Fastest Knife in the West

By CodingStrategies on July 9th, 2018

The first cartoon featuring the Road Runner and his nemesis, Wyle E. Coyote, appeared in 1948 and there were 48 cartoon episodes plus a half-hour special that included this Warner Brothers character favorite. The illustrator admitted that there were rules for this speedy earth-bound avian, such as “no outside force can harm the coyote, only his own ineptitude or the failure of the Acme products.” In general, the coyote was more humiliated than harmed by his failure to catch the Road Runner, and gravity was typically his greatest enemy. He was often pictured with a tiny umbrella over his head in an attempt to hold off a falling anvil. The Road Runner typically uttered his only vocalization just before streaking away, the iconic “Beep-Beep!” Speed was the weapon of the Road Runner, making it possible for him to avoid danger in whatever form imagined by the crafty coyote.

Robert Liston was born on October 28, 1794 in Ecclesmachan, Scotland, and became a surgeon known for his skill in an era prior to anesthesia. Described as “the fastest knife in the West End,” he was particularly skilled at amputations. Cutting and sawing on a conscious, shrieking, desperately fighting patient took strong nerves and a stronger stomach, along with multiple medical assistants who took on the job of holding the patient down. The shorter the operation, the lesser the suffering of the patient and the greater the chance that the patient would survive.

Liston could amputate a leg in 2.5 minutes and was reputed to have been able to complete operations in a matter of seconds at a time when such speed was essential. Liston was six foot two inches tall, and operated in a bottle-green coat with wellington boots, generally covered by a bloody apron. He would arrive in surgery with a collection of knives and saws, and would challenge the students or other observers in the operating theater to record the time required, often holding a bloody knife between his teeth to free his hands to use a bone saw.

His style may have seemed arrogant, but in the age before anesthesia speed was essential and only about one in every 10 of Liston’s patients died on the operating table at London’s University College Hospital. In fact, patients sometimes had to camp out in his waiting room for days to see him. In addition to speed, Liston was a highly regarded surgical instructor and prolific inventor. Some of his creations, such as Liston’s splint and bulldog locking forceps, are available today. He also published two medical texts, The Elements of Surgery and Practical Surgery.

Dr. Richard Gordon, a surgeon and medical historian, wrote a book in 1983 that includes descriptions of four of Liston’s most famous cases, including the 4-minute removal of a 45 pound scrotal tumor whose owner carried it around in a wheelbarrow (ICD-10-CM code D49.59, Neoplasm of unspecified behavior of other genitourinary organ). In another notable case, Liston lanced a lesion on the neck of a small boy which turned out to be an aneurysm (I72.0, Aneurysm of carotid artery); unfortunately, the patient did not survive this procedure. In his second most famous case, he amputated a leg in 2.5 minutes, but in his enthusiasm and desire to move quickly, he removed the patient’s testicles as well (Z90.79, Acquired absence of other genital organs).

Which brings us to Liston’s most famous case, another leg amputation due to a crushing injury (S87.80XA, Crushing injury of unspecified lower leg, initial encounter). Dr. Liston did indeed amputate the offending limb and completed the amputation in less than 2 minutes, but the patient died afterwards from gangrene (T87.89, Other complications of amputation stump; and I96, Gangrene, not otherwise specified). In addition to amputating the patient’s leg, he accidentally amputated the fingers of his young assistant, who also died afterwards from hospital gangrene (S68.128A, Partial traumatic metacarpophalangeal amputation of other finger, initial encounter). Last, while rapidly switching instruments he slashed through the coattails of a distinguished surgical spectator who was standing too close to the operation. This gentleman was so terrified that the knife had pierced a vital organ, he dropped dead from terror (R99, Ill-defined and unknown cause of mortality). The death of the patient and two other individuals during the same procedure makes this the only operation in history with a 300 percent mortality rate.

Toward the end of his career, Liston made medical history while at the same time making his hasty surgical style obsolete. In 1846 Liston operated on a patient named Frederick Churchill, and on the day of the surgery he walked into the operating room and pulled out a jar instead of a knife or stopwatch. American doctors and dentists had recently demonstrated that ether could be used as a surgical anesthetic. From this point on, as anesthetics continued to improve, speed would no longer be a hurdle to successful surgery, and urgency would not be the surgeon’s greatest asset. This only goes to prove the old adage, “The race is not always to the swift, but to those who keep on running.”