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June 9 - June 27, 2025
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.
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. Operating theaters were gateways to death. It was safer to have an operation at home than in a hospital, where mortality rates were three to five times higher than they were in domestic settings.
Being treated at home, however, was expensive.
They themselves were bookish types with very little practical training who used their minds, not their hands, to treat patients. Their education was rooted in the classics. It was not uncommon during this period for physicians to prescribe treatment without first performing a physical examination. Indeed, some dispensed medical advice through letters alone, never laying eyes on the patient in question.
as Lister made his way through the crowds of men shaking hands and congratulating themselves on their choice of profession and this notable victory, he was acutely aware that pain was only one impediment to successful surgery. He knew that for thousands of years, the ever-looming threat of infection had restricted the extent of a surgeon’s reach.
Surviving the operation was one thing. Making a full recovery was another.
the two decades immediately following the popularization of anesthesia saw surgical outcomes worsen. With their newfound confidence about operating without inflicting pain, surgeons became ever more willing to take up the knife, driving up the incidences of postoperative infection and shock. Operating theaters became filthier than ever as the number of surgeries increased. 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 more crowded the operating theater became, the
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With Robert Liston’s ether triumph, Lister had just witnessed the elimination of the first of the two major obstacles to successful surgery—that it could...
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Life was a gift to be employed in honoring God and helping one’s neighbor, not in the pursuit of frivolities. Because of this, many Quakers turned to scientific endeavors, one of the few pastimes allowed by their faith.
Very few people who purchased a microscope during this period did so for serious scientific purposes.
He believed that administering foreign substances to the body was unnecessary and sometimes downright life-threatening. In an age when most medicinal concoctions contained highly toxic drugs like mercury and arsenic, Joseph Jackson’s ideas might not have been too wide of the mark.
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 curriculum at UCL would be as radical as the secular foundations on which it was built, the founders decided.
In keeping with his father’s wishes, Lister completed an arts degree first, which was akin to a modern-day liberal arts foundation, consisting of a variety of courses in history, literature, mathematics, and science. This was an unconventional route into surgery because most students bypassed this step altogether in the 1840s and jumped right into a medical degree. Later in life, Lister would credit his broad background for his ability to connect scientific theories to medical practice.
At the time, the term “medical student” had become a “by-word for vulgar riot and dissipation,” according to the physician William Augustus Guy.
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,
Many of Lister’s instructors still believed the microscope was not only superfluous to a study of surgery but also a threat to the medical establishment itself. Even with improvements like Joseph Jackson’s achromatic lens, the instrument continued to be regarded with suspicion by those within the medical community, many of whom lacked the skill and training to operate one effectively. What revelations did the microscope offer? Surely all relevant signs and symptoms could be observed with the naked eye. And could any of these microscopic discoveries actually lead to the effective treatment of
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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.
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.”
very few felt any need to address an issue that they saw as inevitable and commonplace. Most surgeons were interested in the individual bodies of their patients, not hospital populations and statistics. They were largely unconcerned with the causes of diseases,
Between 1800 and 1850, there were more than two hundred recorded cases of wife sales in England. Undoubtedly, there were more that went unreported.
There was little legal protection for a victimized woman in the mid-nineteenth century. The editor of The Times criticized the lenient sentences handed out by magistrates
The general populace had grown so accustomed to the idea that men were allowed to beat women and children that it practically sanctioned this behavior.
This was an age in which matters of life and death constituted public entertainment.
Surviving the knife was only half the battle.
Lister took to Sharpey immediately. He saw in him a man similar to his own father. The physiology professor valued experiment and observation over authority, a characteristic that was unusual in its day.
The Royal Free Hospital was founded by the surgeon William Marsden in 1828 to provide free care (as the name suggested) to those who could not afford medical treatment. While hospitals around Britain catered to the poor, patients were expected to contribute to their room and board. Additionally, inpatient admission was only granted to those who could obtain a letter from the governor or subscribers of the hospital, which was no easy task. In contrast, Marsden believed that “the only passport [to gaining admission] should be poverty and disease.” His decision to erect the Royal Free was
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The Glaswegian medical community was more authoritarian than speculative, more conservative than maverick. It did not welcome innovation readily. Lister would struggle to find his place amid the more traditionally minded stalwarts at the university.
