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

by Lindsey Fitzharris

Between 1795 and 1860, three doctors put forward the idea that puerperal (or childbed) fever—which, like sepsis, was accompanied by both localized and systemic inflammation—was caused not by miasma but by materies morbi (morbid substances) transmitted from doctor to patient. Each believed the disease could be prevented by following strict rules of cleanliness in the hospitals.

And then there was Ignaz Semmelweis, who solved the problem of how to prevent childbed fever in Vienna at the same time Holmes was writing about it in America. Semmelweis, who was working as an assistant physician at the city’s General Hospital, noticed a discrepancy between the hospital’s two obstetric wards. One was attended by medical students, while the other was under the care of midwives and their pupils. Although each ward provided identical facilities for its patients, the one that was overseen by the medical students had a significantly higher mortality rate, by a factor of three.

In 1847, one of his colleagues died after cutting his hand during a postmortem examination. To his surprise, the Hungarian physician realized that the disease that had killed his friend was identical to puerperal fever.

Believing that puerperal fever was caused not by miasma but by “infective material” from a dead body, Semmelweis set up a basin filled with chlorinated water in the hospital. Those passing from the dissection room to the wards were required to wash their hands before attending to living patients. Mortality rates on the medical students’ ward plummeted. In April 1847, the rate was 18.3 percent. After hand-washing was instituted the following month, rates in June were 2.2 percent, followed by 1.2 percent in July and 1.9 percent in August.

After a number of negative reviews of a book he published on the subject, Semmelweis lashed out at his critics. His behavior became so erratic and embarrassing to his colleagues that he was eventually confined to a mental institute, where he spent his final days raging about childbed fever and the doctors who refused to wash their hands. In fact, Semmelweis’s methods and theories had little impact on the medical community.

“It is a common observation that, when some injury is received without the skin being broken, the patient invariably recovers and that without any severe illness. On the other hand trouble of the gravest kind is always apt to follow, even in trivial injuries, when a wound of the skin is present. How is this? The man who is able to explain this problem will gain undying fame.”

UPON INQUIRING AFTER THE WELFARE of one of his patients, a surgeon at Guy’s Hospital in London was informed by his assistant that the man in question had died. The surgeon, who had become inured to this kind of news, replied, “Oh, very well!” He moved on to the next ward to ask about another patient. Again, the answer came, “Dead, sir.” The surgeon paused a moment. Frustrated, he cried, “Why, they’re not all dead?” To this, his assistant responded, “Yes, sir, they are.” Scenes like this were playing out all over Britain. Mortality rates within hospitals had reached an all-time high by the 1860s. Efforts to clean up the wards had made little impact on incidences of hospitalism.

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. Lister immediately sought out Pasteur’s publications on the decomposition of organic material, and with the help of Agnes he began replicating the French scientist’s experiments in his laboratory at home. For the first time, the answer was within his reach.

Pasteur’s conclusions were bold. 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. While the guardians of the old paradigm were willing to accept the presence of microorganisms in fermentable substances, they only did so on the basis that these microorganisms arose spontaneously as part of the fermenting process.

From these experiments, Pasteur finally proved that microbes were not generated spontaneously; otherwise, the flask with the curved neck would have become reinfected. His experiments established what is now considered one of the cornerstones of biology: Only life begets life.

Fortunately for Pasteur, his work had already begun to attract the attention of a select few within the medical community, like Sir Thomas Spencer Wells, surgeon to Queen Victoria. Wells spoke of Pasteur’s latest work on fermentation and putrefaction in an address to the British Medical Association in 1863, a year before it came to Lister’s attention.