Liston—who reportedly had the fastest knife in the West End—achieved all this in just under sixty seconds.
* * *
NOW, AS LISTON stood before those gathered in the new operating theater of University College London a few days before Christmas, the veteran surgeon held in his hands the jar of clear liquid ether that might do away with the need for speed in surgery. If it lived up to American claims, the nature of surgery might change forever. Still, Liston couldn’t help wondering whether the ether was just another product of quackery that would have little or no useful application in surgery.
Tensions were high. Just fifteen minutes before Liston entered the theater, his colleague William Squire had turned to the packed crowd of onlookers and asked for a volunteer to practice on. A nervous murmur filled the room. In Squire’s hand was an apparatus that looked like an Arabian hookah made of glass with a rubber tube and bell-shaped mask. The device had been fashioned by Squire’s uncle, a pharmacist in London, and used by the dental surgeon James Robinson to extract a tooth just two days prior. It looked foreign to those in the audience. None dared to have it tested on them.
Exasperated, Squire ordered the theater’s porter Shelldrake to submit to the trial. He wasn’t a good choice, because he was “fat, plethoric, and with a liver no doubt very used to strong liquor.” Squire gently placed the apparatus over the man’s fleshy face. After a few deep breaths of ether, the porter reportedly leaped off the table and ran out of the room, cursing the surgeon and crowd at the top of his lungs.
There would be no more tests. The unavoidable moment had arrived.
At twenty-five minutes past two in the afternoon, Frederick Churchill—a thirty-six-year-old butler from Harley Street—was brought in on a stretcher. The young man had been suffering from chronic osteomyelitis of the tibia, a bacterial bone infection which had caused his right knee to swell and become violently bent. His first operation came three years earlier, when the inflamed area was opened up and “a number of irregularly shaped laminated bodies” ranging from the size of a pea to that of a large bean were removed. On November 23, 1846, Churchill was once again back in the hospital. A few days later, Liston made an incision and passed a probe into the knee. Using his unwashed hands, Liston felt for the bone to ensure it wasn’t loose. He ordered that the opening be washed with warm water and dressed and that the patient be allowed to rest. Over the next few days, however, Churchill’s condition deteriorated. He soon experienced sharp pain that radiated from his hip to his toes. This occurred again three weeks later, after which Liston decided the leg must come off.
Churchill was carried into the operating theater on a stretcher and laid out on the wooden table. Two assistants stood nearby in case the ether did not take effect and they had to resort to restraining the terrified patient while Liston removed the limb. At Liston’s signal, Squire stepped forward and held the mask over Churchill’s mouth. Within a few minutes, the patient was unconscious. Squire then placed an ether-soaked handkerchief over Churchill’s face to ensure he wouldn’t wake during the operation. He nodded to Liston and said, “I think he will do, sir.”
Liston opened a long case and removed a straight amputation knife of his own invention. An observer in the audience that afternoon noted that the instrument must have been a favorite, for on the handle were little notches showing the number of times he had used it before. Liston grazed his thumbnail over the blade to test its sharpness. Satisfied that it would do the job, he instructed his assistant William Cadge to “take the artery” and then turned to the crowd.
“Now, gentlemen, time me!” he yelled. A ripple of clicks rang out as pocket watches were pulled from waistcoats and flipped open.
Liston turned back to the patient and clamped his left hand around the man’s thigh. In one rapid movement, he made a deep incision above the right knee. One of his assistants immediately tightened a tourniquet around the leg to halt the flow of blood while Liston pushed his fingers up underneath the flap of skin to pull it back. The surgeon made another series of quick maneuvers with his knife, exposing the thighbone. He then paused.
Many surgeons, once confronted with exposed bone, felt daunted by the task of sawing through it. Earlier in the century, Charles Bell cautioned students to saw slowly and deliberately. Even those who were adept at making incisions could lose their nerve when it came to cutting off a limb. In 1823, Thomas Alcock proclaimed that humanity “shudders at the thought, that men unskilled in any other tools than the daily use of the knife and fork, should with unhallowed hands presume to operate upon their suffering fellow-creatures.” He recalled a spine-chilling story about a surgeon whose saw became so tightly wedged in the bone that it wouldn’t budge. His contemporary William Gibson advised that novices practice with a piece of wood to avoid such nightmarish scenarios.
Liston handed the knife to one of the surgical dressers, who, in return, handed him a saw. The same assistant drew up the muscles, which would later be used in forming an adequate stump for the amputee. The great surgeon made half a dozen strokes before the limb fell off, into the waiting hands of a second assistant, who promptly tossed it into a box full of sawdust just to the side of the operating table.
