The Butchering Art

by Lindsey Fitzharris

  In addition to his observation of similar cases under Erichsen’s care, it’s likely that Lister had been studying the subject shortly before Julia was rushed through the doors of University College Hospital. In fact, strangulated hernias resulting from penetrating wounds were a hot topic due to the high incidences of stabbings and industrial accidents being treated in urban hospitals. George James Guthrie had written a book on the subject four years earlier, in 1847. The surgeon Benjamin Travers had also written extensively on the matter. In 1826, he described in the Edinburgh Journal of Medical Science a case like Julia Sullivan’s. The woman in question had been brought to St. Thomas’ Hospital with a self-inflicted wound to the gut that she had carried out with a razor blade. She was faint on arrival. Travers proceeded to sew up the incised part of her intestine with a silk ligature before enlarging the opening so he could return the protruding viscera to the abdominal cavity and then closed the wound with a quill suture. The patient was denied food and liquids for twenty-four hours. She continued to recover over the next few weeks until she suffered from a sudden inflammation of the bowel. As a result, the surgeon applied sixteen leeches to her abdomen and administered an enema. The wound eventually healed, and she was discharged from St. Thomas’ two months after the operation.

  As a medical student, Lister was familiar with the literature on these cases. And there was another reason why he might have been unusually well equipped to operate on Julia’s incised gut that night. Four months earlier, The Lancet announced that the competition for the Fothergillian Gold Medal issued once every three years by the Medical Society of London would focus on wounds and injuries of the abdomen and their treatment. Lister had already received several recognitions for his work at UCL, and the Fothergillian Gold Medal was one of the more prestigious awards around. Was Lister brushing up on his understanding of abdominal wounds in the hope that he might be able to enter an essay in the competition?

  Although Lister’s operation was a success, Julia’s recovery had only just begun. Lister restricted her to a liquid diet for the remainder of her recovery to ease the pressure in her bowels. He also ordered that Julia be given a regular dose of opium, a drug that had become more popular than alcohol in the nineteenth century due to the ever-expanding British Empire. Before the Pharmacy Act of 1868 limited the sale of dangerous substances to qualified druggists, a person could buy opium from just about anyone, from barbers and confectioners to ironmongers, tobacconists, and wine merchants. Lister administered the powerful drug to patients of all ages, including children.

  Over the next several weeks, Erichsen took over the case from Lister, who despite his heroic efforts in the operating theater was still a subordinate at the hospital. Like the woman at St. Thomas’ Hospital, Julia began experiencing peritonitis shortly after her operation. Erichsen’s treatment included the use of leeches, poultices, and fomentations to alleviate the tympanic effects of the condition. Julia finally recovered. Later in 1851, her case was twice referred to in The Lancet. The journal stressed the significance of Julia’s recovery: “[The surgery] is of such importance … that we have thought it advisable to enter into greater detail than we are wont to do.”

  * * *

  TWO MONTHS AFTER Julia Sullivan’s operation, on a humid day in August, Lister boarded an omnibus to travel across the city to the Old Bailey to testify against her husband, who was on trial for attempted murder. By the mid-nineteenth century, it was not uncommon for surgeons to give evidence in court. They spoke on a wide range of matters, such as the mental health of defendants, various types of wounds, and the chemical or physiological signs of criminal poisoning, which was quickly becoming the “fashionable” way to dispose of an enemy in the Victorian period. Lister was among six people the court called upon to testify against Sullivan.

  The Old Bailey was the most feared theater of justice in the country. Its fortresslike edifice was encased in a semicircular brick wall designed to prevent communication between its prisoners and the public. It sat immediately next to the notorious Newgate Prison, which had once held captive such famous personalities as Daniel Defoe, Captain Kidd, and William Penn, founder of Pennsylvania. Just in front of the two buildings was an open square where public executions took place until 1868. Thousands of spectators congregated on the day of a hanging, scrambling for a place close to the scaffold where they could witness the victim struggle against the deadly constriction of a noose. As little as two days might elapse between a guilty verdict and death for the convicted.

