It is said of Bright that he was perhaps better known abroad than any other British physician of his time. The confidence reposed in him by his professional brethren was dependent largely upon the minute attention he bestowed upon every case. He always took careful notes, and often made drawings, being a good draughtsman and rather a connoisseur in etchings and engravings.
FOOTNOTES:
[1] Historical Notes on Bright’s Disease, Addison’s Disease, and Hodgkin’s Disease, in Guy’s Hospital Reports, 3d series, vol. xxii.
[CHAPTER XII.]
LISTON, SYME, LIZARS, AND THE NEWER SURGERY.
Among operating surgeons few names take higher rank than those of Liston and Syme, at one time close associates in private medical teaching at Edinburgh, at a later period jealous rivals and even antagonists, but happily again warm friends before the sudden end of the elder. Robert Liston was born on the 28th October 1794, his father being the Rev. Henry Liston, minister of Ecclesmachan, Linlithgow, whose accomplishments included a considerable acquaintance with the theory of music, and who wrote a treatise on Perfect Intonation in addition to inventing an organ calculated to produce the desired intonation. He was educated chiefly by his father up to the age of fourteen, and afterwards attended classical and mathematical lectures in Edinburgh University during two sessions, obtaining a prize for Latin composition in the second. At this period of his life he exhibited great fondness for the sea, and was only induced to give up his desire to become a sailor by a promise that if he would study medicine he should eventually be a naval surgeon if he wished. His taste for a seafaring life never forsook him; and one of the relaxations which he most enjoyed up to within a few weeks of his death, was sailing in a yacht which he kept on the Thames. He was also very fond of field-sports.
In 1810 Liston commenced medical study as the pupil of Dr. Barclay, the well-known anatomical lecturer. He soon became noted by his instructor for his zeal and untiring assiduity, and he eventually chose him as his assistant and prosector, an office he retained until 1815. It was thus that Liston acquired the foundation of his remarkable knowledge of surgical anatomy, which his later experience strengthened, and to which he added a dexterity in the use of surgical instruments, and especially the knife, which was unsurpassed in his time.
In 1815 Liston became surgeon’s clerk or house-surgeon in the Royal Infirmary of Edinburgh, in which capacity he availed himself fully of the opportunities for making post mortem examinations, which were then performed by the house-surgeons. In 1816 he went to London, and studied several months at St. George’s Hospital, and also attended some of Abernethy’s lectures. In 1817, having taken the diplomas of the College of Surgeons both in London and Edinburgh, he began practice in Edinburgh, and again assisted Dr. Barclay in his anatomical teaching. But misunderstandings arising between them, Liston left Barclay and commenced to lecture on his own account at the beginning of the session 1818-19, James Syme becoming his assistant. In 1823 Liston gave up teaching anatomy in favour of Syme, in order to devote himself entirely to surgical teaching; but Liston retained a large share of the proceeds of the anatomical lectures, as the originator and more important proprietor of the joint school. This arrangement did not last long, Syme withdrawing to Brown Square in 1824: and it appears that Liston is, at least equally with Syme, open to the charge of having displayed serious jealousy in this matter. They were unavoidably serious rivals, too nearly equals in power, and perhaps too conscious of their own individual claims, to be able to view with equanimity each other’s proceedings and advancement.
