The Butchering Art

by Lindsey Fitzharris

  Many of Lister’s instructors still believed the microscope was not only superfluous to a study of surgery but also a threat to the medical establishment itself. Even with improvements like Joseph Jackson’s achromatic lens, the instrument continued to be regarded with suspicion by those within the medical community, many of whom lacked the skill and training to operate one effectively. What revelations did the microscope offer? Surely all relevant signs and symptoms could be observed with the naked eye. And could any of these microscopic discoveries actually lead to the effective treatment of patients? Unless the instrument offered clear benefits that were applicable to the practice of medicine and surgery, most concluded that there was no reason to waste time with it.

  Still, it was difficult for British doctors to deny the important advances made in pathology on the Continent due to the microscope. The French, in particular, were making discoveries at an extraordinary pace with the aid of the scientific instrument, owing partly to the rise of large hospitals in Paris during the French Revolution. By 1788, there were 20,341 patients residing in forty-eight different hospitals around the city: an unprecedented number unmatched anywhere else in the world. A large percentage of these people would succumb to their infirmities. Because they were often poor, their bodies went unclaimed and fell into the hands of anatomists like Marie François Xavier Bichat, who reportedly carved up no fewer than six hundred bodies in the winter of 1801–1802.

  Bichat’s research led him to conclude that the seat of disease was inside the body and that tissues were distinct entities that could be compromised. This was a departure from prevailing beliefs that disease attacked whole organs or the entire body. Remarkably, Bichat was able to describe and name twenty-one membranes in the human body, including connective, muscle, and nerve tissue, before he died accidentally in 1802 after falling down the steps of his own hospital.

  In the early decades of the nineteenth century, French physicians began using the microscope more and more. The physician Pierre Rayer performed microscopic and chemical analyses of urine for the first time in history. The physiologist and pharmacologist François Magendie began using the instrument as a teaching tool in his physiology classes, and the physicians Gabriel Andral and Jules Gavarret started to analyze blood under the lens. By the time Lister was entering medical school, some Parisian physicians were even using microscopes to diagnose diseases of the skin, blood, kidneys, and urogenital system.

  Back in England, the debate continued to rage over the advantages of microscopic pathological anatomy. Lister, however, was his father’s son. At UCL, he showed himself to have a better grasp of the complex instrument’s workings than most of his professors. Writing to his father about a lecture he attended on optical instruments, he remarked that the instructor “spoke of the improvements introduced by thee, and certainly gave thee the full credit for the whole revolution in microscopic excellence and observation, and said, moreover, that these improvements were the happiest instance of the application of experiment and observation to the construction of the Microscope; also, that thy experiments had been most skilfully executed.”

  And yet Lister wasn’t entirely satisfied with the lecture. To his dismay, the instructor concluded damningly that students should remain skeptical about the microscope’s useful application in medicine, because the results of any experiments with it were likely to be flawed as long as improvements were still needed. A querulous Lister complained to his father that the lecture was “rather a disappointment to me, and I fancy to others too.”

  But Lister would not be easily deterred. He turned his attention to the microscopic structure of muscle after obtaining a fresh portion of human iris from UCL’s professor Wharton Jones. He noted pigment granules in the lens as well as in the iris. Later, he turned his attention to the muscular tissue within hair follicles and devised a new method for making vertical sections thin enough to be observed satisfactorily under the microscope: “By compressing a portion [of the scalp] between two thin pieces of deal [wood], and cutting off with a sharp razor fine shavings of wood and scalp together, moderately thin sections may be obtained.” From these experiments, Lister eventually published two papers in the Quarterly Journal of Microscopical Science. These were the first of many investigations he would conduct with the microscope during his surgical career.

  Years later, Lister’s supervisor had little to say about his subordinate, remarking that he was “too shy and reserved to be more than an acquaintance” when the two were working alongside each other at University College Hospital in 1851. That said, his supervisor did recall something that distinguished Lister from the other students: “He had a better microscope than any man in college.” It was this very instrument that would eventually help him unlock the medical mystery that had been plaguing his profession for centuries.

  2.

  HOUSES OF DEATH

  What a charming task, to sit quietly down in the apartment and take apart this master-piece of workmanship; to call each piece by its proper name; know its proper place and work; to wonder over the multitude of organs pressed together, so diverse in operations, yet each executing its appointed task in the grand confederation.

  —D. HAYES AGNEW

  A HALO OF LIGHT from a gas lamp illuminated the corpse lying on the table at the back of the room. The body had already been mutilated beyond recognition, its abdomen hacked away by the knives of eager students who afterward carelessly tossed the decomposing organs back into the gory cavity. The top of the cadaver’s skull had been removed and was now sitting on a stool next to its deceased owner. The brain had begun to degrade into a gray paste days before.