  Charles Dickens wrote of the Old Bailey, “Nothing is so likely to strike the person who enters [the courts] for the first time, as the calm indifference with which the proceedings are conducted; every trial seems a mere matter of business.” Lawyers, jury members, and court watchers lounged on hard wooden benches, reading the morning newspapers and conversing in low whispers. Some dozed off while waiting for the next case to be called. The atmosphere of nonchalance that pervaded the court could be deeply unsettling to the uninitiated. An outsider could have been forgiven if he missed the fact that the verdicts given at the Old Bailey were frequently carried out at the end of a rope.

  Sullivan stood in the dock directly facing the witness box. Above him was a sounding board to amplify his voice. During the eighteenth century, a mirrored reflector was placed above the dock in order to reflect light into the faces of the accused. By Lister’s time, this had been replaced with gas lighting. This measure allowed judge and jury to examine the defendants’ facial expressions in order to assess the validity of their testimonies, a dubious method that led to many receiving wrongful convictions. To Sullivan’s right sat the twelve members of the jury. Without leaving the room, they were expected to consult one another and arrive at a verdict within earshot of the defendant, whose fate hung in the balance. Behind and above them were the spectator galleries, where people came to watch the proceedings unfold, much as they did in the operating theater. This was an age in which matters of life and death constituted public entertainment.

  The first to testify was Thomas Gentle, the police officer who attended to Julia after the stabbing. He told the court that the prisoner had been drunk when he took him into custody. In contrast, he said, the victim had been sober when she identified Jeremiah Sullivan as her attacker and was in her right mind before, during, and after the assault. Two other witnesses followed, both testifying that they had heard Sullivan threaten his wife prior to the attack.

  Next, Julia herself stepped up to the witness box. Fully recovered and showing no ill effects from the injury she received, she fearlessly faced her attacker, whom she hadn’t seen since the night he had stabbed her. In a lengthy deposition, Julia recalled the events of June 26. At one point, Sullivan accused her of living with another man in the hope that this would mitigate the charge of attempted murder. The court asked Julia if she had ever been unfaithful to her husband, to which she answered, “Never, in my life; he cannot bring any one to say I have been deceitful to him—he has been a murderer to me, and always was.”

  At last, it was Lister’s turn to take the stand. He donned the muted colors of his Quaker faith. His somber demeanor gave him an air of authority that was rare for a man of his age. The young surgeon reported to the judge and jury, “I found a coil of intestine about eight inches across, comprehending, perhaps, about a yard of the small intestines, protruding from the lower part of the abdomen … no doubt all was done by one instrument and one stroke.” The bloodied knife, which was found by Thomas Walsh, a thirteen-year-old errand boy working in the shop next to the house of the surgeon Mr. Mushat, was produced for the inspection of the court. A hush fell over the room as spectators in the public gallery leaned forward to catch a glimpse of the weapon. The prosecutor accused Sullivan of ditching the knife before Gentle and the other constable had taken him into custody. It would have been a perfect moment to do so with everyone’s attention still focused on finding his wife the urgent medical care she needed. The knife was handed to Lister, who inspected
it closely before confirming that its form was consistent with the type of injury Julia sustained and was therefore very likely the weapon Sullivan used to stab his wife.

  Lister’s testimony was damning. Sullivan was found guilty of attempted murder and sentenced to twenty years’ transportation, which meant he would be banished to a penal colony in Australia. Due to the mounting pressure of London’s overcrowded prisons, 162,000 convicts were transported to Australia between 1787 and 1857. Seven out of eight of these were men. Some were as young as nine, others as old as eighty. Transportation was no easy alternative to imprisonment or hanging. The convicts were first sent to hulks, or floating prisons, on the Thames. The conditions on these decommissioned, rotting ships were horrendous, and even the hospitals could not compete with them as breeding grounds for disease. Prisoners were locked in cages belowdecks in appalling surroundings. One guard remembered “seeing the shirts of the prisoners, when hung out upon the rigging, so black with vermin that the linen positively appeared to have been sprinkled over with pepper.” During cholera outbreaks, the chaplain often refused to bury the dead until there was deemed to be a sufficient quantity of bloated, decomposing corpses of which to dispose. If a prisoner survived the hulks, he was shipped to Australia. One in three died on the grueling sea passage, which could take as long as eight months. If convicts behaved themselves, their sentence could be reduced by a “ticket of leave,” which would allow them to return home. The majority, however, never made it back to Britain, choosing to live out the remainder of their miserable lives in exile rather than endure the treacherous sea passage to an English port.

