Much importance has been assigned to Liston’s personal strength as constituting a large element in his operative successes. His hand and arm, it was said, might have furnished models for a Hercules, and their power was not unfrequently shown in operations requiring great muscular exertion. But he was equally successful in those in which the most delicate manipulation was demanded. His decision and force of character were equal to the accurate control over his powerful yet adaptable muscles. He would amputate the thigh single-handed, compress the artery with the left hand, using no tourniquet, and do all the cutting and sawing with the right, with only the aid of a house-surgeon to hold the limb and tie the ligatures on the arteries. He did not need time for reflection; his actions were prompted by a kind of intuition akin to genius; he seemed to comprehend at a glance the requirements of any particular case. Yet he never gave up his habit of studying anatomy, spending as many hours as possible in actual dissection.
One of Liston’s striking exhibitions of decision and invention occurred during an amputation of the thigh by Russell, then Professor of Clinical Surgery at Edinburgh. An artery in the cut bone bled profusely, and in consequence of its bony surroundings could not be tied in the ordinary way. Liston with the amputating-knife at once cut off a chip of wood from the operating table, formed it into a cone, and drove it into the bleeding orifice, and in this way immediately arrested the bleeding.[2]
Liston’s general principles of treatment are also worthy of note, as he exercised by their means a considerable influence on the profession. He early became alive to the unwisdom of over-treatment, and tended more and more to trust to natural recuperative powers. He was thus enabled to dispense with the multitudinous paraphernalia which surrounded the operating surgeon, the repeated poulticing, strapping, bandaging, anointing, which often rendered a stay in a surgical ward almost intolerable.
On the death of Sir Anthony Carlisle in 1840, Liston was elected to the Council of the Royal College of Surgeons, but did not become one of the Examiners until March 1846. There is little doubt that he would before long have attained the Presidency of the College, had not his career been cut short. His practice became very large, and there is no doubt that he undertook an amount of work which many men would have found impossible. Yet he was noted for his consideration of the poor and necessitous. It was remarked in the Times after his death that “his nature abhorred everything sordid, and no man ever was more strongly impressed with the feelings of an honourable, generous, and independent practitioner. In whatever rank of life the ‘case’ occurred, if it was one of difficulty or interest, this master of his art was ready with the potent spell of his unerring bistoury, and his reward was in the consciousness of his own power, and in the noble pride of having been ministrant to the relief of suffering humanity. His manner in ordinary society was sometimes complained of as harsh or abrupt, and he certainly was occasionally neglectful of the mere trifling courtesies of life, and sometimes careless of refinement or punctilio. He was a man of thought more than of show. He could not bear triflers, and he did not always avoid showing his distaste. He was a fervid lover of truth and sincerity, and sometimes, perhaps, expressed himself too strongly when he thought there lurked any meanness or deceit or affectation. But in the proper and trying scene of the labours of the medical man—in the chamber of the sick—he was gentle as he was resolute. He never had a patient who was not anxious to become a friend, and the voice which was sometimes discordant amid the petty annoyances of daily life was music to the sick man’s ear. Into the scene of suffering he never brought a harsh word or an unkind look, and the hand which was hard as iron and true as steel in the theatre of operation was soft as thistle-down to the throbbing pulse and aching brow. It may also be added, with perfect truth, that in the exercise of his arduous duties, among persons of the highest rank and most fastidious sympathies, his delicacy and forbearance were as remarkable as the sound sense which regulated all his professional conduct. His heart was in his business.”
Liston was warm in his friendships though strong in his dislikes. He did not readily take to strangers. It is to be noted that he became frankly reconciled to Syme after their serious divergence. He took the initiative finally in 1839, and a genial correspondence took place between them. They met once more in the autumn of 1847, when Liston visited Edinburgh, and were often together. Liston dined with Syme at Millbank the day after his arrival in Edinburgh, and again the day before he left for London. Before very long, however, Liston was carried off by aneurism of the aorta, which must have existed for years, and been fostered by his great physical exertions, which characterised his recreation as well as his work. It had been found impossible to diagnose his ailment with certainty till some little time before his death, which came with startling suddenness upon the medical world and the public generally. He died on December 7, 1847, aged 53, and was buried at Highgate Cemetery. A body of 400 students and a large number of medical men attended his funeral. He left a widow and a family of six children, two of whom were sons. One of these, however, died very soon after his father. In the following May Lord Brougham delivered a glowing eulogy on Liston at the distribution of prizes at University College. A sum of about £700 was subscribed for a memorial, which took the form of a marble statue—placed in the College—and a gold medal called the Liston Medal, which is awarded annually for surgery at the same institution.
