* * *
WHILE URBANIZATION took a toll on the health of its working class, Britain was eagerly celebrating its seemingly unassailable status as a global mercantile powerhouse. In the summer of 1851, the city swelled with millions of visitors who had come to see the Great Exhibition in Hyde Park, which signaled to the nation that technology was the key to a better future.
Sparkling amid the trees was the Crystal Palace, built by the garden designer Joseph Paxton as a showcase for wonders of industry from around the world. The enormous building was modeled on Paxton’s glass greenhouses. Fashioned from nearly one million square feet of glass, the Crystal Palace was 1,851 feet long—a number deliberately chosen to reflect the year of the exhibition—and it boasted six times more floor space than St. Paul’s Cathedral. During its construction, contractors tested the building’s structural integrity by ordering three hundred compliant laborers to jump up and down on the flooring, and by having troops of soldiers march around its bays.
When the exhibition opened, there were approximately 100,000 objects from more than fifteen thousand contributors on display, among them a printing machine that could turn out five thousand copies of The Illustrated London News in an hour; “tangible ink” that produced raised characters on paper for the blind; and a handful of velocipedes, the predecessor of the modern bicycle, with pedals and cranks on the front axle. The biggest exhibit by far was a massive hydraulic press, which could be operated by just one man, even though each metal tube weighed 1,144 tons. There was also the world’s first major installation of public flushing toilets, designed by the Victorian sanitary engineer George Jennings. Some 827,280 people paid one penny to use the facilities during the exhibition, which gave rise to the popular euphemism “spending a penny.” But such a luxury would not ameliorate the squalor of Britain’s poorest households for many years to come.
There were scientific and medical novelties too, the more practical of which would find their way into the hospitals of Britain. An artificial leech that looked like a miniature bicycle pump was meant to expel “matters and humours from the body” and infuse “animating substances through the skin.” There were prosthetic hands, arms, and legs that promised to restore an amputee’s ability to grasp objects, ride a horse, or dance. One exhibitor from Paris showcased a complete model of the human body made from seventeen hundred parts that included replicas of bones, muscles, veins, and spinal nerves. The five-foot-nine dummy even had crystalline lenses in its eyes, which could be removed to reveal optic nerves and membranes underneath.
The curious traveled from all over the world to marvel at the contraptions that promised to make everyday life easier, faster, and more convenient. One woman walked 247 miles from Penzance on the southwest tip of England to attend the fair. In a letter to her father, the celebrated novelist Charlotte Brontë wrote of the Great Exhibition, “It is a wonderful place—vast, strange, new and impossible to describe. Its grandeur does not consist in one thing, but in the unique assemblage of all things. Whatever human industry has created, you find there.” The Victorians had come to worship at the altar of science, and they had not been disappointed. By the time the Great Exhibition closed on October 11, more than six million people had visited the park, including Joseph Lister and his father, Joseph Jackson, whose nephew had displayed a microscope that was honored with an award by the exhibition organizers.
The true value of the microscope continued to be debated and disputed within the wider medical community in the 1850s. And yet Lister persisted with his research. After the fair had ended, he spent an inordinate amount of time poring over microscope slides that he had prepared. Anything and everything he could lay his hands on ended up under the lens. One afternoon in late autumn, he watched as an amorphous mass of bloody tissue danced before his eyes. Lister squinted into the ocular lens of his microscope before turning the tiny brass dial on the sleek instrument to adjust the focus. Suddenly, the tumor that he and Erichsen had excised from a patient earlier that day popped into view, each cell outlined with perfect clarity. Lister studied the image for a few minutes before he began to sketch the tumor on a pad of paper. He produced dozens of images like this, some of them in such startling detail that he was able to use them as teaching aids decades later.
Even when he toured the country on vacations, his mind was constantly engaged with the natural world around him. Lister sketched muscle tissues from the leg of a spider and the corneal cells from the eye of a boiled lobster. He sliced open starfish he had trapped during a trip to Torquay—a seaside town on the English Channel—and delighted in observing their odd geometric shapes magnified under the lens. Writing to his father, he boasted, “I even saw … a valve in the middle of the upper part of the heart alternately open and close at each pulse.” After he had caught a lamprey in the Thames, he cut into the silvery body and extracted the eel’s brain late at night in his room. Using a camera lucida—an optical device that Joseph Jackson had invented which allowed an artist to trace images projected onto sheets of paper—Lister was able to sketch in precise detail the creature’s medulla cells that he had observed with his microscope.
Lister found an ally for his microscopic research in his professor of physiology. William Sharpey—then in his early fifties—looked as though he were permanently squinting, which seemed apt given the amount of time the man spent peering down the lens of his own microscope. The hair on the top of the Scotsman’s head had thinned considerably by the time Lister came under his tutelage in 1851, though he tried to compensate for the loss by keeping the sides conspicuously bushy. Sharpey was the first to teach a complete course of lectures on physiology, a subject that had traditionally been treated as an appendage to anatomy. This later earned him the title “the Father of Modern Physiology.” He was both an intellectual and a physical giant. When demonstrating to his class how to work a spirometer—an instrument devised to measure the capacity of air in the lungs—he filled each cell of the device so effortlessly that he observed afterward, “This instrument seems to have been designed for people of ordinary development.”
