Winner, 2018 PEN/E.O. Wilson Prize for Literary Science Writing
Short-listed for the 2018 Wellcome Book Prize
A Top 10 Science Book of Fall 2017, Publishers Weekly
A Best History Book of 2017, The Guardian
"Warning: She spares no detail!" —Erik Larson, bestselling author of Dead Wake
In The Butchering Art, the historian Lindsey Fitzharris reveals the shocking world of nineteenth-century surgery and shows how it was transformed by advances made in germ theory and antiseptics between 1860 and 1875. She conjures up early operating theaters—no place for the squeamish—and surgeons, who, working before anesthesia, were lauded for their speed and brute strength. These pioneers knew that the aftermath of surgery was often more dangerous than patients’ afflictions, and they were baffled by the persistent infections that kept mortality rates stubbornly high. At a time when surgery couldn’t have been more hazardous, an unlikely figure stepped forward: a young, melancholy Quaker surgeon named Joseph Lister, who would solve the riddle and change the course of history.
Fitzharris dramatically reconstructs Lister’s career path to his audacious claim that germs were the source of all infection and could be countered by a sterilizing agent applied to wounds. She introduces us to Lister’s contemporaries—some of them brilliant, some outright criminal—and leads us through the grimy schools and squalid hospitals where they learned their art, the dead houses where they studied, and the cemeteries they ransacked for cadavers.
Eerie and illuminating, The Butchering Art celebrates the triumph of a visionary surgeon whose quest to unite science and medicine delivered us into the modern world.
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About the Author
Lindsey Fitzharris is the creator of the popular websites The Chirurgeon’s Apprentice and Grave Matters, and the YouTube series Under the Knife. She writes for The Guardian, The Lancet, and other publications. She received a doctorate in the History of Science, Medicine, and Technology from the University of Oxford and a postdoctoral research fellowship from the Wellcome Trust. The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine is her first book.
Read an Excerpt
THROUGH THE LENS
Let us not overlook the further great fact, that not only does science underlie sculpture, painting, music, poetry, but that science is itself poetic. ... Those engaged in scientific researches constantly show us that they realize not less vividly, but more vividly, than others, the poetry of their subjects.
— HERBERT SPENCER
LITTLE JOSEPH LISTER STOOD ON his toes and put his eye to the ocular lens of his father's latest compound microscope. Unlike the foldaway versions that tourists tucked in their pockets and carried with them on trips to the seaside, the instrument before him was something altogether grander. It was sleek, handsome, powerful: a symbol of scientific progress.
The very first time he looked down the barrel of a microscope, Lister marveled at the intricate world that had previously been hidden from his sight. He delighted in the fact that the objects he could observe under the magnifying lens were seemingly infinite. Once, he plucked a shrimp from the sea and watched in awe at "the heart beating very rapidly" and "the aorta pulsating." He noticed how the blood slowly circulated through the surface of the limbs and over the back of the heart as the creature wriggled under his gaze.
Lister was born on April 5, 1827, to no fanfare. Six months later, though, his mother gushed to her husband in a letter, "The baby has been today unusually lovely." He was the couple's fourth child and second son, one of seven children to be born to Joseph Jackson Lister and his wife, Isabella, two devout Quakers.
Lister had plenty of opportunities to explore miniature worlds with the microscope while he was growing up. Simplicity was the Quaker way of life. Lister wasn't allowed to hunt, participate in sports, or attend the theater. 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. It was not uncommon to find among those even in modest circumstances an intellectual man of high scientific attainments.
Lister's father exemplified this. At the age of fourteen, he left school and became an apprentice to his own father, a wine merchant. Although many Quakers abstained from consuming alcohol in the Victorian period, their faith did not explicitly forbid it. The Lister family's business was centuries old, begun at a time when teetotalism among Quakers hadn't yet gained popularity. Joseph Jackson became a partner in his father's wine business, but it was his discoveries in optics that would earn him worldwide renown during Lister's childhood. He had first become interested in the subject as a young boy when he discovered that a bubble trapped in the window glass of his own father's study acted as a simple magnifier.
