On this day in medical history: A bold surgeon carves out his place

On December 21, 1846, a Scottish surgeon nicknamed “The fastest knife in the West End” performed an amputation at the thigh in less than 30 seconds from first cut to final suture. Afterward, the patient was awoken and politely asked when the procedure would begin. 

The knife was wielded by the legendary Robert Liston, and the patient’s confusion was thanks to the first surgical use of an anesthetic agent in the British Isles.

Ether had been used by American physicians shortly before, but Dr. Liston stands out in history thanks to his precision, skill, and showmanship. While most may be familiar with the apocryphal story of the surgery with a 300% mortality rate, lesser known are Dr. Liston’s accomplishments as an inventor, anatomist, and advocate for patient comfort.

Dr. Liston rejected the notion embraced by many of his colleagues that the excruciating pain caused by surgery was necessary for a proper healing process. He also rejected hypnotism for surgical pain control.

While the prospect of surgery without anesthesia is horrifying to modern-day patients, it was also plenty horrifying to the patients of the mid-19th century. Writing on patient well-being, Dr. Liston further stands out from his cohort:

“It is of the utmost importance to attend to the state of the patient’s mind and feelings,” he wrote in the introduction to Practical Surgery, one of his many texts. “He ought not be kept in suspense, but encouraged and assured; and his apprehensions must be allayed. If this cannot be effected—if he is dejected and despondent—talks of the great risk, and of the certainty of his dying, it is better that the operation be abandoned, or at least delayed. If, on the contrary, he is confident in the resources of his constitution, and in the ability of his attendant, and looks forward to the advantage to be derived from his own fortitude, then there should be no delay.”¹

Although he practiced before the age of microorganisms, Dr. Liston’s brand of medicine was remarkably clean for his time—aside from clutching his knife between his teeth in the middle of an amputation. Dr. Liston always wore a clean surgical apron for each procedure, even though a bloody apron was a symbol of experience among his peers. He washed his hands before surgery and shaved surgical sites prior to incision, as well. His surgical sponges were clean, and his dressings were soaked in cold water, rather than salves and panaceas that harbored pathogens.²

Dr. Liston was also an educator. While reports state he was demanding of his students and trainees, he was also known to invite them to his home for dinners. His vast anatomical and surgical knowledge, coupled with his high ethical standards, created an environment where excellence was the only goal.

After his death in 1847 following a ruptured aortic aneurysm, 500 students and friends attended his funeral.

References:

1. Liston R. Practical Surgery. London: J. Churchill, 1837.
2. Jones AJ, et al. American College of Surgeons. https://www.facs.org/~/media/files/archives/05_liston.ashx. Accessed 12/14/2017.