'The Butchering Art': How A 19th Century Physician Made Surgery Safer

Oct 13, 2017
Originally published on October 13, 2017 5:51 pm

The operating theaters of 19th century England were dirty, crowded spaces where patients screamed and spectators bought tickets to watch life and death struggles.

Surgeons wore blood-encrusted aprons, never washed their hands, and speed was prized over skill, since most patients were awake during surgery in the pre-anesthesia days. Many patients died of infections soon afterward, if they didn't die from shock or blood loss right on the table.

A new biography of surgeon Joseph Lister called The Butchering Art is not about food. It tells the story of how the forward-thinking Lister changed medicine forever by getting other surgeons to understand that germs spread disease but that they could something about it.

Author Lindsey Fitzharris tells All Things Considered host Robert Siegel The Butchering Art "is a love story between science and medicine." Lister's technique of spraying antiseptic on surgical equipment (he had nothing to do with the mouthwash Listerine, but his technique inspired it) slowly caught on. And more patients started to survive.

"It was hard for people to believe, because here comes this young guy saying there's these invisible creatures and you can't see them with your eye but they're killing your patients," she tells Siegel.

"In a plot twist worthy of a public TV period piece miniseries," notes Siegel, "Queen Victoria was a catalyst for wide acceptance of antiseptic surgery."

Lister was the closest surgeon to the queen's residence in Scotland, Fitzharris says, so she directed Lister to come drain a large abscess growing under her armpit. Before the surgery, Lister's assistant sprayed carbolic acid with a machine Lister invented called the donkey engine all over the operation area, sterilizing it but also accidentally spraying the queen in the face.

"She was not amused," says Fitzharris. "But he ... ends up saving her life. And because she allowed him to do this operation, she kind of gives her blessing to the antiseptic techniques and germ theory by default," she says.

"He joked later in life that he was the only man able to plunge a knife into the queen and survive that experience."

Near the end of Lister's career, when he has been honored and knighted for pioneering antiseptic surgery, a new idea comes along called aseptic surgery, but Lister didn't buy it. (Antiseptic surgery uses germ-fighting techniques, the aseptic technique requires the creation of a germ-free environment, which is how operating rooms are run today.)

"He didn't think that was attainable," says Fitzharris. "He never really saw the hospital as the only place a surgeon would operate." In the 19th century, many surgeons operated in homes and offices because middle-class people didn't want to go to hospitals. They were dirty places, and so many people died there, hospitals often demanded money upfront to cover burials.

While modern medicine has come quite far since the days of The Butchering Art, it was really not that long ago that surgery was brutal and deadly.

But there are innovators like Lister, says Fitzharris. "Medicine and science are always changing what we know about the body, and the world is always changing, and you have to kind of adapt and keep up with that."

ATC host Robert Siegel, ATC producer Melissa Gray, and ATC editor Jolie Myers contributed to this story.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

ROBERT SIEGEL, HOST:

Lindsey Fitzharris' new book is called "The Butchering Art." It is not about carving meat for cooking. It's about surgery the way it used to be done. And it's about one surgeon in particular who changed the way it was done - Joseph Lister. In 19th-century England, Lister was the man who championed antiseptic surgery. And his story is one of great professional courage in the face of much opposition.

Lindsey Fitzharris joins us from London. Welcome to the program.

LINDSEY FITZHARRIS: Thank you. Thank you for having me.

SIEGEL: And first, describe what Lister did. What was his great achievement?

FITZHARRIS: Well, I always tell people that "The Butchering Art" is a love story between science and medicine because it's about the surgeon Joseph Lister. Some people are familiar with his name probably through the product Listerine, which he actually had nothing to do with. It was just inspired by his antiseptic techniques. But what he did was he took germ theory, a scientific principle, and he married it to medical practice. And he developed antisepsis or germ-fighting techniques in the operating year.

And all of that seems really obvious to us today, but of course people didn't understand that germs existed before Lister came along. And it was hard for people to believe because, you know, here comes this young guy saying that there's these invisible creatures. And you can't see them with your eye, but they're killing your patients. And so his great triumph was really getting surgeons to accept that germs existed and then also adopt antiseptic techniques in the operating theater.

SIEGEL: Now, your field is 19th-century medicine, which I suppose is easier on the stomach than writing about serial axe murderers, but not by a lot. I want you to describe surgery in, say, the 1850s in England when Joseph Lister entered the field.

FITZHARRIS: Well, the operating theaters were dingy, dirty places. The surgeons wore these aprons that were encrusted with blood. They never changed them. They didn't wash their hands. They didn't wash their instruments. And these operating theaters were filled to the rafters with hundreds of spectators, some of them just curious bypassers (ph) who came in with tickets to see the life-and-death struggle play out on the stage. So there was no sense of hygiene. This certainly wasn't a sterile place. And it was very, very different to how we operate today.

SIEGEL: And since the patient before anesthesia was wide awake during this, a surgeon's skill might be, say, in how quickly he could amputate a limb, not in whether that would be a successful operation or not.

