The Butchering Art

June 27th, 1851. Julia Sullivan, after getting stabbed by her abusive husband, arrives at the Gower Street Hospital in downtown London with several inches of intestines hanging from her slashed belly. Given the early morning hour, no experienced surgeons were staffing the hospital. Sullivan’s fate hung in the inexperienced hands of a second-year medical student. Using a combination of techniques observed in the operating theater and studied in recent issues of The Lancet, the young medical student’s first surgery ultimately saves the lives of both Mrs. and Mr. Sullivan. The former saved from bleeding out. The latter saved from a murder conviction and public hanging. It was the first of many moments giving notice to the talents of surgical pioneer Joseph Lister.

Mid-19th century surgery is a brutal business. Just five years prior to Mrs. Sullivan’s run of terrible-turned-good fortune, London surgeon Robert Liston performed the first amputation featuring ether as a general anesthesia. Until then, the most successful surgeries were those done quickly on fully aware patients. By this accounting, Liston’s facility with the blade was well-known. If we generously measure Joseph Lister’s first surgery as having a 200% success rate, then an earlier surgery performed by Robert Liston had a 300% mortality rate. During one particular surgery, a patient eventually succumbed to his pre- and post-operative wounds, an assistant accidentally lost several fingers to Liston’s quick knife and later died of gangrene, and an elderly man had a fatal heart attack while watching the entire grisly affair. Yes, surgery was a brutal business. If you were fortunate enough to slip past the surgical reaper, post-operative infections (generally referred to as “hospitalism” at the time) had better than even odds of taking you out. It would be decades after Liston’s “triple” before a more seasoned Joseph Lister made defining advances in the treatment and prevention of such infections.

Glasgow, England, August 1865. An 11-year-old boy is trampled by a carriage and suffers a compound fracture. It is just the sort of injury Joseph Lister, now an established surgeon, wanted to test his new surgical protocol. By dowsing the injury, his hands, and his instruments with carbolic acid (also called phenol) and following up with several post-operative carbolic acid treatments, a likely amputee, walks out of the hospital on two good legs six weeks and two days after the accident. Unfortunately, given the level of scientific ignorance and institutional inertia, it would take more than a decade before Lister’s sterilization protocols gained wider acceptance. During that time, Lister incorporated Louis Pasteur’s germ theory to explain the action of carbolic acid and adopted its use beyond the surgical theater to lower mortality rates in all hospital wards.

Throughout The Butchering Art, author Lindsey Fitzharris provides the details behind these and others stories from surgery’s mid-19th century history, primarily via a professional biography of Lister. Fitzharris’s vivid descriptions can make for intense reading at times, but her accounts are never gratuitous. More importantly, The Butchering Art is an excellent account of how advances are made when circumstances, necessity, dedication, and brilliance all come together in the right places at the right times. Highly recommended and certainly worthy of being on my 2017 best books if I read it soon enough.