1 00:00:01,280 --> 00:00:04,000 Speaker 1: Welcome to Stuff You Missed in History Class, a production 2 00:00:04,120 --> 00:00:12,680 Speaker 1: of I Heart Radios How Stuff Works. Hello, and welcome 3 00:00:12,720 --> 00:00:15,960 Speaker 1: to the podcast. I'm Holly Fry and I'm Tracey V. Wilson. 4 00:00:16,160 --> 00:00:19,040 Speaker 1: Today we're talking about Robert Liston. You might have seen 5 00:00:19,079 --> 00:00:20,759 Speaker 1: his name before if you like to look at lists 6 00:00:20,800 --> 00:00:25,079 Speaker 1: of crazy history facts. Uh, he comes up on them. Uh. 7 00:00:25,200 --> 00:00:28,440 Speaker 1: He's often characterized as a pioneer in surgery, and when 8 00:00:28,480 --> 00:00:31,240 Speaker 1: his name comes up, you have probably seen it related 9 00:00:31,280 --> 00:00:35,320 Speaker 1: to a rather horrifying tale about how multiple deaths resulted 10 00:00:35,400 --> 00:00:38,519 Speaker 1: from one of his surgeries yep. And the speed with 11 00:00:38,560 --> 00:00:41,440 Speaker 1: which he performed such surgeries, which earned him the nickname 12 00:00:41,560 --> 00:00:45,120 Speaker 1: the fastest knife in the West End. And that might 13 00:00:45,240 --> 00:00:48,040 Speaker 1: be part of his story, that particular surgery thing, but 14 00:00:48,640 --> 00:00:50,960 Speaker 1: maybe not. But even if it is, that means that 15 00:00:51,360 --> 00:00:54,600 Speaker 1: his entire biography is it's carried forward today as a 16 00:00:54,600 --> 00:00:59,000 Speaker 1: medical practitioner tends to be dominated by the apocryphal events 17 00:00:59,080 --> 00:01:01,520 Speaker 1: of one day, and he in fact had a lifetime 18 00:01:01,560 --> 00:01:05,080 Speaker 1: of achievement and study and teaching in medicine. So today 19 00:01:05,160 --> 00:01:07,600 Speaker 1: we're gonna unpack Liston's career and the way that he 20 00:01:07,640 --> 00:01:10,160 Speaker 1: approached it, and in some ways he really is sort 21 00:01:10,160 --> 00:01:14,200 Speaker 1: of the prototype for that exacting but arrogant doctor trope 22 00:01:14,240 --> 00:01:17,319 Speaker 1: that we see in fiction all the time, because he 23 00:01:17,400 --> 00:01:20,759 Speaker 1: was exacting and he was a very confident man. But 24 00:01:20,959 --> 00:01:24,280 Speaker 1: if he was arrogant, he really kind of earned it. Uh. 25 00:01:24,280 --> 00:01:30,160 Speaker 1: He advanced medicine significantly during his lifetime. Heads up, there's 26 00:01:30,200 --> 00:01:34,080 Speaker 1: surgery to talk. Yeah, we're not going for gore, but 27 00:01:34,200 --> 00:01:36,880 Speaker 1: just in relaying the clinical details of what was going 28 00:01:36,920 --> 00:01:39,880 Speaker 1: on in some of these surgeries, it might get into 29 00:01:39,920 --> 00:01:42,479 Speaker 1: places that the more squeamish in the crowd may not enjoy, 30 00:01:42,640 --> 00:01:44,240 Speaker 1: or if you have young listeners, you might want to 31 00:01:44,280 --> 00:01:48,400 Speaker 1: just preview it first. Again, we're not really belaboring any 32 00:01:48,400 --> 00:01:52,040 Speaker 1: of the points or being particularly indulgent about them, but 33 00:01:52,560 --> 00:01:55,160 Speaker 1: you know, facts of medicine are not always delightful to hear. 34 00:01:55,840 --> 00:01:59,400 Speaker 1: Having reviewed this what we're gonna be talking about, it's 35 00:01:59,560 --> 00:02:03,760 Speaker 1: it's specific, but you know, it's not wallowing in the specificity. 36 00:02:06,040 --> 00:02:08,520 Speaker 1: It's a very tricky thing when you're doing this research 37 00:02:08,600 --> 00:02:12,239 Speaker 1: to go how exactly do I describe this surgery without 38 00:02:12,320 --> 00:02:15,440 Speaker 1: being gross, but while being completely clear about what was 39 00:02:15,520 --> 00:02:22,320 Speaker 1: going on me someone who is not a medical practitioner yet, yes, 40 00:02:22,440 --> 00:02:24,640 Speaker 1: and why it mattered yeah. I mean we're gonna we're 41 00:02:24,639 --> 00:02:26,440 Speaker 1: gonna get into the details of all that. But these 42 00:02:26,480 --> 00:02:28,560 Speaker 1: these things that came along with his reputation, there were 43 00:02:28,560 --> 00:02:30,720 Speaker 1: reasons for all of them. He wasn't just like I 44 00:02:30,760 --> 00:02:33,760 Speaker 1: want to see how fast I can do surgery for kicks, 45 00:02:33,760 --> 00:02:36,800 Speaker 1: Like yeah, that's kind of how he gets portrayed, is 46 00:02:36,880 --> 00:02:41,200 Speaker 1: like almost a like a daredevil, yeah, maniac who just 47 00:02:41,320 --> 00:02:45,079 Speaker 1: loves to like do quick amputations and like thinks it's 48 00:02:45,120 --> 00:02:48,280 Speaker 1: great and it's uh, he does want to do them quickly, 49 00:02:48,320 --> 00:02:51,240 Speaker 1: but there's a logic to it, uh, and it's kind 50 00:02:51,280 --> 00:02:53,919 Speaker 1: of a challenge to his colleagues to rise to his level, 51 00:02:54,560 --> 00:02:57,240 Speaker 1: all of which we're going to get into. Yes. So 52 00:02:58,120 --> 00:03:01,000 Speaker 1: Liston was the son of a minister and inventor, the 53 00:03:01,080 --> 00:03:06,040 Speaker 1: Reverend Henry Liston. Robert was born on October seventeen ninety 54 00:03:06,080 --> 00:03:10,280 Speaker 1: four in West Lothian, Scotland. Robert's mother, Margaret, died when 55 00:03:10,280 --> 00:03:12,880 Speaker 1: he was just six, and his father doesn't appear to 56 00:03:12,919 --> 00:03:16,839 Speaker 1: have remarried after that. Liston was very clearly a very 57 00:03:16,840 --> 00:03:19,760 Speaker 1: smart young man. He enrolled in the University of Edinburgh 58 00:03:19,760 --> 00:03:22,600 Speaker 1: when he was only fourteen. That was having only been 59 00:03:22,639 --> 00:03:25,160 Speaker 1: home schooled by the way, and just two years later 60 00:03:25,200 --> 00:03:28,800 Speaker 1: he began his medical training. His mentor and teacher was 61 00:03:28,880 --> 00:03:32,760 Speaker 1: John Barclay, one of Scotland's most revered anatomists, and Barklay 62 00:03:32,800 --> 00:03:36,600 Speaker 1: actually taught his students outside the University of Edinburgh system 63 00:03:36,680 --> 00:03:39,360 Speaker 1: at his own private school uh and then an eight 64 00:03:39,360 --> 00:03:42,360 Speaker 1: ten o four. The University recognized that his courses were 65 00:03:42,400 --> 00:03:45,320 Speaker 1: thorough and rigorous enough that his students would be allowed 66 00:03:45,360 --> 00:03:48,000 Speaker 1: to take the school's exams and receive a degree from 67 00:03:48,000 --> 00:03:51,720 Speaker 1: the university. Liston studied with Barkley for four years, and 68 00:03:51,760 --> 00:03:54,320 Speaker 1: at the age of only twenty, he became the Royal 69 00:03:54,360 --> 00:03:58,520 Speaker 1: Infirmary of Edinburgh's house surgeon. Two years into that job, 70 00:03:58,640 --> 00:04:01,960 Speaker 1: he enrolled in London Royal College of Surgeons to further 71 00:04:02,080 --> 00:04:06,080 Speaker 1: his expertise, and Listen did pretty quickly become a recognized 72 00:04:06,160 --> 00:04:08,920 Speaker 1: expert in his field. But he also made a name 73 00:04:08,960 --> 00:04:12,400 Speaker 1: for himself for being vocally opinionated and kind of difficult 74 00:04:12,400 --> 00:04:16,200 Speaker 1: to get along with. He would routinely and openly criticize 75 00:04:16,200 --> 00:04:19,080 Speaker 1: his fellow doctors, and he would take patients that other 76 00:04:19,120 --> 00:04:23,240 Speaker 1: surgeons thought were beyond help. His brash approach to challenging 77 00:04:23,320 --> 00:04:25,839 Speaker 1: his colleagues even led to a falling out with his mentor, 78 00:04:25,920 --> 00:04:29,000 Speaker 1: Barclay in eighteen eighteen, the two men had an argument 79 