“God Help you all. What will become of you?”John Abernathy, surgeon, would often conclude his lectures to medical students with this statement
This is going to be another long-form post ;). But I will put the conclusion first to save you time if you don’t want detail. ~ Ferdous
Okay, so I enjoyed the first 3/4 of this book because it was fast-paced and followed the fascinating life of Lister from many perspectives. It showed him as a doctor, a husband, a son, a brother, and a teacher. We get to see him at his most intimate moments – which is not common when studying doctors. We often see them as emotionless robots who go to work and follow a strict set of procedures from 9 to 5 (when it’s more like 9 to 8) who have no personality; no dreams or hopes or fears. But The Butchering Art demonstrated that this was (and is) not the case. It shone a spotlight on his life showing him as a young boy (his fascination with microscopes still new) and it follows his story up to his death. He had many setbacks and his path to success was not straight – to a certain degree he was lucky, his religious lifestyle and people he surrounded himself with helped him in so many ways. That’s not to say that he didn’t earn his success. We also got to enjoy stories about Lister’s contemporaries (some happy and some sad).
But I have to say, I got bored in the second 1/4 when Lister tried to propagate his ideas about germ theory and carbolic acid. The London general medical community was so ignorant and didn’t even entertain the idea that he might be right. This is not the fault of the author. I would give this book 4 stethoscopes out of 5 and say that it’s a book that deserves to be read and anyone interested in the history of surgery would be mistaken to not read it. But it might not capture the heart of the casual reader.
So I wanna highlight some of the most memorable moments in the book – this is gonna be long so feel free to skip ahead. Take notes, students, medicine has come a long way since the Victorian era.
John South (JS) – A surgeon who said that op theatres were seen as places of entertainment like art galleries.
James Syme (S) – a prominent Scottish surgeon (known as the napoleon of surgery) and father-in-law to Joseph Lister
Robert Liston (RL) – the first surgeon to test the efficacy of ether in London
Joseph Jackson Lister (J)- Father of Joseph Lister and mentor
Joseph Lister (JL) – pioneer of clean surgery
Julia Sullivan – An innocent woman who was attacked by her alcoholic husband and was the first patient JL operated on.
Prologue: Age of Agony
In a classic operating room, the surgeon and patient would be on a stage. The operating table had sawdust underneath it to soak up blood and a skylight above it. It was surrounded by semi-circular walls. The first row of the audience were the dressers who would carry wound sutures and supplies for the surgeon. Behind them were the medical students and honored guests. Lastly, everybody else.
The rooms were known as “gateways to death” because of the agony that took place within and the infections that occurred after an amputation. A patient was safer if they had an operation at home. Most deaths were post-op infections. It was believed that pus was natural. The levels were: Gentleman physician, surgeon, apothecary.
Surgery was a loosely regulated apprenticeship with not very much respect or pay. But in 1815 systematic education took place and surgical students in London had to attend lectures and shadow doctors for 6 months to get a license from the Royal college of surgeons.
RL was a renowned surgeon for his strength and speed – both crucial skills at a time when there was no way to relieve pain. He could remove a leg in <30 seconds and often kept his knife in his mouth in order to free up his hands. He could use his left hand as a tourniquet. He ended the age of agony on December 21st, 1846 when he showed that Diethyl ether could be used to render a patient unconscious.
He also unintentionally once cut 3 fingers off his assistant while performing surgery on a patient and slashed a bystander’s coat – causing a 300% fatality.
Through The Lens
In the early 19th century microscopes were seen as novelties. They had many engineering faults that meant they could not be used for science and J set out to fix these problems between 1824 – 1843. Most lenses caused a distortion (a purple halo around the object in view) and J designed an achromatic lens to correct this. He was a major influencer on JL and insisted that his children read to him. One of the first gifts JL received was a book called Evenings at home which contained stories and natural history. The family followed the Quaker lifestyle and believed in vis medicatrix naturae. So when JL announced he wanted to be a surgeon it came as a surprise.
By the time JL got to UCL, London was rotting in its filth. Garbage and manure lined roads that surrounded door-less homes. Everything was covered in soot. From the fake leaves in ladies’ hats to the green dye on walls of manor homes, everything was toxic. JL moved into 28 London street with Edward Palmer, a fellow Quaker and 8 years his senior. It was Palmer who helped JL get a place to view the most important surgery performed by RL. Palmer eventually lost his sanity and was admitted to a mental hospital.
Houses Of Death
The existence of germs wasn’t widely accepted and anatomy lab was dangerous. Lister noticed white spots on his hands – smallpox. 1/3 patients died. John Lister survived but got an unrelated brain tumor. It was this sorrow that caused J to give up his work with the microscope.
JL recovered but became more religious. He wondered if he should give up surgery and become a preacher. He attended a Quaker Meeting and said “I will be with thee and keep thee, fear thou not”even though ministers are the only ones allowed to speak. J said don’t change paths and keep on the path to be a doctor. Became more and more depressed, Left UCL in 1848. Traveled for 12 months and reenrolled. He became a dresser to John Eric Erichsen. 1847: Liston died. The four big diseases (hospitalism) septicemia, erysipelas, gangrene, Pyemia.
The Sutured Gut
Lister was the most senior surgeon on duty when Julia was carried in. Her entrails were exposed. After attending to her surgery and recovery he testified against her attacker and caused him to be transported. When JL was a house surgeon, his mentor operated on a woman who had an acute disease of the larynx. He cut into her circoid artery but she began to asphyxiate from blood and mucus. He used his mouth to vacuum 3 portions of blood and mucus and she was able to breathe.
The Napoleon of Surgery
Professor Syme hated hard methods when easy ones did the job. He knew how to balance time and technology and he had brevity in speech, he was the cousin of RL. JL met him in 1853, Edinburgh. Lister’s Professor Sharpey gave JL an intro letter and encouraged him to go to Scotland.
The two admired each other a lot.
The Frog’s Legs
Richard James Mckenzie was 33 and volunteering as a military surgeon during the 1854 Crimean War with the 72nd Highlander Regiment.
He was originally Syme’s assistant but took a sabbatical to try and fast-track his career. The conditions at the camp were filthy and he eventually died.
Wiliam Marsden founded the Royal Free Hospital in 1828 to provide care for the poor free of charge. He felt deep sadness when finding a dying girl at the steps of St. Andrew’s Church, he tried to admit her to a hospital but couldn’t because she was penniless. A few weeks later, she passed away.