Too Short for a Blog Post, Too Long for a Tweet 171

Here are a few excerpts from a book I recently read, "The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine," by Lindsey Fitzharris.

The living, in the form of diseased patients, were also taking a toll on those on the front line of medicine. Mortality rates among medical students and young doctors were high. Between 1843 and 1859, forty-one young men died after contracting fatal infections at St. Bartholomew’s Hospital, before ever qualifying as doctors. Those who succumbed in this manner were often eulogized as martyrs who had made the ultimate sacrifice in order to advance anatomical knowledge. Even those who survived often suffered some sort of illness during their hospital residencies. Indeed, the challenges were so great for those entering the profession that the surgeon John Abernethy frequently concluded his lectures by uttering bleakly, “God help you all. What will become of you?”

There were some incredibly lucky cases on these fateful Wednesdays, such as that of the young woman who was rushed into the hospital suffering from an acute disease of the larynx. On the day she arrived, Lister stood near Erichsen as he cut into the tender flesh of the woman’s neck. Dark, sticky blood gushed from the incision. Erichsen frantically began slicing through the cricoid cartilage in order to make a free aperture into the air passages, but to no avail. The patient started to asphyxiate on the large quantities of fluid trapped in her chest. Her pulse slowed, and for a moment all that could be heard was the loud whistling of the air that her lungs were trying to draw into her windpipe. At that moment, Erichsen improvised something extraordinary: he clamped his mouth around the open wound in her neck and began to suck out the blood and mucus blocking her air passage. After three mouthfuls, the patient’s pulse quickened, and the color returned to her cheeks. The woman survived against all odds and returned to the wards. But Lister knew that fresh dangers awaited her there. Surviving the knife was only half the battle.

In 1884, the American physician William Pancoast injected sperm from his “best-looking” student into an anesthetized woman—without her knowledge—whose husband had been deemed infertile. Nine months later, she gave birth to a healthy baby. Pancoast eventually told her husband what he had done, but the two men decided to spare the woman the truth. Pancoast’s experiment remained a secret for twenty-five years. After his death in 1909, the donor—a man ironically named Dr. Addison Davis Hard—confessed to the underhanded deed in a letter to Medical World.

Underneath this decrepit facade, Edinburgh pulsated with a dark energy. At the time Lister set foot onto its railway platform, the city had already established itself as a world leader in surgery, albeit one tainted by scandal and murder. It had been only twenty-five years since the infamous William Burke and William Hare had skulked around the streets of Edinburgh, looking for their next victim to accost. Over the course of ten months, the pair had strangled sixteen people and sold their suspiciously fresh corpses to Robert Knox, a surgeon running his own private anatomy school in the city who turned a blind eye to the duo’s cagey activities. (Burke and Hare were eventually apprehended after one of their victims was recognized by a spectator in the dissection theater. Fearing for his life, Hare turned king’s evidence and testified against his partner. He was pardoned for his cooperation, while Burke alone was left to swing from the end of a rope. In a poetic twist of fate, the murderer’s body was later dissected publicly, with hundreds of people in attendance. He was flayed meticulously, and his skin was used to make various macabre trinkets, including pocketbooks, which were hawked to a delighted, bloodthirsty public.)

Lister’s invitation to speak at the conference had come from one of his most vocal critics across the Atlantic. Samuel D. Gross was one of the country’s preeminent surgeons and was also a nonbeliever in the existence of germs. The American surgeon was so set against Lister’s antiseptic system that he had commissioned a painting a year earlier to celebrate his faith in the surgical status quo. In the Portrait of Samuel D. Gross (later known as The Gross Clinic), the artist Thomas Eakins depicts a dark and dingy operating theater. Gross, at the center of the scene, is operating on a boy who is suffering from osteomyelitis of the femur. The surgeon is surrounded by his assistants, one of whom probes the patient’s wound with bloodied fingers. In the foreground, unsterilized instruments and bandages are displayed within reach of equally unclean hands. There is no sign that Lister’s antiseptic methods are being used.

The adoption of Lister’s antiseptic system was the most prominent outward sign of the medical community’s acceptance of a germ theory, and it marked the epochal moment when medicine and science merged. Thomas Eakins—the artist who painted The Gross Clinic—returned to the subject in 1889 to paint The Agnew Clinic. This time, however, instead of painting a dingy operating theater with surgeons caked in blood, Eakins shows the viewer a markedly cleaner, brighter operating environment with participants wearing stark white coats. The Agnew Clinic portrays the embodiment of antisepsis and hygiene. It is Listerism, triumphant.

As he neared the end of his life, Lister expressed the desire that if his story was ever told, it would be done through his scientific achievements alone. In his will—dated June 26, 1908—the eighty-one-year-old surgeon requested that Rickman John Godlee, along with his other nephew Arthur Lister, “arrange [his] scientific manuscripts and sketches, destroying or otherwise disposing of such as are of no permanent scientific value or interest.” 

Lister wrongly believed that his personal story had little bearing on his scientific and surgical achievements. Ideas are never created in a vacuum, and Lister’s life very much attests to that truth. From the moment he looked through the lens of his father’s microscope to the day he was knighted by Queen Victoria, his life was shaped and influenced by his circumstances and the people around him. Like all of us, he saw his world through the prism of opinions held by those whom he admired most: Joseph Jackson, a supportive father and accomplished microscopist; William Sharpey, his instructor at UCL who encouraged him to go to Edinburgh; James Syme, his longtime mentor and father-in-law; and Louis Pasteur, the scientist who gave him the key needed to unlock one of the great medical mysteries of the nineteenth century.

Hector Cameron, Lister’s former student and assistant, later said of him, “We knew we were in contact with Genius. We felt we were helping in the making of History and that all things were becoming new.” What was once impossible was now achievable. What was once inconceivable could now be imagined. The future of medicine suddenly seemed limitless.