00:04:29,040 --> 00:04:32,800 Speaker 1: which led to Liston starting his own anatomy class. And 80 00:04:32,880 --> 00:04:34,760 Speaker 1: that's one of those stories that could go very like 81 00:04:34,920 --> 00:04:37,360 Speaker 1: then he sat there alone in a room, but instead 82 00:04:37,560 --> 00:04:41,040 Speaker 1: when he uh started teaching, he had a packed enrollment 83 00:04:41,360 --> 00:04:43,800 Speaker 1: of sixty students waiting to hear what he had to say. 84 00:04:44,279 --> 00:04:48,159 Speaker 1: The ongoing friction that had surrounded Listen eventually led to 85 00:04:48,200 --> 00:04:50,880 Speaker 1: a change of venue for his work. While he had 86 00:04:50,920 --> 00:04:54,400 Speaker 1: been practicing in Scotland, his willingness to operate on patients 87 00:04:54,440 --> 00:04:57,680 Speaker 1: that the Royal Infirmary had rejected had led to rumors 88 00:04:57,680 --> 00:05:00,760 Speaker 1: that he was orchestrating those kinds of things to build 89 00:05:00,800 --> 00:05:04,479 Speaker 1: his own practice. The accusations that mounted against him of 90 00:05:04,640 --> 00:05:08,880 Speaker 1: luring patients away from other doctors resulted in Listen being 91 00:05:09,040 --> 00:05:12,880 Speaker 1: banished from the infirmary for a short time. The banishment 92 00:05:13,000 --> 00:05:15,560 Speaker 1: was short, but the ill will between him and his 93 00:05:15,680 --> 00:05:20,479 Speaker 1: fellow medical professionals remained. Yeah, so this next section is 94 00:05:20,800 --> 00:05:26,600 Speaker 1: um not entirely documented, so we had to say that upfront, 95 00:05:26,640 --> 00:05:28,560 Speaker 1: but it's an example of some of that ill will, 96 00:05:28,920 --> 00:05:32,520 Speaker 1: and if it is apocryphal, it kind of is I 97 00:05:32,560 --> 00:05:35,400 Speaker 1: think born of that ill will carrying over and becoming 98 00:05:35,839 --> 00:05:39,960 Speaker 1: this other story. So there's a surprising aspect of Liston's 99 00:05:40,080 --> 00:05:43,359 Speaker 1: story during his time in Scotland in that he was 100 00:05:43,400 --> 00:05:47,000 Speaker 1: in close, close proximity to an infamous series of murders 101 00:05:47,000 --> 00:05:50,039 Speaker 1: that took place in the late eighteen twenties. Uh, this 102 00:05:50,160 --> 00:05:53,279 Speaker 1: series of murders, the Burke and Hair murders, are actually 103 00:05:53,279 --> 00:05:56,640 Speaker 1: the subject of a podcast by previous hosts here on 104 00:05:56,640 --> 00:05:58,240 Speaker 1: stuff he missed in history class. So if you want 105 00:05:58,240 --> 00:06:00,240 Speaker 1: the context for it, you can go back and listen 106 00:06:00,279 --> 00:06:04,320 Speaker 1: to that. But exactly how close Liston came to all 107 00:06:04,360 --> 00:06:06,200 Speaker 1: of this is a little bit of a matter of debate, 108 00:06:06,240 --> 00:06:08,839 Speaker 1: but we're going to give you the brief version of it. 109 00:06:09,440 --> 00:06:12,479 Speaker 1: So these two men, William Burke and William Hair, were 110 00:06:12,520 --> 00:06:15,040 Speaker 1: both born in Ireland and they moved to Scotland in 111 00:06:15,080 --> 00:06:18,760 Speaker 1: the eighteen twenties. And November of eighteen seven, an elderly 112 00:06:18,839 --> 00:06:22,000 Speaker 1: man died in the inn where Hair was a manager. 113 00:06:22,520 --> 00:06:25,200 Speaker 1: Hair and his friend Burke took the man's body and 114 00:06:25,320 --> 00:06:29,440 Speaker 1: sold it to surgeon Robert Knox for seven pounds ten shillings. 115 00:06:29,839 --> 00:06:33,320 Speaker 1: And while that first death had been a natural occurrence, 116 00:06:33,360 --> 00:06:36,039 Speaker 1: the profit that was made from it prompted Burken Hair, 117 00:06:36,160 --> 00:06:39,400 Speaker 1: along with their common law wives, to lure a series 118 00:06:39,480 --> 00:06:41,960 Speaker 1: of victims into the inn, where they got them drunk 119 00:06:41,960 --> 00:06:45,080 Speaker 1: and then suffocated them. And they continued to sell these 120 00:06:45,160 --> 00:06:48,039 Speaker 1: victims to Knox, who gladly took them. Because bodies for 121 00:06:48,080 --> 00:06:51,600 Speaker 1: research and teaching, we're in really short supply. Yeah, that's 122 00:06:51,640 --> 00:06:54,960 Speaker 1: also discussed in that past episode on Burken Hair and 123 00:06:55,040 --> 00:06:58,560 Speaker 1: in Holly's In my previous episode on the Doctor's Riot, 124 00:06:58,800 --> 00:07:01,000 Speaker 1: like why there was a short age of bodies for 125 00:07:01,200 --> 00:07:05,800 Speaker 1: medical study. Liston, who was a colleague of Knox, reportedly 126 00:07:06,000 --> 00:07:10,080 Speaker 1: noticed that he suddenly had a regular supply of cadavers 127 00:07:10,120 --> 00:07:13,840 Speaker 1: and he became suspicious of this. The story goes that 128 00:07:14,000 --> 00:07:17,520 Speaker 1: Liston confronted Knox over this while Knox was in the 129 00:07:17,520 --> 00:07:20,720 Speaker 1: middle of giving a lecture and using a young woman's 130 00:07:20,800 --> 00:07:24,920 Speaker 1: body as his illustrative example for the lesson. After the 131 00:07:24,960 --> 00:07:28,600 Speaker 1: men had words, Liston allegedly knocked his colleague to the 132 00:07:28,640 --> 00:07:31,120 Speaker 1: ground and then took the body of the woman who 133 00:07:31,200 --> 00:07:34,520 Speaker 1: was alleged to be a victim named Mary Patterson, and 134 00:07:34,520 --> 00:07:37,520 Speaker 1: then arranged for her to have a proper burial. Okay, Now, 135 00:07:38,320 --> 00:07:41,080 Speaker 1: this story is another that seems to have grown a 136 00:07:41,120 --> 00:07:44,160 Speaker 1: little bit more from his legend than from any actual evidence. 137 00:07:44,440 --> 00:07:48,120 Speaker 1: There's also like a whole other dimension to it, where 138 00:07:48,200 --> 00:07:50,720 Speaker 1: there may have been some lasciviousness involved in how the 139 00:07:50,720 --> 00:07:53,960 Speaker 1: body was being handled, and that may have upset Knox. 140 00:07:54,280 --> 00:07:57,360 Speaker 1: Um I found mention of this whole thing in a book, 141 00:07:57,360 --> 00:08:00,320 Speaker 1: which indicates that the author of that book was told 142 00:08:00,600 --> 00:08:03,280 Speaker 1: follow this logic about a letter that Listen wrote to 143 00:08:03,320 --> 00:08:06,800 Speaker 1: a colleague in which he discussed his suspicions about Knox 144 00:08:07,280 --> 00:08:09,640 Speaker 1: and the altercation and the body of the young woman. 145 00:08:10,160 --> 00:08:11,920 Speaker 1: But the writer of that book does not appear to 146 00:08:11,960 --> 00:08:14,680 Speaker 1: have seen the letter itself, so she is going by 147 00:08:14,760 --> 00:08:18,320 Speaker 1: what someone told her existed. As is mentioned in that writing, 148 00:08:18,320 --> 00:08:20,480 Speaker 1: it does not seem at all out of character for 149 00:08:20,560 --> 00:08:23,400 Speaker 1: Listen to have done something along these lines. He was 150 00:08:23,480 --> 00:08:26,400 Speaker 1: often on pretty poor terms with his fellow surgeons because 151 00:08:26,400 --> 00:08:28,640 Speaker 1: he was very critical of them, and he had a 152 00:08:28,760 --> 00:08:32,959 Speaker 1: very strong personal ethical code. But we don't really know 153 00:08:33,080 --> 00:08:35,760 Speaker 1: with any certainty if any of this part of his 154 00:08:35,800 --> 00:08:38,800 Speaker 1: story is true. It's a little earlier than usual for 155 00:08:38,920 --> 00:08:41,360 Speaker 1: a break, but we want to keep the next phase 156 00:08:41,679 --> 00:08:44,960 Speaker 1: of Liston's career altogether, so we're going to pause quickly 157 00:08:45,040 --> 00:08:55,480 Speaker 1: for a moment for one of our sponsors. We mentioned 158 00:08:55,520 --> 00:08:57,000 Speaker 1: at the end of that last segment that we were 159 00:08:57,040 --> 00:09:00,240 Speaker 1: not sure about Liston's proximity to the burke Hare murderers. 