Project and content management for Contemporary Authors volumes
WORK TITLE: The Butchering Art
WORK NOTES:
PSEUDONYM(S):
BIRTHDATE: 11-May
WEBSITE: http://www.drlindseyfitzharris.com/
CITY:
STATE:
COUNTRY: England
NATIONALITY: British
RESEARCHER NOTES:
| LC control no.: | no2010153997 |
|---|---|
| LCCN Permalink: | https://lccn.loc.gov/no2010153997 |
| HEADING: | Fitzharris, Lindsey, 1982- |
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| 046 | __ |f 1982-05-11 |2 edtf |
| 100 | 1_ |a Fitzharris, Lindsey, |d 1982- |
| 378 | __ |q Lindsey Anne |
| 670 | __ |a A committed Helmontian, 2009: |b t.p. (Lindsey Fitzharris; Worcester Coll.; D.Phil. thesis, Fac. of History, Univ. of Oxford) thesis cat. inf. form (Lindsey Anne Fitzharris; b. May 11, 1982) |
PERSONAL
Born May 11, 1982.
EDUCATION:Oxford University, Ph.D.
ADDRESS
CAREER
Writer and television host. Creator of Chirurgeon’s Apprentice website. Writer and presenter of YouTube series Under the Knife. Has appeared on television programs Secrets of the Dead and Tony Robinson’s Gods & Monsters. Developing television series, Medicine’s Dark Secrets.
AWARDS:Wellcome Trust Postdoctoral Fellowship to work at Queen Mary, University of London, 2009–.
WRITINGS
Contributor to print and online periodicals, including Guardian, Lancet, New Scientist, Penthouse, Huffington Post, and Medium.
SIDELIGHTS
Lindsey Fitzharris, a medical historian and blogger, portrays the gruesomeness of nineteenth-century medicine and the work of the man who reformed it in The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine. Lister, born into an English Quaker family in 1827, surprised his relatives when he announced his intention to become a surgeon, a profession not well regarded at the time; surgeons were considered little more than butchers. Indeed, surgery was a horrific business during most of the period. Surgeons rarely cleaned their hands or instruments between operations, although other medical professionals had little regard for cleanliness either. The advent of ether and chloroform made surgery less painful, but the use of these anesthetics allowed surgeons to probe more deeply into their patients’ bodies, with the result being an increase in infections, which often proved fatal. Most doctors at the time thought infections were caused by “bad air” filled with toxic vapors rather than by germs. Lister was inspired by Louis Pasteur’s research into germ theory in the 1860s and began to believe in the theory. He crusaded for better hygiene in medicine, urging doctors to scrub their hands and surgical tools with carbolic acid between treating one patient and the next. These methods produced a decrease in infections, and Lister used this evidence to win over colleagues throughout Europe, although it took him longer to convince physicians in the United States. Fitzharris chronicles Lister’s diligence in promoting his ideas and the resistance he received, along with the characteristics that marked him. He was known for being modest and for regarding all patients, even the poorest of the poor, with respect–and he directed medical students he supervised to do the same. He and his methods eventually won the respect of the medical establishment, and he became personal surgeon to Queen Victoria.
Several critics considered The Butchering Art compelling. The book “is a formidable achievement—a rousing tale told with brio, featuring a real-life hero worthy of the ages and jolts of Victorian horror to rival the most lurid moments of Wilkie Collins,” related John J. Ross in the Wall Street Journal. Genevieve Valentine, writing on National Public Radio’s website, noted that the work “sounds like something of a niche read,” but she added: “There is something that feels vital in a book about horrors everyone accepted as the costs of doing business, and the importance of persistence in seeing results.” A Kirkus Reviews contributor remarked: “Fitzharris knows how to engage readers in fascinating and shocking details about medical history.” Booklist commentator Tony Miksanek observed that she “captures the chaos, personalities, and bumpy evolution of surgery during the Victorian period.”
Some reviewers thought the surgical gore and filthy conditions were the most interesting aspects of The Butchering Art, while deeming Lister rather pallid. “Lister’s patients were blessed with a kindly, generous physician,” reported Jennifer Senior in the New York Times. “Fitzharris, on the other hand, was cursed with an amiable subject, which perhaps makes him a less exciting figure than other hothead surgeons of his day. … The real drama in Lister’s story comes from the resistance he faced to his theories.” Kate Womersley, writing in Spectator, maintained that Fitzharris may be giving Lister too much credit. The author “is slightly heavy-handed with her conclusion that Lister raised the dark curtain of surgical barbarism to let in the light,” Womersley observed. “Without question, ward conditions and operative hygiene have been transformed. But the scourges of gangrene, erysipelas, pyemia and septicaemia–collectively known as ‘hospitalism’ to Lister’s contemporaries–did not disappear.” The critic allowed, however, that Fitzharris “has written a brilliant biography that embeds Lister in his medical moment.” Ross added that the book “restores this neglected champion of evidence-based medicine to a central place in the history of medicine.” A Publishers Weekly contributor summed up The Butchering Art as a “thoughtful and finely crafted” work that situates Lister’s accomplishments “in the context of a remarkable life and time.”
