In the 1800s, surgery was a brutal race against death, but few surgeons were as skilled—or as infamous—as Robert Liston. Known for his lightning-fast amputations, Liston once achieved the only recorded 300% mortality rate in a single operation. But was he truly “history’s worst surgeon?” Let’s see if we can discover the real truth behind the man who killed three people in one surgery.
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Surgery is never a good thing. However, if you were unlucky enough to live in the 1800s, your chances of surviving a surgical procedure were abysmal. Still, from the doctor’s perspective, at least only one person would be at risk, right?
Wrong.
In one astounding case, 19th-century surgeon Robert Liston managed to perform a surgery with a staggering 300% mortality rate. But there’s more to it than that. Because while Liston is often cited for just this one failure, he was actually a powerful patient advocate and an overwhelmingly positive figure in the brutal and chaotic history of surgery as a practice.
1800s Surgery Was a Nightmare
Surgery in the early 1800s was a last resort, but that doesn’t mean it was uncommon. Even though medical knowledge was getting better by the year, doctors were still woefully unprepared to keep their patients alive after cutting them open.
Here’s why…
First, anaesthesia didn’t become widely available until the late 1840s. This meant that patients would need to endure surgery while fully awake. Of course, the pain could drive patients to writhe uncontrollably, so assistants were tasked with restraining them. Though the use of ether and chloroform would help change this, surgeries up until that point were excruciating, traumatic ordeals that could easily end in death due to shock or blood loss.
Then there’s the matter of germs. Specifically, the fact that doctors didn’t know about them. As we’ve pointed out in other videos, doctors weren’t even washing their hands until the end of the century. So even GOOD surgeons reused tools without cleaning them and wore blood-stained aprons, which made the chances of post-surgery infection super high.
Finally, we have to consider WHAT most surgeries were: amputations. If a person had an injury or infection on a limb, doctors felt the best chance of saving it was to just cut the thing off. This would remove the infected wound, sure, but it also led to rampant blood loss. To minimize this and keep patients from literally dying from shock, surgeons often raced against the clock, relying on sheer speed to complete the procedure. And did we mention that most surgeries were done publicly, with students, doctors, and random spectators crowding around the racing doctor?
In short: 1800s surgery was a chaotic mix of blood, bacteria, and screams, and it was still your best chance of surviving an infected wound! Fortunately, one surgeon quickly established himself as the best of the bunch.
Robert Liston: The Medical Marvel
Robert Liston was born in Ecclesmachan, Scotland, in 1794. His father was a clergyman and inventor, which gave Liston a disciplined upbringing and a knack for innovation. After studying at Edinburgh Medical School, he worked under several prominent doctors. By 1835, Liston had been appointed the first Professor of Clinical Surgery at University College Hospital in London.
To put it as simple as possible, Liston was THE MAN.
He not only had a reputation for speed and skill, but his commitment to his patients was unmatched. Records state that he would often walk around hospitals looking for cases that others considered hopeless. He saved more than a few lives by operating on people who had basically been abandoned to die.
And though he had a reputation for being argumentative with other doctors, he was widely respected by those he treated, especially poorer people, who could rarely afford quality medical care. Many historians
now claim that it’s possible the negative opinions of Liston stemmed from a combination of jealousy at his skill, and wealthy doctors being grossed out by his affinity for the poor.
The Fastest Knife in the West End
Where Liston truly shined was in the practice of amputations.
Liston’s remarkable speed earned him the nickname “the fastest knife in the West End,” and it’s rumoured that he could sometimes complete an amputation in under 30 seconds. This not only reduced the trauma to the patient, but would help reduce the risk of infection. As such, Liston’s mortality rate was relatively low—around 15%, compared to an average of 25% among his peers.
But it wasn’t all about showing off. Liston’s writings indicate that he believed in the importance of avoiding unnecessary surgery whenever possible. Again, his dedication to minimizing patient suffering set him apart in an era when patients were frequently viewed as disposable.
Yet Liston’s success was not without challenges. After clashing with other surgeons, he was forced to take his practice into the homes of his patients. But there was a benefit to this. In treating people where they lived, Liston spared them the horrors of early hospitals, which were so unsanitary that you were actually more likely to die inside than out.
Still, that doesn’t mean he was immune to mistakes. Sometime in the 1830s or 40s, he made a blunder that would tarnish his reputation forever.
The Truth Behind the 300% Mortality Rate
This particular incident took place at University College Hospital in London, where Liston’s reputation for speed and precision had drawn a large crowd of spectators eager to watch his techniques in action. In the operating theatre, Liston prepared to perform one of his famous leg amputations, with the audience packed tightly around him. To stabilize the leg, Liston asked for assistance from one of the medical students.
After asking for the attendees to start their watches – as he always did – he began cutting. As always, Liston’s focus was on speed. However, as he began to cut, he accidentally removed two of the fingers of the assisting medical student. Suddenly, he had both men bleeding profusely and a half-cut leg that nobody was holding. Liston’s only hope was to keep going. However, amid his quick movements, he ended up catching the coattails of a senior doctor standing nearby with his knife.
Thinking he’d been wounded, the senior surgeon cried out in shock and collapsed to the floor. Though he was uninjured, the fear and adrenaline were too much for him, leading to a massive heart attack that killed him on the spot. But the tragedy didn’t end there. Both the patient and the assistant would go on to develop gangrene, with each man dying in the following days.
And that’s how a single operation resulted in the deaths of three people. To this day, it remains the only known surgery in history to produce a 300% mortality rate.
This tale of tragic miscalculation and misfortune became infamous not only for the deaths involved but also as a grim example of the high stakes and uncontrollable variables that defined early surgical procedures. However, many agree that it’s unfair to label Liston as a bad surgeon, even in this case.
The assistant had clearly placed his hands in the wrong place if he was in any way at risk of being cut by Liston’s knife. The bystander, meanwhile, was also clearly standing too close. While it’s often claimed Liston was “flourishing” his knife, it seems unfair, like blaming a race car driver for hitting people crossing the track.
Nonetheless, the incident likely contributed to loads of different myths and stories surrounding Liston, and you can find many videos and articles calling him “the worst surgeon in history,” when – in fact – it’s the opposite that’s true.
Conclusion
Despite this rather embarrassing mishap, Liston continued practising surgery, remaining one of the most highly regarded figures in his field. Liston would also invent several life-saving medical devices, such as bulldog forceps – which are used to hold arteries closed during surgery – and a leg splint that is still used today.
Even more importantly, his research and dedication to his work left a significant impression on his students, including Joseph Lister, who would go on to pioneer antiseptic techniques that quite literally transformed medicine.
Far from “history’s worst surgeon” Liston’s life was filled with dedication to his craft and compassion for his patients. Today, we benefit from medical practices far removed from the brutal era in which Liston practiced, and while modern surgery has evolved in incredible ways, it’s astonishing to think that many of these advances trace back to surgeons like him.
Nevertheless, it’s worth taking a moment to be thankful that you don’t live in the days when “surgery” was fast, bloody work that was just as likely to wreak havoc as save your life.
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