In the pre-anaesthetic, pre-antiseptic era of surgery, speed was of the essence. The success of a surgeon depended on speed combined with dexterity, which in turn determined both patient satisfaction and outcome. Robert Liston, a son of the Scottish manse, established a reputation in Edinburgh for extraordinary speed and dexterity of surgical technique When his rival, James Syme, was preferred as Professor of Clinical Surgery he left for London where he spent the last 13 years of his life, dying at the early age of 53.
Robert Liston was born in Ecclesmachan in West Lothian, eight miles west of Edinburgh. His father, the Rev. Henry Liston, was a Church of Scotland Minister who had invented the euharmonic organ which gave diatonic scales in perfect order. His early education was provided by his father and after graduation from the University of Edinburgh he went on to attend Dr. John Barclay’s ( qv) lectures on anatomy and physiology in the extramural school in Surgeons Square. After becoming assistant and prosector to Dr. Barclay he went on to become a House Surgeon in The Royal Infirmary under Dr. George Bell . In 1816 he went to London studying at St. Bartholomew’s and the London Hospital. On returning to Edinburgh he began his own anatomy class and James Syme joined him as assistant and later as partner before they quarrelled and ultimately became rivals. Quarrels with professional colleagues were to become a hallmark of Liston’s life.
From 1818 to 1834 Liston established a reputation as one of the most skilled operative surgeons of his day. His speed and dexterity in operating, in an era where speed was essential, became legendary. He successfully operated on patients whom other surgeons had refused to take on, or who had been discharged from The Royal Infirmary after unsuccessful surgery. As a result professional jealousies arose and he was formally expelled from The Royal Infirmary for a period of 5 years. He was beaten by Syme in the contest for the Chair of Clinical Surgery in 1833, and went to London the following year as a surgeon to University College Hospital, becoming Professor of Clinical Surgery in the University of London. Here his reputation as a bold, skillful and confident surgeon was enhanced. His limb amputations would be performed in seconds and urethral lithotomy in no more than 2 minutes – all without anaesthesia. He saw the value of anaesthesia before most of his colleagues and was to perform the first open demonstration of an operation performed under ether anaesthesia in England. Liston is reported to have introduced the procedure by saying “we are going to try a yankee dodge today gentlemen, for making men insensible” a reference to Morton’s successful use of an ether anaesthetic a few weeks earlier. The amputation was completed in 25 seconds after which Liston announced “this yankee dodge beats mesmerism hollow”. Mesmerism was hypnosis whose use in surgery had been gaining in popularity until the advent of anaesthesia.
Those who watched him operate described his technique as appearing unhurried – the mark of the skilled surgeon whose speed was the result of a skillful combination of movements performed precisely and efficiently. He devised bone cutting forceps and a splint for long bone fractures. His death at the early age of 53 deprived Britain of a surgeon who was arguably the most technically competent of his era.
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