The Butchering Art

by Lindsey Fitzharris

  Both the students’ address and Lister’s response were subsequently reported in newspapers around the country. Word reached King’s College that Lister had been vocally critical of prevailing teaching methods in London. Tempers flared. The Lancet reported that Lister had forgotten “the rules of decency and good taste as to contemptuously decline an offer that had never been made to him.” And just a few weeks later, the governing council at King’s College appointed John Wood to Fergusson’s chair.

  Lister’s friends in London hadn’t abandoned the fight just yet. Because there had been no formal offer made to him, there had also been no formal rejection. In April, a resolution was put before the council requesting that a second chair of clinical surgery be created and that Lister be considered for the position because “it would be a great benefit to the school.” This time, cooler heads prevailed—much to the dismay of poor Wood, who did not relish the idea of sharing his role with another surgeon. In May, Lister traveled to London to meet with the council and presented them with thirteen conditions. Driving a hard bargain, he stipulated that he wished to retain total control over his wards and his classroom and that the division of fees between him and Wood should be fair. The council members reluctantly accepted his conditions because they knew that having such a renowned professor on their staff would elevate the reputation of the university. Shortly afterward, Lister was officially appointed professor of clinical surgery at King’s College.

  It was a bittersweet moment. For nearly a quarter of a century, Lister had hoped to return to London one day, and now at the age of fifty he had finally been granted that opportunity. But leaving Edinburgh at the height of his career and beginning anew would not be an easy undertaking. Decades earlier, it had been the material rewards and career advancement that had underpinned his desire to move back to the capital. This time, it was the London medical community’s stubborn disbelief in his antiseptic system. His was a mission to convert the nonbelievers, just as he had done in Glasgow and Edinburgh, and throughout America.

  In September 1877, Lister slipped quietly away from the Scottish city where he had first fallen in love with the bloodied and butchering art of surgery under the tutelage of his great mentor, James Syme. But just before boarding the train, he made a valedictory check upon his final intake of patients at the Royal Infirmary. As he walked the hallways one last time, he took stock of the institute’s marked transformation. He was confident that it would be safe in the hands of his disciples, who would now be entrusted with implementing his antiseptic system throughout the hospital. Gone were the filthy wards crammed with patients wasting away in squalid conditions; gone were the bloodied aprons and the operating tables soiled with bodily fluids; and gone were the unwashed instruments, all of which once had the operating theater reeking of “good old hospital stink.” The Royal Infirmary was now bright, clean, and well ventilated. No longer a house of death, it was a house of healing.

  EPILOGUE: THE DARK CURTAIN, RAISED

  It is Surgery that, long after it has passed into obsolescence, will be remembered as the glory of Medicine.

  —RICHARD SELZER

  IN DECEMBER 1892, JOSEPH LISTER traveled to Paris to attend a grand celebration of Louis Pasteur’s seventieth birthday. Hundreds of delegates from around the world gathered at the Sorbonne to pay homage to the scientist, and to express admiration on behalf of their respective countries for the groundbreaking work he had conducted over the course of his career. Lister was present not just as a representative of the Royal Societies of London and Edinburgh but as Pasteur’s friend and intellectual companion.

  On that crisp winter day in Paris, the two men entered the Sorbonne, both preeminent exponents of their respective fields. In addition to foreign dignitaries, thousands of members of the public gathered to watch the celebration. Despite the jubilant atmosphere, however, not all was well privately. Both men were advancing in years, and life seemed to be winding down for the two of them. Lister, now sixty-five, had reached the age at which retirement from his professorship at King’s College was compulsory. Within a few months, his wife and companion of thirty-seven years would die, leaving a void that would never be filled. Pasteur had recently suffered a stroke—the second of three that he would experience during his lifetime. Once, when writing to Lister back in London, Pasteur reflected on his suffering: “The impairment of my speech has become permanent, just as the partial paralysis of my left side has become permanent.” On the day of the celebration, the intellectual giant hobbled onto the stage, unable to move effectively without assistance.

