Bad Decisions in History: featuring Robert Liston

It’s not exactly news that surgery through history was very dangerous and unhygienic compared to today’s standards. In a time when germs and bacteria were poorly understood, and anesthesia was either nonexistent or in early development, needing surgery would have been a terrifying prospect. Due to the lack of anesthesia, surgeons tried to complete their surgeries as quickly as possible, and a good surgeon was considered to be one who was ‘fast with a knife.’ Indeed, in Florence Nightingale’s ‘Notes on Nursing’, she noted that the danger to the patient was in direct ratio to the time the operation lasted.

Robert Liston was a Scottish surgeon, noted for his lightning quick surgical abilities. In a time where the pain of a prolonged surgery could directly correlate to the patient’s chances for survival (assuming infection didn’t set in afterward), he was impressively said to be able to amputate a leg in under three minutes.

Perhaps he was a bit too quick; Dr. Liston is most remembered today for few infamous cases.

Bad decision: Rushing surgery to the point of carelessness

There are three cases where Liston’s surgical haste caused additional injury, or even death. The most reckless of these cases is a young boy who had a tumour in his neck, which might have been an abscess, or a more dangerous aneurism in the carotid artery. Deciding that the child was too young to have an aneurism, Liston quickly lanced what he thought was an abscess. He was wrong, and the patient died of arterial blood loss.

Liston also has the dubious honour of supposedly performing the only operation known to history with a 300% mortality rate. Sounds impossible, doesn’t it? Well, in his rush to amputate a patient’s leg in under two and a half minutes, he accidentally slashed through the fingers of his assistant, chopping them off too. With the energetic arc of his surgeon’s tools, he also cut the coattails of a surgical spectator. Allegedly, this man was so frightened that the knife had pierced his vitals that he died of a heart attack. The patient and the assistant both later died of infection.

Liston’s third most infamous case also involves the amputation of a leg. He sawed off the limb so quickly and carelessly that he accidentally castrated the patient as well. Assuming he didn’t succumb to infection, that patient must have been quite distraught, to say the least.

It’s worth noting that better surgical hygiene practices began to improve after 1847, partially due to the connection made between surgical hygiene and infection and mortality rates by a doctor at the Vienna General Hospital, named Dr Ignaz Philipp Semmelweis.

Though Liston’s surgical mistakes leave the impression of a reckless man with little care for his patients, he was actually recorded as being charitable to the poor and kind to the sick. Early surgery was a risky procedure, and during Liston’s lifetime, speed was considered the best way to reduce pain for the patient, a practice he certainly embraced. Though nitrous oxide was discovered in 1799, it was not pursued as an anesthetic at that time. Similarly, though an operation with ether was performed around 1842, it wasn’t commonly used for several more years. Since Liston passed away in 1847 – the same year of the improved hygiene for surgery at the Viennese hospital – he didn’t have a chance to access any of these new advances in medicine.

Outcome: three horrible surgical mistakes, reasons to be grateful for modern medicine

 

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