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

by Lindsey Fitzharris

Medical voyeurism was nothing new. It arose in the dimly lit anatomical amphitheaters of the Renaissance, where, in front of transfixed spectators, the bodies of executed criminals were dissected as an additional punishment for their crimes.

This sounds just as dingy and seedy as those porn theatres that sprung up in the Deuce in the 70s.

Theirs was a practical trade, one to be taught by precept and example. Many surgeons in the first decades of the nineteenth century didn’t attend university. Some were even illiterate.

This explains why British surgeons don't go by the the title "doctor".

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. It is the only surgery in history said to have had a 300 percent fatality rate.

Is it okay to laugh at this apocryphal story now? LOL.

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 staff was in place, Liston cut diagonally through the fibrous muscle of the scrotum until he reached the wooden staff. Next, he used the probe to widen the hole, ripping open the prostate gland in the process. At this point, he removed the wooden staff and used forceps to extract the stone from the bladder.

Thank fuck he did all of this in under a minute.

Patients worldwide came to further dread the word “hospital,” while the most skilled surgeons distrusted their own abilities.

That hasn't really changed.

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.

In stark contrast to how they are perceived today.

The best that can be said about Victorian hospitals is that they were a slight improvement over their Georgian predecessors. That’s hardly a ringing endorsement when one considers that a hospital’s “Chief Bug-Catcher”—whose job it was to rid the mattresses of lice—was paid more than its surgeons.

Yes, that does indeed tell quite a lot about these glorious institutes of medine.

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.” Some only admitted patients who brought with them money to cover their almost inevitable burial.

Grim.

Erysipelas was one of four major infections that plagued hospitals in the nineteenth century. The other three were hospital gangrene (ulcers that lead to decay of flesh, muscle, and bone), septicemia (blood poisoning), and pyemia (development of pus-filled abscesses).

Didn't even know about erysipelas until just now.

(That the name of a disease like malaria derives from the Italian words mala, or “bad,” and aria, or “air,” suggests that people believed the disease had miasmic origins.)

Etymologically speaking, that actually makes a lot of sense.

Wife-beating was a national pastime, and women like Julia were often treated like property by their husbands.

I believe the author when she said it was common but a national past time?

Between 1800 and 1850, there were more than two hundred recorded cases of wife sales in England. Undoubtedly, there were more that went unreported.

How was this legal?!

Syme’s method made it possible for the patient to bear weight on the ankle stump, which was a remarkable advancement in surgery, and his method was also easier and faster than amputating below the knee.

Obvious in hindsight?

When that procedure failed, Penman consulted Liston, who had recently made a name for himself by removing a forty-five-pound scrotal tumor from a patient at the Edinburgh Infirmary.

That is an insane amount of weight to carry around in your scrotum.

The twelfth-century city walls, built to protect Edinburgh’s residents, constrained the outward expansion of the Old Town. As a consequence, houses grew upward, reaching dangerous heights at a time when building regulations were far from rigorous. The district’s rickety structures could easily exceed ten stories, each level protruding and looming over the one before, so that the tops of these ramshackle buildings blocked out the sunlight. Those who lived on the ground floors were the poorest residents. They were surrounded by cattle and by open sewers that overflowed with human excrement just outside their front doors.

Glad I didn't visit it during the 19th century.

The unpalatable truth was that without the body snatchers and the thousands of corpses they had procured for anatomists during previous decades, Edinburgh would not have established its enviable global reputation for trailblazing surgery.

So a gruesome crime propelled medicine? Cool.

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.

As former national society staff, this made me feel proud to have been associated with the Movement.

On his visit to the city, the German philosopher and journalist Friedrich Engels observed, “I have seen human degradation in some of its worst phases, both in England and abroad, but I can advisedly say, that I did not believe, until I visited the wynds of Glasgow, that so large an amount of filth, crime, misery, and disease existed on one spot in any civilized country.” It was a place, he said, that “no person of common humanity to animals would stable his horse in.”

That sounds grim. Too bad I never got to visit Glasgow to be able to make a fair comparison. LOL

woman.” He also recommended to his students that they use “technical words” so that “nothing was said or suggested that could in any way cause them anxiety or alarm”—something that would undoubtedly be viewed as unethical today but was born purely of compassion when Lister suggested it.

That's actually very thoughtful and something that modern doctors should aspire for.

“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?”

More empathic behaviour from Lister.

