waistcoat pocket, took out a knife, and made a deep incision into the tumour.
The arterial blood leapt from the wound and the boy fell. The artery was tied, but the boy died. The post-mortem showed that Liston was incorrect. He published the case but did not admit that he was in error.
In 1823, prior to Liston joining the University College London, he performed an operated that proved to be a great sensation. He was to remove an enormous tumour from a man’s scrotum. It was a slight tumour, but one described as in the nature of elephantiasis.
The tumour itself measured forty-two inches in circumference and extended below the patient’s knees. He had to actually cart the tumour around in a wheelbarrow.
The account of the surgery says that 'the flow of blood was liken unto the discharge of water from a shower bath', and before half the vessels could be tied, the patient sank off the table, without a pulse, and with relaxed muscles, voluntary and involuntary. A cordial - good strong whisky - was poured into his stomach, and before much sign of recovery could be observed he had taken a pint of it. After removal, the tumour was said to have weighed forty-four and a half pounds. In three weeks the patient was able to walk out.
In another instance, Liston was performing a leg amputation. He had already developed notoriety for amazing speed, and he was fully aware of his own skill. During this particular surgery, Liston decided he would like to beat his own personal record and remove the leg in 2 ½ minutes.
The surgery began quite normal. The patient was prepped and the surgery theatre was set. Once all was ready, Robert looked to his audience and uttered his famous catch-phrase: “Time me, gentlemen. Time me.”
Robert, likely more concentrated on the time than the surgery, brought his knife down so quickly that he was momentarily careless and managed to chop his assistants fingers off along with the limb. However, as he removed the knife he managed to accidentally cut the coattails of one of the spectators, who fainted and dropped to the floor.
As was normal for the time, infection was an obvious concern for all surgeries. Following the surgery, the patient, unfortunately, contracted gangrene and died. However, the assistant who lost their finger also contracted gangrene and died. Finally, the spectator who had fainted when Liston cut his coattails had not just fainted, he had died of fright.
This particular surgery is the only known surgery with a 300% mortality rate.