Not for the Squeamish: Surgery in the 19th Century

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Imagine undergoing major surgery in a grimy operating room without any form of antisepsis. That was the grim reality in the 1800s, when the ruling theory was that damage from “bad air” was responsible for infections in surgical wounds. Hospitals simply aired out the surgical wards at midday to avoid the spread of infection. Those same wards had no facilities for washing hands or cleaning patients’ wounds. Surgeons actually took pride in wearing dirty bloodstained operating gowns as a display of their experience in the surgical trenches. They also believed pus was a natural part of the healing process rather than a sinister sign of sepsis. Not surprisingly, most deaths were due to postoperative infections.

A Radical Idea

Enter one Joseph Lister, a Quaker surgeon who aggressively promoted a radical idea: antiseptic surgery. Dr. Lister is the hero-namesake of The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine, by Lindsey Fitzharris, PhD, a gripping narrative that brings readers into the operating theaters of 19th century England.

It is also a cautionary tale about a pioneer who had to fight an entrenched medical establishment to have antiseptic surgery become part of medical protocol. 


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

Author: Lindsey Fitzharris, PhD

Publisher: Farrar, Straus and Giroux

Publication Date: October 2018

Price: $16.00, paperback; 304 pages

Advent of Anesthesia

Prior to Dr. Lister’s groundbreaking work in antisepsis, another Victorian surgeon, Robert Liston, had pioneered the use of ether, rendering pain-free surgery. The first “etherized” procedure was a highly publicized amputation; Dr. Lister had secured one of the coveted seats in the operating theater. A 36-year-old butler had been suffering from chronic osteomyelitis of the tibia, which had caused the massive bone infection, a condition that was exacerbated by the surgeon’s lack of antisepsis. Amputation was ordered.

They carried the patient into the operating room and laid him on a wooden table. At Dr. Liston’s command, the assistant put the ether mask over the patient, rendering him unconscious. The surgeon took a long surgical knife that he had personally designed (it had gunfighter-like notches in the handle showing the number of amputations he’d performed) and told the crowd in the theater to time him. It took all of 28 seconds for Dr. Liston to remove the patient’s leg.

The term “etherization” was coined, and newspapers celebrated the miracle of “painless” surgery. The surgery might have been more humane, but the filthy conditions in the operating rooms and wards continued to contribute to deadly postoperative infections. In fact, the advent of anesthesia encouraged surgeons to perform more invasive operations, which meant that the filthy knives and hands caused more infections, and mortality rates in hospitals actually rose. This deadly drama offered the opportunity for one of the great stories of medical history to unfold.

Dr. Lister (and two other surgeons, all independent of each other) suggested the unthinkable—doctors themselves were responsible for spreading the deadly infections from patient to patient. However, these three lonely men of medicine were ignored and publicly ridiculed. One of them, a Hungarian doctor named Ignaz Semmelweis, died in an insane asylum; his last days were spent venting about the need for surgeons to wash their hands.

Influenced by His Father’s Work

Dr. Fitzharris’ strength lies in her meticulous attention to detail and exhaustive research. She brings the young Dr. Lister to life, telling how his father’s work as an expert microscope designer inspired his love of science. Dr. Lister examined infected tissue under the lens, concluding that broken bones usually healed without infection, whereas in compound fractures where the skin was pierced, infection often arose.

“Dr. Fitzharris paints a vivid portrait of Dr. Lister as a cool-headed, determined, compassionate physicianscientist whose revolutionary work saved countless lives and changed the practice of medicine.”

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The section about Dr. Lister’s search for an agent to kill bacteria before they spread is riveting. After several false starts, he decided on carbolic acid, which was used at the time to counter foul odors from sewage. After a few gut-wrenching attempts—the details of the medical procedures are not for the squeamish—Dr. Lister performed a surgical procedure on an 11-year-old boy with a badly fractured leg, using carbolic acid to prevent infection. Remarkably, the boy left the infirmary 6 weeks later in tiptop shape.

Not surprisingly, despite this and other successes, it took several years for Dr. Lister’s antiseptic theory to gain acceptance in the mainstream medical community. He also spent grueling sessions in the laboratory after full days of clinical duty, fine-tuning his antiseptic approaches. He advocated for catgut ligatures that dissolved in the tissue and a carbolic spray to disinfect medical workstations and instruments. He backed up all of his claims with research results and case studies.

Readers will fume at the dangerous and arrogant naysayers described in the book; some renowned physicians literally refused to believe that germs they couldn’t see could cause possibly cause any harm. A well-known American physician banned Dr. Lister’s work from his hospital, concluding that it posed a danger to patients.

A Bland Hero

The author has one challenge in delivering a romping narrative about this colorful and poignant period in medical history: Dr. Lister himself is a rather retiring, shy, and bland personality. Nevertheless, Dr. Fitzharris paints a vivid portrait of Dr. Lister as a cool-headed, determined, compassionate physician-scientist whose revolutionary work saved countless lives and changed the practice of medicine.

The Butchering Art is told in morbid detail, much of which makes for page-turning content. It is also an inspirational story of a true hero in medicine, one that is highly recommended for readers of The ASCO Post