160 00:09:00,640 --> 00:09:03,640 Speaker 1: Was entirely true in terms of him being involved with 161 00:09:03,679 --> 00:09:06,640 Speaker 1: an altercation with Knox, but what we do know is that, 162 00:09:06,679 --> 00:09:09,800 Speaker 1: as a consequence of his general displeasure with his situation 163 00:09:09,840 --> 00:09:13,440 Speaker 1: in Edinburgh UH and his ongoing troubles just getting along 164 00:09:13,440 --> 00:09:16,280 Speaker 1: with everyone there, when Liston was offered a job in 165 00:09:16,360 --> 00:09:20,080 Speaker 1: London in eight he took it. That job was serving 166 00:09:20,120 --> 00:09:23,960 Speaker 1: as Professor of surgery at the University College Hospital. That 167 00:09:24,080 --> 00:09:26,959 Speaker 1: was a new facility, making Liston the first to serve 168 00:09:26,960 --> 00:09:30,520 Speaker 1: in that role and consequently very influential in how it 169 00:09:30,559 --> 00:09:34,040 Speaker 1: was established within the hierarchy of the institution. And it 170 00:09:34,120 --> 00:09:36,839 Speaker 1: was in that position that Liston truly made a reputation 171 00:09:36,920 --> 00:09:39,600 Speaker 1: for himself in a number of ways. When you've had 172 00:09:39,679 --> 00:09:42,920 Speaker 1: trouble getting along with people, it seems really convenient to 173 00:09:42,960 --> 00:09:45,000 Speaker 1: just have a fresh new start that's not only a 174 00:09:45,040 --> 00:09:47,679 Speaker 1: new start for you, but also a brand new facility 175 00:09:47,840 --> 00:09:51,080 Speaker 1: and super like prestigious, like people are like, wow, that's 176 00:09:51,080 --> 00:09:56,240 Speaker 1: an amazing job opportunity. Yes. So if you listen to 177 00:09:56,280 --> 00:10:00,800 Speaker 1: our March episode on Ignance semmel Vice, you probably recall 178 00:10:00,920 --> 00:10:03,760 Speaker 1: that he was a proponent of hand washing before surgery, 179 00:10:03,840 --> 00:10:07,120 Speaker 1: and that he was met with significant resistance from other surgeons. 180 00:10:07,720 --> 00:10:11,040 Speaker 1: But some of uses handwashing crusade didn't start until the 181 00:10:11,080 --> 00:10:14,199 Speaker 1: eighteen forties. There were other people that had similar ideas 182 00:10:14,200 --> 00:10:17,000 Speaker 1: earlier than that. One of them was listed in the 183 00:10:17,040 --> 00:10:20,960 Speaker 1: eighteen twenties. He was already thinking about cleanliness and hygiene 184 00:10:20,960 --> 00:10:25,760 Speaker 1: in the operating theater, although he wasn't entirely consistent about it. Yeah, 185 00:10:25,800 --> 00:10:29,880 Speaker 1: there's one particular detail. It's like yikes, um, But Listen 186 00:10:30,000 --> 00:10:33,600 Speaker 1: did routinely wash his hands before surgery, and he also 187 00:10:33,600 --> 00:10:36,840 Speaker 1: put on a clean surgeon's apron before each procedure, and 188 00:10:36,880 --> 00:10:40,560 Speaker 1: he insisted on clean sponges and dressings that were soaked 189 00:10:40,640 --> 00:10:43,280 Speaker 1: only in cold water rather than any of the commonly 190 00:10:43,400 --> 00:10:48,160 Speaker 1: used appointments or other preparations which could potentially uh foster 191 00:10:48,320 --> 00:10:51,400 Speaker 1: germ growth. It's interesting because at this time there was 192 00:10:51,440 --> 00:10:54,800 Speaker 1: a little bit of a cult of personality around surgeons 193 00:10:54,840 --> 00:10:58,320 Speaker 1: having kind of like these filthy, gross looking aprons because 194 00:10:58,360 --> 00:11:00,880 Speaker 1: it proved how much experience they had. Whereas he was 195 00:11:00,960 --> 00:11:04,720 Speaker 1: like no clean, sharp, and fresh every time. Liston also 196 00:11:05,000 --> 00:11:08,520 Speaker 1: shaved incision sites before beginning in operation. That was not 197 00:11:08,640 --> 00:11:12,000 Speaker 1: common practice, and he was onto something with hair removal. 198 00:11:13,040 --> 00:11:17,480 Speaker 1: Per the World Health Organization's guidelines, hair removal simplifies suturing 199 00:11:17,600 --> 00:11:21,559 Speaker 1: and reduces the introduction of potential contaminants, but shaving a 200 00:11:21,679 --> 00:11:24,840 Speaker 1: site can also cause micro trauma to the skin, potentially 201 00:11:24,840 --> 00:11:28,160 Speaker 1: contributing to surgical site infection. You'll often see that listed 202 00:11:28,240 --> 00:11:31,480 Speaker 1: is just SSI and medical literature, and to that end, 203 00:11:31,720 --> 00:11:34,600 Speaker 1: they suggest clippers rather than razors as a better option. 204 00:11:34,720 --> 00:11:38,839 Speaker 1: But Liston was removing hair from surgical sites before germ 205 00:11:38,920 --> 00:11:41,480 Speaker 1: theory had its huge rise in the second half of 206 00:11:41,520 --> 00:11:45,040 Speaker 1: the nineteenth century, and his motivation for hair removal and 207 00:11:45,080 --> 00:11:49,000 Speaker 1: his just proclivity for general cleanliness might have just been 208 00:11:49,440 --> 00:11:52,400 Speaker 1: a desire for tidiness, but all of this certainly helped 209 00:11:52,400 --> 00:11:57,360 Speaker 1: contribute to a safer environment for his work. However, he 210 00:11:57,480 --> 00:12:00,440 Speaker 1: also had some habits that were less than hygienic, and 211 00:12:00,679 --> 00:12:04,200 Speaker 1: we're the opposite of providing any kind of sterile environment, 212 00:12:04,240 --> 00:12:09,720 Speaker 1: including holding his knife in his teeth during procedures, which 213 00:12:09,800 --> 00:12:16,440 Speaker 1: is unhygienic and also just horrifying. Yes, it is uh. 214 00:12:16,600 --> 00:12:18,920 Speaker 1: This is often described as him being because he was 215 00:12:19,040 --> 00:12:21,120 Speaker 1: very fast. We'll talk about that in a minute. He 216 00:12:21,160 --> 00:12:23,319 Speaker 1: didn't want to put it down and he needed to 217 00:12:23,400 --> 00:12:25,800 Speaker 1: use both of his hands. Sometimes he would just stick 218 00:12:25,840 --> 00:12:31,640 Speaker 1: his knife in his mouth. I just watched Tracy get 219 00:12:32,000 --> 00:12:36,240 Speaker 1: the worships imaginable. But as he had been with his 220 00:12:36,280 --> 00:12:39,920 Speaker 1: colleagues in Scotland, Liston continued to be direct and sometimes 221 00:12:39,960 --> 00:12:42,760 Speaker 1: brusque with both his peers and the students who worked 222 00:12:42,840 --> 00:12:46,320 Speaker 1: under him. For students that assisted him in surgery, he 223 00:12:46,320 --> 00:12:50,600 Speaker 1: could be incredibly harsh if they made any mistakes outside 224 00:12:50,600 --> 00:12:53,040 Speaker 1: of surgery. However, he was known to foster really good 225 00:12:53,040 --> 00:12:55,800 Speaker 1: relationships with those same students. He would often invite them 226 00:12:55,840 --> 00:12:59,160 Speaker 1: to his home for meals and have pretty warm conversations. 