  As horrible as banishment was, it was still better than death. Had Julia not survived, Jeremiah Sullivan would certainly have found himself dangling from the end of a noose outside Newgate Prison, a matter of days after an inevitable murder conviction. In that sense, both owed their lives to the surgeon who, when faced with the terrifying prospect of performing his first major operation entirely alone, acted quickly and decisively. It was the first of many surgical triumphs that Lister could call his own.

  4.

  THE ALTAR OF SCIENCE

  Men may rise on stepping-stones

  Of their dead selves to higher things.

  —ALFRED, LORD TENNYSON

  EVERY WEDNESDAY, THE SURGEONS and their staff assembled in the tiny operating theater at University College Hospital. They operated according to seniority, and orders to wipe down the blood-soaked table between procedures were rarely issued. As Erichsen’s house surgeon, Lister attended these operations, observing, recording, assisting. It was in that modest room—with its small instrument cupboard and solitary washbasin—that he began to understand just how much of a lottery surgery was in the 1850s.

  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.

  * * *

  The injuries and afflictions that surgeons dealt with were as varied as London’s population itself. The city was ceaselessly expanding when Lister was working with Erichsen. Thousands of workers migrated to the city each year. Not only were these people living in filth due to the shortage of housing brought on by such rapid urbanization, but their jobs were both physically demanding and hazardous. All of these privations had consequences for their health. The hospital wards were clogged with people who had been maimed, blinded, suffocated, and crippled by the hazardous realities of the modernizing world.

  Between 1834 and 1850, Charing Cross Hospital treated 66,000 emergencies, including 16,552 falls from scaffolds or buildings; 1,308 accidents involving steam engines, mill cogs, or cranes; 5,090 road crashes; and 2,088 burns or scalds. The Spectator reported that almost a third of these injuries were caused by “broken glass or porcelain, casual falls … lifting of weights and incautious use of spokes, hooks, knives and other domestic implements.” These accidents often involved children, such as thirteen-year-old Martha Appleton, who was employed at a cotton-spinning mill as a “scavenger,” which entailed picking up loose material from beneath the machinery. Overworked and undernourished, little Martha fainted one day, and her left hand was jammed in an unattended machine. She lost all five of her fingers, as well as her job. Her story was a familiar one.

  During the working week, Lister encountered many cases of injury and illness brought on by poor living and working conditions. He also saw a fair share of ailments that had only recently become commonplace. There was a fifty-six-year-old painter named Mr. Larecy, for instance, who had been working between ten and fifteen hours each day since he was a young boy. He came onto the wards suffering from a severe attack of what was known as “painter’s colic,” a chronic intestinal disorder caused by overexposure to the lead found in paint. This was a growing problem for an industrializing nation with increasing numbers of people entering workplaces that exposed them to chemicals and metals. Even when poisonous substances like arsenic or lead were absent, the sheer amount of dust from the production and processing of steel, stone, clay, and other materials could kill a worker. It frequently took years before the damage presented itself, by which stage it was often too late. As John Thomas Arlidge—a Victorian doctor who took a keen interest in occupational medicine—observed, “Dust does not kill suddenly, but settles, year after year, a little more firmly into the lungs, until at length a case of plaster is formed. Breathing becomes more and more difficult and depressed, and finally ceases.” Bronchitis, pneumonia, and a variety of other respiratory diseases put many of the working class into an early grave.