  Lister paid tribute to the French scientist during his address. In his typically humble way, he downplayed his own role in the transformation of surgery. Instead, Lister credited Pasteur with “raising the dark curtain” in medicine. “You have changed Surgery … from being a hazardous lottery into a safe and soundly-based science,” he said of Pasteur. “You are the leader of the modern generation of scientific surgeons, and every wise and good man in our profession—especially in Scotland—looks up to you with respect and attachment as few men receive.” If the stroke hadn’t severely hindered his ability to speak, Pasteur might have expressed exactly the same sentiments about Lister.

  The auditorium erupted into thunderous applause as Lister concluded his tribute. Pasteur rose from his chair and with the help of attendants embraced his old friend. According to an official record of the occasion, it was “like the living picture of the brotherhood of science in the relief of humanity.”

  The two would never again meet in person.

  * * *

  LISTER LIVED FOR MANY DECADES after his theories and techniques had been accepted, and he was eventually celebrated as a hero of surgery. He was appointed personal surgeon in ordinary to Queen Victoria—the term “in ordinary” signaling that it was a permanent position. In the final decades of his life, official accolades came thick and fast. He was awarded honorary doctorates from the Universities of Cambridge and Oxford. He was awarded the Boudet Prize for the single greatest contribution to medicine. Shortly afterward, he attended the International Medical Congress in London. In contrast to his circumstances at the first of these gatherings, held in Philadelphia, Lister’s reputation and methods had reached their acme by the time the medical community reconvened in the British capital. He was also knighted and made a baronet; he was elected president of the Royal Society; he was raised to the peerage and titled Lord Lister of Lyme Regis; he helped found the medical research body that would later be named in his honor, the Lister Institute of Preventive Medicine; and ten years before his death he was made privy councillor and honored with the Order of Merit—all for his work in science and medicine.

  The burgeoning awareness of microbes intensified the Victorian public’s preoccupation with cleanliness, and a new generation of carbolic acid cleaning and personal hygiene products flooded onto the market. Perhaps the most famous of these was Listerine, invented by Dr. Joseph Joshua Lawrence in 1879. Lawrence had attended Lister’s lecture in Philadelphia, which inspired him to begin manufacturing his own antiseptic concoction in the back of an old cigar factory in St. Louis shortly thereafter. Lawrence’s formula contained thymol (derived from phenol) in addition to eucalyptol and menthol. It also had an alcohol concentration of 27 percent.

  Nothing would have come of Listerine had the entrepreneurial pharmacist Jordan Wheat Lambert not recognized its potential when he met Lawrence in 1881. Lambert bought the rights to the product and its formula from the good doctor and began marketing it as an antiseptic with multiple uses, including as a dandruff treatment, a floor cleaner, and even a cure for gonorrhea. In 1895, Lambert promoted Listerine to the dental profession as an oral antiseptic, a use for which it has achieved immortality.

  Other products that sprang up in the wake of the antiseptic mania included carbolic soap, carbolic general disinfectants (often simply neat phenol sold in bottles with instructions printed on them), and carbolic tooth powder. Calvert’s Carbolic Tooth Paste became
a household favorite and even attracted the patronage of Queen Victoria. In the United States, a practitioner in Illinois was the first to use carbolic acid for injecting into hemorrhoids, a dubious practice that more often than not left the recipient unable to walk for weeks. The wondrous properties of carbolic acid became so celebrated that a song was written about them. Clarence C. Wiley was a pharmacist from Iowa who won fame for his folk rag titled “Car-Balick-Acid Rag,” composed and copyrighted in 1901. It was published as sheet music and in the form of a player piano roll.

  There were hazards for the ill-informed: in September 1888, the Aberdeen Evening Express reported that thirteen people had been poisoned by carbolic acid in just one incident, and five of them had died. Later regulation in Britain prevented the sale of toxic chemicals in their purest form to the general public. Carbolic acid was also at the center of a corporate legal suit in 1892. The worryingly named Carbolic Smoke Ball was marketed in London as a prophylactic against influenza, in the wake of the flu pandemic that killed one million people between 1889 and 1890. The product was a rubber ball filled with carbolic acid and with a tube attached. This tube was to be inserted into the user’s nose, and the ball was squeezed to release vapors. The nose would then run, the idea being that this would flush out infections.