James Syme, another of the great Scotch surgeons of this century, was born in Edinburgh on the 7th November 1799. His father, a Writer to the Signet, was of good family, but owing to unsuccessful speculations was involved in difficulties, and left nothing behind him. Young Syme was educated at the High School of Edinburgh, and soon showed characteristic patience and perseverance without brilliant parts. A certain thickness of speech, almost amounting to an impediment, strengthened the impression of shyness that he gave. Instead of country sports, he was fond of botanising, and of making skeletons of small animals. A similar tendency manifested itself in his attachment to chemistry and his fondness for making chemical experiments. Thus he was equipped with a sufficient bent towards studies connected with medicine to render it not surprising when he adopted the medical profession.
From 1815 onward Syme attended the University of Edinburgh, taking both Arts and Science lectures at first. Incidentally, in the course of his chemical pursuits, he made an original discovery of the waterproofing process, and having first dissolved indiarubber, was able to construct flexible tubes of it, and to render various substances waterproof by brushing a thin solution of it into their interstices. Not to be diverted from his medical work, Syme declined to take out a patent, but published his method. Mr. Mackintosh of Glasgow soon after patented a process, and Syme gained no advantage from his discovery.
Syme’s early friendship with Liston led him to enter Barclay’s Extra-Academical classes in the winter of 1817-18. In the next winter, however, Syme followed Liston when he started on his own account, and assisted him in demonstrating from the beginning. He perseveringly continued studying, and in 1822 went to Paris to improve himself both in anatomy and operative surgery, gaining especial advantage from Lisfranc’s and from Dupuytren’s operations and instructions.
While demonstrating for Liston, Syme was pursuing his medical studies at the Royal Infirmary and elsewhere, and became impressed with the unwisdom of the repeated and severe blood-letting then in vogue. In 1823, having become a qualified surgeon, and entering into practice in Edinburgh, Syme performed his first striking operation—one which he himself designated as “the greatest and bloodiest in surgery”—namely, amputation at the hip-joint. Its success was an earnest of his future triumphs. In the same year Liston retired from teaching anatomy to devote himself entirely to surgery, and Syme occupied his place. The summer of 1824 was spent in studying surgery as practised in Germany. The same year a coldness which had been growing between Liston and Syme caused the withdrawal of the latter from association with Liston, and his starting a new school in Brown Square in partnership with Dr. Mackintosh. Here Syme taught anatomy and surgery, Dr. Mackintosh medicine and midwifery, and Dr. Fletcher physiology. The class in surgery numbered as many as fifty students. But the difficulties and scandals attending the due supply of subjects for dissection gradually disgusted Syme with the anatomical part of his work, and a quarrel with Dr. Mackintosh finally led to his quitting the Brown Square school, and devoting himself entirely to surgery. This was a bold stroke, seeing that he had four or five formidable competitors in Edinburgh, including Liston, Lizars, and Fergusson (afterwards Sir William). Yet so strikingly was he justified by the event, that in 1828-9 his class increased to 250, the largest ever assembled by any teacher of pure surgery in Edinburgh. Practice had been flowing in upon him, stimulated in 1826 by an important paper on the treatment of wounds, in which he insisted on the importance of providing a free outlet for all discharges instead of almost hermetically sealing them up, as was so frequently done. In 1827 he gave another evidence of his remarkable operative skill by successfully removing a huge tumour involving part of the lower-jaw bone, an operation which no other surgeon would undertake. Sixteen years afterwards the patient was met with, having his deformity well covered by a vigorous beard.