Lister took to Sharpey immediately. He saw in him a man similar to his own father. The physiology professor valued experiment and observation over authority, a characteristic that was unusual in its day. Later in life, Lister reminisced,
As a student at University College I was greatly attracted by Dr. Sharpey’s lectures, which inspired me with a love of physiology that has never left me. My father, whose labours … had raised the compound microscope from little better than a scientific toy to the powerful engine for investigation which it then already was, had equipped me with a first-rate instrument of that kind and I employed it with keen interest in verifying the details of histology brought before us by our great master.
Spurred on by Sharpey’s enthusiasm, Lister began to observe as much human tissue under the microscope as he could acquire. His sketches reveal intricate details of everything from human skin to the cells of a cancerous tongue, which had been cut out of a patient. Lister also created full-color clinical paintings of patients he encountered at the hospital. This was the only method of recording case histories visually before the advent of color photography. In one such painting, Lister portrayed a man leaning back, his arm resting on a chair. His sleeve is rolled up, and his skin is pockmarked with angry sores, probably venereal in nature.
Lister wasn’t content with just being an observer. He also conducted his own experiments, building upon the work of the Italian priest and physiologist Lazzaro Spallanzani, who was the first to correctly describe how the process of mammalian reproduction relied on the union of spermatozoon and ovum. In 1784, Spallanzani developed a technique for artificially inseminating dogs, as well as frogs and even fish. Taking his cue from Spallanzani, Lister took the sperm of a cockerel and tried to artificially fertilize the egg of a chicken outside the body of the bird—but it didn’t work out. (It would take another hundred years before a doctor successfully repeated this experiment in a huma
n. In 1884, the American physician William Pancoast injected sperm from his “best-looking” student into an anesthetized woman—without her knowledge—whose husband had been deemed infertile. Nine months later, she gave birth to a healthy baby. Pancoast eventually told her husband what he had done, but the two men decided to spare the woman the truth. Pancoast’s experiment remained a secret for twenty-five years. After his death in 1909, the donor—a man ironically named Dr. Addison Davis Hard—confessed to the underhanded deed in a letter to Medical World.)
In 1852, Lister made his first major contribution to science using the microscope when he turned his attention to the human eye after obtaining a portion of “fresh blue iris” from Wharton Jones, the university’s professor of ophthalmology. Lister was interested in the debate concerning the nature of the tissue in the constrictor and dilator muscles of the iris. The Swiss physiologist Albert von Kölliker had recently described this tissue as comprising smooth muscle cells, like the kind found in the stomach, the blood vessels, or the bladder. The actions of this type of muscle are involuntary. Kölliker’s discovery was in opposition to the view upheld by one of England’s most eminent ophthalmologists, William Bowman, who believed that the tissue was striped (or striated), which would make the muscle’s movements voluntary.
Lister carefully teased portions of tissue from the iris, which had only been excised from the patient four hours earlier. He placed the sample under the microscope and studied it over the next five and a half hours, sketching each individual cell using the camera lucida. During the course of his research into the matter, Lister examined irises taken from five additional surgical patients at University College Hospital, as well as irises from a horse, a cat, a rabbit, and a guinea pig. What he found confirmed Kölliker’s theory that the iris is in fact composed of smooth muscle fibers arranged as both constrictors and dilators and that their actions are indeed involuntary. Lister published his conclusions in the Quarterly Journal of Microscopical Science. His research stood him apart from so many in his profession who continued to view the microscope as superfluous to the practice of medicine.
Lister’s experiments were undoubtedly considered esoteric by many of the faculty and students alike because they could offer little to the advancement of surgery in the 1850s. And yet Lister persisted. Progress in the form of urbanization and industrialization came at a human cost, but progress in the form of science might provide answers to growing problems within the hospitals. Perhaps the microscope would unlock secrets about the human body that could one day lead to changes in therapeutics.
* * *
A FEW MONTHS LATER, another patient on Erichsen’s wards fell ill with an infectious disease. This time the deadly culprit was hospital gangrene, the most virulent of the “big four” that made up hospitalism. Some doctors called the condition a malignant or “phagedenic” ulcer, the latter deriving from Greek and meaning “to eat away.” The Scottish surgeon John Bell wrote about the horror of hospital gangrene after treating numerous patients who had died from it. In the first stage, “the wound swells, the skin retracts … the cellular membrane is melted down into a foetid mucus, and the fascia is exposed.” As the disease progresses, the wound enlarges and the skin is eaten away, exposing the deep layer of muscles and bone. The patient goes into shock and begins experiencing intense nausea and diarrhea as the body tries to expel the poison from within. The pain is excruciating, and alas, delirium is rare. The patient remains conscious throughout the whole miserable ordeal. Bell wrote, “The cries of the sufferers are the same in the night as in the day-time; they are exhausted in the course of a week and die: or if they survive, and the ulcers continue to eat down and disjoin the muscles, the great vessels are at last exposed and eroded, and they bleed to death.”
