The Butchering Art by Lindsey Fitzharris review – grisly medicine
Long after William Hogarth depicted a gaggle of bewigged and urine-tasting physicians under the title The Company of Undertakers in 1736, doctors remained a popular target of humour and ridicule. This was hardly surprising, as the reality of their practice was even more absurd, and more tragic. By the early 19th century, skilled surgeons could amputate a leg in under 30 seconds but prided themselves on never washing their hands or instruments, kept their suturing needles in their frock coat lapels and wore aprons so stiffened with dried blood they could stand up on their own.
The acclaimed Victorian surgeon Robert Liston pioneered the use of ether in Britain, rendering surgery pain-free for millions, in an amputation in 1846. Yet this landmark operation might never have been necessary had the surgeon not previously probed his patient’s injured knee with his grubby fingers.
Can you stomach it? The grim, grisly world of historical surgery – in pictures
View galleryThe advent of anaesthesia only encouraged surgeons: their ability to perform longer, more invasive surgery meant filthy knives and fingers spread more infection, so that mortality rates in hospitals actually rose during the mid-1800s. Post-operative infection was so endemic in hospital wards it was named “hospitalism” and anyone who could afford to be treated at home avoided hospital admission at all costs.
Lindsey Fitzharris brings this squalid, grisly, disease-filled scene to gloriously pulsating, technicoloured life in her biography of the pioneering surgeon Joseph Lister. Entering the unpromising field of surgery as a student in 1844, Lister makes an unlikely hero. Born to Quaker parents, he was mild-mannered, courteous and anxious about his stammer – the antithesis of the egotistical surgeons who made their names in early Victorian Britain.
In a professional culture riven by feuds, when doctors stubbornly championed their signature methods regardless of scientific evidence, Lister was a misfit. He told his father: “I am by disposition very averse to quarrelling.” Dogged by depression, he almost gave up surgery at one point. Thankfully, for Lister and for us, the reluctant surgeon persevered. After moving to Scotland, he was taken under the wing of James Syme, known as “the Napoleon of surgery” for his fearlessness in the operating theatre. Lister not only became Syme’s right-hand man, he married his daughter, Agnes. This was a shrewd move when medical posts were almost invariably handed down from father to son, but also a wise choice since Agnes took a keen interest in her husband’s research.
From out of this hellish vision, Lister emerges as the cool, modern, scientific saviour
Taking a post at Glasgow Royal Infirmary, Lister demonstrated a rare compassion for his impoverished patients. He urged that every patient should be treated “with the same care and regard” as the Prince of Wales. When one young girl, whom Lister had treated for an abscess on her knee, presented the surgeon with her rag doll and its detached leg, he solemnly threaded a needle and sewed it back on.
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Read moreMore significantly, Lister devoted his spare time to scientific study and especially to the puzzle of post-operative infections. In the foul conditions of Victorian hospitals, wound infection after surgery was so common it was thought inevitable and even essential. Some doctors were adamant that “laudable pus” was a necessary route to recovery. There were two competing theories about the cause of such infections, with “contagionists” arguing that diseases were transmitted from person to person by some kind of agent while “non-contagionists” blamed “miasma” or foul air. Most surgeons stuck to the latter school, unable to see beyond their stuck-up noses to their begrimed fingertips.
Scientific saviour … Joseph Lister. Photograph: AlamyThree brave individuals had independently suggested that it was doctors themselves who were spreading infections, from bed to bed and from corpse to living patient, but these lone voices had been ridiculed and ignored. One of them, a Viennese physician named Ignaz Semmelweis, ended his days in a madhouse still raving about the need for surgeons to wash their hands.
Inspired by his father, an expert in designing microscopes, Lister examined infected tissue under the lens and, aided by his wife, experimented on frogs. Realising that broken bones generally healed without infection when the skin was not broken whereas compound fractures, when jagged bone pierced the skin, often became infected, Lister surmised that the agent was something in the air. But it was only after reading of Louis Pasteur’s discovery of microscopic objects – bacteria – in sour wine that the penny dropped. Those few other doctors who heard of Pasteur’s research were quick to dismiss his “germ theory”. But to Lister it made perfect sense.
Aware that under hospital conditions it was not possible to eliminate these microorganisms, he set out to find an antiseptic that would kill them before they spread. After various attempts he opted for carbolic acid, used in sewage works to counter odours. Then, in August 1865, after two failed efforts, Lister performed an operation to mend the broken leg of an 11-year-old boy, James Greenlees, using carbolic acid to counteract infection. The boy left Glasgow Royal Infirmary six weeks later cured.
Fitzharris has an eye for morbid detail, visceral imagery and comic potential
It took two years before Lister felt ready to publicise his findings, in a five-part report in the Lancet followed by a lecture to the British Medical Association. Crucially, by this point, he had developed a meticulous system of infection control through the washing of hands, instruments and the site of an operation with carbolic acid mixed with linseed oil. Over the ensuing years he fine-tuned this method by advocating catgut ligatures – which dissolved inside the body – and a carbolic spray. Carefully moderating his claims, he backed up his research with plentiful case studies.
The evidence for Lister’s antiseptic system was compelling – or so it seemed. With its customary aversion to new ideas, the medical profession rose in condemnation of his methods. While some refused to believe in germs they could not see, others denounced his theory as worthless and even “dangerous”. One American surgeon banned the approach from his hospital. Calmly and doggedly, Lister toured Europe and the US, proselytising about his ideas and gradually, with the aid of adoring students who called themselves “Listerians”, his system prevailed.
The potential pitfall with reluctant heroes is that they don’t necessarily provide colourful copy. Fitzharris, creator of the hugely popular blog The Chirurgeon’s Apprentice, skilfully negotiates this hazard by illuminating the characters and ideas of the time – a motley assortment of mad mavericks and bizarre beliefs. She has an eye for morbid detail, visceral imagery and comic potential. From out of this hellish vision, Lister emerges as the cool, modern, scientific saviour to whom we should all give thanks.