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November 21, 2017 Archives

The Butchering Art is medical historian Lindsey Fitzharris's first book. And  what a book! Descriptions that bring the horrors of pre-anaesthesia, pre-antisepsis surgery shudderingly into view? Very definitely. Science and history? Oh yes, lots of it, and beautifully told. And through it all, the humanity and vision of Joseph Lister and others like him, working to improve the outcomes of surgery, childbirth, & warfare. 

Before reading the kindle edition of this deeply fascinating volume I had only a fairly sketchy idea of Joseph Lister & his huge impact on health outcomes for those unlucky enough to end up in a Victorian hospital. Yes, I knew he came up with the use of carbolic acid as an antiseptic, an insight that radically changed outcomes for so many people: prior to his work, Fitzharris describes hospitals as "gateways to death"; places that people, especially people with money, avoided if at all possible.  But through Fitzharris's narrative we learn about Lister's background, the importance to him of family (especially his relationship with his father) and his Quaker faith, the trip to Edinburgh that was meant to precede a stay on the Continent but which saw him remain in Edinburgh and then Glasgow for decades, his insights about bacteria as the cause of sepsis following his encounter with Pasteur's work, and the struggle he faced in getting the medical establishment to accept that antisepsis using carbolic acid could save thousands of lives. And it's all interwoven with a great deal of history, science, and social commentary, and some great human-interest vignettes. 

When Lister was young, surgery really was a 'butchering art'. Surgeons prided themselves on how quickly they could perform amputations - a necessary evil given the lack of any effective anaesthesia. In fact, we first meet Lister as an onlooker at the first operation using a true anaesthetic in the UKA, when the great surgeon Robert Liston used ether to render a young man blessedly unconscious while his leg was amputated. (The task took Liston just 28 seconds.)

Fitzharris also relates the tale - which she feels is perhaps apocryphal - of how Liston's speed on one occasion contributed to an operation having a 300% mortality rate. He cut so fast that an assistant was unable to get his hand out of the way & lost 3 fingers to Liston's knife; an unlucky bystander had his coat slashed by the same blade. The bystander died of fright on the spot; both patient and assistant died later of sepsis. 

Lister went on to study medicine and became a great surgeon and outstanding teacher himself; apparently his students absolutely worshipped him. But Fitzharris makes it clear that something else contributed to his discovery of a reliable antisepsis for use in hospitals: the early gift from his father of a high-quality microscope led to a lifelong interest (& a very large number of publications) in scientific research into the causes of putrefaction and sepsis. Then, in 1864, a colleague introduced Lister to Pasteur's work on fermentation and decay. Lister immediately acquired and read Pasteur's publications, replicated the Frenchman's work in his own lab at home, and realised that wound infections were down to bacteria (not realising at first that they were everywhere, not just in the atmosphere). He then began to search for a treatment that would kill the germs but not harm the patient:

"When I read Pasteur's article, I said to myself: just as we can destroy lice on the nit-filled head of a child by applying a poison that causes no lesion to the scalp, I believe that we can apply to a patient's wounds toxic products that will destroy the bacteria without harming the soft parts of this tissue." [Lister, quoted by Fitzharris.]

He settled on carbolic acid because he'd heard that engineers at a sewage works had used this to counteract the stench that accompanied the plant's operations and which hovered over fields where the waste was irrigated. As a bonus, they'd found that the substance also killed protozoan parasites. 

It would be easy to say that the rest is history - but in fact Lister's 'eureka' moment happens about half-way through the book. There's much more history, science, excitement, and unpleasant messiness before the end, including details of a mastectomy sans anaesthesia that another author might have glossed over, or handled less sensitively. While unpleasant, that particular story helps contextualise the awful decision that faced Lister when his own sister, with a tumour hard in her breast, sought her brother's help in its removal. Ether made the actual operation painless for Isabella, which Lister's surgical skill and his scrupulous use of antisepsis saw her survive the operation and live for another 3 years. (His growing reputation saw him subsequently operate on Queen Victoria herself, followed by an appointment as her personal surgeon and an eventual knighthood.)

And Fitzharris reminds us that no-one achieves greatness on their own.

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.

I thoroughly enjoyed this book, & will wait eagerly for the next. In the interim, I'll just have to get my Fitzharris fix on Facebook. If you have an interest in medical history and biological curiosities, you might like to follow her too.


A The Americans had come up with this use of ether some years earlier. 


Lyndsey Fitzharris (2017) The Butchering Art: Joseph Lister's quest to transform the grisly world of Victorian medicine. Scientific American/Farrar, Straus & Giroux; ISBN-10: 0374117292.




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That's the title of this excellent article by Jennings Brown, and I urge you to go and read the whole thing. It's the tale of perhaps the last 3 people in the US who are still alive because they are still living in iron lungs. It's a story of courage and endurance that lets them live a life that most of us would find impossible to imagine. It's also a sad story, because those 3 rely on the love, kindness & skills of friends, family, and complete strangers to keep their much-repaired machines going & so keep them alive. The lungs are so rare that parts and knowledgeable technicians are harder & harder to come by; if they break down, or the power goes off, the people reliant on them may just die in their sleep.  

This is why we have the polio vaccine. This is why my mother's parents would have had bittersweet feelings when that vaccine became available, because it was too late to prevent their daughter contracting polio. And my friend Dorothy, who spent 6 months in an iron lung in her youth, for the very same reason: the vaccine came too late for her. The trouble is that people forget, because in countries like New Zealand it's a long time since wards of people in iron lungs, and kids wearing calipers as they learned to walk again, were a common sight. 

Brown notes that

The worst polio outbreak year in US history took place in 1952, a year before Lillard was infected. There were about 58,000 reported cases. Out of all the cases, 21,269 were paralyzed and 3,145 died...

In 1955, Americans finally had access to the polio vaccine developed by Jonas Salk. “It was hailed as a medical miracle and the excitement about it was really unparalleled as far as health history in the United States,” Jay Wenger, director of the Bill & Melinda Gates Foundation’s polio-eradication effort told me. “No one who remembers the 1950s, in terms of polio, wants to go back there and be in that situation again.”

For this was a common outcome of 'that' situation:


Sadly, we're getting to the point where those who remember the 1950s in terms of polio are becoming fewer in number. Brown's excellent article deserves a wide audience because of this.

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