BIOCRIT
PERIODICALS
Booklist, October 1, 2017, Tony Miksanek, review of The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine, p. 10.
Kirkus Reviews, September 1, 2017, review of The Butchering Art.
New York Times, November 29, 2017, Jennifer Senior, “Wash Up, Doc: How Hospitals Became Clean,” p. C5.
Publishers Weekly, July 3, 2017, review of The Butchering Art, p. 63.
Spectator (London, England), January 13, 2018, Kate Womersley, “The Germ of a Revolutionary Idea,” p. 40.
Wall Street Journal, October 13, 2017, John J. Ross, “‘The Butchering Art’ Resurrects Joseph Lister.”
ONLINE
Huffington Post, https://www.huffingtonpost.com/ (June 25, 2018), brief biography.
Internet Movie Database, https://www.imdb.com/ (June 25, 2018), brief biography.
Lindsey Fitzharris Website, http://www.drlindseyfitzharris.com (June 25, 2018).
National Public Radio Website, https://www.npr.org (October 21, 2017), Genevieve Valentine, “No One’s Hands Are Clean in ‘The Butchering Art.'”
Dr Lindsey Fitzharris
Medical Historian, Writer, DeathXpert
Lindsey Fitzharris holds a PhD in the History of Science, Medicine and Technology from Oxford University. In 2009, she was awarded a Wellcome Trust Postdoctoral Fellowship to work at Queen Mary, University of London - where she is still based today.
Lindsey is the author & creator of The Chirurgeon’s Apprentice, a website dedicated the horrors of pre-anaesthetic surgery. On it, she writes about everything from Victorian anti-masturbation devices, to coffin collars and books bound in human skin. The website has been mentioned by Discover Magazine and Scientific American, and was awarded a Cliopatria for ‘Best Individual Blog’ by the American Historical Association in 2011.
In addition to the blog, Lindsey has also written for the Guardian, the Lancet, and New Scientist; and has appeared on television for Channel 4, the BBC and National Geographic.
She is the writer, producer and host of the upcoming television show, Medicine's Dark Secrets, which begins filming in August.
Connect with her on Facebook or Twitter.
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Lindsey Fitzharris
Writer
Lindsey Fitzharris is a writer, known for The Butchering Art (2017), Medicine's Dark Secrets and Tony Robinson's Gods & Monsters (2011). See full bio »
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As a little girl, I used to drag my grandmother from cemetery to cemetery so that I could hunt ghosts. Some might say I was obsessed with death from an early age, but I’d like to think I was simply fascinated with the past, and with the people who lived there. Thus began a lifelong obsession with history.
I received a doctorate in the history of science, medicine and technology from the University of Oxford. In 2010, I was granted a postdoctoral research fellowship by the Wellcome Trust. I am the author and creator of the popular website The Chirurgeon’s Apprentice, which has received over 2 million hits. I am also the writer and presenter of the YouTube series Under The Knife, which takes a humorous look at our medical past.
I’ve written for The Guardian, The Lancet, New Scientist, Penthouse, The Huffington Post and Medium. I have appeared on PBS, Channel 4, BBC, and National Geographic. My debut book The Butchering Art follows the surgeon Joseph Lister on his quest to transform the brutal and bloody world of Victorian surgery. It will be published worldwide on October 17th.
Quoted in Sidelights: “Fitzharris knows how to engage readers in fascinating and shocking details about medical history.”
Fitzharris, Lindsey: THE BUTCHERING ART
Kirkus Reviews.
(Sept. 1, 2017): From Book Review Index Plus. COPYRIGHT 2017 Kirkus Media LLC http://www.kirkusreviews.com/
Full Text:
Fitzharris, Lindsey THE BUTCHERING ART Scientific American/Farrar, Straus and Giroux (Adult Nonfiction) $27.00 10, 17 ISBN: 978-0-374-11729-0
Medical historian and popular blogger Fitzharris narrates the quest of a tenacious 19th-century doctor to save his patients; in the process, he transformed the world of surgery and medicine.Joseph Lister's choice to become a surgeon was not the most obvious or reputable one for a Quaker growing up as the son of an esteemed scientist acclaimed for his improvements to the microscope. In the early 1800s, a surgeon was little more than a butcher, a "manual laborer who used his hands to make a living, much like a key cutter or plumber today." It didn't help that surgery was extremely risky for patients. The introduction of ether to British medicine in 1846 was a critical turning point because it afforded surgeons more time to perform procedures. However, patients were still dying of post-surgical infections in high numbers, and Louis Pasteur's ideas about germs were still academic and not widely disseminated. Lister took up Pasteur's work and applied it to surgery, experimenting and finally finding an antiseptic and technique that successfully lowered rates of postoperative infection. He made it his mission to share his findings with a medical establishment clinging to old beliefs. It is thanks to Lister's tenacity and belief in the efficacy of his techniques, despite widespread skepticism, that so many people today don't have to look at surgery as a possible death sentence. Fitzharris knows how to engage readers in fascinating and shocking details about medical history. She clearly, if sometimes quickly, explains medical and scientific terms and techniques while also using novelistic details and narrative techniques to move the story along. In deftly capturing an "epochal moment when medicine and science merged," the author also offers an important reminder that, while many regard science as the key to progress, it can only help in so far as people are willing to open their minds to embrace change.
