In our list of Heroes, Robert Liston is somewhat of an anti-hero. An important tale, nevertheless, and so he appears here.
Liston was a brash, arrogant, and entitled man. A peacock, more concerned with his pursuits (both as a womanizer and as a braggart in the surgical theater) than his patients.
He was tall, balding, and of “unimposing looks,” yet had a temper to make up for it and assert his dominance and presence at every moment. He also had a soft side, an ear for the sick, and a need to be liked. But to understand Liston, we have to understand surgery in the 1820s.
A round theater was often packed with paying visitors from all manners of high society. Surgery was a spectacle, a sideshow, and a business, not officially associated with medicine as a healing art but with anatomy, a mechanical and practical one. It wouldn’t be until the 1840s that anesthesia, mostly driven by John Snow (15 March 1813 – 16 June 1858), would enter the operating rooms, and thus surgeons had to work fast and with extreme accuracy if they wanted to finish their handiwork in time for the patient to not flail or die from blood loss. Surgery, as we know it today, did not exist, all surgical moves were amputations.
He was 24 when he became a surgeon at the Royal Infirmary of Edinburgh. But even before that time, he had already left his mark on the discipline, writing under a pseudonym for a number of anatomical magazines. His descriptions of heroic surgical endeavors were all fables, yet they bred a new kind of surgical braggadocio, the competition for faster and faster completion of complicated amputations.
Surgery was, unlike medicine, a lucrative endeavor. Selling seats at the theater, advising and training new surgeons, as well as the cost of the procedure itself made many of the star surgeons very rich. Not rarely did practitioners even perform the operation for free or pay their patients to ensure a constant stream of theatrical stages that sold out to packed rafters. Within the operating theater most surgeons worked surrounded by ascending, concentric standing and seating areas, not unlike that of a coliseum. Many of those rooms were open to the sky to let in light and to vent out the smell of blood and other fluids that dripped down onto a sawdust covered floor.
Closest to the surgeon were his assistant(s) and the patient. The first circle contained colleagues who came to gawk and cheer, interspersed by students of higher means who also made up the following standing rings. Behind those, a number of seating rings were reserved for the very rich, followed by poorer students and the rabble that could afford a ticket to the show.
Liston was a surgeon of the purest sense. He abhorred the “finicky and affected” ideas of medical practice, seeing himself as a provider of services that were neither spiritual nor elegant, a mercenary in the service of surgery.
And then, there was his soft side. He’d often leave his post at the Infirmary, even turning down lucrative surgeries, to perform smaller surgical tasks at the houses for the poor and infirm in and around Edinburgh. He gave copies of his books, then considered required reading, to those who could not afford them, and there are a number of documented cases of him taking on young surgeons without the means, even paying them a modest salary.
Or that time he punched out a colleague for displaying the naked body of a young female murder victim in whiskey for three months before a planned gruesome show autopsy. It later became clear, that the victim, Mary Patterson, had been murdered by infamous body snatchers Burke and Hare and sold to Dr. Knox “still warm, almost breathing.” Patterson had been a medical socialite, having sexual relationships with many surgeons and students, and was well known, thus drawing thousands to pay and gawk.
Knox’ complicity in this is almost guaranteed, he’d started showing “dissection of the very recently deceased” months before and performed up to two autopsies a day in some weeks. An anatomist like him would not have missed the signs of murder in those bodies brought before him by Burke and Hare.
Liston arranged to have the body inspected for sings of foul play and then buried in a small ceremony.
But Liston’s true rise to fame did not come from his charity or even his brash nature. His frequent bar fights with fellow surgeons, his lavish parties during which he bedded young impressionable socialites, or his books were nothing compared to his alleged feats in the OR. None of those are well documented, through the last one is to some extent on account of the persons involved.
During surgery he started a fight with another surgeon that culminated in them disagreeing about the nature of a mass in a boy’s neck. To prove it was not an aneurysm but a tumor Liston stabbed it. It was an aneurysm and the boy died in seconds. Rather than becoming apologetic, Liston removed the artery and had it prepared for display.
Another time, in a rush to finish surgery faster than one of his opponents who’d done one in two minutes and forty seconds, he accidentally amputated his patient’s testicles as well. These, too, were prepared for display. He also beat his colleague by nine seconds.
Finally, to beat his record of two minutes and 31 seconds from this event, he worked so fast, he amputated three of his assistant’s fingers and, during the final flourish, nicked the coat tails of another colleague standing in the spectator row. The patient and assistant died of gangrene three days later, the spectator, believing he’d been slashed, from shock an hour after the surgery.
That day, Liston not only achieved the record in fastest surgery but also in most people killed during one: three.
But why then include Liston in my list?
Liston’s antics were numerous and woven tightly into the fabric of a changing medicine and surgery. His brush with Knox and the Burke and Hare murders, his publication of books that informed a new generation of surgeons and ultimately led to the inclusion of surgery into the medical field, and, finally his students…
Remember his charity? One of those charitable students whom Liston took on for free and even paid a small stipend was Joseph Lister, who later told that his presence at that fateful triple death surgery inspired him to pursue his studies into the aseptic technique and the development of methods to combat post-surgical infectious deaths.
Another of his students present that day was James Young Simpson, who, again inspired by what had transpired that that fateful surgery, worked at finding ways to numb patients to allow for more time in surgery. He experimented with anesthetics and laid the groundwork for sedated and unconscious surgeries that, in concert again with John Snow (15 March 1813 – 16 June 1858), made modern surgery possible.
He also invented a number of surgical tools still in use today.
But, as long as mankind is more attracted to blood and gore, Liston will be remembered as the record holder in speed surgery and most deaths following a procedure.
He died of an aneurysm himself, aged only 53 years, while performing surgery. His grave is small and unassuming, faded writing that is almost illegible today is the last that remains of a once larger than life figure.