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The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine

2018; Lippincott Williams & Wilkins; Volume: 126; Issue: 6 Linguagem: Inglês

10.1213/ane.0000000000002922

1526-7598

Peter G. Brindley,

Medical History and Innovations

The Butchering Art is a simultaneously gory and rollicking read. It is also required reading, not just for surgeons and microbiologists, but for all who owe their careers to hospitals and surgical suites. Once you appreciate Joseph Lister’s pioneering work in antisepsis, you may even agree that surgeons can be heroes—just do not tell them. Typically, before Lister, only those without options went into hospitals or under the knife. Accordingly, when Lister operated on his sister, he did so at home because postoperative care could be as dangerous as the affliction itself. A modest 150 years later, we are all “Listerites.” Millions of antiseptic operations are now performed annually, and on the operating room table rather than the dining room table. Though we no longer use carbolic acid, it is largely because of Lister that the germ theory is no longer considered to be heresy, that hospitals have morphed from “houses of death” to “houses of healing,” and that surgeons have moved beyond “good old hospital stink” and “laudable pus.” Without Lister, we might not even believe that “to cut is to cure.” His work also allowed surgery to expand beyond the body’s peripheries. Indirectly, his work led to both the need for anesthesiology as a specialty and for the subsequent establishment of intensive care units. We continue to battle sepsis on a daily basis and we run the risk of reaching another age without antibiotics due to antimicrobial resistance. Accordingly, Lister’s ideas and ideals are more than mere anachronisms. Before Lister, health care workers lived, and also died, with “the big four”—erysipelas, septicemia, pyemia, and gangrene—collectively known as “hospitalism.” Surgeons dared only to excise lumps, reset bones, and hack off limbs. The innards were considered out of bounds, leaving the apothecaries room to tinker, which, incidentally, led to the creation of the term “internal medicine.” The introduction of anesthesia ended the age of utter agony, but not the age of death. Notably, mortality probably increased after anesthetics were introduced likely because surgeons became bolder, performing longer and more invasive operations as they became less constrained by time. It took people like Lister to make us more vigilant. He taught that being careful saves lives. He also taught to lead by example, and that cleanliness is next to godliness. Born in 1827, Joseph Lister, the son of a Quaker inventor and pioneer in microscopy, was uniquely curious, humble, compassionate, and driven. However, The Butchering Art offers more than an engaging biography. It is also a one-stop guide to Victorian medicine. Our tale starts in 1846 with the first use of ether in Europe by the surgeon-showman Robert Liston at University College London. Liston, the surgeon, was celebrated because he could whip off a leg in <30 seconds, even if a patient’s testicles and fingers were occasionally lost in the process. Watching from the pews was Joseph Lister, the medical student. He was apparently horrified. He subsequently dedicated over 40 years to putting the “care” into “surgical care” and taking the “theater” out of “operating theater.” The anesthetist, both as a reader and as a physician, is the greatest beneficiary of Lister’s dogged determination. Meanwhile, Dr Liston reportedly acknowledged ether’s origins with a wonderful one-liner saying that “Gentlemen, we are going to try a Yankee dodge for making men insensible.” Fitzharris also covers William T. G. Morton (ether), Crawford Williamson Long (ether 4 years before Morton, but he failed to write it up), Horace Wells (nitrous oxide), James Young Simpson (chloroform), and Franz Mesmer (hypnosis, his surname the origin of the term “to mesmerize”). The book offers primers on Louis Pasteur (the father of germ theory), John Snow (avoid that water), Igor Semmelweis (wash those hands), and even Julius Richard Petri (quite a “dish”). The book concludes with Lister leaving Scotland in 1877 for a professorship in his native London. The epilogue makes it clear that his achievements and recognition continued unabated. Lister was subsequently acknowledged as the father of modern surgery, and there could easily be a second edition covering the time from 1877 up to his death in 1912. After all, he later became the Queen’s personal surgeon, headed the Royal Society, received a knighthood and a peerage, and was made a member of King Edward VII’s Privy Council. Posthumously, in 1924, the Lister Medal became a preeminent surgical award, and in 1940, a bacterium was named after him. In case you were wondering, the origin of the mouthwash Listerine is also discussed: it was developed in 1879 by a Missouri chemist who believed the eponymous association would boost sales. The book’s author, Lindsey Fitzharris, has a PhD in the history of science and medicine from Oxford University. She runs a website called “The Chirurgeon’s Apprentice,” presents the YouTube series “Under the Knife,” and has written for The Guardian, The Lancet, and New Scientist. This is her first book. Therefore, while she cannot claim decades of scholarship, we are spared a boring historical tome. Regardless, for me, while this book began as a relaxing read, it became a revelation. The Butchering Art powerfully highlights how far we have come by using the antiseptic method in medicine, and how far we could potentially go. Hospitals are still places where matters of life and death are ubiquitous, and medicine can still be raw, chaotic, and petty. Lister calmly advocated for his ideas despite furious opposition and ridicule from naysayers. His ideas are now self-evident. Not only are diseases contagious; if we persevere, then progress can be, too. Peter G. Brindley, MD, FRCPCDepartments of Critical Care Medicine andAnesthesiology and Pain MedicineDosseter Ethics CentreUniversity of AlbertaEdmonton, Alberta, Canada[email protected]