Books about Victorian medicine are an acquired taste. They’re science by way of B-horror movies, tales of progress set amid blood and spatter and grey guts. To enjoy them requires a tolerance for ick, an enthusiasm for the macabre and (ideally) the iron discipline not to read before supper, especially if that supper is a nice steak.
Lindsey Fitzharris’s slim, atmospheric The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine has its share of resplendent gore. (The author, a medical historian, has a charming blog and a YouTube series called Under the Knife.) The book is an imperfect first effort, stronger at the beginning than at the end, and a bit workaday when it isn’t freaky — it floats less on narrative momentum than on an armada of curious details. But the story it tells is one of abiding fascination, in part because it involves a paradigm shift so basic, so seemingly obvious, that one can scarcely believe the paradigm needed shifting in the first place.
Yet it did. What Lister saw, which his colleagues did not, was that doctors in the Victorian era were making people sick. The Butchering Art traces his efforts to revolutionise medicine through one deceptively simple notion: cleanliness.
As hard as it is to see now, surgery was once a filthy enterprise. Operating theatres were as dirty as London was, their surgeons as grimy as chimney sweeps. Doctors seldom washed their hands. They used the same instruments in successive procedures without cleaning them. “It was not uncommon,” Fitzharris writes, “to see a medical student with shreds of flesh, gut or brains stuck to his clothing after his lessons were over.”
Dissection rooms were perhaps the most gruesome environments of all. Hector Berlioz, who briefly studied medicine before becoming a composer, found them so repulsive that he dove out of a window to escape, unable to bear the sight of rats nibbling on vertebrae and sparrows snacking on scraps of lung. Less sensitive students were known to duel with severed legs and arms.
Hospitals probably killed as many people as they saved in those days. When his sister needed a mastectomy, Lister opted to perform the operation on his dining room table, knowing the odds for a safe convalescence were far better at home than at work. (She survived the operation, dying a few years later from a recurrence of cancer in her liver.) Four types of infection — erysipelas, septicemia, pyemia and gangrene — regularly took the lives of hospitalised patients. The idea that the doctors’ own squalid hygiene played a role in spreading these infections didn’t cross many people’s minds. Most medical professionals believed poisonous vapours, or “miasma,” were to blame.
Lister was one of the first surgeons outside of continental Europe to question this logic. “It is a common observation that, when some injury is received without the skin being broken, the patient invariably recovers,” he once told his medical students. “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 Butchering Art tells Lister’s story in simple chronological fashion, showing how the doctor came to embrace Louis Pasteur’s germ theory, which stipulated that microbes were the cause of disease, and how this belief then guided Lister to establish a series of antiseptic protocols when treating his patients. These protocols would one day become standard and save countless lives.
Lister’s patients were blessed with a kindly, generous physician. Fitzharris, on the other hand, was cursed with an amiable subject, which perhaps makes him a less exciting figure than other hothead surgeons of his day. He was shy and gentle and spoke with a stutter. His students adored him; he married a smart, sensible woman; he came from a supportive Quaker family; and he wrote weekly letters to his father after his mother died.
The real drama in Lister’s story comes from the resistance he faced to his theories. After he published the last article in a five-part series in the medical journal The Lancet, carefully outlining his system for killing “septic germs”, the establishment drew its knives. The inventor of chloroform wrote under a pseudonym to complain that Lister was taking credit for having discovered the miracles of carbolic acid. (He wasn’t.) Others accused him of fearmongering, dismissing Pasteur’s germ theory as pure hooey. The editor of The Lancet himself refused to use the word “germ”.
“It was difficult for many surgeons at the height of their careers,” Fitzharris writes, “to face the fact that for the past 15 or 20 years they might have been inadvertently killing patients by allowing wounds to become infected with tiny, invisible creatures.”
It’s an unhappy reminder that hubris is a terrible impediment to progress.
© 2017 The New York Times