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Source Citation (MLA 8th Edition)
"Fitzharris, Lindsey: THE BUTCHERING ART." Kirkus Reviews, 1 Sept. 2017. Book Review
Index Plus, http://link.galegroup.com/apps/doc/A502192016/GPS?u=schlager&sid=GPS& xid=dbad8b53. Accessed 20 May 2018.
Gale Document Number: GALE|A502192016
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The germ of a revolutionary idea
Kate Womersley
Spectator.
336.9881 (Jan. 13, 2018): p40+. From Book Review Index Plus. COPYRIGHT 2018 The Spectator Ltd. (UK) http://www.spectator.co.uk
Full Text:
The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine by Lindsey Fitzharris
Allen Lane, 16.99 [pounds sterling], pp. 286
Every operation starts the same way. Chlorhexidine scrubbed under nails, lathered over wet hands, palm-to-palm, fingers interlaced, thumbs, wrists, forearms. A soothing routine accompanied by the sound of water hitting a steel trough sink. Washing is an act of safety but also humility. It acknowledges a doctor's capacity to cause disease as well as cure it. More than once I have thought of Joseph Lister--the father of antisepsis (killing germs) and forefather of asepsis (excluding germs completely) --as I perform this hygienic set-piece. Not that he would have liked the idea of me, his sister's great-great-great granddaughter, studying medicine. Lister 'could not bear the indecency of discussing with women the secrets of the "fleshly tabernacle"', and sought to block their membership of the profession.
In the 1860s, much of the surgical establishment dismissed antisepsis as 'hocus-pocus'. They were unwilling to believe that current techniques might actually be harming patients. Instruments were rarely cleaned between cases, surgical aprons stiffened with blood, and surgeons had been known to suck patients' wounds in the middle of an operation. Professional assets included a firm fist that could double as a tourniquet, and the dexterity to flay flesh to the bone in seconds (even if a testicle or finger was collateral damage). A surgeon's currency was speed and strength rather than sanitary practice.
Joseph Lister (1827-1912)--with his 'indescribable air of gentleness, verging on shyness', a stutter and almost 'womanly' concern for others--was not the obvious candidate to overhaul this filthy mess. Medicine didn't run in the family. Devout Quakers, the Listers believed that homeopathy and divine intention were the best healers. Nevertheless, aged 17, Lister found himself in the overcrowded stench of central London embarking on a surgical education.
Lindsey Fitzharris has written a brilliant biography that embeds Lister in his medical moment. The smells and sights of rotting flesh seeped through the capital's streets, into the teaching hospitals and around the graveyards (raided by body-snatchers). It was the time of cholera, smallpox and typhoid. Amid the gore, the intellectual scene of the city was flourishing. Lister
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Quoted in Sidelights: “is slightly heavy- handed with her conclusion that Lister raised the dark curtain of surgical barbarism to let in the light,” Womersley observed. “Without question, ward conditions and operative hygiene have been transformed. But the scourges of gangrene, erysipelas, pyemia and septicaemia–collectively known as ‘hospitalism’ to Lister’s contemporaries –did not disappear.” “has written a brilliant biography that embeds Lister in his medical moment.”
http://go.galegroup.com/ps/marklist.do?actionCmd=GET_MA...
rubbed shoulders with Thomas Hodgkin (whose father had identified the lymphoma that bears his name). Professor William Sharpey encouraged Lister's enthusiasm for the new experimental science of physiology. Lister spent his evenings peering into the achromatic microscope invented by his father, Joseph Jackson, to inspect animal specimens and swatches of human iris. He even tried in vitro fertilisation with cockerel sperm and a chicken egg.
By the time of Lister's graduation, ether and chloroform had ended surgery's 'age of agony'. No longer constrained by a patient's reaction to pain, surgeons ventured deeper into the body with ever more radical procedures. As a result, surgery actually became riskier and infection rates increased. A patient in recovery was interpreted very differently to today: inflammation around the surgical site and 'laudable pus' were seen as reassuring signs. Why certain patients developed systemic sepsis was unclear. Perhaps disease travelled from one person to another via a pathogenic agent. Or, as the anti-contagionists believed, maybe illness arose spontaneously from dirty conditions, moving through the air in miasmatic clouds.
Lister was unconvinced by both theories. He observed that a patient's environment mattered (death rates were higher in hospital than in domestic settings), but doubted that infective life could arise de novo. Prompted by scepticism rather than Archimedean revelation, Lister went back to Joseph Jackson's microscope. Louis Pasteur's recent work in France inspired Lister to make a connection with the microbes he observed in a sample of gangrene. Could infective processes be halted in a similar way to fermentation and putrefaction?