At the beginning of the nineteenth century, most microscopes were sold as gentlemen's toys. They were housed in expensive cases lined with plush velvet. Some were mounted on square wooden bases that contained accessory drawers holding extra lenses, rods, and fittings that more often than not went unused. Most makers supplied their wealthy clients with a set of prepared slides of animal bone sections, fish scales, and delicate flowers. Very few people who purchased a microscope during this period did so for serious scientific purposes.
Joseph Jackson Lister was an exception. Between 1824 and 1843, he became a great devotee of the instrument and set out to correct many of its defects. Most lenses caused distortion due to light of different wavelengths being diffracted at various angles through glass. This produced a purple halo around the object in view: an effect that led many to distrust the microscope's revelations. Joseph Jackson toiled to fix this flaw and in 1830 showcased his achromatic lens, which eliminated the distracting halo. While engaged with his own business, Joseph Jackson somehow found time to grind lenses himself and supply the mathematical calculations necessary for their manufacture to some of the leading makers of microscopes in London. His work earned him a fellowship in the Royal Society in 1832.
On the first floor of little Lister's childhood home was the "museum," a room filled with hundreds of fossils and other specimens that various members of the family had collected over the years. His father insisted that each of his children read to him in the mornings while he dressed. Their library consisted of a collection of religious and scientific tomes. One of Joseph Jackson's earliest gifts to his son was a four- volume book called Evenings at Home; or, The Juvenile Budget Opened, which contained fables, fairy tales, and natural history.
Lister escaped many of the dangerous medical treatments that some of his contemporaries experienced while growing up, because his father believed in vis medicatrix naturae, or "the healing power of nature." Like many Quakers, Joseph Jackson was a therapeutic nihilist, adhering to the idea that Providence played the most important role in the healing process. 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 heroin, cocaine, and opium, Joseph Jackson's ideas might not have been too wide of the mark.
Because of the household's dearly held principles, it came as a surprise to everyone in the family when young Lister announced that he wanted to be a surgeon — a job that involved physically intervening in God's handiwork. None of his relations, except a distant cousin, were doctors. And surgery, in particular, carried with it a certain social stigma even for those outside the Quaker community. 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.
But the impact a medical career might have on his social and financial standing later in life was far from Lister's mind when he was a boy. During the summer of 1841, at the age of fourteen, he wrote to his father, who was away attending to the family's wine business, "When Mamma was out I was by myself and had nothing to do but draw skeletons." Lister requested a sable brush so that he could "shade another man to shew the rest of the muscles." He drew and labeled all the bones in the cranium, as well as those of the hands, from both the front and the back. Like his father, young Lister was a proficient artist — a skill that would later help him to document in startling detail his observations made during his medical career.
Lister was also preoccupied with a sheep's head that summer of 1841 and in the same letter declared, "I got almost all the meat off; and I think all the brains out ... [before] putting it into the macerating tub." He did this to soften the remaining tissue on the skull. Later, he had managed to articulate the skeleton of a frog he had dissected after stealing a piece of wood from his sister's cabinet drawer onto which he anchored the creature. He wrote to his father with glee, "It looks just as if [the frog] was going to take a leap," adding, conspiratorially, "Do not tell Mary about the piece of wood."
Whatever Joseph Jackson Lister's reservations were about the medical profession, it was clear that his son would soon be joining its professional ranks.
LISTER FOUND HIMSELF very far away from the life he had known as a child when he began his studies at University College London (UCL) at the age of seventeen. His village of Upton had a mere 12,738 inhabitants. Although only ten miles from the city, Upton could only be reached by horse and buggy trundling along the muddy tracks that passed for roads at that time. An oriental bridge crossed a stream that flowed through the Listers' garden, in which there were apple, beech, elm, and chestnut trees. His father wrote of the "folding windows open to the garden; and the temperate warmth and stillness, and the chirping of birds and hum of insects, the bright lawn and aloe and the darker spread of the cedars and chequered sky above."
