The Barbaric 19th Century Surgery with a 300 Percent Mortality Rate

Everyone sometimes has a shitty afternoon at work where nothing seems to go right. For most of us, that doesn’t mean much more than a bunch of fumbled keyboard shortcuts and a pissed-off boss, but for a surgeon in the pre-anesthetic days, a shitty afternoon can have a real impact.

Robert Liston was a pioneering surgeon in the 1800s, the days when amputating a leg was medicine’s answer to about 30 percent of ailments, and doctors had arms like lumberjacks from sawing through femurs all day. It was an odd time in terms of medicine, with massive breakthroughs in some areas and surprisingly lo-fi approaches in others.

This was the era when science’s understanding of the causes of disease and infection weren’t quite there yet. Liston was a fan of washing his hands before operating, which made him stick out at the time — it was only in the years following his heyday that the idea of washing your hands before thrusting them into someone’s guts gained any traction. The “miasma theory” of disease was the prevailing one — that people got ill from breathing in bad air — and with microscopy in its infancy, knowledge of germs and bacteria was minimal. Given the rugged, ultra-manly nature of surgeons at the time, pausing between patients to wash your hands was seen as girly and effete. The attitude was one of, “Look at this namby-pamby prick, prizing bits of intestine out of his fingernails like he thinks he’s special.” 

Lots of people died during surgery, of course, but the emphasis was all placed on speed — get things done quickly and the patient will be safer. This led, inevitably, to a bit of dick-swinging among surgeons as to who could hack off the most legs in the least amount of time.

The majority of amputees still went on to die of gangrene until more hygienic practices came in. But even making it through the procedure was pretty impressive for the time, and far fewer of Liston’s patients died than most. Part of this was due to his innovative technique of amputating with a U-shaped cut, leaving a flap of skin that could be folded and stitched over the exposed bone end.

Liston originally worked in Edinburgh, and would burst into the operating room yelling at his students and encouraging them to time him. The patient — usually unanaesthetized (although it was Liston who was to perform the first amputation under an ether-induced general anesthesia) — would be lying there, terrified and in agony, about to go through the most painful procedure of their lives, and feel reduced to a prop in someone else’s boast. (Liston wasn’t alone in this — it was kind of how things worked back then — but it still must have sucked, going through this absurdly painful, life-altering experience while the man about to remove a huge part of your body bellows his catchphrase: “Time me, gentlemen!”)

Then, with a bloody knife gripped between his teeth to free his hands for the saw, Liston would carve his way through the infected leg, finishing in 150 seconds or less. Two and a half intense, messy minutes, then onto the next one — an assembly line of agony. Depending on the nature of the surgery it might have been even quicker: A paper published by the American College of Surgeons observed, “His above-the-knee amputations from incision to final suture were completed in less than 30 seconds.” 

It was after he moved to London that Liston’s most notorious operation is said to have taken place. The story goes that Liston once managed to do an operation in which three people died — he accidentally cut off his assistant’s fingers (leading them to get gangrene and die), accidentally slashed a spectating surgeon’s clothing (causing him to die of shock) and failed to prevent his patient from getting gangrene (which he then died of).

One operation, three deaths and a record 300 percent fatality rate for a medical procedure involving one patient. The age’s greatest surgeon’s shittiest afternoon.

That’s really bad. It’s like trying to change a tire but accidentally destroying three vehicles instead. The story became very well-known toward the end of the 20th century after it was included in a book by anesthetist and author Richard Gordon, and pops up online a lot, but subsequent research has found no primary sources for it — and so, it seems like the story might be apocryphal. 

If it wasn’t true, though, why has the story attached itself to Liston?

By several accounts, Liston was a jerk, extremely aware of his talents and short with those he considered beneath him. He was a big, argumentative man, more than happy to admonish colleagues in public and aggressive toward doctors he saw as being too hesitant to slice into a patient. His move from Edinburgh to London came after a series of fallings-out, although it came with a fancy dinner thrown in his honor as his talent was undeniable. 

So he probably pissed off a fair amount of people over the years, which is maybe where the tale came from. But he also saved an enormous amount of lives, advocated for more hygiene in surgery before it became the norm, fought against the notion that anesthesia was bad (because pain encouraged the body to heal) and pushed for compassion in aftercare in a way few had done before, arguing that “when the operation is finished; the patient is yet to be conducted, by kindness and judgment, through the process of cure.”

He might have been rude, but he was an extraordinary physician, and by no account did he accidentally kill three people in one operation. It’s unfair that a made-up story of him doing badly has overshadowed his many achievements. 

That said, he did once accidentally remove a patient’s testicles along with the patient’s leg, so on second thought, he deserves everything he gets, the long-dead nutsack-sawing motherfucker.