Lister developed a regimen for washing hands and tools in carbolic acid, tending wounds with saturated dressings and spraying a chemical mist over the unconscious patient. As his conviction grew, he agreed to remove a cancerous lump from his own sister's breast, which had already been declared inoperable by two surgical colleagues. Etherised upon her brother's dining room table, Isabella Lister's procedure was a success. Avoiding infection, she survived three years before her cancer recurred.
Fitzharris subtly demonstrates how Lister eventually secured his medical reputation not in spite of, but perhaps because of, his religious upbringing. Quakerism has tended to be portrayed as a distraction from his scientific interests, particularly as Lister considered leaving medical school to enter the ministry. But once satisfied that surgery was an altruistic path, Lister recognised that evidence alone would not change the status quo. The art of persuasion would be critical to converting non-believers.
The 'scientific Germans' eagerly adopted antisepsis, but the 'plodding and practical English surgeon' and cautious Americans were more resistant. Touring the US, Lister made the most of his platform to evangelise to roomfuls of students and sceptics. By interweaving case histories, demonstrations and rhetoric, he won over a generation of disciples. It wasn't long before he became president of the Royal Society and personal surgeon to Queen Victoria. He was now part of the establishment.
Despite The Butchering Art's admirable detail and vivid storytelling, Fitzharris is slightly heavy- handed with her conclusion that Lister raised the dark curtain of surgical barbarism to let in the light. Without question, ward conditions and operative hygiene have been transformed. But the
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scourges of gangrene, erysipelas, pyemia and septicaemia--collectively known as 'hospitalism' to Lister's contemporaries --did not disappear. Even with today's antibiotics, surgical patients are not invulnerable. Nosocomial infections are a new strain of hospitalism: MRSA and resistant superbugs threaten to undermine Listerian modernity, and send us back to a time when a scalpel's trace could be the death of you.
Source Citation (MLA 8th Edition)
Womersley, Kate. "The germ of a revolutionary idea." Spectator, 13 Jan. 2018, p. 40+. Book
Review Index Plus, http://link.galegroup.com/apps/doc/A524739371/GPS?u=schlager& sid=GPS&xid=c77468c0. Accessed 20 May 2018.
Gale Document Number: GALE|A524739371
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Quoted in Sidelights: “captures the chaos, personalities, and bumpy evolution of surgery during the Victorian period.”
http://go.galegroup.com/ps/marklist.do?actionCmd=GET_MA...
The Butchering Art: Joseph Lister's
Quest to Transform the Grisly World
of Victorian Medicine
Tony Miksanek
Booklist.
114.3 (Oct. 1, 2017): p10. From Book Review Index Plus. COPYRIGHT 2017 American Library Association http://www.ala.org/aboutala/offices/publishing/booklist/
Full Text:
The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine. By Lindsey Fitzharris. Oct. 2017. 304p. illus. Farrar/Scientific American, $27 (97803741172901.617.092.
In the nineteenth century, surgery was not exactly science or art but rather a dicey and gruesome affair. Prior to the discovery and widespread use of anesthetic agents, patients were awake during their operations, enduring unimaginable pain and horror. And if they survived the surgical procedure, death from postoperative infection remained a big risk. Medical historian Fitzharris captures the chaos, personalities, and bumpy evolution of surgery during the Victorian period. The star of the story is the man who devoted much of his life searching for the source and solution to the problem of hospital infections. Born in 1827, Joseph Lister was religious and driven by scientific curiosity. He contracted a mild case of smallpox, suffered from depression, and was a bit of a hypochondriac. He experimented on frog legs and corresponded with Louis Pasteur. He was interested in how wounds healed. Lister's advocacy of antiseptic principles in surgery was revolutionary but a hard sell. He traveled across Europe and America, arguing for the acceptance of germ theory and promoting disinfection. Hygiene had its hero. --Tony Miksanek
Source Citation (MLA 8th Edition)
Miksanek, Tony. "The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of
Victorian Medicine." Booklist, 1 Oct. 2017, p. 10. Book Review Index Plus, http://link.galegroup.com/apps/doc/A510653679/GPS?u=schlager&sid=GPS& xid=8d773df1. Accessed 20 May 2018.
Gale Document Number: GALE|A510653679
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Quoted in Sidelights: thoughtful and finely crafted” “in the context of a remarkable life and time.”
http://go.galegroup.com/ps/marklist.do?actionCmd=GET_MA...
The Butchering Art: Joseph Lister's
Quest to Transform the Grisly World
of Victorian Medicine
Publishers Weekly.
