“The ascendancy of knowledge over ignorance, and diligence over negligence, defined the profession’s future…”

If you are interested in Victorian times, in medical history, in social history, in well-told narratives… have I got the book for you. The Butchering Art by Lindsey Fitzharris ticks all the boxes for me with regard to having a great read: dry sense of humor, loads of facts, about a time period that I’m very interested in, and medicine? Yes please. 

I think that it’s quite amazing how fast (and how far) medicine (especially surgery) has come from its roots in Victorian science. In close to 150 years, we’ve completely reshaped the goals and methods of surgery, along with significantly reducing the death rates associated with that. When you keep in mind just how grubby surgery was, it’s an astonishing leap forward. 

So, always curious about the history of medicine, I was trawling my TBR shelves (go me!) and stumbled upon this title. Shortlisted for the 2018 Wellcome Book Prize along with other notable accolades, it was a brilliant read and one of those “read at the right time” situations for me. I loved it. 

So, what’s the book about? It’s revolves around Joseph Lister (1827-1912), a surgeon who introduced new principles of cleanliness (along with the germ theory) which went on to transform surgical practice and reduce post-operative mortality (or “ward fever”) deaths by huge numbers. Or, as the book says, the shift in medical procedure from antisepsis (germ killing) to asepsis (germ-free practices). It’s quite the story. 

Fitzharris reports that during this period of time, surgery was traumatic and risky. No anesthesia was available, surgeons’ cleanliness habits were anything but, and this was a time when most physicians believed that pus from a surgical incision was a “good thing” instead of an ominous onset of sepsis. In fact, surgeons were known as having a particular odor when they were working: “good old hospital stink” which was really the smell of rotting flesh and blood from their time in the operating theater. Crikey.

It was actually safer to have an operation at your own home (instead of in hospital) – hospitals had mortality rates that were three to five times higher. Curiously, Death was known at the time as Old Jacky, and some patients were said to be able to predict who would recover and who would die during surgery. Odds were that the patient would die… 

In fact, hospitals were such filthy places that many of them had a person who was charged with going around to rid the patient mattresses of lice. In fact, this person was more highly paid than surgeons, so that demonstrates how important hospitals viewed this lice person. 

Despite being such places of high mortality rates, there were a lot of hospital expansions and excitement about new techniques for surgeons at this time. The latest official medical text, The Art of Surgery, was in its ninth edition and was such a respected resource that a copy of it was given to every single doctor in the federal army during the Civil War. 

The medical field was still ignoring germ theory though, and so public health was still pretty terrible, particularly for those who were in poverty. The world’s first flushing toilet came about during Albert’s Great Exhibition, and more 800,000 people paid a penny to test these facilities out for themselves during their visit. 

(Interestingly (for me – maybe not for you!), this is where the English saying, “going to spend a penny” (for needing to go to the lavatory) arose. I remember my grandma frequently using this euphemism when I was growing up, and I always thought it was because in my childhood (1960s/1970s), the lavatories at the local park would have a locking mechanism so anyone in need would have to put a coin (usually a big penny) into the slot before it opened. I can only imagine how many wet pants this tradition caused British schoolchildren as they didn’t have a penny to use.) 

London, packed with all these thousands of visitors for the Great Exhibition, was not really equipped to deal with the teeming masses, and there was a time when the river Thames was called “The Great Stink” due to it smelling particularly badly due human excrement that had piled up on the riverbanks. Yuck, but where else were people supposed to go? 

Back to Victorian medicine: Fitzharris uses a wide variety of sources for this history, including one called the Yearbook of Medicine, Surgery, and Their Allied Sciences, which gave the helpful statement: 

“The bandages and instruments which have been employed for gangrenous wounds ought not, if possible, to be employed a second time…” 

This was the world of medicine that Lister entered, after having given his first speech at his new job in LATIN because the establishment believed that that showed these men (of course) were of higher learning. (Imagine the reaction of today’s surgeons being told to do that…) 

(Non sequitur: Glasgow (in Scotland where Lister’s first job was) was actually growing in such numbers that people called it “the second City of the Empire” after London. Well, didn’t know that.)

I think it’s best to do bullet points from now on…:

• Lister was extremely interested in the parallel work of Louis Pasteur and his research on fermentation and the decomposition of organic matter. Lister was convinced that it was linked with the health of surgical wounds, but no one else was ready to listen yet.. (Curiously, another doc, Thomas Spencer Wells, was also interested in Pasteur’s work. Wells happened to be the surgeon for Queen Victoria… I love these overlaps!)

• There’s also a good link between Lister and Lord Brougham (who founded University College of London where my brother teaches). Lord Brougham was president of the both the university and the hospital, and Lister was trying to get a gig teaching there as a professor. Brougham is also the name for a type of carriage and was so named for this guy. (See here for more on Lord Brougham and his travelling mummified body.) After other doctors started to believe that Lister was onto something with his cleanliness theories, they began to be known as the “Listerians” and as they became more established in the medical world, they gradually started to spread the theory throughout the profession. 

• Random trivia: it was around this time that more personal hygiene items started to come on to the market, including a mouth-wash called, wait for it, Listerine. Developed by an American in Philadelphia after he had listened to a speech by Lister as part of his professional medical society meeting…  It was marketed as a variety of things, including a treatment for dandruff, a floor cleaner, and notably, even a cure for gonorrhea. (I know. I’d never put this together with Lister either…)

• All this was happening around the time of a big flu epidemic that occurred earlier than the most famous flu epidemic of 1918. This particular epidemic was in 1889-1890, and brought a doctor to the fore named Robert Wood Johnson, who, influenced by one of Lister’s talks, joined together with his two brothers to develop a company focused on developing sterile surgical dressings and sutures. The name of the company: Johnson & Johnson. Huh.

• (And also, around this time, was the start of public health and John Snow mapping the outbreak of cholera… Well, I never. It’s fascinating how things overlap sometimes…)

And, really, the information goes on and on in one of the most interesting reads I’ve had this year. 

Honestly, if you’re looking for some great non-fiction about a field that still holds its importance today, Fitzharris is a great guide to show you the way of Victorian medicine. I loved it (in case you can’t tell). 

For some Victorian social history reads, you could try these: 

• The Great Filth: Disease, Death and the Victorian Life – Stephen Halliday (2009)
• Consuming Passions: Leisure and Pleasure in Victorian England – Judith Flanders (2006)
• Inside the Victorian Home: A Portrait of Domestic Life in Victorian England – Judith Flanders (2003)  (I’m a fangirl of Flanders. Anything by this author has a high chance of being excellent.)