  As a marketing ploy that they assumed no buyer would take literally, the Smoke Ball’s manufacturers advertised that those who found the product ineffective would be compensated with one hundred pounds—an extraordinary sum at the time. The judge presiding over a lawsuit that resulted from this error of judgment rejected the Carbolic Smoke Ball Company’s claims that this was “mere puff” and ruled that the advertisement had made an unambiguous promise to customers. He ordered the company to pay compensation to an influenza sufferer and disappointed Smoke Ball purchaser named Louisa Carlill. To this day, the case is often cited to law students as an example of the basic principles of contractual obligation.

  Among the more surprising offshoots of Lister’s work was the establishment of one of the most recognizable corporations in the world today. Like the inventor of Listerine, Robert Wood Johnson first became aware of antisepsis when he attended Lister’s lecture at the International Medical Congress in Philadelphia. Inspired by what he had heard that day, Johnson joined forces with his two brothers James and Edward, and founded a company to manufacture the first sterile surgical dressings and sutures mass-produced according to Lister’s methods. They named it Johnson & Johnson.

  But Lister’s most enduring legacy was the successful and widespread dissemination of his ideas, attributable as much to a small but dedicated group of his students—the core Listerians—as to his own dogged persistence during those long years of controversy surrounding his antiseptic system. At the end of his career, Lister was often followed by a procession of solemn, reverential students, the first of whom bore aloft the sacred carbolic spray as a talisman of their mentor’s extraordinary accomplishments. They came from all over the world to study under the great surgeon: from Paris, Vienna, Rome, and New York. And they took back with them his ideas, his methods, and his unshakable conviction that with the correct application of meticulous and hard-won techniques surgery could one day save far more lives than it inadvertently ended.

  The adoption of Lister’s antiseptic system was the most prominent outward sign of the medical community’s acceptance of a germ theory, and it marked the epochal moment when medicine and science merged. Thomas Eakins—the artist who painted The Gross Clinic—returned to the subject in 1889 to paint The Agnew Clinic. This time, however, instead of painting a dingy operating theater with surgeons caked in blood, Eakins shows the viewer a markedly cleaner, brighter operating environment with participants wearing stark white coats. The Agnew Clinic portrays the embodiment of antisepsis and hygiene. It is Listerism, triumphant.

  As the years passed, there was a gradual shift in medical procedure from antisepsis (germ killing) to asepsis (germ-free practices). The very theory on which Lister based his entire system seemed to demand that aseptic methods replace antisepsis. But he opposed this change because he felt asepsis—which required the scrupulous sterilization of everything within the patient’s vicinity before procedures commenced—was impractical if surgeons were to continue operating outside the controlled environment of a hospital. Surgery, he felt, should be safe whether it was performed on one’s dining table or in an operating theater, and antisepsis was the only viable solution when it came to operating in a patient’s own home.

  Lister recognized the importance of the hospital, but only in relation to the care and treatment of the poor. His former student Guy Theodore Wrench later argued that had it not been for his mentor’s work, hospitals might have ceased to exist altogether. “Large hospitals were being abandoned and hut hospitals substituted,” Wrench wrote. “Lister’s work … came in the nick of time. It saved not only patients but hospitals. It prevented … an entire reversion of the method of dealing surgically with the poor.” But as essential as hospitals were, Lister did not think that the whole of his profession would be (or should be) based in them; those with means, he believed, would continue to be treated outside institutional walls, in their homes or in private clinics.

  As he neared the end of his life, Lister expressed the desire that if his story was ever told, it would be done through his scientific achievements alone. In his will—dated June 26, 1908—the eighty-one-year-old surgeon requested that Rickman John Godlee, along with his other nephew Arthur Lister, “arrange [his] scientific manuscripts and sketches, destroying or otherwise disposing of such as are of no permanent scientific value or interest.”

