The Butchering Art

by Lindsey Fitzharris

  Lister immediately wrote to his father with the news: “Dr. Lawrie … is in such a state of health as cannot permit him to hold his office much longer.” He expressed interest in applying for the position himself. With such a prestigious title, he would be able to grow his own lucrative private practice in Glasgow, something he had not been able to do in Edinburgh. Moreover, Lister assumed that he would be appointed surgeon to the city’s hospital through the influence of his friends who were part of the medical faculty there. Most important, as he told his father, he felt confident that if he was to secure the position, it would give him “greater claim to any London appointment” that might arise in the future.

  But there was a downside. If Lister moved to Glasgow, it would spell an end to his six-year partnership with his friend, colleague, and father-in-law. He lamented to Joseph Jackson, “I should very much regret leaving Edinburgh, and particularly Mr. Syme, for whom, as thee know, I have a very deep regard.” Lister also fretted about what it might mean for his old mentor and the surgical practice they had cultivated over the past few years: “Mr. Syme … would evidently be more agreeable that I should stay here and help him at the hospital … for there is no one else in this town who is on the same sort of footing with him as myself in surgical matters.” Despite this, the thirty-two-year-old surgeon could not ignore the opportunities that would await him were he to take up a professorship in Glasgow. He set aside his attachment to Syme and the Royal Infirmary and put his name forward for the post.

  Seven other highly skilled candidates also applied for the position: five from Glasgow, two from Edinburgh. Complicating matters was the fact that all appointments for Regius Professorships in Britain were in the hands of a minister of the Crown, who was unlikely to know much about the specific requirements of any given post or which candidates might be best qualified to fill it. Syme graciously recommended his son-in-law, noting in characteristically terse language that Lister had a “strict regard for accuracy, extremely correct powers of observation, and a remarkably sound judgment, united to uncommon manual dexterity and a practical turn of mind.”

  Time elapsed, but still there was no word about the position. Then, in December, Lister received a private letter from a confidant who informed him that he would be offered the Regius Professorship. But his elation was soon dampened when The Glasgow Herald announced in January that the matter had not yet been settled. The article drew attention to an open letter that had been circulated throughout the medical community by the city’s two MPs, who asked local doctors to “inform us which candidate is, in your opinion, the best qualified for the appointment, by placing a cross opposite to his name.” There was an outcry from those concerned about corruption and patronage. If a candidate was handpicked by Glaswegian doctors, then surely there would be a bias against outsiders like Lister.

  The protest grew, with William Sharpey, John Eric Erichsen, and James Syme all writing letters in support of Lister’s candidacy. Ten days after the editorial appeared, Lister was asked officially by the home secretary to fill Lawrie’s position. The following day, a jubilant son wrote to his father, “At last the welcome news has arrived … that Her Majesty has approved of my appointment.” Lister described feeling “intoxicated with [a] gladness” that had been “doubled or trebled, I doubt not, by the long period of suspense that preceded it.” As a happy consequence, he also believed that the decision had cleared Glasgow of the charge of narrow-mindedness and clannishness universally made against it. In this new city, Lister believed he and Agnes would make themselves at home.

  * * *

  Glasgow was only forty miles from Edinburgh. An ancient university was at the heart of both cities, but the intellectual atmosphere in Glasgow was very different from the one that Lister had grown accustomed to in Edinburgh while working alongside Syme. The Glaswegian medical community was more authoritarian than speculative, more conservative than maverick. It did not welcome innovation readily. Lister would struggle to find his place amid the more traditionally minded stalwarts at the university.

  When Lister arrived for his induction ceremony, the room was crowded with distinguished men from the institution, the same people who would soon be his colleagues. They had congregated in droves to hear the new professor of clinical surgery give his first speech. Lister was anxious. A day earlier, he had been told that he would have to deliver his thesis in Latin, an antiquated tradition that stemmed from the belief that medical men should be able to exhibit their breadth of learning. One contemporary wrote, “We ought to be men and gentlemen first before we are doctors or men of science.”

