Robert Liston
Portrait of Robert Liston painted in 1847 by Samuel John Stump
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
Alma materUniversity of Edinburgh Medical School
Scientific career
FieldsSurgery

Robert Liston FRCSE, FRCS, FRS (28 October 1794 – 7 December 1847)[1] was a British surgeon. Liston was noted for his speed and skill in an era prior to anaesthetics, when speed made a difference in terms of pain and survival.[2][3] He was the first Professor of Clinical Surgery at University College Hospital in London and performed the first public operation utilizing modern anaesthesia in Europe.

Early life

He was born in the manse of Ecclesmachan, the son of Margaret Ireland from Culross and her husband Rev Henry Liston a clergyman and an inventor, from Ecclesmachan in West Lothian west of Edinburgh. His grandfather – also Robert Liston – was the Moderator of the General Assembly of the Church of Scotland.[2][3][lower-alpha 1]

Career

After a local education both from his father and in Abercorn village school, Liston studied at Edinburgh Medical School from 1808, and in 1810 became assistant to his tutor Dr John Barclay. In 1816, he went to London for a year to train under William Blizard. He returned to Edinburgh to teach anatomy alongside James Syme. He was then living at 95 Princes Street – a fine house facing Edinburgh Castle.[4] In 1820, he married the daughter of Adam Crawford, a Leith wine merchant.[5] In 1818, he had become house surgeon in The Royal Infirmary of Edinburgh under Dr George Bell.[2][3] However, he was dismissed in 1822 due to disagreements with Bell and not reinstated until 1827. In 1828, he was promoted to operating surgeon.[6]

He became first 'The Northern Anatomist' of Blackwell's Magazine.[3] In 1832/1833, he is listed as living at 99 George Street in the centre of Edinburgh's New Town.[7] In 1833, he applied for Edinburgh's Professorship of Anatomy but was beaten by James Syme (5 years his junior) who had a much better aptitude for teaching. Liston then left Edinburgh and relocated to London.[6]

For the last seven years of his life[8] he lived at 5 Clifford Street, off Bond Street in Mayfair, in a building and area now of historical significance,[9] hence Richard Gordon's specific mention of this address in his section on Robert Liston.[10]

He was elected a Fellow of the Royal Society in 1841.[6]

The coffin of Robert Liston FRS in the Terrace Catacombs, Highgate Cemetery

Death

He died of an aneurysm on 7 December 1847 at his Mayfair home, and his funeral took place at St Michael's Church, Highgate, six days later. The funeral procession from his home consisted of five mourning coaches and fifteen private carriages. In the former were relatives and his fellow medical professors of University College, and in the latter were friends of eminence in the higher ranks of society. Near the cemetery, the cortege was met by four hundred of his former pupils, and by about two hundred medical practitioners and others. He was buried on the western side of Highgate Cemetery in the Terrace Catacombs.[11][5]

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 Surgery, arguing the importance of quick surgeries; "these operations must be set about with determination and completed rapidly."[12]

Liston's image has been preserved in both bust and portrait form.[13] 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".[14]

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 21⁄2 minutes."[10] 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]

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."[15][16][lower-alpha 2]

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.[10]

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".[17][lower-alpha 1][18] 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."[19] 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.[20]

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".[21]

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.[22] 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.[23]

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's most famous case

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 what he calls Liston's most famous case in his book, as quoted verbatim below.

Amputated the leg in under 21⁄2 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 fainted from fright (and was later discovered to have died from shock).[28]

— Richard Gordon[29]

This episode has since been dubbed as the only known surgery in history with a 300 percent mortality rate. The situation that Gordon labels "Liston's most famous case" has been described as apocryphal.[30] No primary sources confirm that this surgery ever took place.[31]

Publications by Liston

See also

Notes

  1. 1 2 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. ↑ 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. 1 2 3 4 5 6 7 "Robert Liston". Retrieved 25 March 2017.
  3. 1 2 3 4 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 Directory 1819
  5. 1 2 Cansick, Frederick Teague (1872). "The Monumental inscriptions of Middlesex". www.archive.org. Retrieved 2 April 2021.
  6. 1 2 3 "Liston, Robert (1794–1847)". livesonline.rcseng.ac.uk. Retrieved 24 October 2021.
  7. ↑ "Edinburgh Post Office annual directory, 1832–1833". National Library of Scotland. p. 110. Retrieved 25 February 2018.
  8. ↑ "Death of Robert Liston, Esq., F.R.S", The Lancet, 2 (1267): 633–634, 11 December 1847, doi:10.1016/s0140-6736(02)73183-8, retrieved 16 July 2010
  9. ↑ 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. {{cite book}}: |last= has generic name (help)
  10. 1 2 3 4 Gordon, Richard (2001), p.1
  11. ↑ London Cemeteries: An illustrated Gide and Gazetteer H Meeler 7 B Parsons
  12. ↑ Liston, Robert (1837). Practical Surgery. John Churchill. p. 323.
  13. ↑ Stanley, Peter (2003), "For Fear of Pain: British Surgery, 1790–1850", Clio Medica (Amsterdam, Netherlands), The Wellcome Series in the History of Medicine, Amsterdam & New York: Rodopi, Clio Medica 70: 15, ISBN 978-90-420-1024-6, ISSN 0045-7183, PMID 12737690, retrieved 18 July 2010
  14. ↑ "Liston Testimonial Fund", The Lancet, vol. 1, no. 20, p. 514, 13 May 1848, retrieved 18 July 2010
  15. ↑ 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.
  16. ↑ 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)
  17. ↑ 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)
  18. ↑ 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.
  19. ↑ Gordon, Richard (2001) p.35; (1983) p.44
  20. ↑ Gordon, Richard (2001) pp.34–36; (1983) pp.43–45
  21. 1 2 Gordon, Richard (2001), p.2
  22. ↑ 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
  23. ↑ Richardson (1987), p.327 in References section.
  24. ↑ 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.
  25. ↑ Centenary of the first public operation under an anæsthetic in Europe carried out at University College Hospital by Robert Liston on 21st December 1846. U.C.H Medical School. 21 December 1946. Retrieved 22 February 2021.
  26. ↑ Cock, W.F. (1911). "The first operation under ether in Europe". University College Hospital Magazine. 1: 127–44. in Gordon, R. (1983), p.146.
  27. 1 2 Thomas, Bill (1 February 2012). "Saints and sinner: Robert Liston". The Bulletin of the Royal College of Surgeons of England. 94 (2): 64–65. doi:10.1308/147363512X13189526439197. ISSN 1473-6357.
  28. ↑ "How Surgeon Robert Liston Killed His Patient — Plus Two Bystanders". allthatsinteresting.com. 5 October 2017.
  29. ↑ Gordon, Richard (2001), p.3;(1983), p.15
  30. ↑ Soniak, Matt (24 October 2012). "'Time Me, Gentlemen': The Fastest Surgeon of the 19th Century". Mental Floss. The Atlantic. Retrieved 30 April 2019.
  31. ↑ "31. The Myth of Robert Liston by Historical Hysteria". Anchor. Retrieved 13 March 2022.

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

Further reading

Wikisource has the text of the 1911 Encyclopædia Britannica article "Liston, Robert".
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