264.27 (July 3, 2017): p63. From Book Review Index Plus. COPYRIGHT 2017 PWxyz, LLC http://www.publishersweekly.com/
Full Text:
* The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine Lindsey Fitzharris. Scientific American, $27 (304p) ISBN 978-0-374-11729-0
British science writer Fitzharris slices into medical history with this excellent biography of Joseph Lister, the 19th-century "hero of surgery." Lister championed the destruction of microorganisms in surgical wounds, thus preventing deadly postoperative infections. This was a radical approach inspired by French microbiologist and chemist Louis Pasteur's discovery of bacteria. Lister, whose Quaker father introduced him to the wonders of the microscope, became an evangelist for the germ theory of disease and the sterilization of both surgical instruments and doctors' hands. The medical community resisted Lister's procedures, but his successful treatment of Queen Victoria boosted his reputation and techniques--winning converts first in Scotland, then America, and finally London. "Lister's methods transformed surgery from a butchering art to a modern science, one where newly tried and tested methodologies trumped hackneyed practices," Fitzharris writes. She infuses her thoughtful and finely crafted examination of this revolution with the same sense of wonder and compassion Lister himself brought to his patients, colleagues, and students. "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," Fitzharris notes, respecting his wish and fulfilling it in the context of a remarkable life and time. (Oct.)
Source Citation (MLA 8th Edition)
"The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian
Medicine." Publishers Weekly, 3 July 2017, p. 63. Book Review Index Plus, http://link.galegroup.com/apps/doc/A498381408/GPS?u=schlager&sid=GPS& xid=f82f3c03. Accessed 20 May 2018.
Gale Document Number: GALE|A498381408
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Quoted in Sidellights: “sounds like something of a niche read,” but she added: “There is something that feels vital in a book about horrors everyone accepted as the costs of doing business, and the importance of persistence in seeing results.”
No One's Hands Are Clean In 'The Butchering Art'
October 21, 20177:00 AM ET
Genevieve Valentine
The Butchering Art
The Butchering Art
Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine
by Lindsey Fitzharris
Hardcover, 304 pages
purchase
To read The Butchering Art, you should have a stronger stomach than mine.
The book makes no bones (pun unfortunately intended) about what you'll find inside — it's subtitled Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine, so you're duly forewarned. And I thought I knew more or less what I was in for. I knew about the disgusting sanitary conditions in 19th-century hospitals; I knew about the much-too-slow development of anesthesia; I knew the chilling quote from Dr. Charles Meigs about the impossibility that a doctor could carry disease on his person between patients: "Doctors are gentlemen, and a gentleman's hands are clean." I still wasn't ready.
At heart, it's a slender but effective biography of Lister, the sort of comforting historical figure more interested in his work than his legacy. First as a student and then as a surgeon, he was obsessed with the postoperative infections that killed so many patients that many doctors wouldn't operate on the torso because of the likelihood of death from infection. (Gangrene, erysipelas and septicemia were so prevalent they were collectively called "hospitalism" — the disease you contracted after the doctors had taken care of what ailed you.)
'The Butchering Art': How A 19th Century Physician Made Surgery Safer
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'The Butchering Art': How A 19th Century Physician Made Surgery Safer
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The Butchering Art traces Lister's lifelong obsession with finding an antiseptic treatment, a quest balanced somewhere between serendipity and Sisyphus: His inventor father gifted him the sort of microscope that can see bacteria, and he spent decades trying to figure out what exactly he was looking for. He is a subtle figure, as biographies go — with the exception of his published medical papers, most reactions to his triumphs and failures in "this bloody and butchering department of the healing art" are pulled from private letters to family. His marriage is so uneventful it hardly exists, and nearly all third-party talk of him is about his skill as a doctor and his hunt for an antiseptic cure. He disappears into his work; we're left to be grateful for it.
And after the book sets forth the conditions in which Lister began his life's work, we definitely are. The details are almost unavoidably ghoulish. Lindsey Fitzharris tries to paint a vivid picture without unnecessary gore, but so much gore is necessary — not just descriptions of anesthetic-free amputations, but of patients turned away from hospitals because they were too poor to rent a bed or were incurable and therefore not worth treating. Some of it reads as the brutal relic of a vanished past; some of it reads as a brutal relic of the present. This is a book in which cancer is as immediate a character as any of the gentlemen fighting over corpses in the hopes of surgical immortality.
Lindsey Fitzharris tries to paint a vivid picture without unnecessary gore, but so much gore is necessary.
After Lister makes his great discovery, the book becomes a slightly more remote horror story: Lister trying to disprove those who stood against him as he pleaded for his methods. Fitzharris traces Lister's predecessors, mentors and detractors, all of whose work informed the whole; The Butchering Art is very careful to emphasize the many threads of scientific study that come together in a sea change like this one. And it's equally careful to quietly remind us that in every hospital that dismissed Lister's methods, hundreds died. (Since we already know all the gory details, it feels about as awful as it should.)
Equal parts a queasy outline of Victorian medicine and a quiet story of a life spent pushing for scientific progress, The Butchering Art sounds like something of a niche read. But in an era where science is as much a battleground as it was two centuries ago, there is something that feels vital in a book about horrors everyone accepted as the costs of doing business, and the importance of persistence in seeing results. Just ... maybe don't read it on a full stomach.
Genevieve Valentine's latest novel is Icon.
