Before anesthetics and antibiotics, amputation of a limb was a life-threatening procedure. Time was an essential factor for both of these issues, infection and pain being reduced if the amputation was performed faster. One 19th century surgeon by the name of Robert Liston was particularly adept at speedy amputations, earning the name “The Fastest Knife in the West End”.
Author, and friend of Robert Liston, Richard Gordon described him thusly:
An abrupt, abrasive, argumentative man, unfailingly charitable to the poor and tender to the sick, impossibly vain, he was vilely unpopular among 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 wards, banishing him South where he became professor of surgery at University College Hospital in London and made a fortune.
And it’s no wonder he made a fortune. He invented the Bulldogs forceps (used for smaller arteries and blood vessels), see-through isinglass sticking plaster (often used as you would a Band-Aid®), and a leg splint (for use in fractured femurs). On top of all the medical progress, however, was his skills as a surgeon.
“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” claims Florence Nightingale (Notes on Nursing, 1859), and Liston prided himself on his speed. While he is known for performing leg amputations at or even under 2 1/2 minutes, there is a report of his removing one Frederick Churchill’s (a butler) leg in 28 seconds! In a 1910 letter to the British Medical Journal (vol 2, p. 1290), Dr. F. William Cock claimed that it may have even been the first operation to use ether:
THE FIRST OPERATION UNDER ETHER IN EUROPE.
Sir, — I am collecting materials for a description of the first operation under ether in Europe — that performed by Robert Liston on December 21st, 1846 — and should be glad to hear from any surviving witness. At present Lord Lister is the only one known to me. The dresser whose notes of the case are now before me, was Edward Palmer. — I am, etc.,
F. William Cock, M.D., F.S.A
London, W., Oct. 15th.
Though this was a momentous occasion (The People’s Journal making the famous claim, “We have conquered pain”), it was much later in Liston’s surgical career. Dr. Cock asks “to hear from any surviving witness”, which is coincidental considering Liston’s most well known surgery: the operation of 300% mortality. Gordon writes about this surgery as well:
Liston’s most famous case
Amputated the leg in under 21⁄2 minutes (the patient died afterwards in the ward from hospital gangrene; they usually did in those pre-Listerian days). He amputated in addition the fingers of his young assistant (who died afterwards in the ward from hospital gangrene). He also slashed through the coat tails of a distinguished surgical spectator, who was so terrified that the knife had pierced his vitals he dropped dead from fright.
That was the only operation in history with a 300 percent mortality.
And it wasn’t the only shocking surgery he performed. Two other frightening events were recorded by Gordon. One in which a leg was amputated quickly, but in the fervor of the moment, the patient’s testicles along with it (listed as his “second most famous case”). Another patient, a young boy, had a red and pulsing growth on his neck. The house-surgeon claimed it was an aneurysm of the carotid artery, but Liston disagreed strongly. Picking up a knife, he shouted, “Pooh! Whoever heard of an aneurism in a boy so young?” and promptly sliced it, being greeted by a arterial blood and the boy’s death.
Not all of his surgeries were disastrous, however, one example being the “fourth most famous case” written by Gordon involved the removal of a 45-pound scrotal tumor in 4 minutes. During his time performing surgeries, the survival rate for amputation was quite low. Between 1852 and 1857 and the London Hospital, limb amputation had a mortality rate of 47%. Even lower for leg amputation. As frightening or horrifying the tales of Liston’s surgeries can be, his work definitely lowered the chances of death among his patients. Whether it was worth being nearby as a spectator is another problem entirely.