In contrast to the vivid colors of the lush gardens surrounding Upton House, London was blocked out in a palette of gray. The art critic John Ruskin called it a "ghastly heap of fermenting brickwork, pouring out poison at every pore." Garbage was habitually heaped outside houses, some of which had no doors because the poor often used them as fuel for their grates during the winter months. Roads and alleyways were soiled with manure from the thousands of saddled horses, carts, omnibuses, and hansom cabs that rattled through the city each day. Everything — from the buildings to the people — was covered in a layer of soot.
Within the space of a hundred years, London's population soared from one million to just over six million inhabitants in the nineteenth century. The wealthy left the city in search of greener pastures, leaving behind grand homes that soon fell into disrepair as they were appropriated by the masses. Single rooms might contain thirty or more people of all ages clad in soiled rags and squatting, sleeping, and defecating in straw-filled billets. The extremely poor were forced to live in "cellar homes," permanently shut off from sunlight. The rats gnawed at the faces and fingers of malnourished infants, many of whom died in these dark, fetid, and damp surroundings.
Death was a frequent visitor to London's inhabitants, and disposing of the deceased was a growing problem. Churchyards were bursting at the seams with human remains, posing huge threats to public health. It was not uncommon to see bones projecting from freshly turned ground. Bodies were crammed on top of one another in graves, most of which were merely open pits with row after row of coffins. At the beginning of the century, two men purportedly asphyxiated on gases emanating from decomposing bodies after they fell twenty feet to the bottom of a burial pit.
For those living near these pits, the smell was unbearable. The houses on Clement's Lane in East London backed onto the local churchyard, which oozed with putrid slime; the stench was so overpowering that occupants kept their windows shut all year long. Children attending the local Sunday school at Enon Chapel could not escape this unpleasantness. They were given their lessons as flies buzzed around them, no doubt originating from inside the church's crypt, which was stuffed with twelve thousand rotting corpses.
Arrangements for the disposal of human waste were equally rudimentary before the passing of the Public Health Act in 1848, which established the centralized General Board of Health and initiated a sanitarian revolution. Before then, many streets in London were effectively open sewers, releasing powerful (and often deadly) amounts of methane. In the worst housing developments, lines of domiciles known as "back-to-backs" were separated only by narrow passageways four to five feet wide. Trenches brimming with piss ran down the middle. Even the increased number of water closets between 1824 and 1844 did little to solve the problem. Their construction forced landlords to hire men to remove "night soil" from overflowing cesspools in the city's buildings. An entire underground army of "bone boilers," "toshers," and "mud-larks" developed to exploit the tide of human waste underneath the city. These scavengers — whom the author Steven Johnson calls history's first waste recyclers — would pick through the thousands of pounds of garbage, feces, and animal corpses and then cart off these foul goods to market, where they could be reused by tanners, farmers, and other traders.
The business conducted elsewhere wasn't any more wholesome. Fat boilers, glue renderers, fellmongers, tripe scrapers, and dog skinners all went about their malodorous tasks in some of the most densely populated areas of the city. For instance, in Smithfield — just a few minutes' walk from St. Paul's Cathedral — was a slaughterhouse. Its walls were caked with putrefied blood and fat. Sheep were hurled into its depths, breaking their legs before being knifed, flayed, and butchered by the men below. After a long day's work, these same men carried on their clothes the ordure of their unholy profession back to the slums in which they lived.
This was a world crawling with hidden dangers. Even the green dye in the floral-patterned wallpapers of well-to-do homes and in the artificial leaves that adorned ladies' hats contained deadly arsenic. Everything was contaminated with toxic substances, from the food that was consumed each day to the very water that people drank. At the time Lister went off to UCL, London was drowning in its own filth.
