Robert Liston

Robert Liston (28 October 1794 – 7 December 1847)[1] 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.[2][3]

This article is about the Scottish surgeon. For the British diplomat, see Robert Liston (diplomat). For the Scottish clergyman, see Robert Liston (minister).

Robert Liston
Robert Liston, 1847 portrait by Samuel John Stump
Born(1794-10-28)28 October 1794
Ecclesmachan, West Lothian, Scotland
Died7 December 1847(1847-12-07) (aged 53)
London, England
NationalityScottish
Alma materUniversity of Edinburgh
Scientific career
FieldsSurgery

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.[2][3][lower-alpha 1]

Career

Liston received his education at the University of Edinburgh, became first 'The Northern Anatomist' of Blackwell's Magazine,[3] and in 1818 became a surgeon in The Royal Infirmary of Edinburgh.[2][3] In 1832/1833 he is listed as living at 99 George Street in the centre of Edinburgh's New Town.[4] He lived from 1840 to 1847[5] at 5 Clifford Street, off Bond Street in Mayfair, in a building and area now of historical significance,[6] hence Richard Gordon's specific mention of this address in his section on Robert Liston.[7]

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."[8]

Liston's image has been preserved in both bust and portrait form.[9] 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".[10]

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".[7] 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;[2] 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 witness reportedly dying of shock, making this surgery the deadliest in history.[11][lower-alpha 2][12]

In Florence Nightingale's Notes on Nursing, she states "there are many physical operations where ceteris paribus (all else being equal) 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".[13][14][lower-alpha 3]

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.[7]

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".[15][lower-alpha 1][16] 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".[17] 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.[18]

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".[19]

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 a 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 whisky for three months before dissection, during which time she was essentially on voyeuristic display.[20] 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.[21]

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.[2][22]
  • 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",[2][19][23] referring 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, Bulldogs forceps (a type of locking artery forceps), and a leg splint used to stabilise dislocations and fractures of the femur, and still used today.[2][7]

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[19]
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[19]
Second most famous case

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

— Richard Gordon[19]
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 feignted from fright.

— Richard Gordon[24]
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.[25]

Publications by Liston
  • "Cases of Aneurism; Fracture of the Femur; Case of Aneurism", The Edinburgh Medical and Surgical Journal, 16, pp. 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 (602), pp. 846–851, 14 March 1835, doi:10.1016/s0140-6736(02)96871-6, retrieved 18 July 2010
  • Liston, R. (1837), "Observations on Some Tumours of The Mouth and Jaws", Medico-Chirurgical Transactions, 20, pp. 165–199, doi:10.1177/095952873702000112, 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 (1102), pp. 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
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See also

Notes
  1. The difference in pagination between the 1983 and 2001 editions is attributable to the fact that for the 1983 edition, the frontispiece is counted as page 1, with printed page numbering commencing at page 13, which is the first chapter, on Robert Liston. Conversely, the online edition commences numbered pagination at chapter one. A comparison of the 1983 edition and the viewable online text shows no discernible deletions of text. Certainly chapter one appears word-for-word, as does chapter 11 (Disastrous Motherhood). In the latter case, the 1983 pagination encompasses four pages, whereas the online book encompasses three. However, the text is the same. The 1983 edition has each sequential chapter commencing on the same page as the preceding chapter ends, which causes a greater page range for some chapters. The online edition has each chapter commencing on its own page. Text is compressed so that there are more words per line, but of the text is verbatim for that able to be compared.
  2. The main article of relevance re Liston at general-anaesthesia.com appears to be 'Utopian Surgery'on the btlc.com website, in which Liston is mentioned near the bottom of the 'Historical Background' section, with a link which takes one to the L.V. Martin page, in which there is another link to Liston, which takes one to the page with the url in this reference
  3. There are several publications of Notes on Nursing, including online versions. The exact pagination will depend on such things as prefaces and introductory chapters on Nightingale. There may be additional variations in online sources. Some online versions may even not contain some footnotes or margin notes from Nightingale's book. However, the online source cited at the same time as this footnote, does have Nightingale's footnote on page 30.

