The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine

by Lindsey Fitzharris

Initially, his antiseptic system received more support on the Continent than it did in Britain, so much so that in 1870 Lister was asked by both the French and the Germans to furnish some guidelines for treating wounded soldiers fighting in the Franco-Prussian War. As a consequence, the German physician Richard von Volkmann became a spirited devotee after his hospital at Halle—overcrowded with wounded soldiers from the war and so dreadfully overcome with infection that its closure was imminent—achieved astonishing results by employing Lister’s methods. Following this, Lister’s system was taken up by other European surgeons, including a Dane named M. H. Saxtorph, who reported success in a letter to Lister. Armed with this testimony, Lister goaded the surgeons in London who had been the most critical of his antiseptic treatment: “It may seem strange that results like these should have been obtained in Copenhagen, when so little approach to them has yet been made in the capital of England.”

as Lister was changing Victoria’s dressings, he noticed that pus had formed underneath the linen that he had placed over the surgical wound. Lister needed to act quickly to prevent infection from setting in. Spying the atomizer, he had an idea. He took the rubber tubing off the apparatus, soaked it overnight in carbolic acid, and inserted it into the wound the following morning in order to drain the pus. The following day, Lister’s nephew wrote that his uncle “rejoiced to find nothing escape [from the wound] unless it were a drop or so of clear serum.” Lister himself later claimed that this was the first time he used such a drain. His ingenious ad hoc invention, along with his application of antiseptic methods, undoubtedly saved Victoria’s life.

In a letter that appeared in The Lancet, a correspondent who signed his name “Flaneur” made a perceptive observation regarding the city’s slow adoption of antisepsis: The truth is, that this is a question in science rather than in surgery, and hence, while eagerly adopted by the scientific Germans, and a little grudgingly by the semi-scientific Scotch, the antiseptic doctrine has never been in any degree appreciated or understood by the plodding and practical English surgeon. Happily for his patients, he has for a long time been to a considerable extent practising a partially antiseptic system, thanks to his cleanly English instincts; but it has been like the lady who talked prose without knowing it. It was easier for Lister to convince doctors in Glasgow and Edinburgh of the value of his antiseptic system because each of those cities had one hospital and one university at its heart. London’s medical community was far more fragmented and less scientifically minded.

Wards adhering to his system were celebrated by many for their “fresh, healthy atmosphere” and an “absence of any smell,” while The Lancet characterized his progress through the university towns of Germany, where his system was particularly popular, as a triumphal march. Still, one nation remained unconvinced of the merits of Lister’s methods: the United States. In fact, in several American hospitals, Lister’s techniques had been banned; many doctors saw them as unnecessary and overly complicated distractions because they had not yet accepted the germ theory of putrefaction. Even by the mid-1870s, understanding of wound care and infection had barely progressed, despite Lister’s theories and techniques appearing in American medical journals. The medical community had, for the most part, rejected his antiseptic methods as quackery.

Before heading back to Britain, Lister moved on to Boston, and it would prove to be a serendipitous visit. There, he met Henry J. Bigelow, the man who had banned his antiseptic techniques at Massachusetts General Hospital. Bigelow hadn’t attended the medical conference in Philadelphia, but he had read reports about Lister’s lecture. Although he still wasn’t convinced about the existence of germs, he was impressed by Lister’s dedication to his system and the care and attention he paid his patients. Bigelow invited Lister to speak at Harvard University, where he was warmly received by the medical students in attendance. Not long afterward, the American surgeon delivered a lecture of his own. In it, he praised “the new doctrine” and confessed his conversion to Lister’s antiseptic system: “I have learned that the duty of the surgeon … should be to destroy the actual intruders [germs], and effectually to exclude their thronging companions.” With Bigelow’s endorsement, Massachusetts General became the first hospital in America to make institutional use of carbolic acid as a surgical antiseptic. It was an extraordinary volte-face of policy in a hospital that for years had banned Lister’s methods and even threatened to fire those who dared implement them.

In September 1877, Lister slipped quietly away from the Scottish city where he had first fallen in love with the bloodied and butchering art of surgery under the tutelage of his great mentor, James Syme. But just before boarding the train, he made a valedictory check upon his final intake of patients at the Royal Infirmary. As he walked the hallways one last time, he took stock of the institute’s marked transformation. He was confident that it would be safe in the hands of his disciples, who would now be entrusted with implementing his antiseptic system throughout the hospital. Gone were the filthy wards crammed with patients wasting away in squalid conditions; gone were the bloodied aprons and the operating tables soiled with bodily fluids; and gone were the unwashed instruments, all of which once had the operating theater reeking of “good old hospital stink.” The Royal Infirmary was now bright, clean, and well ventilated. No longer a house of death, it was a house of healing.

LISTER LIVED FOR MANY DECADES after his theories and techniques had been accepted, and he was eventually celebrated as a hero of surgery. He was appointed personal surgeon in ordinary to Queen Victoria—the term “in ordinary” signaling that it was a permanent position. In the final decades of his life, official accolades came thick and fast. He was awarded honorary doctorates from the Universities of Cambridge and Oxford. He was awarded the Boudet Prize for the single greatest contribution to medicine.

The burgeoning awareness of microbes intensified the Victorian public’s preoccupation with cleanliness, and a new generation of carbolic acid cleaning and personal hygiene products flooded onto the market. Perhaps the most famous of these was Listerine, invented by Dr. Joseph Joshua Lawrence in 1879.

Among the more surprising offshoots of Lister’s work was the establishment of one of the most recognizable corporations in the world today. Like the inventor of Listerine, Robert Wood Johnson first became aware of antisepsis when he attended Lister’s lecture at the International Medical Congress in Philadelphia. Inspired by what he had heard that day, Johnson joined forces with his two brothers James and Edward, and founded a company to manufacture the first sterile surgical dressings and sutures mass-produced according to Lister’s methods. They named it Johnson & Johnson.

The adoption of Lister’s antiseptic system was the most prominent outward sign of the medical community’s acceptance of a germ theory, and it marked the epochal moment when medicine and science merged.