FITZHARRIS: Yeah, exactly. I mean, we think of surgeons as being meticulous and careful and measured in the way they move today. But in the past, it was all about brute strength and force. And there was this guy named Robert Liston. He was known as the fastest knife in the West End in Britain in the 1840s. And he could remove a leg in about a minute, which doesn't seem that bad.

But if you think about that, if you just sit there for a minute and think about your leg being sawed through - but of course it was crucial that they be fast because you could die of shock and blood loss. And the patients were terrified. One of his patients actually leapt off the table and runs into a closet. And Liston follows after him and tears the door off the closet and drags him back into the operating theater. So it was very, very different than how we operate today.

SIEGEL: Well, continuing for those who are still listening to our conversation, I wanted to draw attention to something you wrote about which I found very surprising after the introduction of anesthesia, which is the great revolution before Lister's introduction of antisepsis, that after anesthetics were introduced surgical deaths or post-surgical deaths in hospitals went up.

FITZHARRIS: Yes. It actually became more deadly because they didn't have the struggling patient and they were more willing to pick up the knife. And they were more willing to go deeper into the body because their patients were unconscious. So actually, immediately following the discovery of anesthesia in the 1840s, surgery becomes a lot more dangerous. You see post-operative infection going way up. And the operating table sort of becomes this conveyor belt. And, you know, the table isn't washed down between patients. The instruments aren't washed down. The hands of the surgeons aren't being washed. So it was actually really horrific. And that's where Lister comes into this story.

SIEGEL: Lister applied the findings of the great French scientist Louis Pasteur. Disease, Pasteur found, is caused by germs. Lister used carbolic acid as an antiseptic. He published his findings. Ultimately, they're accepted. But in a plot twist worthy of a public TV period piece miniseries, Queen Victoria was a catalyst for wide acceptance of antiseptic surgery. Tell the story of the queen's surgery.

FITZHARRIS: That's right, yeah. The queen, she got very ill. She was up in Scotland and she got an abscess in her armpit. And it grew, and it grew. And Lister was the nearest surgeon who could operate. And so he came there to operate on this large abscess. And it could have easily turned fatal.

Lister came in with the carbolic acid. And at this time in his profession, he had developed this thing called the donkey engine, which was this big machine that sprayed carbolic acid all over and disinfected everything. And actually, the funny story is that one of his colleagues was spraying the carbolic acid and accidently sprayed it right into Victoria's face. She wasn't very amused. But he ends up lancing this abscess and draining it and ends up saving her life.

And because she allowed him to do this operation, she's - she kind of gives her blessing to the antiseptic techniques and germ theory by default. So it's a huge step for Lister. And he joked later in life that he was the only man to plunge a knife into the queen and survive that experience, so...

(LAUGHTER)

SIEGEL: You write something about Lister near the end of his career when he's been recognized. He's knighted. He's then ennobled for his pioneering antiseptic surgery. And there's a new idea, which is aseptic surgery, not just the use of antiseptic but surgical operations - believe it - in a sterile hospital room. And the great man isn't buying.

FITZHARRIS: Yeah. That's always a shocking thing for people when they find that out. Yeah, antiseptic is germ-fighting and aseptic is a germ-free environment, which is, of course, what we do in operating theaters today. The reason why Lister was against asepsis was because he didn't think that it was attainable. He never really saw the hospital as being the only place where surgeons would operate because remember; in the 19th century, surgeons also operated in people's homes or they operated in offices. And in fact, you only really went to the hospital if you were very poor. It wasn't a place that the wealthy or the middle class would go to because they were so overcrowded and dingy and grimy.

SIEGEL: And your chances of not coming out alive were rather high also.

FITZHARRIS: Yes. Yes. And in fact, a lot of hospitals which - you would have to present money for your inevitable burial. That's how much they anticipated that you were going to die in these hospitals. So Lister, although asepsis - an aseptic environment would be ideal, he just didn't think that it was an attainable goal because surgeons would continue to operate outside of the hospital.

SIEGEL: Does your career studying 19th-century medicine - does it leave you feeling about how far we've come from these days? Or...

FITZHARRIS: Yeah.

SIEGEL: ...Are you astonished by just it was a couple of generations ago that people were born into this sort of notion of medicine and surgery?

FITZHARRIS: I know. I always - I joke to people that I'm here to destroy their romantic notions of what it was like to live in the past. And it wasn't too long ago. You're absolutely right. And to think about how far we've come - I hope that when people read my book, especially doctors and scientists themselves, that they realize that we might know the truth, so to speak. But how is that going to change in five years, 10 years, 15 years, 20 years? And that medicine and science are always changing. What we know about the body, even about the world, is always changing. And you have to kind of adapt and keep up with that like Lister was doing.

SIEGEL: Well, Lindsey Fitzharris, thanks for talking with us today.

FITZHARRIS: Thank you so much.

SIEGEL: Lindsey Fitzharris' new biography of Joseph Lister is called "The Butchering Art."

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