LXIV: 300% Mortality

Surgeons are some of the most revered members of modern society. Respected for their high level of education and their lifesaving skills, they have a tendency to acquire nicknames, the best taking on pseudonyms like “the quickest knife in the West End” and the worst garnering the likes of “the surgeon with the 300% mortality rate”.

There was in fact one extraordinary man who bore both of those nicknames at once.

Robert Liston was born in West Lothian, Scotland, in 1794. “The Great Northern Anatomist”, as he was sometimes known, was educated at the University of Edinburgh and became a surgeon at the Royal Infirmary of Edinburgh at the tender age of 24.

Although surgery — and amputation in particular — had been a well-established medical practice for several thousand years, the concept of surgery as a survivable procedure was in relative infancy. Surgeries were quick, crude, dirty, and extremely painful. Nitrous oxide (laughing gas) and its anesthetic properties had been discovered in 1772 and the first operation with the patient under the influence of ether was performed in 1842, but no one gave either of these incredible advancements much note. As a result, anesthesia was not at all widely used during much of Liston’s career as a surgeon.

Without anesthesia, the key to surgery was speed. A patient who was fully conscious was not only suffering tremendous pain, but also had a tendency to move around and make noises, which made operating rather difficult. The go-to procedure of the day was the one-cut amputation, severing skin, muscle, and bone in one fell swoop, and Liston was its master.

Liston was known for his theatrics in the operating room. To the spectators he would cry out, “Time me, gentlemen, time me!” as he whirled about the patient, slashing wildly with his scalpel until he grabbed the bone saw, clenching the bloody scalpel in his teeth as he cut through the bone. “The fastest knife in the West End” could amputate a leg mid-femur in two and a half minutes or a smaller limb in only twenty-eight seconds. Liston recorded his most infamous cases — both bad and good — in his journal, quoted verbatim as follows:

Fourth most famous case

Removal in 4 minutes of a 45-pound scrotal tumour, whose owner had to carry it round in a wheelbarrow.

Third most famous case

Argument with the house-surgeon. Was the red, pulsating tumour in a small boy’s neck a straightforward abscess of the skin, or a dangerous aneurism of the carotid artery? ‘Pooh!’ Liston exclaimed impatiently. ‘Whoever heard of an aneurism in one so young?’ Flashing a knife from his waistcoat pocket, he lanced it. Houseman’s note — ‘Out leaped arterial blood, and the boy fell.’ The patient died but the artery lives, in the University College Hospital pathology museum, specimen No. 1256.

Second most famous case

Amputated the leg in 2½ minutes, but in his enthusiasm the patient’s testicles as well.

Apparently in his enthusiastic desire to the remove the leg as rapidly as possible, Liston was a bit reckless with his scalpel. In his most famous case, he was so reckless that his actually achieved a 300% mortality rate. Liston was hacking away as usual when a bystander got too close and had his coattails chopped off by the doctor’s whirling blade. Though unharmed, he was so frightened that he dropped dead of a heart attack on the spot. Moments later, a surgical assistant made the same mistake, but he lost more than his coattails. The hapless assistant had his fingers amputated along with the patient’s leg, and the wound later became gangrenous, leading to the assistant’s death. To complete the deathly triad, the patient himself acquired gangrene from the unsanitary amputation and died.

But the whole thing only took 2½ minutes.

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