And so he began subscribing to what was known in the 1860s as the “cleanliness and cold water” school of thought, which drew analogies between the tarnishing of silver and the infections caused by bad air. Advocates of this philosophy knew that if a person dipped a spoon in cold water, it would delay the formation of a sulfide coating. Using that same logic, they thought that by boiling water and letting it cool before washing both the instruments and the wound site, a surgeon could prevent postoperative infections from developing. Their emphasis on cold water specifically was meant to counteract the heat that they believed caused inflammation and fever.

This doesn't make a lick of sense to me.

Semmelweis saved many lives; however, he was not able to convince many physicians of the merits of his belief that incidences of puerperal fever were related to contamination caused through contact with dead bodies.

Something that would appear obvious to modern audiences.

The surgeon John Snow also began investigating the matter when a deadly outbreak occurred near his house in Soho, London, in 1854.

Another book I need to grab a hold of.

And yet the hard truth remained: delaying amputation would undoubtedly put Greenlees’s life in danger. If the boy developed a hospital infection as a result, sawing off his leg afterward might not be enough to stop the relentless pursuit of sepsis once it took hold. At the same time, Lister still believed that carbolic acid could stave off infection, and if it did, Greenlees’s leg—and his livelihood—could be saved. This was the opportunity he had been waiting for. Lister made a split-second decision. He would take his chances with the antiseptic.

An ethical dilemma that the good surgeon rightly noted but in the end, he still gambled with that child's life.

“The novelty,” he wrote, was “not the surgical use of carbolic acid (which I never claimed), but the methods of its employment with view of protecting the reparatory processes from disturbances by external agency.”

Exactly.

“Nature is here regarded as some murderous hag,” he wrote, “whose fiendish machinations must be counteracted. She must be entrapped into good behavior, she is no longer to be trusted.” Even the editor of The Lancet refused to use the word “germs,” instead calling them “septic elements contained in the air.” It was difficult for many surgeons at the height of their careers to face the fact that for the past fifteen or twenty years they might have been inadvertently killing patients by allowing wounds to become infected with tiny, invisible creatures.

Oops?

The ability to swallow then deserted him too, which was a fatal situation in an era when feeding tubes did not exist. It was clear that Syme was not going to recover this time. On June 26, 1870, “the Napoleon of Surgery” died.

Swallowing is an innate behaviour in babies. Those who didn't have it at this time would've, similarly, succumbed to death very soon.

As was customary during this time, students presented tickets inscribed with their names when they attended a lecture. This allowed an instructor to note absentees.

Old forms of attendance marking eh, Prof. Lister?

The term “catgut” is something of a misnomer. The type of cord is actually prepared from the intestines of sheep or goat, although sometimes it can be made from the innards of cattle, hogs, horses, mules, or donkeys.

Misnomer, I'll say.

If cross-contamination could not be controlled, he argued, then hospitals should be periodically destroyed and built anew.

That sounds expensive and untenable for obvious reasons.

The role of scientific knowledge and methodology in medical practice—which was central to the transition of the profession from a butchering art to a forward-looking discipline—had not yet been established. But the tide was turning in Lister’s favor.

It was only decades later that Lister abandoned the carbolic spray when the German physician and microbiologist Robert Koch developed a technique for staining and growing bacteria in a Petri dish (named after his assistant Julius Petri). This enabled Koch to match particular microorganisms to specific diseases and advance the theory that bacteria exist as distinct species, each producing a unique clinical syndrome. Using his method, Koch showed that airborne pathogens were not the main culprit of wound infection, which meant that sterilizing the air was futile.

This is why Lister is a central figure to whole history of surgical intervention in medicine.

Still, one nation remained unconvinced of the merits of Lister’s methods: the United States.

Of course, always the Americans.

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.

About err... bloody time.

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.

Did not know that.

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.

Not bad Mr Lister. Not bad at all!

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.

The Agnew Clinic portrays the embodiment of antisepsis and hygiene. It is Listerism, triumphant.

Need to look up this painting.

Lister wrongly believed that his personal story had little bearing on his scientific and surgical achievements. Ideas are never created in a vacuum, and Lister’s life very much attests to that truth. From the moment he looked through the lens of his father’s microscope to the day he was knighted by Queen Victoria, his life was shaped and influenced by his circumstances and the people around him. Like all of us, he saw his world through the prism of opinions held by those whom he admired most: Joseph Jackson, a supportive father and accomplished microscopist; William Sharpey, his instructor at UCL who encouraged him to go to Edinburgh; James Syme, his longtime mentor and father-in-law; and Louis Pasteur, the scientist who gave him the key needed to unlock one of the great medical mysteries of the nineteenth century.

A summary of the book, basically.