227 00:12:59,320 --> 00:13:02,880 Speaker 1: And in these relationships he was very clear that the 228 00:13:02,920 --> 00:13:05,320 Speaker 1: reason that he was so tough it was because he 229 00:13:05,400 --> 00:13:08,800 Speaker 1: was adamant that any small error could compromise the patient, 230 00:13:08,960 --> 00:13:11,920 Speaker 1: and to him, that was simply not acceptable. The thing 231 00:13:12,000 --> 00:13:15,560 Speaker 1: that makes headlines when it comes to discussing Robert Liston 232 00:13:15,760 --> 00:13:19,040 Speaker 1: is his amputations. There is a valid reason for that. 233 00:13:19,120 --> 00:13:21,960 Speaker 1: He was very well known for his amputations. He did 234 00:13:22,120 --> 00:13:25,720 Speaker 1: a lot of them, and he was lightening quick about it, 235 00:13:25,800 --> 00:13:29,720 Speaker 1: and he also completely changed the way that they were performed. Yeah, 236 00:13:29,760 --> 00:13:32,000 Speaker 1: I had read one thing, but I didn't find corroboration 237 00:13:32,120 --> 00:13:35,199 Speaker 1: that he notched that's that knife that he used with 238 00:13:35,240 --> 00:13:38,160 Speaker 1: each of his amputations, like you'd put a notch on it, 239 00:13:38,240 --> 00:13:40,840 Speaker 1: and that it was just covered in these ticks. Um. 240 00:13:41,040 --> 00:13:43,040 Speaker 1: I don't know if that's true or not. But this 241 00:13:43,080 --> 00:13:44,840 Speaker 1: is where we're going to tell you to brace, because 242 00:13:44,880 --> 00:13:47,120 Speaker 1: this is where things get a little bit graphic, just 243 00:13:47,200 --> 00:13:49,440 Speaker 1: because we we want to talk about the technique that 244 00:13:49,480 --> 00:13:53,160 Speaker 1: Listen used in amputations and why it was different. So 245 00:13:53,200 --> 00:13:57,520 Speaker 1: prior to him, amputations were generally performed using what's called 246 00:13:57,520 --> 00:14:00,240 Speaker 1: a circular incision, and so to do this this, Urgin 247 00:14:00,280 --> 00:14:02,560 Speaker 1: would position his arms sort of wrapped around the limb 248 00:14:02,600 --> 00:14:04,960 Speaker 1: or extremity that was going to be removed, and then 249 00:14:05,000 --> 00:14:07,640 Speaker 1: he would make the cut using a circular motion around it, 250 00:14:07,720 --> 00:14:10,960 Speaker 1: kind of pulling the arm out. And alternate was the 251 00:14:10,960 --> 00:14:14,360 Speaker 1: guillotine method, which had the benefit of being quick, but 252 00:14:14,440 --> 00:14:17,400 Speaker 1: the problem with both of these techniques was that to 253 00:14:17,520 --> 00:14:20,280 Speaker 1: close the amputation, the surgeon would then have to pull 254 00:14:20,360 --> 00:14:23,560 Speaker 1: down skin and tissue around the severed bone to suture 255 00:14:23,600 --> 00:14:25,840 Speaker 1: it and that could be difficult, and it could cause 256 00:14:25,840 --> 00:14:30,000 Speaker 1: the patient unnecessary pain and discomfort during an already difficult 257 00:14:30,040 --> 00:14:33,840 Speaker 1: surgery and healing process. So Listen developed a technique for 258 00:14:33,880 --> 00:14:38,080 Speaker 1: his amputation that addressed this problem. In his approach, the 259 00:14:38,120 --> 00:14:40,760 Speaker 1: surgeon would first make a cut that ran parallel to 260 00:14:40,840 --> 00:14:44,160 Speaker 1: the bone, starting below where the extremity was to be severed, 261 00:14:44,200 --> 00:14:47,000 Speaker 1: and that way, when he turned the knife to cut 262 00:14:47,040 --> 00:14:49,960 Speaker 1: through the extremity, he would have a flap of skin 263 00:14:50,120 --> 00:14:52,760 Speaker 1: left behind that could be folded over the end of 264 00:14:52,800 --> 00:14:56,240 Speaker 1: the amputation, and that made a much more convenient way 265 00:14:56,280 --> 00:15:01,560 Speaker 1: to close the wound, also less painful. Yeah, and as 266 00:15:01,640 --> 00:15:05,080 Speaker 1: part of his ongoing efforts to make amputations safer and faster. 267 00:15:05,240 --> 00:15:07,640 Speaker 1: Because we should mention that this was before the use 268 00:15:07,680 --> 00:15:12,000 Speaker 1: of anesthesia, UH, patients might have sometimes been given alcohol 269 00:15:12,160 --> 00:15:14,840 Speaker 1: or even laudanum or a bit of opium, but that 270 00:15:14,920 --> 00:15:18,440 Speaker 1: was not common practice, and we don't really have documentation 271 00:15:18,520 --> 00:15:20,520 Speaker 1: on which of these patients were prepped with any kind 272 00:15:20,560 --> 00:15:24,240 Speaker 1: of help in that manner. But Listen also invented tools 273 00:15:24,320 --> 00:15:29,120 Speaker 1: to assist in the procedure. So he required a long, 274 00:15:29,240 --> 00:15:32,200 Speaker 1: straight knife that had both edges sharpened, and while he 275 00:15:32,240 --> 00:15:34,840 Speaker 1: didn't invent the knife knives have been around forever, this 276 00:15:34,880 --> 00:15:37,120 Speaker 1: particular version of it came to be known as a 277 00:15:37,160 --> 00:15:40,360 Speaker 1: listed knife. And his other big contribution to the tools 278 00:15:40,400 --> 00:15:42,880 Speaker 1: of the trade was a locking forceps so that he 279 00:15:42,880 --> 00:15:46,360 Speaker 1: could lock them down and control arterial bleeding during uh 280 00:15:46,440 --> 00:15:50,040 Speaker 1: an operation, and that same type of locking clamp or 281 00:15:50,120 --> 00:15:53,480 Speaker 1: forceps continues to be used in surgery today. But the 282 00:15:53,640 --> 00:15:57,440 Speaker 1: real reason that his amputations became so famous was because 283 00:15:57,480 --> 00:16:00,320 Speaker 1: of how very fast he did it. Again, he was 284 00:16:00,440 --> 00:16:03,160 Speaker 1: driven by the desire to minimize the time that the 285 00:16:03,160 --> 00:16:05,800 Speaker 1: patient had to suffer for what threw had to have 286 00:16:05,880 --> 00:16:10,000 Speaker 1: been just excruciating pain while being held down with no 287 00:16:10,120 --> 00:16:14,680 Speaker 1: kind of effective sedative. Many articles that you see about 288 00:16:14,800 --> 00:16:18,440 Speaker 1: him will use headlines quoting him asking those in attendance 289 00:16:18,480 --> 00:16:21,760 Speaker 1: to time him. Some of his surgeries allegedly took as 290 00:16:21,800 --> 00:16:24,640 Speaker 1: little as thirty seconds, and he's also alleged to have 291 00:16:24,760 --> 00:16:28,040 Speaker 1: completely severed and sutured the leg of an adult man 292 00:16:28,200 --> 00:16:31,880 Speaker 1: in two and a half minutes. He was focused on 293 00:16:31,960 --> 00:16:34,360 Speaker 1: speed because he felt like the less time that a 294 00:16:34,400 --> 00:16:37,760 Speaker 1: patient was left open, the less likely that their wound 295 00:16:37,760 --> 00:16:41,520 Speaker 1: would become infected. Liston was also a very large and 296 00:16:41,560 --> 00:16:44,520 Speaker 1: powerful man. He was about six ft two and very strong, 297 00:16:44,960 --> 00:16:47,400 Speaker 1: So part of his speed was just because he could 298 00:16:47,440 --> 00:16:49,920 Speaker 1: exert a lot of pressure on a cut to do 299 00:16:49,960 --> 00:16:53,600 Speaker 1: this quickly. And there are stories of Listen being a 300 00:16:53,680 --> 00:16:56,760 Speaker 1: showman about his work, sort of courting the audience that 301 00:16:56,840 --> 00:16:59,960 Speaker 1: was always on hand in his operating theater, and he doesn't. 302 00:17:00,120 --> 00:17:03,440 Speaker 1: We did draw a crowd because his contemporaries recognized his 303 00:17:03,520 --> 00:17:07,159 Speaker 1: skill in his innovation and his dedication to excellence, and 304 00:17:07,160 --> 00:17:09,000 Speaker 1: they wanted to see how he worked so they could 305 00:17:09,080 --> 00:17:12,080 Speaker 1: learn from him. And whether he was show voting during 306 00:17:12,080 --> 00:17:15,160 Speaker 1: surgery or he was just truly trying to simply show 307 00:17:15,240 --> 00:17:18,440 Speaker 1: his work as an educational tool to those in attendance 308 00:17:18,760 --> 00:17:20,600 Speaker 1: is one of those things that shifts a little bit 309 00:17:20,720 --> 00:17:23,560 Speaker 1: depending on what account you're reading. He was a very 310 00:17:23,640 --> 00:17:26,479 Speaker 1: confident man, so I have no trouble believing that he was, 311 00:17:26,680 --> 00:17:29,200 Speaker 1: you know, pretty loud and boisterous when he