Robert Liston – Deadliest Surgeon in History

Surgery sucks. Lying on the butcher's table, surrounded by people who likely view you as nothing but a biomechanical machine, is terrifying. Knowing that a slight miscalculation by the anesthetist can 'put you to sleep' permanently. Stories of fatigued surgeons forgetting scalpels and various other tools in their patients' bodies play through your mind as the world fades to black.

Now imagine going in for major surgery in a world without anesthetics or adequate hygiene. Death becomes far more likely under those circumstances. Usually death during surgery is reserved for the unfortunate soul on the table.

That wasn't the case in the 19th century, when Robert Liston performed a surgery with a 300% mortality rate. This is the story of 'The Fastest Knife in the West End'.

Robert Liston – Gotta Go Fast

I have two loves, speed, and surgery

Liston was born in Scotland, in 1794. He studied medicine in Edinburgh from 1808 to 1815, after which he spent a year training in London. Returning to Edinburgh in 1817 to teach anatomy at his alma mater.

The next year he was appointed as a surgeon at The Royal Infirmary of Edinburgh. Here he found his passion and purpose in life – surgery. Knife play under the guise of medicine was so important to Robert Liston that he wrote a book about it.

Practical Surgery was published in 1837. He laid out his argument for speedy surgeries as such:

"these operations must be set about with determination and completed rapidly."

The logic of the day was that lengthy surgeries would likely cause the patient (victim) to bleed out. Due to the fact that there was no way to stop the patient from feeling every tiny morsel of pain during surgery, a speedy procedure would at least lessen the duration of the torture.

Oops

Liston got so good at performing speedy surgeries that he sometimes caught people off guard. Such was the case when he performed a surgery on a boy with a lump on his neck. Assuming the lump to be nothing more than a skin tag, Robert carved it out of the lad's neck. Unfortunately for the boy, the lump was an aneurysm of his carotid artery, which is a very important artery.

While performing an amputation of a man's leg, Liston managed to amputate more than he intended to. Old Knife-hands took to carving his patient's leg with such gusto that he also cut off the man's testicles in the process. Whether he was cackling madly while doing so is up for debate.

His career wasn't all an unmitigated bloodbath. Robert Liston only lost 1 out of every 10 patients. That was a much better record than the industry standard of 1 in 4 deaths on the table.

Richard Gordon is the main source for biographical knowledge about Robert Liston. He described Liston in his book, Great Medical Disasters:

“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.”

World Record – Deadliest Surgery in History

It's snipping time!

Robert Liston was certainly a masterful wielder of the scalpel. His policy of speed over accuracy seemed to work for him. I can't imagine what his patients thought, though they were clearly safer in his hands than the ordinary surgeon of the time. So not very safe at all.

The apocryphal tale of Liston's deadliest surgery begins like this. Spectators sit in the amphitheater-like surgery room, eagerly awaiting the master. Lying on the bloodstained table is a man with a badly broken leg. Sharp-nosed spectators might have been able to smell the beginnings of gangrene coming from the leg.

Robert Liston strode into the room, his boots squelching on the floor. The spectators want to cheer, but their apprehension keeps them at bay. Liston's assistants pin down the patient as the surgeon pulls his tools close.

He holds up the knife to the onlookers as he declares:

“Time me Gentlemen, time me!”

The blade flashes down as a fountain of blood soars into the air. Liston's hands are a blur as he tears through the meat just under the patient's knee. The knife appears clutched between the surgeon's teeth as the sound of sawing fills the room.

One of the onlookers got too close and felt the knife slice through his coattails. The man seemed to faint, crumpling to the ground. Everyone else ignored him as they were so focused on the inhuman display of speed.

The patient's screams are joined by those of Liston's assistant. He recoils from where he is holding the leg down. Blood spraying from the stumps of his index and middle fingers, carved away by Robert Liston.

Paying his assistant no mind, Robert completes the amputation in 2 minutes and 28 seconds. He stitches up the patient as his intact assistants manage to stop the bleeding of the fingerless helper.

Robert Liston holds up the knife in triumph. His spectators likely cheer. Everyone seems happy.

Someone checks on the fainted man, to find he has no pulse. He died of shock. Liston probably shrugs it off. Later, the patient would develop gangrene and die in agony. All in a day's work for a 19th century surgeon.

He may have felt a bit awkward upon learning that his assistant also developed gangrene and died.

Appreciate us now?

Luckily modern surgery is a little safer and more nuanced than those performed by Robert Liston in the 19th century. Hopefully there will never again be a surgery with a 300% death rate.