One of his graduates later wrote that Lister was in fact worshipped by his students.
It was inevitable that Lister—a man who was trying to reform surgical practice from within and at a fundamental level—would come up against someone like Smith, who thought hospitals existed for only one reason: to treat patients. In the eyes of Lister and progressive contemporaries such as James Syme, a hospital was much more than this: it was a place where students could learn from real-life cases.
Most of the medical positions at the larger hospitals in Britain in 1860 were voluntary, and although there was prestige in holding them, physicians and surgeons were not paid a salary. The bulk of a surgeon’s income came from two sources: private practice and fee-paying students.
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. Lister, true to his Quaker roots, exhibited an unusual level of compassion for those on his wards.
Lister understood that being in a hospital could be a terrifying experience and followed his own golden rule: “Every patient, even the most degraded, should be treated with the same care and regard as though he were the Prince of Wales himself.”
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.
Even if surgeons accepted that germs were the culprit, many of them were unable or unwilling to follow his methodology with the level of precision needed to achieve the promised results. They had been trained by a generation of surgeons who valued speed and practicality over exactitude.
As long as others were applying his methods shoddily or halfheartedly, winning hearts and minds would prove next to impossible. Lister needed to go with a more proactive approach.
New opinions are always suspected, and usually opposed, without any other reason but because they are not already common. —JOHN LOCKE
As Lister’s methods evolved, skeptics characterized these constant modifications as admissions on his part that the original system did not work. They didn’t see these adjustments as part of the natural progression of a scientific process.
Initially, his antiseptic system received more support on the Continent than it did in Britain, so much so that in 1870 Lister was asked by both the French and the Germans to furnish some guidelines for treating wounded soldiers fighting in the Franco-Prussian War.
His reputation would be ruined if his actions caused lasting harm to the monarch.
Lister himself later claimed that this was the first time he used such a drain. His ingenious ad hoc invention, along with his application of antiseptic methods, undoubtedly saved Victoria’s life. One week later, Lister left Balmoral Castle and returned to Edinburgh, satisfied with the queen’s recovery.
News of Joseph Lister’s successful treatment of Victoria spread, bolstering faith in his methods. The queen had given Lister’s antiseptic system the royal stamp of approval simply by allowing him to operate on her.
“It is a perfect enigma to me,” he wrote to Lister, “that you can devote yourself to researches which demand so much care, time and incessant painstaking, at the same time as you devote yourself to the profession of surgery and to that of chief surgeon to a great hospital. I do not think that another instance of such a prodigy could be found amongst us here.” To Lister—a man who had always placed immense faith in the scientific method—this was as high a compliment as could be paid him, especially since it came from such a revered figure as Pasteur.
It was easier for Lister to convince doctors in Glasgow and Edinburgh of the value of his antiseptic system because each of those cities had one hospital and one university at its heart. London’s medical community was far more fragmented and less scientifically minded. Clinical teaching was not yet as common in the capital as it was in Scotland.
Still, one nation remained unconvinced of the merits of Lister’s methods: the United States. In fact, in several American hospitals, Lister’s techniques had been banned; many doctors saw them as unnecessary and overly complicated distractions because they had not yet accepted the germ theory of putrefaction.
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.
But leaving Edinburgh at the height of his career and beginning anew would not be an easy undertaking. Decades earlier, it had been the material rewards and career advancement that had underpinned his desire to move back to the capital. This time, it was the London medical community’s stubborn disbelief in his antiseptic system. His was a mission to convert the nonbelievers, just as he had done in Glasgow and Edinburgh, and throughout America.
a new generation of carbolic acid cleaning and personal hygiene products flooded onto the market. Perhaps the most famous of these was Listerine,
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.