Robert Liston

Robert Liston (28 October 1794 – 7 December 1847) was a pioneering Scottish surgeon, and the son of the Scottish minister and inventor Henry Liston, whose father was also a Robert Liston, Moderator of the General Assembly of the Church of Scotland.

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. 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".

Richard Gordon describes Liston as "the fastest knife in the West End. He could amputate a leg in 21⁄₂ minutes". 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; he is said to have been able to perform the removal of a limb in an amputation in 28 seconds.

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.

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". 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". 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 mortality rate fell.

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".

In writings on Liston, he is portrayed as a man of strong character and ethics, which was the source of some of his confrontational style. In one case, he confronted a medical colleague (Dr Robert Knox) over the treatment of an attractive young woman (Mary Paterson) who it later transpired was murdered (Burke and Hare murders), with Knox thought complicit in the murder. She was in Knox's dissecting rooms within four hours of her death, and kept in whiskey for three months before dissection, during which time she was essentially on voyeuristic display. Liston's response is documented in a letter from him

According to Liston, he saw Mary Paterson's body in Knox's rooms and immediately suspected foul play. He knocked Knox down after an altercation in front of his students – Liston assumed some students had slept with her when she was alive, and that they should dissect her body offended her sense of decency. He removed her body for burial.