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

by Lindsey Fitzharris

“We are going to try a Yankee dodge today, gentlemen, for making men insensible!”

At six feet two, Liston was eight inches taller than the average British male. He had built his reputation on brute force and speed at a time when both were crucial to the survival of the patient.

Liston could remove a leg in less than thirty seconds, and in order to keep both hands free, he often clasped the bloody knife between his teeth while working.

Liston’s speed was both a gift and a curse. Once, he accidentally sliced off a patient’s testicle along with the leg he was amputating. His most famous (and possibly apocryphal)

mishap involved an operation during which he worked so rapidly that he took off three of his assistant’s fingers and, while switching blades, slashed a spectator’s coat. Both the assistant and the patient died later of gangrene, and the unfortunate bystander expired on the spot from fright. I...

Sixty years later, Pace would recount the story to medical students at University College London—the horror of the experience, no doubt, fresh in his mind as he sat in the very hospital in which he had lost his leg.

Like many surgeons operating in a pre-anesthetic era, Liston had learned to steel himself against the cries and protests of those strapped to the blood-spattered operating table.

On one occasion, Liston’s patient, who had come in to have a bladder stone removed, ran from the room in terror and locked himself in the lavatory before the procedure could begin. Liston, hot on his heels, broke the door down and dragged the screaming patient back to the operating room. There, he bound the man fast before passing a curved metal tube up the patient’s penis and into the bladder. He then slid a finger into the man’s rectum, feeling for the stone. Once Liston had located it, his assistant removed the metal tube and replaced it with a wooden staff, which acted as a guide so the surgeon wouldn’t fatally rupture the patient’s rectum or intestines as he began cutting deep into the bladder. Once the sta...

gland in the process. At this point, he removed the wooden staff and used forceps to extract the stone from the bladder. Liston—who reportedly had the fastest knife in the West E...

The surgeon was very much viewed as a manual laborer who used his hands to make his living, much like a key cutter or plumber today. Nothing better demonstrated the inferiority of surgeons than their relative poverty. Before 1848, no major hospital had a salaried surgeon on its staff, and most surgeons (with the exception of a notable few) made very little money from their private practices.

The extremely poor were forced to live in “cellar homes,” permanently shut off from sunlight. The rats gnawed at the faces and fingers of malnourished infants, many of whom died in these dark, fetid, and damp surroundings.

Arrangements for the disposal of human waste were equally rudimentary before the passing of the Public Health Act in 1848, which established the centralized General Board of Health and initiated a sanitarian revolution. Before then, many streets in London were effectively open sewers, releasing powerful (and often deadly) amounts of methane.

Even the increased number of water closets between 1824 and 1844 did little to solve the problem. Their construction forced landlords to hire men to remove “night soil” from overflowing cesspools in the city’s buildings. An entire underground army of “bone boilers,” “toshers,” and “mud-larks” developed to exploit the tide of human waste underneath the city.

The business conducted elsewhere wasn’t any more wholesome. Fat boilers, glue renderers, fellmongers, tripe scrapers, and dog skinners all went about their malodorous tasks in some of the most densely populated areas of the city.

Bloomsbury, the area surrounding the university where Lister would spend his time as a student, for example, had the pleasing aura of a freshly scrubbed baby. It was in a constant state of flux, growing at such a rapid pace that those who moved there in 1800 would hardly recognize it just a few decades later.

“Not a single session has passed over our heads since I was appointed to my office among you, that has not paid its tax of life to the great Reaper, whose harvest is always ready, whose sickle is never weary.”

These so-called pinprick cuts were a fast way to an early grave. The dangers were always present, even for the most experienced anatomists. Death was often inescapable for those trying their hardest to prevent it.

It wasn’t long before Lister experienced the physical dangers of his occupation. He was ensconced in his medical studies when he noticed tiny white pustules on the backs of his hands. It could only be one thing: smallpox.

John survived but developed an unrelated brain tumor shortly afterward. He suffered for several years—first losing his eyesight, then the function of his legs—before finally dying in 1846 at the age of twenty-three.

Hodgkin watched in astonishment as his friend stood up in the silent prayer meeting and said: “I will be with thee & keep thee: fear thou not.” The only Quakers permitted to speak at meetings were ministers.

Instead, he urged Lister to continue with his medical studies and please God by helping the sick. Yet Lister slipped deeper and deeper into depression. Unable to function, he left UCL abruptly in March 1848.

the theory held that the best way to treat a disease was to produce the somatic condition opposite to the pathological state in question. With a fever, for instance, one had to cool the body down. With disorders of the mind, one had to restore strength and firmness to the patient’s frayed nerves.

“Naturopathy”—the treatment of disease through the promotion of the body’s own healing powers—also played a significant role in Victorian medicine.

In 1849, he overcame his inner demons and reenrolled at UCL, where a passion for surgery was reborn in him.

Despite these changes—or because these enlargements suddenly brought hundreds of patients into proximity with one another—hospitals were known by the public as “Houses of Death.

The surgeon James Y. Simpson remarked as late as 1869 that a “soldier has more chance of survival on the field of Waterloo than a man who goes into hospital.”

Hospital discovered mushrooms and maggots thriving in the damp, dirty sheets of a patient recovering from a compound fracture. The afflicted man, believing this to be the norm, had not complained about the conditions, nor had any of his fellow ward mates thought the squalor especially noteworthy. Worst of all was the fact that hospitals constantly reeked of piss, shit, and vomit. A sickening odor permeated every surgical ward. The smell was so offensive that doctors sometimes walked around with handkerchiefs pressed to their noses. It was this affront to the senses that most tested surgical students on their first day in the hospital.