  Into the late hours the night before, Lister struggled to prepare his important speech. Now, as he stood before the audience, he nervously clutched at a Latin dictionary that he had brought along at Agnes’s suggestion. To compound his angst, he also worried that his stutter would return, as it sometimes did when he was under intense pressure. But as he began to speak, he fell into a rhythm. The Latin rolled off his tongue with surprising ease. Just as he was about to launch into further passages of his thesis, the principal of the university rose out of his seat and interrupted him. He indicated that Lister could stop because he had already satisfied the requirements with the first few paragraphs of his paper. He had passed his first test.

  The University of Glasgow’s conservative leanings notwithstanding, changes were under way. Recent appointments to the faculty attracted newcomers and helped offset the institution’s somewhat flagging reputation. In 1846, William Thomson (known as Lord Kelvin, who later formulated the first and second laws of thermodynamics) joined the faculty as professor of natural philosophy, bringing with him an emphasis on laboratory and experimental work in the classroom. Two years later, Allen Thomson became professor of anatomy. His lectures on microscopic anatomy were a novel addition to the university’s otherwise stale curriculum. As a result of these changes, the university began to see a steady rise in its intake of medical students. When Lister joined the faculty, there were 311 students registered, nearly three times the number enrolled just twenty years earlier. Of these, over half had signed up for Lister’s new course on systematic surgery, making it the largest of its kind in Britain.

  The university was not equipped for this sudden influx of students. While Edinburgh had allocated hundreds of pounds for renovation of its classrooms and teaching apparatus, Glasgow offered virtually nothing in the way of financial investment. Lister—whose practical teaching methods required the use of anatomical specimens, models, and drawings—found the lecture theater assigned to him to be inadequate. He decided to invest his own money in renovating the space, and the measures he undertook included the building of a “retiring room” attached to the theater where he could store his unusual specimen collection. The desks and chairs were also replaced, and the entire room was cleaned and eventually repainted. Agnes helped with the redecorating. Writing to Lister’s mother, Isabella, in May, she noted, “How nice it looks … the green baize on the three doors and the diagram-frame setting off the oak colouring, and the bright little brass handles on the doors setting them off; and the very handsome slate on the frame on one side and the skeleton nicely mounted on the other. Some plates are hung on a diagram-frame and some preparations are on the nice oak-table.” The refurbishments had an instantaneous effect on Lister’s incoming students, who removed their hats upon entering the lecture theater and waited in reverent silence after taking their seats. The fresh surroundings signaled to them that they could expect an equally fresh approach to their education.

  Despite his lingering concerns about speaking in front of a large crowd, Lister’s first lecture there was an unqualified success. He opened with a quotation from the sixteenth-century surgeon Ambroise Paré, who famously said, “I dressed him, God cured him,” before moving on to a discussion about the importance of anatomy and physiology in surgery. Lister’s discourse was both informative and entertaining. His nephew said that the students “laughed, too, in the right places” as the
normally reserved Quaker made a “quiet gentlemanly hit at homeopathy,” which he had been condemning since his student days at UCL.

  One of the principal topics of his talk was on making serviceable stumps when amputating limbs so that amputees could regain as much function as possible and wouldn’t become burdens on their families or society. Again, he had the room bursting into laughter when he told them a story about a stoic youth from Scotland who was able to dance the Highland fling after Lister had removed both of the man’s legs. After the lecture, Lister wrote to his mother, “I now feel, that with the same gracious help I can do anything.… It was curious how entirely absent any shade of anxiety was during the whole proceedings.”

  The students immediately warmed to their new professor, who in turn became more comfortable in his role as their teacher. They were even grateful for his tendency to stutter, which forced him to speak slowly and enabled them to take notes more easily. One of his graduates later wrote that Lister was in fact worshipped by his students. Back in Edinburgh, Syme also heard of his protégé’s progress. He wrote to his son-in-law, “The game may be considered in your own hands,” adding, almost as an afterthought, “Wishing you all comfort in playing it out.”

