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April 19 - April 23, 2019
In the 1840s, operative surgery was a filthy business fraught with hidden dangers. It was to be avoided at all costs. Due
The physician Thomas Percival advised surgeons to change their aprons and to clean the table and instruments between procedures, not for hygienic purposes, but to avoid “every thing that may incite terror.” Few heeded his advice. The surgeon, wearing a blood-encrusted apron, rarely washed his hands or his instruments and carried with him into the theater the unmistakable smell of rotting flesh, which those in the profession cheerfully referred to as “good old hospital stink.”
At a time when surgeons believed pus was a natural part of the healing process rather than a sinister sign of sepsis, most deaths were due to postoperative infections.
Surgeons still lacking an understanding of the causes of infection would operate on multiple patients in succession using the same unwashed instruments on each occasion.
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.
Churchyards were bursting at the seams with human remains, posing huge threats to public health. It was not uncommon to see bones projecting from freshly turned ground.
Before then, many streets in London were effectively open sewers, releasing powerful (and
Instruments like the amputation knife of Lister’s student days were havens for bacteria. Fashion often trumped function. Many had decorative etchings and were stored in velvet cases, which bore bloodstains from past operations.
also warned future medical students about the poisonous effects of a slight wound or crack in the skin made by the dissecting knife. These so-called pinprick cuts were a fast way to an early grave.
The living, in the form of diseased patients, were also taking a toll on those on the front line of medicine. Mortality rates among medical students and young doctors were high. Between 1843 and 1859, forty-one young men died after contracting fatal infections at St. Bartholomew’s Hospital,
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.
Pregnant women who suffered vaginal tears during delivery were especially at risk in these dangerous environments because these wounds provided welcome openings for the bacteria that doctors and surgeons carried on them wherever they went.
In England and Wales in the 1840s, approximately 3,000 mothers died each year from bacterial infections such as puerperal fever (also known as childbed fever).
Preference was given to acute cases. “Incurables”—people with cancer or tuberculosis, for instance—were turned away, as were people with venereal infections.
The pain, of course, was excruciating, and the procedure carried with it no guarantee of survival, especially because the patient would have to convalesce on a poorly ventilated ward of a Victorian hospital crawling with bacteria and other germs.
Before the Pharmacy Act of 1868 limited the sale of dangerous substances to qualified druggists, a person could buy opium from just about anyone, from barbers and confectioners to ironmongers, tobacconists, and wine merchants.
Due to the mounting pressure of London’s overcrowded prisons, 162,000 convicts were transported to Australia between 1787 and 1857. Seven out of eight of these were men. Some were as young as nine, others as old as eighty.
The convicts were first sent to hulks, or floating prisons, on the Thames. The conditions on these decommissioned, rotting ships were horrendous, and even the hospitals could not compete with them as breeding grounds for disease. Prisoners were locked in cages belowdecks in appalling surroundings.
During cholera outbreaks, the chaplain often refused to bury the dead until there was deemed to be a sufficient quantity of bloated, decomposing corpses of which to dispose. If a prisoner survived the hulks, he was shipped to Australia.
One in three died on the grueling sea passage, which could take as long as eight months.
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. This was a growing problem for an industrializing nation with increasing numbers of people entering workplaces that exposed them to chemicals and metals.
Bronchitis, pneumonia, and a variety of other respiratory diseases put many of the working class into an early grave.
effects of diet on the health of the city’s laborers. Besides consuming large quantities of beer on a daily basis, nearly all of his patients ate huge amounts of cheap meat but very few vegetables or portions of fruit. Over the summer, two people came onto Lister’s wards with sunken eyes, ghostly pale skin, and tooth loss—the telltale signs of scurvy.
pockmarked the body in the later stages of the disease, many victims endured paralysis, blindness, dementia, and “saddle nose,” a grotesque deformity that occurs when the bridge of the nose caves into the face. (Syphilis was so common that “no nose clubs” sprang up all over London. One newspaper reported that “an eccentric gentleman, having taken a fancy to see a large party of noseless persons, invited every one thus afflicted, whom he met in the streets, to dine on a certain day at a tavern, where he formed them into a brotherhood.”
Many treatments for syphilis involved the use of mercury, which could be administered in the form of an ointment, a steam bath, or a pill.
Frequently, people died from mercury poisoning before they died of the disease itself.
when the only bodies that could be legally obtained for dissection were those of hanged murderers.
With the proliferation of private medical schools, there simply weren’t enough bodies to go around. As a result, the city was crawling with body snatchers, or “resurrectionists” as they were sometimes called.
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.
“Every patient, even the most degraded, should be treated with the same care and regard as though he were the Prince of Wales himself.”
After Lister treated and dressed her wound, the girl held up her doll to him. He gently took the toy from her and noticed that it was missing its tiny leg. The girl fumbled around under her pillow and—much to Lister’s amusement—produced the severed limb. He shook his head ominously as he inspected his newest patient. Lister turned to Guthrie and asked for a needle and cotton.
To ensure the patient’s comfort, he would arrange an assortment of small pillows and hot-water bottles, warning his attendees that the latter should be covered with flannel so the anesthetized person would not inadvertently burn him- or herself during recovery.
Lister’s focus on cleanliness was still linked to his belief that outbreaks of hospitalism were due to the poisonous atmosphere on the wards.
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.
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.
Cholera, in particular, had become increasingly difficult to explain within a miasmic paradigm. There had already been three major outbreaks in recent decades that had claimed the lives of nearly 100,000 people in England and Wales alone.
Like Budd, Snow concluded that cholera was transmitted through contaminated water supplies, not by poisonous gases or miasmas in the air. He published a map of the epidemic to support his theory. Despite strong skepticism from the local authorities, Snow was able to persuade them to remove the handle from the Broad Street pump, after which the outbreak quickly subsided.
Pasteur had conducted a number of experiments that demonstrated that germs could be destroyed in three ways: by heat, by filtration, or by antiseptics.
With Bigelow’s endorsement, Massachusetts General became the first hospital in America to make institutional use of carbolic acid as a surgical antiseptic.
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.”
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
He was awarded honorary doctorates from the Universities of Cambridge and Oxford.
He was also knighted and made a baronet; he was elected president of the Royal Society; he was raised to the peerage and titled Lord Lister of Lyme Regis;
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.
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.
Lister recognized the importance of the hospital, but only in relation to the care and treatment of the poor.