Meanwhile, the first assistant momentarily released the tourniquet to reveal the severed arteries and veins that would need to be tied up. In a mid-thigh amputation, there are commonly eleven to secure by ligature. Liston tied off the main artery with a square knot and then turned his attention to the smaller blood vessels, which he drew up one by one using a sharp hook called a tenaculum. His assistant loosened the tourniquet once more while Liston stitched the remaining flesh closed.
It took all of twenty-eight seconds for Liston to remove Churchill’s right leg, during which time the patient neither stirred nor cried out. When the young man awoke a few minutes later, he reportedly asked when the surgery would begin and was answered by the sight of his elevated stump, much to the amusement of the spectators who sat astounded by what they had just witnessed. His face alight with the excitement of the moment, Liston announced, “This Yankee dodge, gentlemen, beats mesmerism hollow!”
The age of agony was nearing its end.
* * *
TWO DAYS LATER, the surgeon James Miller read a hastily penned letter from Liston to his medical students in Edinburgh, “announcing in enthusiastic terms, that a new light had burst on Surgery.” During the first few months of 1847, both surgeons and curious celebrities visited operating theaters to witness the miracle of ether. Everyone from Sir Charles Napier, colonial governor of what is now a province of Pakistan, to Prince Jérôme Bonaparte, the youngest brother of Napoleon I, came to see the effects of ether with their own eyes.
The term “etherization” was coined, and its use in surgery was celebrated in newspapers around the country. News of its powers spread. “The history of Medicine has presented no parallel to the perfect success that has attended the use of ether,” the Exeter Flying Post proclaimed. Liston’s success was also trumpeted in the London People’s Journal: “Oh, what delight for every feeling heart … the announcement of this noble discovery of the power to still the sense of pain, and veil the eye and memory from all the horrors of an operation.… WE HAVE CONQUERED PAIN!”
Equally momentous to Liston’s triumph with ether was the presence that day of a young man named Joseph Lister, who had seated himself quietly at the back of the operating theater. Dazzled and enthralled by the dramatic performance, this aspiring medical student realized as he walked out of the theater onto Gower Street that the nature of his future profession would forever be changed. No longer would he and his classmates have to behold “so horrible and distressing a scene” as that observed by William Wilde, a surgical student who was reluctantly present at the excision of a patient’s eyeball without anesthetic. Nor would they feel the need to escape, as John Flint South had done whenever the cries of those being butchered by a surgeon grew intolerable.
Nevertheless, as Lister made his way through the
crowds of men shaking hands and congratulating themselves on their choice of profession and this notable victory, he was acutely aware that pain was only one impediment to successful surgery.
He knew that for thousands of years, the ever-looming threat of infection had restricted the extent of a surgeon’s reach. Entering the abdomen, for instance, had proven almost uniformly fatal because of it. The chest was also off-limits. For the most part, whereas physicians treated internal conditions—hence the term “internal medicine,” which still persists today—surgeons dealt with peripheral ones: lacerations, fractures, skin ulcers, burns. Only with amputations did the surgeon’s knife penetrate deep into the body. Surviving the operation was one thing. Making a full recovery was another.
As it turned out, the two decades immediately following the popularization of anesthesia saw surgical outcomes worsen. With their newfound confidence about operating without inflicting pain, surgeons became ever more willing to take up the knife, driving up the incidences of postoperative infection and shock. Operating theaters became filthier than ever as the number of surgeries increased. Surgeons still lacking an understanding of the causes of infection would operate on multiple patients in succession using the same unwashed instruments on each occasion. The more crowded the operating theater became, the less likely it was that even the most primitive sanitary precautions would be taken. Of those who went under the knife, many either died or never fully recovered and then spent the rest of their lives as invalids. This problem was universal. Patients worldwide came to further dread the word “hospital,” while the most skilled surgeons distrusted their own abilities.
With Robert Liston’s ether triumph, Lister had just witnessed the elimination of the first of the two major obstacles to successful surgery—that it could now be performed without inflicting pain. Inspired by what he had seen on the afternoon of December 21, the deeply perceptive Joseph Lister would soon embark on devoting the rest of his life to elucidating the causes and nature of postoperative infections and finding a solution for them. In the shadow of one of the profession’s last great butchers, another surgical revolution was about to begin.
1.
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 late
r 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.”
The Butchering Art Page 2