In the midst of all this grime and muck, the city's citizens were trying to make improvements to their capital. Bloomsbury, the area surrounding the university where Lister would spend his time as a student, for example, had the pleasing aura of a freshly scrubbed baby. It was in a constant state of flux, growing at such a rapid pace that those who moved there in 1800 would hardly recognize it just a few decades later. When the young doctor Peter Mark Roget — who later became the author of the thesaurus that now bears his name — moved to 46 Great Russell Street at the turn of the century, he referred to the "pure" air and sprawling gardens surrounding his home. By the 1820s, the architect Robert Smirke had begun construction of the new British Museum on Roget's street. This imposing neoclassical structure would take twenty years to complete, during which time a cacophony of hammers, saws, and chisels rang out over Bloomsbury, shattering the neighborhood's formerly tranquil atmosphere that Roget had enjoyed so much.
The university was part of this urban growth. One balmy evening in early June 1825, the future lord chancellor of Great Britain Henry Brougham and several reforming members of Parliament sat down together at the Crown and Anchor Tavern in the Strand. There they conceived the project that was to become University College London (UCL). At this new institution, there were to be no religious stipulations. It was the first university in the country that didn't require its students to attend daily Anglican church services — a fact that suited Lister quite well. Later, rivals from King's College would label those who attended UCL "the Godless scum of Gower Street," referring to the thoroughfare on which the university was located.
The curriculum at UCL would be as radical as the secular foundations on which it was built, the founders decided. The university was to feature traditional subjects like those taught at Oxford and Cambridge, as well as new ones, such as geography, architecture, and modern history. The medical school, in particular, would have an advantage over the two other universities due to its proximity to the Northern London Hospital (later known as University College Hospital), built six years after UCL was founded.
There were many who balked at the idea of a university being established in London. The satirical newspaper John Bull questioned the suitability of the raucous city as a place in which to educate Britain's young minds. With trademark sarcasm, the newspaper quipped, "The morality of London, its quietude and salubrity, appear to combine to render the Capital the most convenient place for the education of youth." The article continued by imagining that the university would be built in the notorious slums near Westminster Abbey named Tothill Fields; "in order to meet any objections which heads of families may make to the perilous exposure of their sons to the casualties arising from crowded streets, a large body of plain respectable females, of the middle age, will be engaged to attend students to and from the College in the mornings and evenings of each day." Amid protests and concerns, however, the edifice of UCL was built, and the school began accepting students in October 1828.
THE UNIVERSITY WAS still in its infancy when Joseph Lister first arrived there in 1844. UCL had only three faculties: arts, medicine, and law. 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.
Excerpted from "The Butchering Art"
Copyright © 2017 Lindsey Fitzharris.
Excerpted by permission of Scientific American / Farrar, Straus and Giroux.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
PROLOGUE: THE AGE OF AGONY,
1. THROUGH THE LENS,
2. HOUSES OF DEATH,
3. THE SUTURED GUT,
4. THE ALTAR OF SCIENCE,
5. THE NAPOLEON OF SURGERY,
6. THE FROG'S LEGS,
7. CLEANLINESS AND COLD WATER,
8. THEY'RE ALL DEAD,
9. THE STORM,
10. THE GLASS GARDEN,
11. THE QUEEN'S ABSCESS,
EPILOGUE: THE DARK CURTAIN, RAISED,
A Note About the Author,
Most Helpful Customer Reviews
This book is fantastically detailed in the most delightful & horrid ways. The author is so descriptive, you'll be glad you can't smell the world she lets us enter. I could not put it down.
An excellently researched and thoroughly readable account of the horrors and practices of early Victorian medicine and the men who performed it. Fitzharris' descriptions of both the medical procedures of the time, as well as the cultural zeitgeist in which they existed are simultaneously horrifying and gripping. Even though the subject is grisly the book manages to keep its tone optimistic and light enough to be a quick page-turner, and the reader will find themselves both informed and fascinated throughout the narrative. Altogether an impressive first work by Fitzharris; it deserves a place on the shelf of anyone interested in medicine, the Victorian era, or with an educated eye for the macabre.