talked through 312 00:17:29,280 --> 00:17:31,800 Speaker 1: what he was doing with a patient. I feel like 313 00:17:31,880 --> 00:17:34,400 Speaker 1: he would fit in well with a number of fictional 314 00:17:34,480 --> 00:17:40,480 Speaker 1: surgeons on Grey's Anatomy, with a number of fictional surgeons everywhere. Right, 315 00:17:42,040 --> 00:17:46,840 Speaker 1: He's a little he's a little Stephen Strange, He's he's 316 00:17:46,880 --> 00:17:50,840 Speaker 1: all of them. So there are several infamous surgeries that 317 00:17:50,920 --> 00:17:54,119 Speaker 1: come up when discussing Liston's work. This is another moment 318 00:17:54,160 --> 00:17:57,239 Speaker 1: where you might want to brace. In one surgery, he 319 00:17:57,280 --> 00:18:00,320 Speaker 1: was removing a man's leg at the hip, and he 320 00:18:00,400 --> 00:18:04,800 Speaker 1: also removed the testicles as well. And the other pretty 321 00:18:04,840 --> 00:18:08,600 Speaker 1: notorious surgery is one that is often used as evidence 322 00:18:08,720 --> 00:18:11,760 Speaker 1: of him being really overzealous. It's an incident in which 323 00:18:11,800 --> 00:18:15,280 Speaker 1: he was said to have removed the patient's leg as planned, 324 00:18:15,920 --> 00:18:18,919 Speaker 1: but he also removed at least two fingers from his 325 00:18:18,960 --> 00:18:22,199 Speaker 1: assistant's hand he was holding the patient's leg, And this 326 00:18:22,400 --> 00:18:25,720 Speaker 1: story continues that in the long swoop of his cut, 327 00:18:25,840 --> 00:18:28,880 Speaker 1: he also managed to nick the coat of a spectator 328 00:18:28,920 --> 00:18:32,280 Speaker 1: who had leaned into close. So the story goes that 329 00:18:32,320 --> 00:18:35,520 Speaker 1: the patient and assistant both died of infection and that 330 00:18:35,600 --> 00:18:38,879 Speaker 1: the spectator died of shock. So this tale is often 331 00:18:38,880 --> 00:18:43,879 Speaker 1: invoked with a headline involving listons mortality rate, but it 332 00:18:44,040 --> 00:18:47,600 Speaker 1: is also probably apocryphal, one of those stories that's so 333 00:18:47,720 --> 00:18:50,840 Speaker 1: fantastic and attached to such a big character that it 334 00:18:50,880 --> 00:18:52,920 Speaker 1: has sort of gained the life of its own, even 335 00:18:52,960 --> 00:18:55,920 Speaker 1: without supporting evidence. Yes, so the first of those two 336 00:18:55,920 --> 00:18:59,720 Speaker 1: examples happened the second probably not. He Yeah, that was 337 00:18:59,800 --> 00:19:03,639 Speaker 1: in an inadvertent overcut on the first one, and that 338 00:19:03,720 --> 00:19:07,160 Speaker 1: second one does seem to be It may have happened, 339 00:19:07,160 --> 00:19:10,800 Speaker 1: but we do not have supporting it. What we do 340 00:19:10,960 --> 00:19:14,600 Speaker 1: know is that even though while Listen did lose patients 341 00:19:14,800 --> 00:19:17,240 Speaker 1: out of the sixty six amputations on record in his 342 00:19:17,320 --> 00:19:20,399 Speaker 1: first five years in London, ten of them died, that 343 00:19:20,480 --> 00:19:22,159 Speaker 1: was actually better than the average and a lot of 344 00:19:22,160 --> 00:19:25,120 Speaker 1: other hospitals. Like having ten out of sixty six patients 345 00:19:25,160 --> 00:19:27,679 Speaker 1: die might sound terrifying by today's standards, but it was 346 00:19:28,000 --> 00:19:30,239 Speaker 1: just way better than so many other hospitals that were 347 00:19:30,240 --> 00:19:33,320 Speaker 1: performing similar surgeries, where there was often a one in 348 00:19:33,520 --> 00:19:38,000 Speaker 1: four chance that the patient wouldn't survive. If we also 349 00:19:38,080 --> 00:19:40,240 Speaker 1: sort of add in the idea that he was known 350 00:19:40,280 --> 00:19:43,480 Speaker 1: for taking patients that other people thought were beyond help, 351 00:19:44,080 --> 00:19:48,919 Speaker 1: that seems like an even more positive part of his equation. Yeah, 352 00:19:48,960 --> 00:19:52,560 Speaker 1: I mean he uh. There there are stories of people 353 00:19:52,600 --> 00:19:55,359 Speaker 1: of his waiting room just being perpetually full because people 354 00:19:55,400 --> 00:19:59,320 Speaker 1: were all very afraid of having amputations, of course, but 355 00:19:59,400 --> 00:20:01,240 Speaker 1: they were more trusting of him than they were of 356 00:20:01,240 --> 00:20:05,240 Speaker 1: almost anyone else. And Robert Listen, we should say, was 357 00:20:05,320 --> 00:20:08,600 Speaker 1: not only interested in teaching amputation though he had very 358 00:20:08,640 --> 00:20:11,720 Speaker 1: firm opinions and a lot of experience, and he used 359 00:20:11,760 --> 00:20:14,280 Speaker 1: both to teach the next generation of surgeons how to 360 00:20:14,359 --> 00:20:17,879 Speaker 1: hone their craft. In eighteen thirty seven he published his 361 00:20:17,920 --> 00:20:21,480 Speaker 1: book Practical Surgery with one and twenty engravings on wood, 362 00:20:22,000 --> 00:20:24,760 Speaker 1: and then it was adapted for US publication the following year, 363 00:20:25,280 --> 00:20:27,640 Speaker 1: and that was followed up in eighteen forty by Elements 364 00:20:27,640 --> 00:20:30,880 Speaker 1: of Surgery, which also got an American edition at that time. 365 00:20:30,880 --> 00:20:32,440 Speaker 1: It took two years that came out in the eighteen 366 00:20:32,480 --> 00:20:35,720 Speaker 1: forty two and in his writing, one of the things 367 00:20:35,720 --> 00:20:38,520 Speaker 1: that he talks about is his three guiding principles of 368 00:20:38,520 --> 00:20:41,679 Speaker 1: surgery that he felt that all doctors should follow. The 369 00:20:41,720 --> 00:20:45,399 Speaker 1: first principle that Listen listed was an expert knowledge of anatomy. 370 00:20:45,600 --> 00:20:48,879 Speaker 1: He believed very strongly that one must study and practice 371 00:20:49,000 --> 00:20:52,359 Speaker 1: on cadavers before ever being allowed to operate in any 372 00:20:52,400 --> 00:20:56,600 Speaker 1: capacity on a living person. That's not surprising that anatomy 373 00:20:56,640 --> 00:20:59,360 Speaker 1: would be his governing guide as a surgeon. The need 374 00:20:59,440 --> 00:21:02,480 Speaker 1: to know that human embody as obvious but also anatomy 375 00:21:02,560 --> 00:21:06,080 Speaker 1: formed the foundation of his early studies with Barclay and Listen. 376 00:21:06,240 --> 00:21:10,280 Speaker 1: Second principle of surgical practice, and this is actually pretty 377 00:21:10,320 --> 00:21:13,760 Speaker 1: groundbreaking for his time, was to always factor in the 378 00:21:13,800 --> 00:21:17,840 Speaker 1: patient's emotions. He was very conscious of the mental state 379 00:21:18,280 --> 00:21:20,879 Speaker 1: of the people that he treated, and he wanted physicians 380 00:21:20,880 --> 00:21:24,240 Speaker 1: to be open with their patients and fairly transparent, but 381 00:21:24,280 --> 00:21:27,399 Speaker 1: also reassure them about the procedures that they were recommending 382 00:21:27,800 --> 00:21:30,679 Speaker 1: and the treatment that would follow. And if a patient 383 00:21:30,840 --> 00:21:33,800 Speaker 1: was truly filled with dread, he thought it best to 384 00:21:33,880 --> 00:21:36,760 Speaker 1: postpone or even cancel the surgery because he thought that 385 00:21:36,840 --> 00:21:39,399 Speaker 1: was only going to decrease their odds of making it 386 00:21:39,440 --> 00:21:42,919 Speaker 1: through healthfully. The third principle that Listed outlined was the 387 00:21:43,000 --> 00:21:45,960 Speaker 1: need for courage on the part of the surgeon. There 388 00:21:46,040 --> 00:21:50,040 Speaker 1: was no place for hesitation and operating room. Trepidacious surgeon 389 