The first English descriptions of the affliction come from late eighteenth-century naval surgeons, who witnessed outbreaks of it in the damp, cramped quarters of the king’s fleet. Isolated on the high seas, the sailors could do nothing to contain its spread once it appeared, and the sickly sweet smell of rotting flesh would soon pervade the already fetid air belowdecks. In the summer of 1799, one surgeon saw a sailor punched in the ear during a brawl. He suffered a slight wound from the blow. Within days, however, an ulcer had appeared that devoured one side of the man’s face and neck, exposing his trachea and the inside of his throat before killing him.
Hundreds of stories like this abound. On the HMS Saturn, a malignant ulcer appeared on the tip of a seaman’s penis. After several days of agonizing pain during which the wound blackened and festered, the organ finally fell off. The surgeon on board reported that the “whole length of the urethra to the bulb sloughed away, and also the scrotum, leaving the testes and spermatic vessels barely covered with cellular substance.” As if the inevitable outcome needed underlining, the surgeon added, “He died.”
When it came to these festering, flesh-eating ulcers, Bell advised that patients be removed from the hospital as quickly as possible: “Without the circle of infected walls men are safe.” Anything was better than “this house of death,” as Bell put it. Let the surgeon “lay them in a school-room, a church, on a dung-hill, or in a stable.” Others agreed: “This hospital gangrene … no doubt depends on the unwholesome atmosphere exciting preternatural irritability, and the treatment, therefore, essentially requires removal from the sphere of this deleterious influence.”
Erichsen did not differ in his thinking. He too subscribed to the long-held belief that hospital gangrene was caused by a corruption in the air. But isolating the afflicted from other patients could be difficult. When outbreaks occurred, the problem was as much political as it was medical. Wards had to be shut. Admissions had to be halted. Everyone from the hospital administrators to the surgeons themselves scrambled to contain its relentless spread.
When Lister saw filmy discharge seeping through a patient’s dressings one day in 1852, this must have been on his mind. As he peeled back the damp bandages, he was met with a powerful odor emanating from a rotting, ulcerating wound. An epidemic of hospital gangrene soon swept Erichsen’s wards as a result of this single patient. Lister was quickly put in charge of carrying out treatment on the infected—a task that reflects just how far he had come in his residency to be trusted with such important work.
At the height of the outbreak, Lister observed something peculiar. He routinely scraped away the brown pultaceous slough from patients’ infected wounds while they were anesthetized. He then applied mercury pernitrate, a highly caustic and toxic solution, to them. Afterward, he recorded in his notebook: “As a rule … a perfectly healthy granulating sore was disclosed which healed kindly under ordinary dressings.” Only in one case—that of a “very stout woman, in whom the disease attacked an enormous wound of the forearm”—had the mercury pernitrate not worked. Instead, the infection spread with “astonishing rapidity” over the entire sore, and eventually the arm had to be amputated by Erichsen. But before the operation, Lister cleaned out the wound and washed her arm thoroughly with soap and water. The amputation was a success, and the stump healed perfectly—a fact Lister attributed to his own efforts to sanitize the arm beforehand.
Lister’s curiosity had been piqued. Why was it that a majority of the ulcers healed when they were debrided and cleaned with the caustic solution? Although he didn’t dismiss the idea that miasma could be partly to blame, he wasn’t convinced that the foul air was entirely responsible for what was happening on the wards of University College Hospital. Something in the wound itself had to be at fault—not just the air around the patient. From the pus that he had scraped out of the infected wounds, he carefully prepared microscopic slides to examine under the lens. The implications of what he saw would take root in his mind and eventually make him question an entire belief system upheld by no less a figure than his superior and mentor, John Eric Erichsen.
He later recorded, “I examined microscopically the slough from one of the sores, and I made a sketch of some bodies of pretty uniform size w
hich I imagined might be the materies morbi [morbid substances] … the idea that it was probably of parasitic nature was at that early period already present in my mind.”
* * *
Lister’s revelation inspired him to conduct broader investigations into the causes of hospital infection. Despite his reenergized commitment to surgery, however, he remained unsure of his career path. Having come across a variety of medical cases during his house surgeoncy, he flirted with the idea of becoming a physician. After completing his residency under Erichsen, Lister accepted an appointment as clinical clerk (the equivalent of a dresser on the medical side) to the senior physician Dr. Walter H. Walshe at University College Hospital. Lister’s nephew Rickman John Godlee later said that “the allurements of medicine seem to have been even stronger than those of surgery” at this time.
The Butchering Art Page 8