References
  1. University College London Hospitals. "Timeline 1800–1899". Retrieved 16 October 2019.
  2. "Robert Liston". Retrieved 25 March 2017.
  3. Gordon, Richard (2001). "Triple Knock-Out: Disastrous surgical enthusiasm". Great Medical Disasters. London: House of Stratus. pp. 1–3. ISBN 978-1-84232-519-3. Retrieved 16 July 2010. 1983 publication by Hutchinson & Co., London. pp. 13–15. ISBN 0-09-152230-7
  4. "Edinburgh Post Office annual directory, 1832-1833". National Library of Scotland. p. 110. Retrieved 25 February 2018.
  5. "Death of Robert Liston, Esq., F.R.S", The Lancet, 2 (1267), pp. 633–634, 11 December 1847, doi:10.1016/s0140-6736(02)73183-8, retrieved 16 July 2010
  6. Sheppard, F.H.W. (General Editor) (1963). "British History Online". Survey of London – Cork Street and Savile Row Area: Table of notable inhabitants on the Burlington Estate Vols 31 & 32(Pt2). pp. 566–572. Retrieved 17 October 2009.
  7. Gordon, Richard (2001), p.1
  8. Ashley Cowie, Monumentally Funny Events in History: From Napoléon’s Petit Package to Pythagoras’ Fear of Farts, Ancient-Origins
  9. Stanley, Peter (2003), For Fear of Pain: British Surgery, 1790–1850, The Wellcome Series in the History of Medicine, Clio Medica 70, Amsterdam & New York: Rodopi, p. 15, ISBN 978-90-420-1024-6, ISSN 0045-7183, retrieved 18 July 2010
  10. "Liston Testimonial Fund", The Lancet, 1 (20), p. 514, 13 May 1848, retrieved 18 July 2010
  11. "Robert Liston". General Anaesthesia. 2008. Retrieved 17 October 2009.
  12. Ellis, Harold (1996), Operations That Made History, London: Greenwich Medical Media, p. 64, ISBN 978-1-900151-15-3, retrieved 16 July 2010
  13. Nightingale, Florence (1974). Notes on Nursing: What it is and what it is not. Glasgow & London: Blackie & Son Ltd. p. 22 (footnote). ISBN 978-0-216-89974-2.
  14. Nightingale, Florence (1860). Notes on Nursing: What it is and what it is not. Boston: William Carter. p. 30 in online text. Retrieved 24 October 2009. Full text at Internet Archive (archive.org)
  15. Gordon, Richard (2001). "Disastrous Motherhood: Tales from the Vienna Wards". Great Medical Disasters. London: House of Stratus. pp. 34–36. (p. 43 of pp. 43–46 in 1983 edition)
  16. Holmes, O.W. (1842–1843). "On the contagiousness of puerperal fever". New England Quarterly Journal of Medicine. i: 503–30. in Gordon, R. (1983), p.147.
  17. Gordon, Richard (2001) p.35; (1983) p.44
  18. Gordon, Richard (2001) pp.34–36; (1983) pp.43–45
  19. Gordon, Richard (2001), p.2
  20. Richardson, Ruth (1987), "Trading Assassins", Death, Dissection and the Destitute, London: Routledge & Kegan Paul, pp. 131–158, ISBN 978-0-7102-0919-1, retrieved 16 July 2010
  21. Richardson (1987), p.327 in References section.
  22. Flemming, P. (1926). "Robert Liston, the first professor of clinical surgery at UCH". University College Hospital Magazine. 1: 176–85. in Gordon, R. (1983), p.146.
  23. Cock, W.F. (1911). "The first operation under ether in Europe". University College Hospital Magazine. 1: 127–44. in Gordon, R. (1983), p.146.
  24. Gordon, Richard (2001), p.3;(1983), p.15
  25. Soniak, Matt (24 October 2012). "'Time Me, Gentlemen': The Fastest Surgeon of the 19th Century". Mental Floss. The Atlantic. Retrieved 30 April 2019.

22. "Great Medical Disasters", Gordon, Richard. 2001. Print. Page 15.

Further reading
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