00:21:50,119 --> 00:21:54,000 Speaker 1: might hesitate too long and consequently doom a patient. In 390 00:21:54,040 --> 00:21:57,280 Speaker 1: addition to the amputations gone awry that we mentioned earlier, 391 00:21:57,359 --> 00:22:00,119 Speaker 1: there was at least one other incident when list and 392 00:22:00,200 --> 00:22:03,359 Speaker 1: self assuredness and his confidence led him to a quick 393 00:22:03,400 --> 00:22:07,000 Speaker 1: decision with fatal results for his patient. So at one 394 00:22:07,000 --> 00:22:09,399 Speaker 1: point he was presented with a child who had a 395 00:22:09,440 --> 00:22:11,919 Speaker 1: mass on his neck, and Listen believed that it was 396 00:22:11,960 --> 00:22:14,920 Speaker 1: an abscess that was his assessment, and so he punctured 397 00:22:14,920 --> 00:22:17,119 Speaker 1: it with a knife, and it had in fact been 398 00:22:17,160 --> 00:22:20,000 Speaker 1: an aneurysm, and the child died. So it may sound 399 00:22:20,040 --> 00:22:24,159 Speaker 1: surprising giving his seeming passion for surgery, but Listen was 400 00:22:24,160 --> 00:22:27,280 Speaker 1: actually very conscious of the importance of trying to avoid 401 00:22:27,520 --> 00:22:31,919 Speaker 1: unnecessary surgeries. He thought that the ongoing advancement of medical 402 00:22:31,960 --> 00:22:36,000 Speaker 1: science would continue to allow pathology to better determine which 403 00:22:36,040 --> 00:22:39,879 Speaker 1: patients would truly benefit from a surgical intervention versus what 404 00:22:40,000 --> 00:22:44,000 Speaker 1: should be treated with other noninvasive methods, and the preface 405 00:22:44,040 --> 00:22:46,280 Speaker 1: of one of his books on surgery, he wrote, quote, 406 00:22:46,280 --> 00:22:50,439 Speaker 1: the functions and structure of parts are more frequently preserved uninjured, 407 00:22:50,800 --> 00:22:55,200 Speaker 1: mutilation is more rarely required, and operations are dispensed with. 408 00:22:55,480 --> 00:22:58,959 Speaker 1: The wider the extension of pathology, the fewer the operations 409 00:22:59,000 --> 00:23:03,080 Speaker 1: will be the affording the best criterion of professional attainment. 410 00:23:03,560 --> 00:23:06,800 Speaker 1: Who will question that there is more merit in saving 411 00:23:06,880 --> 00:23:10,680 Speaker 1: one limb by superior skill than lopping off a thousand 412 00:23:10,800 --> 00:23:15,879 Speaker 1: with the utmost dexterity. There's totally the opposite of everybody's 413 00:23:15,920 --> 00:23:19,040 Speaker 1: impression that he was just like ready to run with 414 00:23:19,400 --> 00:23:23,639 Speaker 1: the amputations as possible. Yeah, he definitely gets characterized this 415 00:23:23,680 --> 00:23:26,480 Speaker 1: pretty amputation happy, but in fact he's like, no, that's 416 00:23:26,520 --> 00:23:30,680 Speaker 1: the last possible option. Uh. Coming up, we're going to 417 00:23:30,720 --> 00:23:33,360 Speaker 1: talk about an area of surgical work that is rarely 418 00:23:33,400 --> 00:23:36,159 Speaker 1: discussed as part of Liston's career. But first we are 419 00:23:36,160 --> 00:23:47,400 Speaker 1: going to take a quick sponsor break. While amputations made 420 00:23:47,520 --> 00:23:51,560 Speaker 1: Robert Liston famous, he made significant contributions to the advancement 421 00:23:51,840 --> 00:23:54,760 Speaker 1: of plastic surgery as well, and he wrote about this 422 00:23:54,800 --> 00:23:58,879 Speaker 1: in Practical Surgery, particularly rhinoplasty, in a section that is 423 00:23:58,920 --> 00:24:03,120 Speaker 1: dedicated to discuss sing the restoration of lost parts. At 424 00:24:03,119 --> 00:24:06,199 Speaker 1: the time, other surgeons were known to mock the idea 425 00:24:06,240 --> 00:24:10,040 Speaker 1: of plastic surgery, particularly methods and techniques of restoration that 426 00:24:10,080 --> 00:24:12,520 Speaker 1: had been developed in other countries. So if you listen 427 00:24:12,600 --> 00:24:15,880 Speaker 1: to our past episode on sastruda, you know that Indian 428 00:24:15,920 --> 00:24:19,639 Speaker 1: physicians had developed various plastic surgeries over the centuries, and 429 00:24:19,800 --> 00:24:24,000 Speaker 1: many of Liston's colleagues found such concepts to be absurd. Yeah, 430 00:24:24,040 --> 00:24:27,040 Speaker 1: there was definitely an element of racism in some of 431 00:24:27,080 --> 00:24:30,720 Speaker 1: their mockery of it. Of those doctors that have been 432 00:24:30,720 --> 00:24:34,119 Speaker 1: mocking plastic surgery, Liston wrote, quote, put the scoffer in 433 00:24:34,160 --> 00:24:37,240 Speaker 1: place of the patient. Let him lose his nose reputably 434 00:24:37,359 --> 00:24:41,840 Speaker 1: or otherwise, allow him some weeks of consequent misery and degradation. 435 00:24:42,440 --> 00:24:45,520 Speaker 1: Then bring him into contact with a dexterous surgeon who 436 00:24:45,520 --> 00:24:48,360 Speaker 1: thinks it not beneath him to make noses as well 437 00:24:48,359 --> 00:24:51,720 Speaker 1: as stumps, and thereon be little doubt that the rhinoplastic 438 00:24:51,840 --> 00:24:55,320 Speaker 1: art will have obtained a zealous pros The lite Liston 439 00:24:55,480 --> 00:24:59,960 Speaker 1: incidentally performed the forehead rhinoplastic that was developed in India 440 00:25:00,240 --> 00:25:03,000 Speaker 1: that we talked about in that sh Shrewda episode. That's 441 00:25:03,080 --> 00:25:05,639 Speaker 1: the case and all other aspects of surgery Liston was 442 00:25:05,720 --> 00:25:09,479 Speaker 1: exacting in any plastic surgery procedure that he did. He 443 00:25:09,600 --> 00:25:13,360 Speaker 1: was dismayed that his contemporaries were so sloppy when repairing 444 00:25:13,480 --> 00:25:16,200 Speaker 1: left lips, because he felt that a good surgeon should 445 00:25:16,240 --> 00:25:20,159 Speaker 1: be able to achieve an almost imperceptible scar. And Listen 446 00:25:20,520 --> 00:25:23,880 Speaker 1: did have a reputation for impeccable work with left lips 447 00:25:23,920 --> 00:25:28,000 Speaker 1: surgeries and established standards for reconstructive surgery at the time 448 00:25:28,080 --> 00:25:29,919 Speaker 1: that a lot of other people in his field had 449 00:25:29,960 --> 00:25:32,199 Speaker 1: to kind of struggle to catch up to. Yeah, he 450 00:25:32,320 --> 00:25:34,359 Speaker 1: was quite ahead of his time in that regard, at 451 00:25:34,400 --> 00:25:38,240 Speaker 1: least in um in Western medicine. There's another aspect of 452 00:25:38,280 --> 00:25:40,560 Speaker 1: his story which is noteworthy, and that is that on 453 00:25:40,600 --> 00:25:44,600 Speaker 1: December twenty one, forty six, Robert Liston made history as 454 00:25:44,680 --> 00:25:48,280 Speaker 1: the first surgeon in Europe to perform an amputation using anesthesia. 455 00:25:49,000 --> 00:25:52,440 Speaker 1: The idea came from the United States, specifically a Boston 456 00:25:52,520 --> 00:25:56,439 Speaker 1: dentist named William Thomas Green Morton. In a very short 457 00:25:56,480 --> 00:25:59,800 Speaker 1: period of time, medical professionals in Britain went from having 458 00:26:00,040 --> 00:26:03,640 Speaker 1: first heard of ether's use to actively using it themselves. 