By Bill Marsano. “Cleanliness is next to godliness” is a maxim that comes from a sermon by John Wesley, a co-founder of Methodism. That was in 1778, but although the idea itself goes as far back as the Babylonians and ancient Hebrews, the medical profession somehow hadn’t got wind of it. Lindsey Fitzharris’s splendid and highly readable book sets the scene and leads us, in the end, to cleanliness triumphant. The scene, horrifyingly, was this: even as late as the mid-1800s most people who went into hospitals died not from the illnesses they had but from illnesses they got. That is, from iatrogenic illnesses. “Iatrogenic” is fancy word for illness caused by medical treatment. In short, hospitals were killing their patients. What stopped them was the acceptance of the “germ theory” of disease and the consequent requirement that doctors wash their bloody hands. Others had groped their way toward this solution but it was Ignaz Semmelweiss, in the 1840s, who proved it. He was largely ignored; doctors continued to proudly strut through the wards in blood-stained aprons. Louis Pasteur, France’s scientific titan, proved the fallacy of spontaneous generation, the belief that insect and other organisms “just happened,” arising from rotting meat or piles of rags or bad air or bad smells (miasmas). Their work and ideas came together in Joseph Lister, on whom Fitzharris concentrates as the tireless, even relentless promulgator of medical cleanliness, not only in England but in the U.S. as well. It wasn’t easy for him. Some doctors simply resented being told they’d been wrong; some refused to break with their (filthy) traditions; many refused to believe in germs because they couldn’t see them. There were campaigns against him, but Lister never gave up—and that’s why a good many of us are alive to read his story.—Bill Marsano is a writer and editor of 50 years’ experience.
historical-places-events, medical, horror, nonfiction, surgery, infections ---------- If you thought battlefield surgery was brutal long before the present, hospital surgery and care was just as horrendous. In detailing the influences and motivations of the most influential doctor of the 19th century with regards to sepsis and antisepsis the reader is immersed in the horrors that comprised the hospital care of the day. If one is naive enough to believe that nosocomial infections are only a product of careless use of antibiotics today, this will set the record straight. It was a hard-won victory to convince such a hide bound profession to accept as truth what the microscope proved. Along the way the reader is given a glimpse of the judicial system and the horrors of the industrial revolution. Extremely well researched and graphically written. Two disclaimers: I have been a RN since 1968. Also, I had originally requested and received a free review copy via NetGalley, but was unable to sight read it. Recently I bought an audio copy and feel that Ralph Lister gave an exceptional audio performance as narrator. I also feel that his British accent is a definite plus.
“Heroic medicine” is well named. Prior to the advent of anesthetics, patients were awake and aware for surgical procedures. The pain and horror of feeling a surgeon cutting into your body is something we now associate with a nightmare. Going through asurgery was nearly as likely to kill you as not receiving treatment at all. With the discovery of ether, surgeons no longer had to restrict their operations to procedures which could be completed in minutes. With the field of surgery becoming ever more ambitious, post-surgical infections became the chief danger to patients. In a time before germ theory was accepted, opinions and practices used to treat or prevent infections (laudable pus, anyone?) varied widely, and with little success. In the 1860s, Quaker surgeon Joseph Lister set about trying to determine scientifically the causes of post-surgical infections, and how to best prevent these deadly conditions. Lindsey Fitzharris gives us a great view of Victorian medical practice, and of the scientific and medical theories and traditions that made the prevention of nosocomial (hospital-induced) infections so difficult. The Butchering Art is both a history and a biography. The book earns a place next to The Knife Man by Wendy Moore (about contemporaneous surgeon John Hunter) and The Ghost Map by Stephen Johnson (about Dr. John Snow, who helped trace a cholera outbreak in London to a single water pump). Any history buff interested in the history of medicine will enjoy this book. More casual readers will likely also find this book to be entertaining and accessible. Beware though, Fitzharris provides several very accurate and vivid descriptions of Victorian-era surgeries, so the book is decidedly not for the faint of heart. An advance copy of this book was provided by the publisher via NetGalley in exchange for an honest review.