The Butchering Art

by Lindsey Fitzharris

  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.

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  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.

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  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.

  At five feet ten inches, Lister was taller than most of his classmates. Those who knew him often commented on
his striking stature and the gracefulness with which he moved. He was classically handsome at this age, with a straight nose, full lips, and brown wavy hair. He had a nervous energy about him that became more pronounced in the company of others. Hector Charles Cameron—one of Lister’s biographers and a friend in later years—recalled the first time he met the future surgeon: “When I was admitted to the drawing-room Lister was standing with his back to the fire, tea cup in hand. As I remember him he was nearly always standing.… If for a few minutes he was seated, some new turn in the conversation seemed inevitably to force him to his feet.”

  Lister’s mind was in a constant whirl of activity. When he was agitated or embarrassed, the corner of his mouth twitched, and a stammer that had plagued him in his early childhood would return. Despite this inner turbulence, Lister was described by the Stewart of Halifax as having an “indescribable air of gentleness, verging on shyness.” A friend would later write of him, “He lived in the world of his thoughts, modest, unmasterful, unassuming.”

  Lister was a sober character, made all the more so by his upbringing. His community’s religious teachings stipulated that people of his faith wear somber colors at all times, and address others using antiquated pronouns such as “thee” and “thou.” As a child, Lister was surrounded by a sea of black coats and broad-brimmed hats, which the men of the family never removed, even during church services. The women dressed in plain garments with folded kerchiefs around the neck and plain shawls on their shoulders. They wore white muslin caps known as coal-scuttle bonnets. When Lister headed off to university, he donned muted colors in deference to his faith, which, among the more fashionable students of his class, no doubt made him stand out as much as his height.

  Shortly after arriving at UCL, Lister took up residence at 28 London Street, near the university, and lived there with a fellow Quaker named Edward Palmer, who was eight years his senior. Palmer was one of Robert Liston’s assistants, in fact, and was described by those who knew him as a “man in straightened [sic] circumstances but with a real enthusiasm for the surgeon’s profession.” The two quickly became friends. It was partly due to Palmer’s influence that Lister was able to attend Liston’s historic experiment with ether on December 21, 1846. That Lister was there at all suggests that this was not his first time attending a medical lecture; it’s unlikely that the great Liston would have admitted him that afternoon had he not already been acquainted with him. Indeed, Lister began his study of anatomy several months before he finished his bachelor’s in arts. In his account books from the last quarter of that year, Lister notes costs for the purchase of “forceps and sharpening knives,” as well as payment of eleven shillings, to a mysterious “U.L.,” for a body part that he dissected. His eagerness to begin his medical education was apparent to all who knew him in his early years.

  There was a darker side to Edward Palmer’s personality that didn’t benefit Lister. In 1847, the two men moved to 2 Bedford Place in Ampthill Square and were joined by John Hodgkin—nephew of the famous Dr. Thomas Hodgkin, who was the first to describe the very rare form of lymphoma that now bears his name. The Hodgkins and the Listers had long been friends, bonding over their shared faith. The two boys had attended Grove House together, a boarding school in Tottenham that taught a rather advanced curriculum for its time, focusing not just on the classics but also on mathematics, natural science, and modern languages. Hodgkin, who was five years younger than Lister, called their rooms in Ampthill Square “dingy” and found his two housemates “far too mature and grave,” which made “life a time of depression and joylessness.” He was not as taken with Edward Palmer as his childhood friend seemed to be when Hodgkin first arrived at UCL. The young man referred to Palmer as a “curious being … peculiar … undoubtedly an odd man.” Although Palmer was extremely devout, Hodgkin didn’t think his oddity was especially connected with his religion. Most unsettling to Hodgkin was the fact that Lister became more withdrawn the longer he lived under Palmer’s supervision. Aside from attending lectures, he seemed to take increasingly less interest in extracurricular activities, instead choosing to work hard in rather gloomy surroundings. And Palmer, who would become unhinged in later life and end his days in a mental institution, was hardly a cheerful influence in the aspiring surgeon’s life. Hodgkin warned that he didn’t think Palmer was “a very suitable companion even for Lister.”