Quoted in Sidelights: “Lister’s patients were blessed with a kindly, generous physician,” reported Jennifer Senior in the New York Times. “Fitzharris, on the other hand, was cursed with an amiable subject, which perhaps makes him a less exciting figure than other hothead surgeons of his day. … The real drama in Lister’s story comes from the resistance he faced to his theories.”
The Story of How Surgeons Cleaned Up Their Act
By Jennifer Senior
Nov. 29, 2017
Image
CreditPatricia Wall/The New York Times
Books about Victorian medicine are an acquired taste. They’re science by way of B-horror movies, tales of progress set amid blood and spatter and gray guts. To enjoy them requires a tolerance for ick, an enthusiasm for the macabre and (ideally) the iron discipline not to read before supper, especially if that supper is a nice steak.
Lindsey Fitzharris’s slim, atmospheric “The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine” has its share of resplendent gore. (The author, a medical historian, has a charming blog and a YouTube series called “Under the Knife.”) The book is an imperfect first effort, stronger at the beginning than at the end, and a bit workaday when it isn’t freaky — it floats less on narrative momentum than on an armada of curious details. But the story it tells is one of abiding fascination, in part because it involves a paradigm shift so basic, so seemingly obvious, that one can scarcely believe the paradigm needed shifting in the first place.
Yet it did. What Lister saw, which his colleagues did not, was that doctors in the Victorian era were making people sick. “The Butchering Art” traces his efforts to revolutionize medicine through one deceptively simple notion: Cleanliness.
As hard as it is to fathom now, surgery was once a filthy enterprise. Operating theaters were as dirty as London was, their surgeons as grimy as chimney sweeps. Doctors seldom washed their hands. They used the same instruments in successive procedures without cleaning them. “It was not uncommon,” Fitzharris writes, “to see a medical student with shreds of flesh, gut or brains stuck to his clothing after his lessons were over.”
Dissection rooms were perhaps the most gruesome environments of all. Hector Berlioz, who briefly studied medicine before becoming a composer, found them so repulsive that he dove out of a window to escape, unable to bear the sight of rats nibbling on vertebrae and sparrows snacking on scraps of lung. Less sensitive students were known to duel with severed legs and arms.
Hospitals probably killed as many people as they saved in those days. When his sister needed a mastectomy, Lister opted to perform the operation on his dining room table, knowing the odds for a safe convalescence were far better at home than at work. (She survived the operation, dying a few years later from a recurrence of cancer in her liver.) Four types of infection — erysipelas, septicemia, pyemia and gangrene — regularly took the lives of hospitalized patients. The idea that the doctors’ own squalid hygiene played a role in spreading these infections didn’t cross many people’s minds. Most medical professionals believed poisonous vapors, or “miasma,” were to blame.
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Lister was one of the first surgeons outside of continental Europe to question this logic. “It is a common observation that, when some injury is received without the skin being broken, the patient invariably recovers,” he once told his medical students. “On the other hand, trouble of the gravest kind is always apt to follow, even in trivial injuries, when a wound of the skin is present. How is this?”
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Lindsey FitzharrisCreditAdrian Teal
“The Butchering Art” tells Lister’s story in simple chronological fashion, showing how the doctor came to embrace Louis Pasteur’s germ theory, which stipulated that microbes were the cause of disease, and how this belief then guided Lister to establish a series of antiseptic protocols when treating his patients. These protocols would one day become standard and save countless lives.
Lister’s patients were blessed with a kindly, generous physician. Fitzharris, on the other hand, was cursed with an amiable subject, which perhaps makes him a less exciting figure than other hothead surgeons of his day. He was shy and gentle and spoke with a stutter. His students adored him; he married a smart, sensible woman; he came from a supportive Quaker family; and he wrote weekly letters to his father after his mother died.
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The real drama in Lister’s story comes from the resistance he faced to his theories. After he published the last article in a five-part series in the medical journal The Lancet, carefully outlining his system for killing “septic germs,” the establishment drew its knives. The inventor of chloroform wrote under a pseudonym to complain that Lister was taking credit for having discovered the miracles of carbolic acid. (He wasn’t.) Others accused him of fearmongering, dismissing Pasteur’s germ theory as pure hooey. The editor of The Lancet himself refused to use the word “germ.”
“It was difficult for many surgeons at the height of their careers,” Fitzharris writes, “to face the fact that for the past 15 or 20 years they might have been inadvertently killing patients by allowing wounds to become infected with tiny, invisible creatures.”
It’s an unhappy reminder that hubris is a terrible impediment to progress.
Lister also had trouble selling his ideas in America, a country that lost tens of thousands of soldiers in the Civil War because field doctors had mismanaged their injuries, letting their suppurating wounds fester for their “laudable pus.” (In England, too, many doctors believed that pus and inflammation were signs of healing, not danger.) Unmentioned but also relevant: President James A. Garfield may have survived his assassin’s bullet in 1881 if his doctors hadn’t probed the wound with dirty fingers and unsterilized instruments.
Yet Lister’s ideas eventually prevailed. The fact that he operated on Queen Victoria in 1871 for an abscess in her armpit probably helped; it was useful, too, when his intellectual opponents died off. But a question that tantalizingly lingers at the end of “The Butchering Art” — one the author never fully explores — is: Why did Lister get all the credit for making the connection between hygiene and infection?