  Lister wrongly believed that his personal story had little bearing on his scientific and surgical achievements. Ideas are never created in a vacuum, and Lister’s life very much attests to that truth. From the moment he looked through the lens of his father’s microscope to the day he was knighted by Queen Victoria, his life was shaped and influenced by his circumstances and the people around him. Like all of us, he saw his world through the prism of opinions held by those whom he admired most: Joseph Jackson, a supportive father and accomplished microscopist; William Sharpey, his instructor at UCL who encouraged him to go to Edinburgh; James Syme, his longtime mentor and father-in-law; and Louis Pasteur, the scientist who gave him the key needed to unlock one of the great medical mysteries of the nineteenth century.

  Lister died peacefully on a cold, wintry morning in February 1912. Near his bedside were unfinished papers on the nature and causes of suppuration—a subject that had fascinated him since his student days. Even at the end, when his vision and hearing were severely impaired, Lister continued to engage with the scientific world around him. After his death, all his wishes were carried out, except one. His private and family correspondence was not destroyed, but preserved by his nephew. It is through his writing that we are first allowed a glimpse into Lister’s inner sanctum.

  Joseph Jackson had once reminded his son that it was a blessing that he had been permitted to be the means by which the antiseptic system was introduced to “thy fellow mortals.” A life of self-sacrifice and singular determination had been fully vindicated. His pioneering work ensured that the results of surgery would no longer be left to chance. Henceforth, the ascendancy of knowledge over ignorance, and diligence over negligence, defined the profession’s future. Surgeons became proactive rather than reactive when it came to postoperative infection. No longer lauded for their quick hand with a knife, they were revered for being careful, methodical, and precise. Lister’s methods transformed surgery from a butchering art to a modern science, one where newly tried and tested methodologies trumped hackneyed practices. They opened up new frontiers in medicine—allowing us to delve further into the living body—and in the process they saved hundreds of thousands of lives.

  Hector Cameron, Lister’s former student and assistant, later said of him, “We knew we were in contact with Genius. We felt we were helping in the making of History and that all
things were becoming new.” What was once impossible was now achievable. What was once inconceivable could now be imagined. The future of medicine suddenly seemed limitless.

  NOTES

  The page numbers for the notes that appear in the print version of this title are not in your e-book. Please use the search function on your e-reading device to search for the relevant passages documented or discussed.

  PROLOGUE: THE AGE OF AGONY

  When a distinguished but elderly scientist: Arthur C. Clarke, Profiles of the Future (London: Victor Gollancz Ltd, 1962), 25.

  The surgeon John Flint South: John Flint South, Memorials of John Flint South: Twice President of the Royal College of Surgeons, and Surgeon to St. Thomas’s Hospital, collected by the Reverend Charles Lett Feltoe (London: John Murray, 1884), 27.

  People were packed like herrings: Ibid., 127, 128, 160.

  The audience was made up: Ibid., 127.

  parts gushing forth not only: Paolo Mascagni, Anatomia universa XLIV (Pisa: Capurro, 1823), quoted in Andrew Cunningham, The Anatomist Anatomis’d: An Experimental Discipline in Enlightenment Europe (Farnham, U.K.: Ashgate, 2010), 25.

  “What a terrible sight”: Jean-Jacques Rousseau, “Seventh Walk,” in Reveries of the Solitary Walker, trans. Peter France (Harmondsworth, U.K.: Penguin, 1979), 114, quoted in Cunningham, Anatomist Anatomis’d, 25.

  In 1840, for instance: J. J. Rivlin, “Getting a Medical Qualification in England in the Nineteenth Century,” http://www.evolve360.co.uk/data/10/docs/09/09rivlin.pdf, based on a paper delivered to a joint meeting of the Liverpool Medical History Society and the Liverpool Society for the History of Science and Technology, Oct. 12, 1996.