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Robert Liston (28 October 1794 – 7 December 1847) was a British surgeon. Liston was noted for his speed and skill in an era prior to anaesthesia, when speed made a difference in terms of pain and survival. He was the first Professor of Clinical Surgery at University College Hospital in London and performed the first public operation utilising modern anaesthesia in Europe.
He became first "The Northern Anatomist" of Blackwood’s Magazine. In 1832/1833, he is listed as living at 99 George Street in the centre of Edinburgh's New Town. In 1833, he applied for Edinburgh's Professorship of Anatomy but was beaten by James Syme (five years his junior) who had a much better aptitude for teaching. Liston then left Edinburgh and relocated to London.
For the last seven years of his life he lived 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.Gordon, Richard (2001), p.1
He was elected a Fellow of the Royal Society in 1841.
In 1837, he published Practical Surgery, 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".
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." Full text at Internet Archive (archive.org)
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". (p. 43 of pp. 43–46 in 1983 edition) in Gordon, R. (1983), p.147. 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."Gordon, Richard (2001) p.35; (1983) p.44 The connection between surgical hygiene, infection, and maternal mortality rates at Vienna General Hospital was only made in 1847 by Vienna physician Ignaz Semmelweis from Hungary, after a close colleague of his died. He instituted the hygiene practices exhorted by Holmes, and the mortality rate fell.Gordon, Richard (2001) pp.34–36; (1983) pp.43–45
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".Gordon, Richard (2001), p.2
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. 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.Richardson (1987), p.327 in References section.
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. No primary sources confirm that this surgery ever took place.
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