  Both Lister and Palmer stood in contrast to many of their peers. In an address to incoming medical students, one of the surgical instructors at UCL warned about the “snares which notoriously lie in wait for the youthful traveler when he has left his parental hearth, and is wandering through the high-ways and by-ways—the broad streets and narrow alleys—of a great and over-peopled city.” He railed against “vicious habits” like gambling, theatergoing, and drinking, declaring that they were “more contagious than leprosy of old, and disfigure the mind, more than that Eastern plague ever did the body.” The instructor urged the incoming class to resist these vices and instead seek to uncover scientific truths through diligent study of anatomy, physiology, and chemistry.

  His warnings were not misplaced.

  At the time, the term “medical student” had become a “by-word for vulgar riot and dissipation,” according to the physician William Augustus Guy. This sentiment was universal. An American journalist observed that medical students in New York were “apt to be lawless, exuberant, and addicted to nocturnal activities.” They were often a rough-looking lot who congregated in cheap lodgings and inns surrounding the great teaching hospitals. They dressed fashionably—almost gaudily—except for their distinctly grimy shirts. They walked around with cigars hanging from their mouths: an indulgence, but one that was a necessity for masking the smell of decay that permeated their clothes after time spent in the dissection room. They were the brawling, boozing, boisterous types, judging by the number of warnings against bad behavior that instructors gave to their pupils.

  Of course, not everyone at UCL was a raffish youngblood. Some, like Lister, were hardworking and diligent. They lived frugally, hocking watches in the local pawnbrokers’ shops that dotted the narrow streets surrounding the university to pay for medical equipment. Others visited cutlers like J. H. Savigny, whose shop established in 1800 on the Strand was the first in London to specialize in surgical instruments. Places like this purported to sell scalpels, knives, and saws that, according to one British newspaper, were “wrought to such a degree of accuracy, as will greatly lessen the pain of the patient, and totally remove all apprehension of disappointment in the operator.”

  More than anything, what separated surgical students from the rest of the student body was the instruments they carried. Surgery was still a manual craft. It was a matter of technique, not technology. The instrument case of a newly qualified surgeon consisted of knives, bone saws, forceps, probes, hooks, needles, ligatures, and lancets, the latter being especially important given the persistent popularity of bloodletting in the Victorian period. Many surgeons also carried pocket cases of instruments with them, which they used for minor procedures, usually when making house calls.

  The amputation knife assumed an almost mythical place in the surgeon’s kit. It was one of the few instruments that underwent significant design changes in the first half of the nineteenth century. This was due in part to the changing nature of amputations. Older surgeons preferred the circular method, which involved making a sweeping incision around the circumference of the limb, pulling away the skin and muscle, and sawing through the bone. This called for a heavy knife with a curved, broad blade. Later generations, however, preferred what they called the flap method. Liston performed the flap method on the etherized Churchill in 1846. By the 1820s, the amputation knife was already thinner and lighter, with a straight blade reflecting the growing popularity of this technique. It involved “transfixing,” which essentially required the surgeon to stab the patient, pushing the amputation knife downward into the limb before drawing it back upward and then piercing the
skin from the underside of the incision.

  Some surgeons customized their knives to suit their preferred techniques. Robert Liston—who was said to carry his scalpels up his coat sleeve to keep them warm—designed his very own amputation knife, which was considerably larger than the norm, with a blade fourteen inches long and one and a quarter inches wide. The dagger’s point, the last two inches of which were razor-sharp, was created to cut through the skin, thick muscles, tendons, and tissues of the thigh with a single slice. It is little wonder that for Jack the Ripper, the “Liston knife” was the weapon of choice for the gutting of victims during his killing spree in 1888.

  Instruments like the amputation knife of Lister’s student days were havens for bacteria. Fashion often trumped function. Many had decorative etchings and were stored in velvet cases, which bore bloodstains from past operations. The surgeon William Fergusson recommended that the handles of surgical instruments be made of ebony, because this would be easier to grip when cutting through slippery bundles of veins and arteries. Traditional materials such as wood, ivory, and tortoiseshell also continued to be used in the nineteenth century, even after an upsurge in the production of metal instruments. As late as 1897, one catalogue stated, “We do not think that the day when metal-handled instruments will replace ebony and ivory is near at hand.”

  Lister’s first instrument case had everything a novice surgeon would need at the start of his training: bone saws to hack off limbs; forceps to pick apart tissue; probes to root out bullets and foreign bodies. But there was one tool Lister had carried with him to UCL that very few in his class possessed: his microscope. Under his father’s tutelage, he had grown into a very capable microscopist and learned to trust in the scientific instrument’s powers.