In the first of a two-part blog post, Principal Investigator Dr Michael Brown explores the role of mythology in shaping the reputation of one of the nineteenth century’s most (in)famous surgeons.
In 1912, the American-born pharmaceutical entrepreneur Henry Wellcome (1853-1936) commissioned the Bristol artist Ernest Board (1877-1934) to paint 26 images of important events from the history of science and medicine. One of these images portrays the Scottish surgeon Robert Liston (1794-1847), performing the first operation carried out in Britain under inhalation anaesthesia at University College Hospital on 21 December 1846. That Wellcome chose this event is testament to its mythic place in the history of British surgery. By the early twentieth century it had come to represent a pivotal moment in surgery’s imagined transition from a squalid, barbaric past into a clean, pain-free modernity.
However, if the value of that particular historical moment remains largely unquestioned, the identity of its key protagonist is less clear-cut. Though indelibly identified with the first use of ether in Europe, Robert Liston is something of a liminal figure, standing at the threshold of this new age of surgery while never being truly a part of it. In large part this is due to the fact that he died of an aneurism of the aorta less than a year later, at the peak of his career. But it also derives from his rootedness in the operative cultures of the pre-anaesthetic era.
Indeed, within the historical literature he is often portrayed as the literal embodiment of the physical prowess, manual dexterity, and, most especially, operative speed, that came to characterise the era immediately before the introduction of anaesthesia. And for those who have sought to caricature the ancien regime of pre-anaesthetic surgery as one of cruelty and horror, these physical capacities, particularly his speed, are represented as both ‘a gift and a curse’, simultaneously mitigating the amount of pain suffered by the patient, while also putting them in greater danger.[1]
The roots of Liston’s modern reputation as an ‘incorrigible bustler’ are readily traced and demonstrate the ease with which spurious anecdote can pass into historical fact.[2] Take, for example, Lindsey Fitzharris’ popular history of Joseph Lister, The Butchering Art (2017). Her reference to Liston as ‘the fastest knife in the West End’ and her account of an apocryphal operation in which his obsession with speed supposedly led to the deaths of the patient, an assistant, and a bystander are taken, virtually word for word, from a book written by the anaesthetist and Doctor in the House author Richard Gordon (1921-2017).[3] This book, the unapologetically sensationalist Great Medical Disasters (1983), contains a brief three-page sketch of the man and is the source of much modern Liston folklore. For example, Gordon’s claims that Liston ‘sprung across the bloodstained boards upon … his patient like a duelist [sic], calling “Time me gentlemen, time me!”’ and that ‘To free both hands, he would clasp the bloody knife between his teeth’ are often repeated in popular accounts.[4]
Gordon’s own sources, other than his own imagination, are two articles published in the University College Hospital Magazine in the early twentieth century. One of these is a general biographical account of Liston, written by Percy Flemming (1863-1941) in 1926.[5] This is the principal source for the claim that Liston would hold the knife between his teeth.[6] Flemming likewise claims that Liston ‘would begin an operation by exclaiming, “time me, gentlemen, time me”’.[7] In turn, this claim is an extrapolation from the second of Gordon’s sources, an account of Liston’s first use of ether, written by F. William Cock (1858-1943) and published in 1911.[8] A contemporary review in The Lancet states that ‘Dr Cock’s restrained, but vigorous, writing invests the narrative with due fascination’.[9] Meanwhile, Flemming refers to these events as having been ‘graphically described by my old friend F. W Cock’.[10]
In fact, on inspection, it is clear that Cock’s article is largely a work of fiction, embellishing the known details of the operation with entirely imagined dialogue, including Liston’s request to be timed.[11] It is also the first account to claim that Liston referred to anaesthesia as a ‘Yankee dodge’ that ‘beat mesmerism hollow’.[12] Despite Alison Winter’s attribution of this quotation to Liston’s assistant William Squire (1825-1899) in his account of the operation published in The Lancet in 1888, there is no evidence of such a phrase, either in this article or in his later recollections published in the British Medical Journal in 1896.[13] Indeed, what is consistent in Squire’s reports, and in other later nineteenth-century accounts, is that Liston either made ‘few remarks’ or said ‘nothing’, as he was so struck by the effects of ether on the patient that ‘he could scarcely command himself sufficiently to address even a few words to the spectators’.[14]
Clearly, then, Liston’s ambivalent historical reputation, awkwardly poised between hero and villain, is shaped by myth as much as fact. This mythology is rooted in an early twentieth-century caricature of the pre-anaesthetic surgeon as a flamboyant and speedy operator, a caricature repeated in modern-day popular histories and popular culture, such as BBC television’s Quacks (2017).
It is perhaps somewhat ironic that Robert Liston’s place within the cultures of Romantic surgery was no less ambiguous or contested than his historical reputation has proved to be. To some of his contemporaries he was perhaps the greatest operative surgeon of the age. To others, however, he was an unthinking mechanic almost entirely devoid of sympathy and compassion. In the second part of this blog post, we shall therefore consider how his contemporary reputation was shaped by Anglo-Scottish surgical rivalry, as well as by the fervid politics of early nineteenth-century medical and surgical reform.
[1] Lindsey Fitzharris, The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine (London: Allen Lane, 2017), p. 10.
[2] Richard Gordon, Great Medical Disasters (New York: Stein and Day, 1983), p. 19.
[3] Fitzharris, Butchering Art, pp. 10-12. There is no reference to Gordon’s book in The Butchering Art, but the Wikipedia entry on Robert Liston is heavily reliant on it: https://en.wikipedia.org/wiki/Robert_Liston.
[4] Gordon, Great Medical Disasters, pp. 19-21. For example, see Wendy Moore, The Mesmerist: The Society Doctor who held Victorian Society Spellbound (London: Weidenfield and Nicholson, 2017), pp. 94-5.
[5] Percy Flemming, ‘Robert Liston’, University College Hospital Magazine 11:4 (September 1926), 176-85.
[6] Flemming, ‘Liston’, p. 177.
[7] Flemming, ‘Liston’, p. 179.
[8] F. William Cock, ‘The First Operation under Ether – The Story of Three Days’, University College Hospital Magazine 1:4 (February 1911), 127-44.
[9] The Lancet 177:4573 (22 April 1911), p. 1093.
[10] Flemming, ‘Liston’, p. 183.
[11] Cock, ‘Ether’, p. 137. Earlier accounts do suggest that he was timed at thirty-two seconds, but not that he asked to be e.g. British Medical Journal 2:1868 (17 October 1896), p. 1140.
[12] Cock, ‘Ether’, pp. 137-8.
[13] Alison Winter, Mesmerised: Powers of Mind in Victorian Britain (Chicago: Chicago University Press, 1998), p. 180, n. 48. Fitzharris, Butchering Art, p. 7 uses the same quotation, citing a number of secondary sources, including Winter. The Lancet 132:3408 (22 December 1888), 1220-1; British Medical Journal 2:1868 (17 October 1896), 1142-3.
[14] The Lancet 132:3408 (22 December 1888), p. 1221; British Medical Journal 2:1868 (17 October 1896), pp. 1140, 1143.
Image: Robert Liston operating. Henry Board (c. 1912). (Wellcome Images)
