I love a good medical history. There’s just something about the collision of history and gore and progress that is fascinating. Deborah Blum’s The Poisoner’s Handbook is one of my favorite nonfictions ever (the PBS doc was fascinating, too) and I am very excited for The Mystery of the Exploding Teeth by Thomas Morris that’s also on my TBR. But Exploding Teeth will have to wait (or, rather, I’ll have to wait, because I ordered it from the bookstore but the bookstore is super closed right now) because in a late-night perusal of my digital library gave me The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine by Lindsey Fitzharris.
Be still, my heart.
Even the cover is glorious and the gory action starts right away with an immediate trip to a Victorian-era surgical theater. If you don’t know and aren’t currently eating lunch, surgical theaters in the Victorian era were places where surgeons would perform surgery for an audience. They were also popular for mummy autopsies during that craze in Europe, too.
The things people did before TV.
As you can imagine, surgical theaters were bloody and appallingly unhygienic places, and although the patients who were front and center of the action were often in dire need of surgery, their outcomes for survival were, shall we say, not ideal. Part of the surgical theater craze came before anesthetic, so that was extra fun. Fitzharris hits the sweet spot between fact and imagination to make the scene uncomfortable to read without it becoming stomach-turning. For the faint of heart, I will say that later on, some of the descriptions did border on intense, but I should also mention that I was donating blood at the time I was reading them and also living through a global pandemic and the two real-life experiences may not have created an ideal condition for the reading of this book. Fair warning.
But between the bouts of gore is a truly riveting retelling of how Joseph Lister (who didn’t create Listerine but for whom the product that would eventually become mouthwash was named) came upon the outrageous idea that wounds should be sterilized with carbolic acid before bandaging. This was coupled with the even more absurd notion that surgeons should also sterilize their instruments before and between surgeries. Granted, this was only a few years after the first rumblings that perhaps doctors should consider washing their hands after such things as conducting autopsies and before procedures like delivering children, so, you know. Progress.
It would be easy to look at the pushback Lister got for his ideas and the tremendous rejection he found in the medical community despite significant evidence backing up his claims, but Fitzharris does a good job of not patronizing those early doctors—a feat largely achieved through providing tremendous context. Louis Pasteur had only recently come up with pasteurization and had moved on to proposing what was known then as “germ theory.” In other words, the theory that illness was caused by tiny organisms, not miasma. The common medical knowledge of the day was that pus was a sign of healing, not infection. Amputations were thought to be safer and more reliable than setting a bad break or stitching up a bad cut. In other words, it was a real bad time to be alive. (Not included in the book but a contemporary and related event was Dr. John Snow’s investigation into the 1854 cholera outbreak in London. Again, real bad time to be alive.)
Despite the forgiveness for ignorance I found through that context, Fitzharris doesn’t shy away from pointing out all the ways Lister’s methods immediately benefitted patients—and the missed opportunities to use them because of stubbornness. The Civil War, for example, is remembered as one of the bloodiest conflicts in history, both on the battlefield and in the hospitals. Doctors in the U.S. rejected Lister’s ideas until long after the war; had they embraced them, perhaps many of those deaths and amputations could have been avoided.
One of the things Fitzharris points out a few times is that many established surgeons bristled at the new directive because it implied not only that their current methods that they had honed over the course of a career were inadequate, but that those same methods had led to the senseless deaths of many of their old patients. This is, of course, true, but the surgeons seemed to take it personally, not with the perspective that with progress comes change. They seemed to take it as an accusation that they had somehow killed those patients through negligence, not done the best they could in the ignorance that existed before this discovery. As we as a world are blindly feeling our way through this whole COVID thing, that sense of defensiveness and ignorance felt alarmingly prescient. What things are we rejecting today just because they aren’t the way things have been done before? How will history remember our reactions to the new and different that later becomes validated by the future?
I don’t know. But now I know a lot more about gnarly olde-timey surgery and I can’t wait to tell the grossest parts to everyone around me ad nauseum.