Liston had published a little book on the Surgical Anatomy of Crural Hernia (1819), and soon acquired fame by performing several brilliant operations, difficult amputations, ligatures of arteries, lithotomy, &c. At that time there were many defects in the management of the Royal Infirmary, and Liston set to work, young as he was, to agitate for their removal. Unfortunately he did not make any attempts to conciliate the managers in so doing, and his outspoken complaints were met with bitter opposition from some of the surgeons as well as managers. He entered into the spirit of controversy which Dr. Gregory had done so much to foment, and in which so much of the talent and time of Edinburgh men was then wasted. In 1821 Liston records that he was almost daily applied to by patients from the Infirmary who had failed to secure relief from the surgeons, and he was exposed to the charge of decoying patients thence. It was even demanded of him, on pain of perpetual exclusion from the surgeoncy to the Infirmary, that he should refuse his professional assistance to any person who had been a patient there. He naturally refused to comply with any such condition, nor would he absent himself from attendance on the Infirmary practice, as was also suggested. It is fair to say that Liston courted the fullest investigation of his actions, and denied that he had ever directly or indirectly insinuated to any patient of the Infirmary that the practice followed there was bad, or that he himself knew better, or had in any way tried to entice patients away. But he did complain of the tedious and often injurious delay which took place before patients were operated upon, and the unsatisfactory result of many of the operations; while he himself had undoubtedly cured many discharged as incurable, or imperfectly relieved. The young surgeon showed so vigorous a front that great efforts were made to make the most of any imprudences he committed, and to deter students from attending his classes, especially by hints that they would come off very badly before the College of Surgeons if they did. Strange that he who now maintained so bold an attack upon convention and authority, should have shown such jealousy of his former demonstrator, Syme, and have endeavoured by manner, and more than manner, to repress and depreciate a still younger man’s skill. This was but one of the many inconsistencies and difficulties that Liston’s consciousness of his own powers and his abrupt and somewhat rough manner of dealing with differences of opinion led him into. Nevertheless the scathing charges of incompetency which Liston brought against some of the surgeons then in office, and supported in detail, were sufficient to prove to the managers that Liston was no ordinary young man, but must be allowed a full field for his talents; and consequently gaining increasing fame as a lecturer on surgery, and attracting large classes of students, Liston in 1828 became one of the surgeons to the Royal Infirmary.
But Liston’s interest was insufficient to gain him the Professorship of Surgery in the University when it fell vacant, and he gladly accepted the offer of the Surgeoncy to the North London Hospital with the Professorship of Clinical Surgery in University College in 1834. His transfer to London was a striking success. He had already published, in 1833, his “Principles of Surgery,” which went through several editions. Its clearness, simplicity, and homeliness of style made it popular, and well calculated to widen his fame. Unornamental almost to a fault, and perhaps deficient in illustration, he gave much practical information, and definitely elucidated his subject. His “Practical Surgery,” published in 1837, chiefly giving the results of his own experiences, was still more popular. His brilliant talents, however, were those of an operator. It was said of him that he possessed every qualification for success in this department, great physical strength and activity, coolness, promptitude, energy, and unflinching courage, a steady hand and a quick eye, a resolution which rose with the difficulties he encountered, and rested on a just reliance on his complete knowledge of anatomy and pathology. Yet the brilliant operator was not over anxious to exhibit his talents; he was often considered remarkably cautious. His deliberation was as marked before undertaking an operation as was his fearlessness when it was undertaken. His readiness and resource under the most varied and difficult combinations of circumstances were surprising. He excelled in irregular operations in which no well established mode of procedure could be followed, but he had to depend on the decision of the moment as to the particular case. He knew exactly what he meant to do and how to do it, and this without delay or hesitation. Thus he won the reputation of being the most dexterous operator of his day.
In addition to his “Surgery” Liston published numerous valuable papers on amputation, difficult cases of aneurism, tracheotomy, lithotomy, and lithotrity. He left his impress on a very large number of operations, either devising new methods of meeting old difficulties, or improving the accepted modes of dealing with them. He invented an improved shoe for the treatment of club-foot, and was great at reducing dislocations. He once succeeded in reducing a dislocated hip-joint after the dislocation had continued no less than two years. He introduced the method of reducing dislocated phalanges, especially of the thumb, by passing the ring of a door-key over the part and hitching it against the projecting end of the bone, so that extension and pressure could be brought to bear simultaneously. After dislocation of the thigh backwards, he several times took advantage of the immediate powerlessness of the muscles from shock, and reduced the limb on the spot without the use of pulleys or even without the aid of an assistant. He invented or modified splints for broken limbs. His methods of performing amputations by flaps became very largely adopted. He had great success in what are known as plastic operations, such as restoring a nose by taking a flap from the upper lip. His name is scarcely more associated with amputations, however, than with lithotomy and lithotrity, to which he devoted great attention. Many of his lectures on those subjects were published in the Lancet and were widely read.