459 00:26:04,080 --> 00:26:07,040 Speaker 1: A letter from Boston describing its use had arrived in 460 00:26:07,080 --> 00:26:11,040 Speaker 1: London on December seventeenth, just four days before Liston's use 461 00:26:11,160 --> 00:26:14,479 Speaker 1: of ether. In those four days, the doctor who had 462 00:26:14,520 --> 00:26:18,200 Speaker 1: received the letter, Dr Francis Boot, and that his dentist 463 00:26:18,359 --> 00:26:22,000 Speaker 1: friend James Robinson, had put together an inhaler for ether 464 00:26:22,240 --> 00:26:25,760 Speaker 1: by adapting an existing piece of technology called a Knuth's 465 00:26:25,840 --> 00:26:29,720 Speaker 1: apparatus that was intended to make carbonated water. Yeah, it 466 00:26:29,800 --> 00:26:32,200 Speaker 1: had two glass vessels and they were kind of using 467 00:26:32,240 --> 00:26:36,520 Speaker 1: those to adapt for the administration of ether. And Boot 468 00:26:36,560 --> 00:26:40,640 Speaker 1: and Robinson's ether administering apparatus worked but not consistently, so 469 00:26:40,720 --> 00:26:43,399 Speaker 1: they worked to improve it. Uh and this again was 470 00:26:43,440 --> 00:26:45,560 Speaker 1: happening like over the course of twenty four hours, and 471 00:26:45,600 --> 00:26:47,800 Speaker 1: when Liston got wind of what they were doing, he 472 00:26:47,880 --> 00:26:49,800 Speaker 1: paid the two men a call and kind of got 473 00:26:49,880 --> 00:26:52,280 Speaker 1: up to speed with where they were at. And then 474 00:26:52,359 --> 00:26:54,959 Speaker 1: he collaborated with William Squire, one of his students who 475 00:26:54,960 --> 00:26:57,560 Speaker 1: he had brought with him on that visit, and Peter Squire, 476 00:26:57,600 --> 00:27:02,840 Speaker 1: William's uncle, to further refine the ether inhaler, introducing regulating valves. 477 00:27:03,320 --> 00:27:06,119 Speaker 1: In a letter to a friend, Listen described the device 478 00:27:06,200 --> 00:27:09,600 Speaker 1: this way quote, it is only the bottom of news apparatus, 479 00:27:09,600 --> 00:27:12,120 Speaker 1: with a sort of funnel above with bits of sponge, 480 00:27:12,280 --> 00:27:15,800 Speaker 1: and at the other whole a flexible tube. And so. 481 00:27:15,880 --> 00:27:18,960 Speaker 1: On December twenty one, Liston removed the lower leg of 482 00:27:18,960 --> 00:27:22,879 Speaker 1: a patient named Frederick Churchill while Peter Squire administered the 483 00:27:22,920 --> 00:27:27,480 Speaker 1: anesthesia through the inhaler. Churchill, not related to Winston. Churchill, 484 00:27:27,560 --> 00:27:30,400 Speaker 1: was soon subdued by the ether and Liston was able 485 00:27:30,440 --> 00:27:33,080 Speaker 1: to perform the surgery. Just a few minutes after the 486 00:27:33,119 --> 00:27:36,320 Speaker 1: procedure was finished, the patient awakened and asked when the 487 00:27:36,320 --> 00:27:39,639 Speaker 1: operation was going to start. This caused the spectators on 488 00:27:39,680 --> 00:27:42,600 Speaker 1: hand to laugh, and then that made Churchill nervous. He 489 00:27:42,680 --> 00:27:45,600 Speaker 1: tried to back out of the surgery, still not realizing 490 00:27:45,640 --> 00:27:48,520 Speaker 1: that had already been done, and then it hadn't been 491 00:27:48,520 --> 00:27:52,080 Speaker 1: the horrific experience that he had anticipated happening. And at 492 00:27:52,119 --> 00:27:56,639 Speaker 1: this point Robert Liston reportedly announced quote this Yankee dodge 493 00:27:56,680 --> 00:28:00,800 Speaker 1: beats mesmerism hollow. At this point, mesmeris um had been 494 00:28:00,840 --> 00:28:03,800 Speaker 1: pitched as a potential treatment for surgical pain. It was 495 00:28:03,840 --> 00:28:06,919 Speaker 1: something that Liston had never believed in in terms of efficacy, 496 00:28:07,000 --> 00:28:10,840 Speaker 1: and so he was perfectly happy that he had used 497 00:28:10,880 --> 00:28:14,439 Speaker 1: ether successfully. It's worth considering that in adopting the idea 498 00:28:14,480 --> 00:28:18,520 Speaker 1: of using ether so readily, Liston was essentially ending part 499 00:28:18,520 --> 00:28:21,040 Speaker 1: of the need to speed through surgeries and ending the 500 00:28:21,119 --> 00:28:23,760 Speaker 1: very practice for which he was so well known. He 501 00:28:23,920 --> 00:28:27,600 Speaker 1: still made quick work of it. There were still reasons, yeah, 502 00:28:27,680 --> 00:28:30,760 Speaker 1: he just as as medical professionals today, he did not 503 00:28:30,840 --> 00:28:33,760 Speaker 1: want to keep patients under for any longer than necessary, 504 00:28:34,880 --> 00:28:37,320 Speaker 1: especially at this point. You know, ether very new. There 505 00:28:37,480 --> 00:28:41,440 Speaker 1: were certainly some accidents that happened following this initial use, 506 00:28:41,520 --> 00:28:44,280 Speaker 1: but it was It's kind of one of those interesting 507 00:28:44,280 --> 00:28:46,920 Speaker 1: things where people talk about him being such a showboter 508 00:28:47,000 --> 00:28:50,440 Speaker 1: and wanting attention, but then he quickly adopted the technology 509 00:28:50,560 --> 00:28:52,440 Speaker 1: that that would get rid of the thing that he 510 00:28:52,480 --> 00:28:56,320 Speaker 1: was allegedly show voting about. So there's some contradictory, some 511 00:28:56,360 --> 00:29:01,320 Speaker 1: contradictory impulses there. On December seven, eighteen forty seven, less 512 00:29:01,320 --> 00:29:04,320 Speaker 1: than a year after his headline making use of anesthesia 513 00:29:04,360 --> 00:29:07,280 Speaker 1: on Robert Churchill, Robert Liston died at the age of 514 00:29:07,280 --> 00:29:10,800 Speaker 1: fifty three. In the journal The Lancet, his death was 515 00:29:10,800 --> 00:29:14,280 Speaker 1: announced with the following opening quote, it is with feelings 516 00:29:14,320 --> 00:29:17,840 Speaker 1: of inexpressible regret, a regret in which an entire profession 517 00:29:17,880 --> 00:29:20,960 Speaker 1: will sympathize, that we announced the death of Mr Liston. 518 00:29:21,720 --> 00:29:24,280 Speaker 1: Our regret is for a great surgeon and a personal 519 00:29:24,360 --> 00:29:27,239 Speaker 1: friend the profession has had in him one of its 520 00:29:27,360 --> 00:29:31,960 Speaker 1: most distinguished ornaments, one who, as a scientific operator, had 521 00:29:32,040 --> 00:29:35,960 Speaker 1: not his superior in this country, throughout Europe, or the world. 522 00:29:36,560 --> 00:29:40,040 Speaker 1: The announcement went on to report on Robert Liston's final days, 523 00:29:40,080 --> 00:29:43,720 Speaker 1: as relayed by his personal doctor, Mr CATJ. Listen had 524 00:29:43,760 --> 00:29:46,640 Speaker 1: a series of symptoms, all of which seemed pretty minor 525 00:29:46,760 --> 00:29:50,680 Speaker 1: on their own, including an occasional cough, a fleeting feeling 526 00:29:50,760 --> 00:29:53,960 Speaker 1: of constriction in his throat, and a slight difficulty in swallowing. 527 00:29:54,480 --> 00:29:57,360 Speaker 1: He had experienced an incident in which he coughed up blood, 528 00:29:57,360 --> 00:30:00,120 Speaker 1: which is definitely more alarming, and there was also no 529 00:30:00,200 --> 00:30:04,360 Speaker 1: obvious source for it. According to its doctors, Liston had 530 00:30:04,400 --> 00:30:06,960 Speaker 1: believed that he had an aneurysm at that point, but 531 00:30:07,120 --> 00:30:10,880 Speaker 1: his physicians were reluctant to agree with him. He rallied 532 00:30:10,960 --> 00:30:13,120 Speaker 1: for a time, and then throughout the autumn of eighteen 533 00:30:13,160 --> 00:30:16,240 Speaker 1: forty seven his health declined until his death, and his 534 00:30:16,320 --> 00:30:20,080 Speaker 1: post mortem examination, which is also reported in great detail 535 00:30:20,200 --> 00:30:24,000 Speaker 1: in the Lancet, revealed that Liston had in fact been 536 00:30:24,120 --> 00:30:26,680 Speaker 1: right about his own diagnosis all along, and that he 537 00:30:26,680 --> 00:30:29,320 Speaker 1: had in fact died of a large aneurysm near his heart. 