Robert Liston


Robert Liston 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.

Early life

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

Career

Liston received his education at the University of Edinburgh, became first 'The Northern Anatomist' of Blackwell's Magazine, and in 1818 became a surgeon in The Royal Infirmary of Edinburgh. In 1832/1833 he is listed as living at 99 George Street in the centre of Edinburgh's New Town. He lived from 1840 to 1847 at 5 Clifford Street, off Bond Street in Mayfair, in a building and area now of historical significance, hence Richard Gordon's specific mention of this address in his section on Robert Liston.
He died of an aneurysm and was buried in the Terrace Catacombs in Highgate Cemetery.

Legacy

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.
In 1837, he published Practical Surgeries arguing the importance of quick surgeries; "these operations must be set about with determination and completed rapidly."
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

describes Liston as "the fastest knife in the West End. He could amputate a leg in 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, accidentally amputating his assistant surgeons fingers, causing the patient and assistant to die of sepsis, and a witnees reportedley dying of shock, making this surgery the deadliest in history.
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".
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 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". 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 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 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 over the treatment of a young woman who it later transpired was murdered, with Knox thought complicit in the murder. She was in Knox's dissecting rooms within four hours of her death, and kept in whisky 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.
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:
;Third most famous case:
;Second most famous case:
;Liston's most famous case:
;Veracity:
Doubts have been raised as to the veracity of these cases. The situation that Gordon labels "Liston's most famous case" may be apocryphal.

Publications by Liston