  Early in Lister’s medical studies, he came face-to-face with a similar scene at UCL. A central walkway split the dingy dissection room in half, with five wooden tables on either side. Cadavers were left with their incised heads hanging over the edges, which caused blood to gather in congealed puddles below. A thick layer of sawdust covered the floor, making the deadhouse disconcertingly quiet to those who entered it. “Not a sound could be heard even of my own feet.… There was only that dull and rolling sound of the traffic in the streets which is peculiar to London, and which came dismally down through the ventilators in the roof,” a fellow student observed.

  Although UCL and its hospital were still relatively new in 1847, its dissection room was just as grim as those found in older institutions. It harbored all kinds of horrible sights, sounds, and smells. When Lister sliced into the abdomen of a cadaver—its recesses turgid with a thick soup of undigested food and fecal matter—he released a powerful mixture of fetid smells that would cleave to the inside of the nostrils for a considerable time after one had quit the scene. To make matters worse, there was an open fireplace at the end of the room, making it unbearably stuffy during the winter months when anatomy lessons commenced.

  Unlike today, students could not escape the dead during their studies and often lived side by side with the bodies they dissected. Even those who did not live immediately adjacent to an anatomy school carried with them reminders of their gruesome activities, because neither gloves nor other forms of protective gear were worn inside the dissection room. Indeed, 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.

  The cadaver tested the courage and composure of anyone who dared set foot inside the deadhouse. Even the most seasoned dissectors could find themselves in pulse-quickening situations from time to time. James Marion Sims—an illustrious gynecological surgeon—recalled a terrifying incident from his student days. His instructor was performing a dissection by candlelight one evening when he accidentally knocked loose a chain that was wrapped around the corpse and anchored to the ceiling above the upper end of the table. The cadaver, pulled by the weight of its own lower limbs, “jerked to the floor in the upright posture” with its “arms forcibly thrown over” the dissector’s shoulders. Just then, the candle, which had been resting on the dead man’s ches
t, sputtered out, leaving the room in total darkness. Sims was astounded by the sight of his instructor calmly taking hold of the body under its arms and placing it back on the table, before remarking that if it had been up to him, he’d have left the dead man to the force of gravity.

  For the uninitiated, the dissection room was a waking nightmare. The French composer and former medical student Hector Berlioz jumped out of a window and ran home, later recalling that it was “as though Death himself and all his grisly band were hot on my heels” the first time he stepped into a dissection room. He described an overwhelming feeling of revulsion at the sight of “the limbs scattered about, the heads smirking, the skulls gaping, the bloody cesspool underfoot,” and “the repulsive stench of the place.” One of the worst sights, he thought, was of the rats nibbling on bleeding vertebrae and the swarms of sparrows pecking at the leftover scraps of spongy lung tissue. The profession was not for everyone.

  But for those wishing to continue with their degrees, there was no avoiding the dissection room. Far from viewing it as repulsive, most students ultimately embraced the opportunity to carve up the dead when the time came to commence their anatomical lessons, and Lister was no exception. Theirs was a centuries-old battle between reason and superstition: a chance to shed light where there was still scientific darkness. Within the medical profession, the anatomist was often hailed as an explorer boldly traveling into regions that had been largely unknown to the scientific world only half a century earlier. One contemporary wrote that through dissection, the anatomist “forced the dead human body to disclose its secrets for the benefit of the living.” It was a rite of passage through which one gained membership in the medical fraternity.

  Little by little, students began to view the bodies set before them not as people but as objects. This ability to divorce oneself emotionally came to characterize the mind-set of the medical community. In The Pickwick Papers, Charles Dickens describes a fictional but entirely credible conversation between two medical students on a frosty Christmas morning. “Have you finished that leg yet?” asks Benjamin Allen. “Nearly,” replies his colleague Bob Sawyer, “it’s a very muscular one for a child’s.… Nothing like dissecting to give one an appetite.”

  Today, we disparagingly call this apparent coldness clinical detachment, but in Lister’s day it was described as a necessary inhumanity. The French anatomist Joseph-Guichard Duverney remarked that by “seeing and practicing” on dead bodies, “we lose foolish tenderness, so we can hear them cry, without any disorder.” This was not simply a by-product of medical education. It was the goal.

  As medical students became desensitized, they also became irreverent—much to the public’s horror. Pranks in the deadhouse were so common that by the time Lister entered medical school, they had become a mark of the profession. Harper’s New Monthly Magazine condemned the jet-black humor and indifference toward the dead that pervaded the dissection room. Some students completely overstepped the bounds of decency and used the rotting body parts of their allotted cadavers as weapons, fighting mock duels with the severed legs and arms. Others smuggled entrails out of the room and secreted them in places where they would shock and horrify the uninitiated when discovered. One surgeon remembered curious spectators visiting the dissection room when he was a student. These outsiders wore double-breasted jackets and often received in their tail pockets free donations of available appendages.

