Renowned London surgeon Robert Liston had the two qualities most valued among his peers in pre-anesthetic medicine: speed and strength. At 6 feet, 2 inches, he stood eight inches taller than the average British man — a “giant for his time.” He purportedly could remove a leg in less than 30 seconds, and in order to keep both hands free, he often clasped the bloody knife between his teeth while working.
But Liston’s speed didn’t always pay off. There was the time he sliced off a patient’s testicle while removing a leg. During his most famous surgical slip, Liston worked with such speed that he cut off three of his assistant’s fingers and slashed an innocent bystander’s coat. Both the patient and assistant died of gangrene, and the spectator died of fright. “It is the only surgery in history said to have had a 300 percent fatality rate,” writes Lindsey Fitzharris, PhD, author of The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine.
Fitzharris, who spoke at Learn Serve Lead 2018: The AAMC Annual Meeting, admits she has always had a fascination with the macabre, from hunting ghosts as a child to spending hundreds of hours combing through diaries, medical casebooks, and letters researching her debut book, which won the 2018 PEN/E.O. Wilson Literary Science Writing Award.
“I like to say the book is a love story between scientific theory and medicine,” Fitzharris says. Indeed, while the medical field is inherently forward-thinking, with the next major treatment or cure always on the horizon, it wasn’t that long ago that surgery was so brutal — and infections so rampant — that patients rarely survived. Even medical students were at risk: Between 1843 and 1859, 41 young doctors-in-training died after contracting infections at St. Bartholomew’s Hospital in London, Fitzharris notes.
This was, of course, before Joseph Lister discovered the antiseptic approach to wound-healing in the 1860s. As a professor of surgery in Glasgow, Lister lowered surgery death rates by covering wounds in dressings soaked with carbolic acid.
Before Lister’s discovery, “hospitalism” — a catch-all term for any number of infections that ravaged most patients who passed through hospital doors — claimed lives for decades. And before ether made an appearance as an anesthetic, a chorus of agony-filled cries combined with the hacking of limbs could be heard throughout operating theaters filled to the brim with eager spectators.
Here are four moments in Fitzharris’ book that paint a clear picture of just how far we’ve come:
- Inside out: Lister was no expert in emergency medicine, but one hot summer night in 1851, he had no choice but to act like one. He was confronted by a frantic police officer carrying an unconscious woman who had been stabbed in the abdomen. “Slick coils of her intestines had started to protrude from her body,” Fitzharris describes. The woman, Julia Sullivan, had fallen victim to a drunken and jealous husband. The wound was less than an inch long, but deep enough that eight inches of her entrails were spilling out. Lister acted quickly and calmly. He rinsed fecal matter off her intestines before enlarging the wound and pushing her innards back into her abdomen, then sewing it up with fine needle and silk. The approach differed from the usual treatment for punctured bowel – cauterization with a painful, red-hot iron blade, which “was excruciating, and the procedure carried with it no guarantee of survival,” Fitzharris notes.
- A mouthful: Many of the notable – and nausea-inducing – moments in Victorian medicine were on-the-spot decisions. One such moment occurred when Eric Erichsen, MD, chief of surgery at London’s University College Hospital, encountered a woman who suffered from acute disease of the larynx.
Erichsen, like many of his contemporaries, believed infections came from miasma, or “bad air.” Because of this, Erichsen had little concern with keeping wounds clean. When cutting through the woman’s neck did not properly release the blood and pus from her lungs, Erichsen took a more proactive approach. “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.” Erichsen then “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.”
- Take it on the chin: When Robert Liston turned someone away due to the extreme nature of his or her condition, the patient knew there were limited options. Liston, after all, prided himself on removing a 45-pound scrotal tumor. So when Liston told a man named Robert Penman that he would not operate on the nearly five pound tumor in his lower jaw, Penman wasn’t sure where else to turn. Enter James Syme, often called the “Napoleon of surgery.” Penman sat in a chair with his extremities constrained — this was before anesthetic was used — while Syme slowly removed pieces of the tumor. “For twenty-four excruciating minutes, Syme hacked away at the bony growth, dropping slices of tumor and jawbone with a sickening rattle into a bucket at his feet.” Long after the procedure, Syme ran into his patient on the street. “His receding chin was concealed by a luxuriant beard. Anyone looking at Penman, Syme concluded with satisfaction, would never guess that he had undergone such a traumatic procedure.”
- The “dead house” of dread: Fitzharris’ description of Victorian dissection rooms, or dead houses, is truly the stuff of nightmares. “Unlike today,” she writes, “students could not escape the dead during their studies and often lived side by side with the bodies they dissected. … It was not uncommon to see a medical student with shreds of flesh, gut, or brains stuck to his clothing after his lessons were over.” Students became so desensitized to decaying bodies, they would often smuggle intestines out of the dead house to pull pranks and have mock jousting matches with lifeless limbs. One of the worst sights, according to French composer and former medical student Hector Berlioz, was “the rats nibbling on bleeding vertebrae and the swarms of sparrows pecking at the leftover scraps of spongy lung tissue.” Fitzharris continues wryly, “The profession was not for everyone.”
What can we learn from the past?
Lister tried to educate his colleagues about the way in which infections spread, and at the time, it largely fell on deaf ears. “This is exactly the take-home I want people to think about,” Fitzharris says. “We see this playing out in science and medicine constantly.”
In two centuries, future scientists will likely look back on our current practices and marvel at the ignorance of their ancestors. “I hope medical professionals and scientists try to keep this lesson in mind,” she says. “What we know today isn’t what we’re going to know tomorrow.”