538 00:30:30,160 --> 00:30:33,640 Speaker 1: Uh So, even without in in any sort of evidence 539 00:30:33,840 --> 00:30:35,800 Speaker 1: of what was going on, he had kind of intuited 540 00:30:36,280 --> 00:30:39,000 Speaker 1: what was up, which some people point out as additional 541 00:30:39,200 --> 00:30:44,040 Speaker 1: evidence of his his medical insight. Uh that is Robert Liston, 542 00:30:44,080 --> 00:30:46,400 Speaker 1: who is, to my mind, a lot more complicated than 543 00:30:46,920 --> 00:30:48,960 Speaker 1: he did a lot of amputations and killed some people. 544 00:30:49,200 --> 00:30:55,480 Speaker 1: M sure. Uh yeah, so I I That's kind of 545 00:30:55,480 --> 00:30:58,240 Speaker 1: why I wanted to do an episode on him, because 546 00:30:58,240 --> 00:31:02,360 Speaker 1: he I often see that headline of like mortality rate, 547 00:31:02,400 --> 00:31:04,680 Speaker 1: and I'm like, yeah, but it's a lot of other 548 00:31:04,680 --> 00:31:06,480 Speaker 1: stuff going on there, dude, and we don't know that 549 00:31:06,480 --> 00:31:09,840 Speaker 1: that's true. Yeah. Well, and even just the fastest knife 550 00:31:09,880 --> 00:31:12,840 Speaker 1: part is like he it wasn't the fastest knife because 551 00:31:12,840 --> 00:31:16,240 Speaker 1: he was just trying to be the fastest for no reason. Yeah, 552 00:31:16,280 --> 00:31:19,600 Speaker 1: he was not racing for fun. He was really trying 553 00:31:19,640 --> 00:31:23,120 Speaker 1: to take care of his patience, which was also why 554 00:31:23,160 --> 00:31:27,040 Speaker 1: he could be briskly to his his colleagues when he 555 00:31:27,080 --> 00:31:31,520 Speaker 1: felt that they were not prioritizing taking care of their patients. Uh. 556 00:31:31,680 --> 00:31:36,600 Speaker 1: He's an interesting, interesting gent. I have listener mail. It 557 00:31:36,640 --> 00:31:38,840 Speaker 1: has nothing to do at all with any kind of 558 00:31:38,840 --> 00:31:44,680 Speaker 1: surgical anything that would make you squeamish. Great. It is 559 00:31:44,720 --> 00:31:48,520 Speaker 1: a postcard from our listeners, Susan, I think again the 560 00:31:48,520 --> 00:31:52,880 Speaker 1: postcard obscuring of some writing always happens. Uh. And it's 561 00:31:52,920 --> 00:31:55,880 Speaker 1: a picture of Cincinnati riverboats, and Susan writes, Hi, Tracy 562 00:31:55,920 --> 00:31:59,000 Speaker 1: and Holly, I have been abundantly blessed. My work took 563 00:31:59,000 --> 00:32:01,040 Speaker 1: me to the New York City area for four years, 564 00:32:01,080 --> 00:32:03,400 Speaker 1: and now it brought me back home to a hot 565 00:32:03,440 --> 00:32:05,360 Speaker 1: bed of history. I would love to see your smiling 566 00:32:05,360 --> 00:32:08,959 Speaker 1: faces in Cincinnati. This becomes sort of a p s 567 00:32:08,960 --> 00:32:11,320 Speaker 1: A because we talked about this on the show periodically 568 00:32:11,480 --> 00:32:13,840 Speaker 1: and there is an f a Q on our website 569 00:32:13,840 --> 00:32:16,360 Speaker 1: that mentions it. But I also just wanted to make 570 00:32:16,400 --> 00:32:19,000 Speaker 1: sure we reviewed for any of our listeners that might 571 00:32:19,000 --> 00:32:21,480 Speaker 1: not know. Um, we do get questions about will you 572 00:32:21,480 --> 00:32:25,760 Speaker 1: come to our town still and for insight into how 573 00:32:25,800 --> 00:32:29,600 Speaker 1: all of that works. Um, we of course we want 574 00:32:29,600 --> 00:32:31,400 Speaker 1: to go everywhere. We want to see everybody that wants 575 00:32:31,440 --> 00:32:33,440 Speaker 1: to see us, But there are a couple of different 576 00:32:33,440 --> 00:32:35,360 Speaker 1: things that factor into that. One, if it's a tour 577 00:32:35,520 --> 00:32:39,280 Speaker 1: that we are putting together ourselves, like with our company, Uh, 578 00:32:39,360 --> 00:32:43,240 Speaker 1: those are based on like numbers of downloads and and 579 00:32:43,800 --> 00:32:47,719 Speaker 1: demographic data about what cities were most popular in so 580 00:32:47,800 --> 00:32:51,280 Speaker 1: that we can maximize our our benefit from that effort. 581 00:32:51,640 --> 00:32:54,840 Speaker 1: And then also what the venues are Like They're like, 582 00:32:54,920 --> 00:32:58,080 Speaker 1: if we have a sizeable number of listeners in a place, 583 00:32:58,160 --> 00:33:00,880 Speaker 1: but the only venue that would really be available holds 584 00:33:00,920 --> 00:33:04,440 Speaker 1: two thousand people, like that's more people than are probably 585 00:33:04,480 --> 00:33:08,000 Speaker 1: going to come to our show, that becomes a little trickier. Yeah, 586 00:33:08,040 --> 00:33:12,280 Speaker 1: there's there's like math involved of like us paying for 587 00:33:12,320 --> 00:33:16,000 Speaker 1: the venue and whether or not that money would come back, etcetera. 588 00:33:16,040 --> 00:33:18,960 Speaker 1: It's a very boring series of algorithms, and then like 589 00:33:19,240 --> 00:33:21,920 Speaker 1: the travel from one place to the next place, Like 590 00:33:22,000 --> 00:33:25,480 Speaker 1: it seems like very easy thing, but it's complicated. It's 591 00:33:25,520 --> 00:33:29,560 Speaker 1: fun also complicated. Yeah. The other way though, that we 592 00:33:29,720 --> 00:33:32,959 Speaker 1: end up doing live appearances in various places that are 593 00:33:33,000 --> 00:33:36,040 Speaker 1: not necessarily part of a tour is when we get invited. 594 00:33:36,240 --> 00:33:39,640 Speaker 1: So if you think that we should come to your area, 595 00:33:39,760 --> 00:33:47,280 Speaker 1: it's worth talking to the people at like conventions or libraries, museums, parks. 596 00:33:47,320 --> 00:33:49,960 Speaker 1: We've done all of those. Uh, talk to the people 597 00:33:50,000 --> 00:33:52,000 Speaker 1: there that book their programming and mentioned that you would 598 00:33:52,040 --> 00:33:54,280 Speaker 1: like to see us, and maybe they will extend us 599 00:33:54,280 --> 00:33:57,240 Speaker 1: an invitation and then we will come. That is exactly 600 00:33:57,280 --> 00:34:03,200 Speaker 1: the advice that give to people who ask me us. Uh. So, yeah, 601 00:34:03,240 --> 00:34:05,080 Speaker 1: those are great ways. If you are in a city 602 00:34:05,080 --> 00:34:07,200 Speaker 1: we have not been to, or maybe we've been there 603 00:34:07,200 --> 00:34:09,319 Speaker 1: and you want us to come back. Uh yeah, you 604 00:34:09,320 --> 00:34:11,680 Speaker 1: could do that. You could reach out to two places 605 00:34:11,719 --> 00:34:13,399 Speaker 1: nearby you that might be a good fit for us 606 00:34:13,400 --> 00:34:15,040 Speaker 1: and see if they would be interested in having us. 607 00:34:15,280 --> 00:34:17,040 Speaker 1: They may or may not, but that's one way to 608 00:34:17,080 --> 00:34:20,959 Speaker 1: try to um stir that whole thing into motion. So 609 00:34:22,080 --> 00:34:24,799 Speaker 1: you would like to write to us. Whether you want 610 00:34:24,800 --> 00:34:27,080 Speaker 1: to stir or an appearance into motion or not, you 611 00:34:27,120 --> 00:34:29,799 Speaker 1: can do so at History podcast at how stuff works 612 00:34:29,800 --> 00:34:32,839 Speaker 1: dot com. You can also subscribe to this podcast and 613 00:34:32,880 --> 00:34:35,359 Speaker 1: we hope you do on the I heart Radio app, 614 00:34:35,480 --> 00:34:37,960 Speaker 1: at Apple Podcasts, or wherever it is that you listen. 615 00:34:38,320 --> 00:34:41,280 Speaker 1: You can find us on social media. Got missed in History? 616 00:34:46,480 --> 00:34:48,680 Speaker 1: Stuffy Missed in History Class is a production of I 617 00:34:48,800 --> 00:34:51,840 Speaker 1: Heart Radios how stuff Works. For more podcasts for my 618 00:34:51,880 --> 00:34:54,920 Speaker 1: heart Radio, visit the I heart Radio app, Apple Podcasts, 619 00:34:55,080 --> 00:34:57,000 Speaker 1: or wherever you listen to your favorite shows.