  It wasn’t all frivolity. Cutting open dead bodies also carried with it many physical risks, some of which were fatal. William Tennant Gairdner, a professor at the University of Glasgow, addressed an incoming class with this dire message: “Not a single session has passed over our heads since I was appointed to my office among you, that has not paid its tax of life to the great Reaper, whose harvest is always ready, whose sickle is never weary.”

  Jacob Bigelow—professor of surgery at Harvard University and father of Henry Jacob Bigelow, who later witnessed William T. G. Morton’s operation with ether—also warned future medical students about the poisonous effects of a slight wound or crack in the skin made by the dissecting knife. These so-called pinprick cuts were a fast way to an early grave. The dangers were always present, even for the most experienced anatomists. Death was often inescapable for those trying their hardest to prevent it.

  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?”

  * * *

  It wasn’t long before Lister experienced the physical dangers of his occupation. He was ensconced in his medical studies when he noticed tiny white pustules on the backs of his hands. It could only be one thing: smallpox.

  He was all too familiar with the telltale signs of this terrible disease because his brother John had contracted smallpox a few years earlier. Around a third of those who caught it died. Those who survived were often left with disfiguring scars. One contemporary wrote that the “hideous traces of its power” haunted its victims, “turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover.” For this reason, smallpox was one of the most feared diseases of the nineteenth century.

  John survived but developed an unrelated brain tumor shortly afterward. He suffered for several years—first losing his eyesight, then the function of his legs—before finally dying in 1846 at the age of twenty-three. The death was especially hard on Lister’s father, Joseph Jackson, who lost all enthusiasm for his work with the microscope as a result. He was never to return to it again. For Lister, it was the first time he had witnessed the true limitations of his profession, for there wasn’t a doctor in the world who could operate successfully on John’s brain tumor in the 1840s.

  Despite the sheer terror accompanying the onset of smallpox, Lister’s own case turned out to be mild, like his brother’s. He recovered within a short period and didn’t suffer any scarring on his face or hands. But his brush with death unnerved him and left dozens of questions about his own fate twisting in his mind. He turned more fervently to religion. His friend and fellow lodger John Hodgkin later wrote that Lister was passing through some religious conflict of the soul following his recovery from smallpox. His attention began to drift away from his studies at the university as he began to wonder whether his true vocation lay not with surgery but with the Quaker ministry. As a preacher, he could make a real difference. Medicine had done nothing to save his brother’s life. Maybe the Quakers had been right to place greater trust in the healing power of nature than in the medical profession.

  Lister’s crisis of conscience reached its tipping point one Wednesday evening in 1847, when he and Hodgkin attended a Quaker gathering at the Friends Meeting House, located on Gracechurch Street, not far from campus. Hodgkin watched in astonishment as his friend stood up in the silent prayer meeting and said: “I will be with thee & keep thee: fear thou not.” The only Quakers permitted to speak at meetings were ministers. By quoting passages from the Bible, Lister was indicating to those in his community (including Hodgkin) that he felt his destiny lay not in the operating theater—surrounded by blood and guts—but in the pulpit. Joseph Jackson immediately interceded. He didn’t believe his son’s otherwise laudable desire to do the Lord’s work would be best served within the limits of the Quaker ministry. Instead, he urged Lister to continue with his medical studies and please God by helping the sick.

&
nbsp; Yet Lister slipped deeper and deeper into depression. Unable to function, he left UCL abruptly in March 1848. His mental collapse was a manifestation of the depression that would dog him his entire life. One of his contemporaries later said of him that a “cloud of seriousness” always hung over Lister and “tempered all he did.” He carried with him a “garment of sadness which he seemed seldom to discard,” brought on by his own overwhelming “sense of responsibility that lay like a burden upon his soul.”

  While it may seem anachronistic, the term “nervous breakdown” was used by Lister’s nephew and biographer Rickman John Godlee later to describe this period of his uncle’s life. Throughout Victoria’s reign, most medical practitioners treated nervous disorders by administering concoctions containing dangerous ingredients, including morphine, strychnine, quinine, codeine, atropine, mercury, and even arsenic, which was added to the London Pharmacopoeia in 1809. The use of these nerve tonics, as they were called, was advocated by adherents of the prevalent medical orthodoxy of the time known as allopathy, meaning “other than the disease.” In short, the theory held that the best way to treat a disease was to produce the somatic condition opposite to the pathological state in question. With a fever, for instance, one had to cool the body down. With disorders of the mind, one had to restore strength and firmness to the patient’s frayed nerves.

  “Naturopathy”—the treatment of disease through the promotion of the body’s own healing powers—also played a significant role in Victorian medicine. Doctors put great stock in a change of air and scenery to combat what they considered the source of shattered nerves: stress, overwork, and mental anxiety. It was important that patients remove themselves from the environment in which they had broken down.