I was out and about recently when I came across an old black Mercedes. It was probably around my own vintage, from the fifties or maybe even older. Unfortunately, the owner wasn’t around so I couldn’t find out anything about its history, but I imagine it would have had a few stories to tell.

It was a beautiful looking car but as I got closer to it, I could see evidence of age. There were gaps in the doors which werenl’t closing properly and on closer inspection there were signs of home-made repairs where fillers had been used. They were rough and ready, and the patches had been hand-painted. That didn’t spoil the sense of history attached to it though. Signs of a life well lived. It was still being driven too so the engine was obviously in good nick.

It kind of reminded me of myself. A bit of mileage on the clock, some bits removed over the years and some other bits added with a few scars prove it. But the engine is ok for the moment and all the moving parts are kept in order with various pills and potions.

I’ve been very fortunate with the professionalism of my surgeons, but things might have been different if I had been born in the 19th century when Robert Liston was practising medicine. 

His career has been well documented on the Internet and he was known as the fastest surgeon of his era, not necessarily the best though.

Before the discovery of general anaesthesia, surgery was a horrific prospect with the patient fully conscious and suffering unspeakable agony with a significant risk of death. In those days surgeons had to get creative in an attempt to save lives while minimizing a patient’s pain. One of the most effective ways was to perform the surgery as quickly as possible, sometimes in under five minutes.

There was an upside to this method. The less time a surgery took, the less likely the patient was to bleed out and the less they would suffer. However, there was also a downside as accuracy would often be sacrificed in favour of speed.

Perhaps the fastest surgeon of this period was Robert Liston, who was often referred to as the “fastest knife in the west end”. He received his medical education at the University of Edinburgh, where he developed a reputation for being a very difficult individual with a caustic and arrogant personality.

He was particularly interested in anatomy and quickly built a reputation as a fast and highly skilled surgeon. He was widely disliked by his peers, and many wanted him banned from the wards because of his unpleasant attitude. Following a series of disagreements with his colleagues, he left Scotland and moved to London.

Standing six feet two inches tall, Liston was an imposing figure who was famously strong and spoke with a loud and brusque voice that would often intimidate both his students and patients. He was unusual at the time in that he would wash his hands and remove his frock coat and put on an apron to operate. Proper surgical antisepsis would not be widely accepted until the late 1800’s.

Before performing an operation, Liston would stride boldly into the surgical theatre, which was frequently packed out with spectators including visiting surgeons, all eager to witness his unparalleled surgical technique. With the presence of a true showman, he would then nod to the medical students present with their pocket watches in hand and announce, “Time me, gentlemen!”

A typical amputation would take approximately two to three minutes to perform, with his fastest amputation being reported to be an astonishing 28 seconds. 

A handkerchief would be placed in the patient’s mouth to mask his screams, a medical student would be asked to hold the limb that was being removed, and two other students would keep the patient still. Liston would then cut through the flesh with a scalpel, saw through the bone and suture the wound. Despite the speed with which he performed these procedures, his results were excellent for the time.

Between 1835 and 1840, Liston performed 66 amputations and only 10 died, a mortality rate of less than 1 in 6. The average mortality rate for amputations was 1 in 4.

In addition to his record-breaking 28-second leg amputation, Liston is infamous for some particularly remarkable cases. In another leg amputation that took a comparatively slow two and a half minutes, Liston accidentally also removed the patient’s testicles. In a more successful operation involving the testes, he removed of a 45-pound scrotal tumour, that the patient had to carry around in a wheelbarrow, in just four minutes.

Perhaps Liston’s most famous case, however, is the only operation in history with a 300% mortality rate. Robert Liston was performing a leg amputation on a patient who was lying flat on his table. As he brought down his knife, he was so focused on his speed that he took his surgical assistant’s fingers off along with the patient’s leg. As he swung the knife back up, it clipped a spectator’s coattails who collapsed and died. Unknown to Liston at the time, this death was only the first of three. The second and third deaths came a few days later, but still due to the operation. It later became apparent that the equipment Dr. Liston used was infected and not sanitized. The assistant’s finger and the patient’s amputated leg became infected, developed gangrene and both died from their wounds. The spectator who collapsed was later discovered to have died of fright.

Liston, without doubt, made a significant contribution to the field of surgery in the pre-anaesthetic era. Years later, when anaesthesia was invented, he became the first surgeon to operate using it, and his surgery was a success.