Robert Liston, dubbed with the nickname "The Fastest Knife in the West" for his incredibly quick amputations, was somewhat of a surgical revolutionary. Perhaps his nickname came from an incident during one particular, and possibly fallacious, fatal surgery. It is said that during an amputation, Liston was moving so fast he severed the finger of an assistant as he cut through the patient's leg, and while switching tools slashed an observer's coat. The assistant and the patient both died from infections of their wounds, and the observer, terrified he had been stabbed, died of shock.
Liston was born in Ecclesmachan, West Lothian, Scotland, in 1794. At only 14, he studied medicine at the University of Edinburgh from 1808 to 1810. After he finished college, he began his medical training under famed anatomist John Barclay. In 1816, he went to London to train under a surgeon named William Blizard. Then in 1818, he returned to Edinbugh, where he was appointed a lecturer of anatomy alongside James Syme, while also being the house surgeon at the Royal Infirmary. Liston was a fearless surgeon, and would operate on patients that were turned away by fellow surgeons. This led to him being briefly banished from the infirmary in 1822, but later reinstated in 1827.
During the 1800s, it was believed wounds became infected because of "bad air". Hospitals would air out surgical wards to prevent the spread of infections. The wards also had no facilities to wash hands or clean surgical wounds. Surgeons prided themselves on how dirty and bloody their operating gowns were, as it was a display of good experience. Many patients were awake during surgery, as anesthetic was not yet used. The mortality rate was around 47%, with most patients dying due to post-operative complications, such as sepsis. Robert Liston was one of a few surgeons that put change into motion. Unlike his colleagues, Liston would put on a clean gown, wash his hands, and have clean surgical tools for every operation. Although, he would hold tools in his teeth to free up his hands and not slow him down. Liston pioneered the use of ether, providing pain-free surgery. Ether, also known as nitros oxide or "laughing gas", was originally used as a recreational drug, until one surgeon noticed people didn't feel pain while intoxicated by it. In 1846, Liston performed the first public procedure employing modern anesthesia. He also had a lower mortality rate than most other surgeons. Since there was no asepsis or blood transfusion, survival depended on how quickly a surgeon could complete the procedure and control the bleeding. Liston could remove a leg in two minutes, and even 30 seconds in one case. Lastly, he also changed how amputations were done. Typically, amputations were done in one circular cut, meaning the skin had to be pulled down over the bone. Liston decided to leave a u-shaped flap of skin that could be folded over the bone. This technique had a shorter recovery time, caused less pain, and helped prevent infection.
In 1847, at age 57, Robert Liston died from a ruptured aortic aneurysm. His funeral was held at St. Michael's Church, attended by 500 students, friends, and pupils. He was buried on the western side of Highgate Cemetery in the terrace catacombs. Following his death, a committee of about 78 people was formed, where it was decided to place a marble statue in a public spot, and introduce the "Liston Medal", a gold medal awarded annually for achievements in surgery by the University College of London. Today, he is mostly known for his 30 second amputation and its 300% mortality rate. Though, his use of flaps in amputations, amputation knife, and locking vascular forceps left a substantive impact on surgical technique.