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

by Lindsey Fitzharris

The instrument case of a newly qualified surgeon consisted of knives, bone saws, forceps, probes, hooks, needles, ligatures, and lancets, the latter being especially important given the persistent popularity of bloodletting in the Victorian period. Many surgeons also carried pocket cases of instruments with them, which they used for minor procedures, usually when making house calls.

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.

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.

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. Without this status, it is unlikely that Lister would have gone out of his way to travel there to meet Professor Syme as a prelude to setting out on his Continental tour to visit Europe’s medical institutes.

A new and great scientific discovery is always apt to leave in its trail many casualties among the reputations of those who have been champions of an older method. It is hard for them to forgive the man whose work has rendered their own of no account.

“Anything that leads a man to think it a matter of indifference whether he writes or tells a lie is most pernicious,” Lister wrote; “he comes to write lies afterwards with the same indifference.

His reports in The Lancet might not have been enough to convince some surgeons of the validity of the germ theory, but his students saw with their own eyes the antiseptic system working every time they accompanied him onto the wards. If seeing was believing, Lister was creating a group of disciples: men who would graduate and spread his ideas beyond the narrow confines of the university. His followers, who later became known as the “Listerians,” soon came to dominate the institutions and ideology of British surgery, spreading the doctrine of antisepsis with a reverential devotion.

Lister’s students—who might attend a demonstration with their minds settled on one technique, only to discover that their professor had already developed a new method since their last encounter—came to expect these changes. For them, it underlined the value of experimentation in medicine and illustrated that observational acuity and accuracy could lead to improvements in surgery.

There was one group who never doubted Lister’s antiseptic treatment: the people who survived because of it.

To bring about a change in American attitudes, Lister knew he would need to evangelize for his work in person.

Of course, a man changing the course of history is never without his detractors.

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.

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 paid tribute to the French scientist during his address. In his typically humble way, he downplayed his own role in the transformation of surgery. Instead, Lister credited Pasteur with “raising the dark curtain” in medicine. “You have changed Surgery … from being a hazardous lottery into a safe and soundly-based science,” he said of Pasteur. “You are the leader of the modern generation of scientific surgeons, and every wise and good man in our profession—especially in Scotland—looks up to you with respect and attachment as few men receive.

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. Lawrence had attended Lister’s lecture in Philadelphia, which inspired him to begin manufacturing his own antiseptic concoction in the back of an old cigar factory in St. Louis shortly thereafter. Lawrence’s formula contained thymol (derived from phenol) in addition to eucalyptol and menthol. It also had an alcohol concentration of 27 percent. Nothing would have come of Listerine had the entrepreneurial pharmacist Jordan Wheat Lambert not recognized its potential when he met Lawrence in 1881. Lambert bought the rights to the product and its formula from the good doctor and began marketing it as an antiseptic with multiple uses, including as a dandruff treatment, a floor cleaner, and even a cure for gonorrhea. In 1895, Lambert promoted Listerine to the dental profession as an oral antiseptic, a use for which it has achieved immortality. Other products that sprang up in the wake of the antiseptic mania included carbolic soap, carbolic general disinfectants (often simply neat phenol sold in bottles with instructions printed on them), and carbolic tooth powder. Calvert’s Carbolic Tooth Paste became a household favorite and even attracted the patronage of Queen Victoria. In the Uni...

“Lister’s work … came in the nick of time. It saved not only patients but hospitals. It prevented … an entire reversion of the method of dealing surgically with the poor.