There were, after all, others — most famously the Hungarian doctor Ignaz Semmelweis. In 1847, he hypothesized that puerperal fever was spread by doctors carrying “cadaverous particles” from the deadhouse to the obstetrics ward at Vienna’s General Hospital. When he set up a basin filled with chlorinated water and enjoined his colleagues to do something radical after autopsies — wash their hands — mortality rates plummeted.
The establishment still rejected Semmelweis’s hypothesis when he published it. Over the years, Fitzharris writes, his behavior grew increasingly erratic. He was eventually committed to an asylum.
Lister, meanwhile, lived to a ripe old age and got a mouthwash named after him. Timing, personality and geopolitics always help determine who earns the garlands for innovation. But it’s sad to think that Semmelweis never lived to see the vindication of his theory. He died in that asylum, possibly from an infection, believing that his contribution had been bleached from the record.
Follow Jennifer Senior on Twitter: @JenSeniorNY.
The Butchering Art
Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine
By Lindsey Fitzharris
286 pages. Scientific American/Farrar, Straus & Giroux. $27.
A version of this article appears in print on November 29, 2017, on Page C5 of the New York edition with the headline: Wash Up, Doc: How Hospitals Became Clean. Order Reprints | Today’s Paper | Subscribe
A version of this article appears in print on November 29, 2017, on Page C5 of the New York edition with the headline: Wash Up, Doc: How Hospitals Became Clean. Order Reprints | Today’s Paper | Subscribe
Quoted in Sidelights: “is a formidable achievement—a rousing tale told with brio, featuring a real-life hero worthy of the ages and jolts of Victorian horror to rival the most lurid moments of Wilkie Collins,”
“restores this neglected champion of evidence-based medicine to a central place in the history of medicine.”
Review: ‘The Butchering Art’ Resurrects Joseph Lister
Some medical practitioners once believed that hospital infections came from poisonous air. Joseph Lister argued otherwise.
Operating on a patient ca. 1890. The man at right is using the carbolic-acid spray popularized by Lister.
Operating on a patient ca. 1890. The man at right is using the carbolic-acid spray popularized by Lister. Photo: Getty Images
By John J. Ross
Oct. 13, 2017 3:18 p.m. ET
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What was the most dangerous place in the vast territories of the British Empire in the 19th century? Was it the savage savannas of Zululand? Perhaps the frozen wastes of the Northwest Passage, or the treacherous high passes of the Hindu Kush?
To judge from “The Butchering Art,” a fine and long overdue biography of the great physician Joseph Lister by Lindsey Fitzharris, the answer might be a much more domestic corner of empire: the Victorian teaching hospital.
Hospitals of the era were factories of death, where patients came in with trauma and were brought out for burial after developing what was called “hospital gangrene.” Modern notions of hygiene were unknown. The eminent surgeon Sir Frederick Treves recalled that “there was one sponge to a ward. With this putrid article and a basin of once-clear water all the wounds in the ward were washed in turn twice a day. By this ritual any chance that a patient had of recovery was eliminated.”
Filth and squalor were taken for granted. Hospitals reeked with “the unmistakable smell of rotting flesh,” Ms. Fitzharris writes, “which those in the profession cheerfully referred to as ‘good old hospital stink.’ ” Wound infection was so universal that it was considered part of normal healing, and even beneficial. In the lucky few, “laudable pus” drained out and survival was possible. In the unlucky, the wound turned black, and death was nigh.
The Butchering Art
By Lindsey Fitzharris
Farrar, Straus & Giroux, 286 pages, $27
The death rate after amputations at urban teaching hospitals was 41%, compared with only 11% for rural patients who had surgery and post-op care at home. Some doctors thought that hospitals were a ghastly menace to public health and called for them to be demolished.
Enter Joseph Lister. He was born in 1827, the middle child in a large Quaker family. His father was a wine merchant and an accomplished amateur scientist. Wine dealing was unusual for Quakers, who tended to be teetotalers, but the pursuit of science was not. Quakers scorned the recreations of the English ruling class as wicked frivolities but encouraged the study of nature, which they believed revealed the magnificence of divine providence.
Although his youthful dissections of dead animals might have tipped them off, Lister’s family was surprised and perhaps dismayed when he decided to become a surgeon. Surgery was still a low, mechanical profession. Prestige and earning potential were attached to Oxbridge-educated practitioners of internal medicine, who rarely cured anyone but were able to quote Hippocrates in the original Greek.
Lister, tall and serious, commanded the respect of his peers. According to Ms. Fitzharris, “those who knew him often commented on his striking stature and the gracefulness with which he moved. He was classically handsome [and] . . . had a nervous energy about him that became more pronounced in the company of others.” To combat a mild stammer, he threw himself into debate at the local medical society, attacking homeopathy and defending the value of the microscope in clinical medicine. (Lister’s fellow students saw his microscope obsession as a harmless if useless eccentricity, like trainspotting or pigeon-fancying.)