  Lister also observed the effects of diet on the health of the city’s laborers. Besides consuming large quantities of beer on a daily basis, nearly all of his patients ate huge amounts of cheap meat but very few vegetables or portions of fruit. Over the summer, two people came onto Lister’s wards with sunken eyes, ghostly pale skin, and tooth loss—the telltale signs of scurvy. Doctors didn’t yet understand that scurvy was brought on by a lack of vitamin C, which the human body is unable to synthesize for itself. In fact, many practitioners believed it was caused by a lack of mineral salt in the body. In keeping with this line of thought, Lister treated both patients with nitrate of potash, a mineral that many in the medical community wrongly believed could cure the disease.

  If the low quality of the poor’s food was an obvious daily problem, then the long-term repercussions of another human imperative were slightly more insidious. Over time, Lister developed a practiced eye for the varying signs of sexually transmitted diseases. Many of the patients whom he treated were afflicted with the pox (syphilis). Before the discovery of penicillin, syphilis was an incurable and ultimately fatal disease. Those suffering from it often turned to surgeons because a majority of their work at this time dealt not with operative surgery but with external afflictions. The symptoms syphilis engendered worsened over time. In addition to the unsightly skin ulcers that pockmarked the body in the later stages of the disease, many victims endured paralysis, blindness, dementia, and “saddle nose,” a grotesque deformity that occurs when the bridge of the nose caves into the face. (Syphili
s was so common that “no nose clubs” sprang up all over London. One newspaper reported that “an eccentric gentleman, having taken a fancy to see a large party of noseless persons, invited every one thus afflicted, whom he met in the streets, to dine on a certain day at a tavern, where he formed them into a brotherhood.” The man, who assumed the alias of Mr. Crampton for these clandestine parties, entertained his noseless friends every month for a year until his death, at which time the group “unhappily dissolved.”)

  Many treatments for syphilis involved the use of mercury, which could be administered in the form of an ointment, a steam bath, or a pill. Unfortunately, the side effects could be as painful and as terrifying as the disease itself. Most patients who underwent extensive treatments experienced multiple tooth loss, ulcerations, and neurological damage. Frequently, people died from mercury poisoning before they died of the disease itself.

  At University College Hospital, a fifty-six-year-old Irish laborer named Matthew Kelly had been admitted after suffering from three severe falls, which he feared were caused by “the falling sickness,” or epilepsy. Lister, however, was suspicious of the painful spots on his thighs and wondered if there could be another cause of his fits. Given the man’s sexual history and “strong inclination to venery,” Lister suspected that Kelly was actually experiencing incipient cerebritis, or the last stages of syphilis, which can include seizures that appear epileptic in nature. Because this disease was so little understood, there was not much Lister could do for Kelly, and he was eventually released from the hospital after being deemed incurable.

  It was not the only occasion on which Lister had to discharge unwell patients, sometimes endangering the health of those with whom they might come into contact. Another case involved a twenty-one-year-old shoemaker named James Chappell, who was admitted onto the hospital’s wards during the summer of 1851. He had contracted both syphilis and gonorrhea several years earlier and had been in and out of hospitals ever since. Lister noted that although the young man was unmarried, he had been engaged in sexual activity since he was fifteen. Lister recorded in his casebooks that Chappell “formed a connexion with a female, and sometimes at this early age had connexion 3 or 4 times a day.” The most pressing concern for Chappell was not, however, the consequences of his irrepressible libido. What had brought him to Lister’s ward was a hacking cough that was accompanied by white discharge tinged with blood, sometimes amounting to as much as one and a half pints. The diagnosis was plain: first-stage phthisis, or pulmonary tuberculosis—a respiratory disease for which there was no cure in the 1850s. Hospital policy dictated that incurables not be admitted, and so Lister sent Chappell back out into the general population. The medical community did not yet know that tuberculosis is a highly infectious disease. The fact that Chappell was forced to sleep in the same room with five or six of his shop mates leaves one wondering how many other people he infected. Such was life for the typical Victorian worker who came to frequent the wards of London’s hospitals.