“There cannot always be fresh fields of conquest by the knife; there must be portions of the human frame that will ever remain sacred from its intrusions, at least in the surgeon’s hands. That we have already, if not quite, reached these final limits, there can be little question. The abdomen, the chest, and the brain will be forever shut from the intrusion of the wise and humane surgeon.”

The editor of The Times criticized the lenient sentences handed out by magistrates of the court to abusive husbands, opining that the “conjugal tie appears to be considered as conferring on the man a certain degree of impunity for brutality towards the woman.”

Most hospitals had a “taking-in day” designated for admitting new patients onto the wards. This might happen only once a week.

In the nineteenth century, almost all the hospitals in London except the Royal Free controlled inpatient admission through a system of ticketing. One could obtain a ticket from one of the hospital’s “subscribers,” who had paid an annual fee in exchange for the right to recommend patients to the hospital and vote in elections of medical staff. Securing a ticket required tireless soliciting on the part of potential patients, who might spend days waiting and calling upon the servants of subscribers and begging their way into the hospital. Preference was given to acute cases. “Incurables”—people with cancer or tuberculosis, for instance—were turned away, as were people with venereal infections.

Charles Dickens wrote of the Old Bailey, “Nothing is so likely to strike the person who enters [the courts] for the first time, as the calm indifference with which the proceedings are conducted; every trial seems a mere matter of business.” Lawyers, jury members, and court watchers lounged on hard wooden benches, reading the morning newspapers and conversing in low whispers. Some dozed off while waiting for the next case to be called. The atmosphere of nonchalance that pervaded the court could be deeply unsettling to the uninitiated. An outsider could have been forgiven if he missed the fact that the verdicts given at the Old Bailey were frequently carried out at the end of a rope.

Mr. Larecy, for instance, who had been working between ten and fifteen hours each day since he was a young boy. He came onto the wards suffering from a severe attack of what was known as “painter’s colic,” a chronic intestinal disorder caused by overexposure to the lead found in paint.

Over the summer, two people came onto Lister’s wards with sunken eyes, ghostly pale skin, and tooth loss—the telltale signs of scurvy. Doctors didn’t yet understand that scurvy was brought on by a lack of vitamin C, which the human body is unable to synthesize for itself.

Over time, Lister developed a practiced eye for the varying signs of sexually transmitted diseases.

There was also the world’s first major installation of public flushing toilets, designed by the Victorian sanitary engineer George Jennings. Some 827,280 people paid one penny to use the facilities during the exhibition, which gave rise to the popular euphemism “spending a penny.”

In 1884, the American physician William Pancoast injected sperm from his “best-looking” student into an anesthetized woman—without her knowledge—whose husband had been deemed infertile. Nine months later, she gave birth to a healthy baby. Pancoast eventually told her husband what he had done, but the two men decided to spare the woman the truth. Pancoast’s experiment remained a secret for twenty-five years. After his death in 1909, the donor—a man ironically named Dr. Addison Davis Hard—confessed to the underhanded deed in a letter to Medical World.)

A silence fell upon the theater for several seconds, before the spell was broken by the crowd erupting into riotous cheers and hurrahs for the two surgeons.

The dressers and clerks dubbed Syme “the Master” and Lister “the Chief”—a term of endearment that stuck with him for the rest of his life.

Florence Nightingale—the woman who would later revolutionize nursing—had not yet fully developed the protocols of cleanliness for which she would become celebrated. Furthermore, it would be another nine years before the founding of the International Red Cross, which would be instrumental in training nurses in the latter half of the nineteenth century.

Like most hospitals in the 1860s, the Royal Infirmary attracted patients who were too poor to pay for private care. Some were uneducated and illiterate. Many doctors and surgeons viewed them as socially inferior and treated them with a clinical detachment that was often dehumanizing.

One of his students later recounted a time when Lister admonished an instrument clerk who had brought an uncovered tray full of knives into the operating theater. The seasoned surgeon quickly threw a towel over the tray and said in slow, sorrowful tones, “How can you have such cruel disregard for this poor woman’s feelings? Is it not enough for her to be passing through this ordeal without adding unnecessarily to her sufferings by displaying this array of naked steel?”

“Every patient, even the most degraded, should be treated with the same care and regard as though he were the Prince of Wales himself.”

He concluded that blood coagulation is caused by “the influence exerted upon it by ordinary matter, the contact of which for a very brief period effects a change in the blood, inducing a mutual reaction between its solid and fluid constituents, in which the corpuscles impart to the liquor sanguinis a disposition to coagulate.”

The surgeon John Snow also began investigating the matter when a deadly outbreak occurred near his house in Soho, London, in 1854. Snow started plotting cases on a map, and that was when he noticed that a majority of people who fell ill were receiving their water from a pump on the southwest corner of the intersection of Broad (now Broadwick) Street and Cambridge (now Lexington) Street.

The problem of hospital infection had vexed Lister for so long that he wondered if he would ever find a solution to it. But since his conversation with Professor Anderson about Pasteur’s latest research on fermentation, he felt a renewed optimism.

The research with which Lister was familiarizing himself began nine years earlier when a local wine merchant approached Pasteur with a problem.

And because Pasteur believed that life alone was responsible for asymmetry, he had to conclude that fermentation was a biological process and that the yeast that helped produce wine was a living organism.

To say that the yeast acted on the beetroot juice because it was a living organism was to go against the very tenets of mainstream chemistry in the mid-nineteenth century.

His experiments established what is now considered one of the cornerstones of biology: Only life begets life.