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Robert Liston (Born 28 October 1794, in Ecclesmachan, West Lothian - Died in London 1847) was the son of the Scottish minister Henry Liston. [1] [2]

Robert Liston was a pioneering Scottish surgeon, who received his education at the University of Edinburgh, became first 'The Great Northern Anatomist' of Blackwell's Magazine,[2] and in 1818 became a surgeon in The Royal Infirmary of Edinburgh.[1] [2] He lived from 1840-1847 (the year of his death) at No. 5 Clifford Street, off Bond Street in Mayfair, in a building and indeed area now of some historical significance,[3] hence Richard Gordon's specific mention of this address in his section on Robert Liston.[4]

Liston was noted for his skill and speed in an era prior to anaesthetics, when speed made a difference in terms of pain and survival.[1] [2] 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".[5] [6] [a]

Gordon describes Liston as "the fastest knife in the West End. He could amputate a leg in 2 1/2 minutes".[4] 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;[1] he is said to have been able to perform the removal of a limb in an amputation (and stitch the end back up) in 28 seconds.[7] [b]

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.[4]

Gordon's talent for 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".[8] [9] 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".[10] 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 after a close colleague of his died. He instituted the very hygiene practices exhorted by Holmes, and the moratlity rate fell.[11]

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".[12]

Contents

Liston's firsts

  • He also performed the first operation in Europe under modern anaesthesia, utilising ether, then a new substance from America, on 21 December 1846 at the University College Hospital,[1] [12] [14]
  • He invented see-through isinglass sticking plaster, the 'bulldog' locking artery forceps, and a leg splint used to stabilise dislocations and fractures of the femur, and still used today.[4] [1]

Liston's most famous cases

Richard Gordon describes Liston's four most famous cases in his 1983 book, as 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".[12]

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.[12]

Second most famous case: "Amputated the leg in 2 1/2 minutes, but in his enthusiasm the patient's testicles as well" [12]

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, they usually did in those pre-Listerian days). He also slashed through the coat tails of a distinguished surgical spectator, who was so terrified that the knife had pierced his vitals he dropped dead from fright. That was the only operation in history with a 300 per cent mortality.[15]

Publications by Liston

See also

Notes

a. ^  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.

b. ^  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 mentoned 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

References

  1. ^ a b c d e f g Robert Liston "The Gazetteer for Scotland". Date unknown. http://www.geo.ed.ac.uk/scotgaz/people/famousfirst1230.html Robert Liston. Retrieved 2009-10-17.  
  2. ^ a b c d Gordon, Richard (1983). "Triple Knock-Out: Disastrous surgical enthusiasm". in …. Great Medical Disasters. London: Hutchinson & Co.. pp. 13-15. ISBN 0-09-152230-7.   Also published 2001 by House of Stratus, London ISBN 1-842-32519-1
  3. ^ Sheppard, F.H.W. (General Editor) (1963). clifford-street "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. http://www.british-history.ac.uk/report.aspx?compid=41494&strquery=robert-liston clifford-street. Retrieved 2009-10-17.  
  4. ^ a b c d Gordon, Richard (1983), p.13
  5. ^ Nightingale, Florence (1974. First published 1859)). Notes on Nursing: What it is and what it is not.. Glasgow & London: Blackie & Son Ltd.. p. 22 (footnote). ISBN 0-216-89974-5.  
  6. ^ Nightingale, Florence (1860). Notes on Nursing: What it is and what it is not.. Boston: William Carter. p. 30 in online text.. http://www.archive.org/details/notesonnursingwh00nigh. Retrieved 2009-10-24.   Full text at Internet Archive (archive.org)
  7. ^ Pearce, David and/or Martin, L.V. (Updated 2008). "Robert Liston in Another Look at Dumfries (Martin) in Utopian Surgery (Pearce)". BLTC Research @ bltc.com. http://www.general-anaesthesia.com/images/robert-liston.html. Retrieved 2009-10-17.  
  8. ^ Gordon, Richard (1983). "Disastrous Motherhood: Tales from the Vienna Wards". in …. Great Medical Disasters. London: Hutchinson & Co.. pp. 43-46.   p.43
  9. ^ Holmes, O.W. (1842-3). "On the contagiousness of puerperal fever". New England Quarterly Journal of Medicine. i: 503–30.   in Gordon, R. (1983), p.147.
  10. ^ Gordon, Richard (1983) p.44
  11. ^ Gordon, Richard (1983) pp.43-45
  12. ^ a b c d e Gordon, Richard (1983), p.14
  13. ^ 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.
  14. ^ Cock, W.F. (1911). "The first operation under ether in Europe". University College Hospital Magazine. 1: 127–44.   in Gordon, R. (1983), p.146.
  15. ^ Gordon, Richard (1983), p.15

Further Reading

Matthew Kaufman, Robert Liston: Surgery’s Hero (Edinburgh, the Royal College of Surgeons of Edinburgh, 2009), ISBN: 9780954621377 [1]

External links


1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

ROBERT LISTON (1794-1847), Scottish surgeon, was born on the 28th of October 1794 at Ecclesmachan, Linlithgow, where his father was parish minister. He began the study of anatomy under Dr John Barclay (1758-1826) at Edinburgh in 1810, and soon became a skilful anatomist. After eight years' study, he became a lecturer on anatomy and surgery in the Edinburgh School of Medicine; and in 1827 he was elected one of the surgeons to the Royal Infirmary. In 1835 he was chosen professor of clinical surgery in University College, London, and this appointment he held until his death, which occurred in London on the 7th of December 1847. Liston was a teacher more by what he did than by what he said. He taught simplicity in all operative procedures; fertile in expedients, of great nerve and of powerful frame, he is remembered as an extraordinarily bold, skilful and rapid operator. He was the author of The Elements of Surgery (1831-1832) and Practical Surgery (1837), and made several improvements in methods of amputation, and in the dressing of wounds.


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