Painful Surgery
Before anesthetics removed the terrible pain of surgery, the success of an operation was measured by the speed with which it was performed.
Robert Liston is said to have once removed a limb and sown up the stump in 30 seconds from start to finish, although two minutes appears to have been his more regular time.
19th Century Medicine
Born in Scotland in October 1784, Liston studied medicine at the University of Edinburgh and graduated in 1818. It was a time when the practice of the physician was hampered by a poor understanding of illness.
Some doctors still believed that removing a few pints of blood from a patient would alleviate ailments despite the complete absence of evidence that it did.
Miasma was the prevailing theory of disease transmission that said some kind of noxious “bad air” carried sickness. However, the following were “listed among the general causes of illness: ‘diseased parents,’ night air, sedentary habits, anger, wet feet and abrupt changes of temperature.
“Cholera, shortly to be epidemic in many British cities, was said to be caused by rancid or putrid food, by ‘cold fruits’ such as cucumbers and melons, and by passionate fear or rage” (Victoria and Albert Museum).
Rest was the usually prescribed therapy, along with cleansing the body through laxatives and/or preparations to induce vomiting.
Most of the medicines available were based on folk remedies. Also, such dangerous substances as arsenic, opium, and cocaine were often prescribed.
At least until the late 1840s when anesthetics began to appear, what patients in a doctor’s office dreaded hearing more than anything else was the need for surgery.
Robert Liston’s Accomplishments
Liston was ahead of his time with regard to operating-theatre hygiene. Unlike most of his professional colleagues, he washed his hands before each operation. Another innovation was wearing a clean, new apron for each surgery.
The medical newspaper ASCO Post notes that during Liston’s time, “Surgeons actually took pride in wearing dirty bloodstained operating gowns as a display of their experience in the surgical trenches. They also believed pus was a natural part of the healing process rather than a sinister sign of sepsis. Not surprisingly, most deaths were due to postoperative infections.”
Knowing the high mortality rate among those undergoing surgery, Liston felt much as his patients must have that going under the knife should be the last option.
Even though the medical profession of his time knew next to nothing about sepsis, Liston tried to keep his hospital environment as clean as possible. And, he understood the terror his patients felt and did what little he could to ease their fear, his lightning-fast operating techniques being part of that.
Such was the quality of his work that his patients were more likely to survive than if attended to by less skilled surgeons.
In 2012, general surgeon Bill Thomas noted in the Bulletin of the Royal College of Surgeons of England that Liston “performed 66 amputations between 1835 and 1840 and only 10 died―a mortality rate of 1 in 6. A little down the road at the time in St Bartholomew’s Hospital, the surgeons were sending one in four to the mortuary.”
The Hazards of Surgery
Occasionally, there was a downside to Liston’s dedication to speed. In his haste to amputate a man’s leg, he accidentally removed his testicles as well. But, there was worse.
He was removing another patient’s leg when his flaying blade took off the finger of an assistant who was holding the limb steady.
The notion of sterilizing instruments was some years in the future so both the patient and assistant contracted an infection and died.
A third casualty of the procedure was a man who was observing the surgery. Liston’s scalpel sliced into the tailcoat of the man, who fell to the floor, apparently dying of shock.
There are some who cast doubt on the accuracy of this story of a 300 percent mortality rate from a single operation, but it has been repeated often by usually credible sources.
A child with a neck mass was taken to see Liston. The surgeon thought it was an abscess and cut into it. Unfortunately, it was an aneurysm and the boy bled to death.
Coincidentally, it was a burst aneurysm that killed Robert Liston in December 1847. He was 53 years old.
Bonus Factoids
- Liston also invented several medical instruments, including a splint that was still used until recently to deal with fractured femurs.
- On December 21, 1846, Robert Liston performed the first operation in Europe using the ether anesthetic that had been developed in America. He called it “the Yankee dodge” and praised it for alleviating the excruciating pain of surgery.
- While in Edinburgh, Liston confronted fellow doctor Robert Knox over the mistreatment of a young woman called Mary Paterson. Knox had basically pickled Paterson in whiskey and put her body on humiliating display. It turns out that Ms. Paterson has been murdered by the notorious body snatchers Burke and Hare.