Lister had a nervous breakdown as a student. This seems to have been brought on by a mild case of smallpox, as well as by the usual hazards of overwork and encounters with mortality in the dissecting room. He took a year off and immersed himself in research upon his return, writing dense papers on the anatomy of the iris and the tiny muscles responsible for goose bumps.
In 1851, Lister was named one of the four resident physicians for John Eric Erichsen, chief of surgery at London’s University College Hospital. Erichsen believed the prevalent theory that infections came from miasma, or poisons in the air that arose from rot and decay. Lister was not so sure. Gangrenous wounds often healed when he scoured out the rotten tissue and applied mercury pernitrate to the healthy tissue that remained. If miasma were the problem, wouldn’t the wounds have become immediately reinfected in the fetid hospital air? This was the beginning of Lister’s lifelong interest in the cause and prevention of hospital infection.
Lister excelled at surgery. While still a student, he saved the life of a woman who had been stabbed in the belly by her abusive husband. He meticulously sewed up a loop of lacerated bowel, replaced it within the abdominal cavity, and helped nurse her through the inevitable peritonitis that followed. The case was so unusual that the Lancet reported on it twice.
After passing his examinations for the Royal College of Surgeons in 1852, he spent most of the next 25 years in Scotland. He served as the right-hand man of James Syme, the churlish but technically superb professor of surgery at the University of Edinburgh, and married Syme’s daughter Agnes, who would play a major role in his research into inflammation.
Lister’s reputation rose quickly, and he became the Regius Professor in Clinical Surgery at the University of Glasgow in 1860. The surgical wing of that city’s Royal Infirmary was a tremendous disappointment to Lister. Although it was almost new, “everything was veneered with grime.” The male ward was immediately adjacent to a graveyard, where an overflow of fresh corpses from a cholera epidemic moldered inches below the ground. The infirmary was beset with the usual epidemics of hospital gangrene. The problem was not miasma but the lack of basic cleanliness.
In the 1860s, Louis Pasteur carried out a series of experiments that suggested that germs, rather than bad air, were the cause of infection. Lister was quick to see the implications: Treatment with chemical agents that killed germs could not only be used to treat infections but might even be able to prevent them altogether.
Lister hit on carbolic acid, a derivative of coal tar that the sewage engineers of Glasgow used to decrease the stench of the human waste that they recycled for fertilizer. Lister first studied its use in compound fractures, in which the bone protruded from the skin. These were common in Glasgow, where people were often run over by carriages or mangled in machinery. Patients inevitably developed massive infections and required amputations. Lister found that cleansing the wound with carbolic acid cut the amputation rate to 9%.
Infection rates plummeted when Lister used carbolic acid to wash hands and scalpels, to dress wounds, and to sterilize sutures. He even sprayed it into the air of the operating room. But other physicians were skeptical and bitterly resisted the notion that their sloppy and unhygienic practices were the cause of so many deaths.
Lister went on the road, traveling Europe to push his gospel of antisepsis. One contemporary commentator noted that antisepsis was “eagerly adopted by the scientific Germans, and a little grudgingly by the semi-scientific Scotch,” but only much later by the “plodding and practical English surgeon.” Eventually, Ms. Fitzharris writes, only “one nation remained unconvinced of the merits of Lister’s methods: the United States,” where Harvard’s Henry Jacob Bigelow derided antisepsis as “medical hocus-pocus.”
Lister won over his opponents, not with bile and rhetoric but with a relentless focus on data and results, coupled with his innate amiability. He paid particular attention to audiences of medical students, perhaps anticipating Max Planck’s observation that bitter disciples of old dogmas are never won over by new theories, they simply die off and are replaced by a new generation.
The modesty and compassion of Lister would have been remarkable in any man, let alone a surgeon. His patients and students adored him. Lister taught his residents that “every patient, even the most degraded, should be treated with the same care and regard as though he were the Prince of Wales himself.” After he drained a young girl’s knee abscess, the girl showed him her doll, which was missing a leg. As Ms. Fitzharris writes, “The girl fumbled around under her pillow and—much to Lister’s amusement—produced the severed limb.” Lister called for needle and thread and “stitched the limb back onto the doll and with quiet delight handed it back to the little girl.”
Ms. Fitzharris, a historian of medicine, is occasionally fuzzy on clinical matters. Hodgkin’s disease is said to be a “very rare form of lymphoma,” a description that might surprise the estimated 200,000 Americans living with it. And she avoids the more problematic aspects of Lister’s career, most notably his opposition to female medical students, who he believed would be soiled by exposure to nasty dissecting rooms and brutish hospital wards. But her biography of Lister restores this neglected champion of evidence-based medicine to a central place in the history of medicine. “The Butchering Art” is a formidable achievement—a rousing tale told with brio, featuring a real-life hero worthy of the ages and jolts of Victorian horror to rival the most lurid moments of Wilkie Collins.
—Dr. Ross, a physician, is the
author of “Shakespeare’s
Tremor and Orwell’s Cough.”