  * * *

  Shortly after his appointment to the university, Lister was elected a Fellow of the Royal Society—an extraordinary honor at this early stage of his career. It was a distinction his father had also had bestowed upon him, in recognition of his development of the first achromatic lens. Joseph Jackson was thrilled by the news of his son’s joining him as a society member. Lister joined a long line of illustrious members, whose names included Robert Boyle, Sir Isaac Newton, and Charles Darwin. The vote was a tribute to the originality of his research into inflammation and coagulation of the blood, which he presented in a series of papers to the Royal Society in 1860.

  Lister was deeply ensconced in this work at the university when he applied for a position as a surgeon at Glasgow’s Royal Infirmary. He believed a hospital post was crucial to his role as a teacher, as it would allow him to demonstrate his theories and methods to students on real living patients. Before taking up his professorship, he had been told by friends in the medical faculty that his appointment to the Royal Infirmary would be all but guaranteed once he had settled into his academic role. Indeed, Lister had disclosed this expectation when he had first written to his father about Lawrie’s retirement and the vacancy at the university. It therefore came as a great surprise to Lister when his application was rejected.

  Lister put his case before David Smith, a boot- and shoemaker who was also the chairman of the hospital’s board. One could buy one’s way onto the board by making a large donation, so it was not uncommon for a hospital to be managed by people like Smith who had no medical background. The Royal Infirmary’s board had twenty-five directors. Two were medical professors at the university, but the rest were a mishmash of religious officials, politicians, and other representatives of public bodies; they were hardly scientific visionaries. It was inevitable that Lister—a man who was trying to reform surgical practice from within and at a fundamental level—would come up against someone like Smith, who thought hospitals existed for only one reason: to treat patients. In the eyes of Lister and progressive contemporaries such as James Syme, a hospital was much more than this: it was a place where students could learn from real-life cases.

  Lister explained to Smith that it was important as professor of clinical surgery to be able to perform demonstrations for students on the wards of the hospital so that they could unite theory with practice. He himself was a product of this type of education. Smith thought this idea preposterous. “Stop, stop, Mr. Lister, that’s a real Edinburgh idea,” he told the frustrated surgeon. “Our institution is a curative one. It is not an educational one.” A majority of the hospital’s directors agreed with Smith and voted against Lister’s appointment in 1860.

  There was truth in Smith’s assertion that the primary role of Glasgow’s Royal Infirmary was curative. The city’s population had quadrupled between 1800 and 1850 and would again between 1850 and 1925. There had been an inpouring of dispossessed Highlanders in the 1820s and thousands fleeing Ireland’s potato famine in the 1840s. By the time of Lister’s arrival, Glasgow was one of the largest cities in the world and was known as “the Second City of the Empire” after London. As the only major hospital in a city with a population of 400,000 people, the Royal Infirmary struggled to keep pace with the growing medical demands placed on it.

  As in London and Edinburgh, crime was endemic and disease rampant. Yet Glasgow was worse than most cities in Britain at this time. On his visit to the city, the German philosopher and journalist Friedrich Engels observed, “I have seen human degradation in some of its worst phases, both in England and abroad, but I can advisedly say, that I did not believe, until I visited the wynds of Glasgow, that so large an amount of filth, crime, misery, and disease existed on one spot in any civilized country.” It was a place, he said, that “no person of common humanity to animals would stable his horse in.”

  Glasgow was expanding its heavy manufacturing, particularly shipbuilding, engineering, locomotive construction, metalworking, and oil, and as a consequence, terrible injuries featured frequently at the hospital. There was thirty-five-year-old William Duff, who severely scalded his face and upper torso while lighting a candle over a manhole at the new Oil Works in Keith Place. There was also eighteen-year-old Joseph Neille, who was working at a local munitions factory when he placed a tin flask that he had thought contained tea onto the fire. Only after it was too late did he realize the flask was actually filled with two pounds of gunpowder. And the hospital often dealt with fractured skulls, severed hands, and fatal falls.

  Given the increase in industrial accidents and the ongoing outbreaks of disease, it is understandable why David Smith thought the Royal Infirmary’s primary duty was to its patients, not to its medical students and their professors. Still, Smith’s view that the presence of someone like Lister would be obstructive, due to his using the wards as a teaching environment, was by no means universally held. Decades earlier, many urban hospitals outside Glasgow had recognized the benefits of forging coalitions with universities so that they could attract the best and brightest practitioners in medicine.

  Most of the medical positions at the larger hospitals in Britain in 1860 were voluntary, and although there was prestige in holding them, physicians and surgeons were not paid a salary. The bulk of a surgeon’s income came from two sources: private practice and fee-paying students. And with the development of clinical teaching in the hospitals of Paris and elsewhere, British students had come to expect the same rigor from their homegrown education. Hospital administrators knew that if they allowed their medical staff to teach on the wards, they could attract some of the more renowned physicians and surgeons, who would otherwise have little incentive to lend their time and expertise to an institution offering no pay. Glasgow’s Royal Infirmary evidently did not share this view at the time that Lister applied for a surgical position at the hospital. This was made all the more absurd by the fact that the hospital was close to the university, which would have made a mutually beneficial alliance between the two simple to expedite.

  Months passed and Lister still hadn’t been given official charge of patients at the city’s hospital. His students were dismayed by the delay as well, because it meant that they too could not benefit from any clinical instruction from him on the wards. They had been so taken with his lectures that they made him honorary president of their medical society. At the end of the winter course, the class went a step further to show their appreciation for their much-admired instructor. They signed a declaration in which they shared their wish that his appointment to the Royal Infirmary was imminent: “Permit us to express our hope for the sake both of the rising Profession and of the Institution itself, that in the approaching appointment of a surgeon to the Royal Infirmary your application may meet with that success which your ability
and position demand.” The document was signed by no fewer than 161 students.

  In fact, it was nearly two years after Lister began teaching at the university that he was put in charge of patients at the Glasgow Royal Infirmary. Even after the motion was passed, there were continued protests from some of the hospital’s managers, who expressed concern over Lister’s growing reputation as a progressive. Still, Lister had won this battle, if not yet the war.

  * * *

  When Lister stepped onto the hospital’s wards in 1861, a new surgical wing had just been constructed. Originally, the hospital contained 136 beds, but with this addition there were now 572 beds, making it twice as large as Edinburgh’s Royal Infirmary and four times as large as the London hospital in which Lister trained as a student. Each surgeon was given charge of one female and two male wards, the latter of which were divided between the treatment of acute and chronic conditions. Despite having been built months earlier, the surgical wing soon proved to be one of the most insanitary places in which Lister had ever worked. As one of his colleagues noted, “Its newness had not saved it from invasion by the prevailing diseases of infected wounds.”

  The all-too-familiar enemies of secondary hemorrhage, septicemia, pyemia, hospital gangrene, tetanus, and erysipelas were never absent from the wards. Infective suppuration in wounds came to be expected. Lister’s male acute ward was located on the ground floor, which was adjacent to the graveyard (overflowing with rotting corpses from the last cholera epidemic) and separated from it only by a thin wall. He complained of the “uppermost tier of a multitude of coffins” reaching to within a few inches of the surface of the ground and said that it was “to the disappointment of all concerned [that] this noble structure proved extremely unhealthy.” There were also few provisions for the washing of hands and instruments throughout the hospital. As Lister’s house surgeon reflected, “When almost every wound was foul with suppuration, it seemed natural at the time to postpone the complete cleansing of hands and instruments, until the programme of dressings and probings had been finished.” Everything was veneered with grime.