If faced with surgery most of us expect to go under the knife painlessly and wake up sorted. For almost the whole of human history that would have been impossible. Agony, a botched job or death were next to certain. How then did we get from butchery to modern surgery in the last 200 years?
Dr Lindsey Fitzharris (http://www.drlindseyfitzharris.com/) gives us the story of Joseph Lister. Be prepared for the descriptions of oozing pus and rotting flesh that accompanied infections in the days before antiseptics. Before Lister’s promotion of antiseptics and sterilisation as a means to prevent post-operative gangrene, doctors did not wash their hands before plunging them into an open wound.
Anaesthesia was a huge breakthrough — but it didn’t solve the widespread problem of infected wounds leading to agonising death. Surviving an operation was only the first hurdle towards recovery. In the mid-19th century, the two leading theories of infection determined that airborne pathogens were the culprits. One theory suggested that infections were brought in via imported goods from pestilent regions of the world. The other held that disease was carried via vapours, gases, noxious smells and ‘miasma’. In fact, as Fitzharris’s painstakingly detailed descriptions of life in hospitals and industrial cities make clear, germ-harbouring dirt and waste were a permanent feature of everyday life. She paints a vivid picture of the stench and horror of the London that Lister knew as a medical student in the 1840s. There were burial pits, for example, heaving with thousands of decomposing bodies: the local churchyard at Clement’s Lane in the East End ‘oozed with putrid slime’. From Smithfield meat market, one observer wrote, ‘men carried on their clothes the ordure of their unholy profession back to the slums in which they lived’. The doctors, surgeons and assistants in hospital dissecting rooms (and the spectators and students who crowded in to watch) also carried their work away with them. Revolting, stinking gases and liquids poured from the cadaver’s stomach on to sawdust where rats nibbled bits of human vertebrae. A blood-caked apron was the sign of professional expertise; during operations, spectators and doctors were spattered with blood and might go home with human tissue sticking to their coats.
Joseph Lister, a Quaker, was born into a home filled with fossil collections and scientific curiosity. His father was a wine merchant with a fascination for optics that earned him a fellowship of the Royal Society. Lister’s later use of the microscope was to be central to his work on antiseptics. As a doctor, Lister worked with the most famous medical figures of the time. He started his surgical career at University College under Dr John Erichsen, who once clamped his mouth to the open neck wound of a patient asphyxiating from blood in the lungs — and sucked out the liquid and mucus. Lister’s introduction of an antiseptic changed the culture and hygiene of medicine totally.
Building on Louis Pasteur’s discoveries about microbes, Lister observed that carbolic acid was used by sewage workers to counteract the smell in fields irrigated with liquid waste. He developed a carbolic spray that proved successful in post-operative healing and thus ensured that for the next century the prevailing odour of disinfectant and sanitation would be the sweetish smell of coal tar. Lister is described as ‘modest, unmasterful, unassuming’ but his achievements echo down the years in all sorts of unlikely ways. Inspired by hearing him lecture at Philadelphia, three brothers called Johnson established a small business that made sterile surgical dressings. And in 1879, Dr Joseph Lawrence created a phenol-and-eucalyptus mouthwash. He named it Listerine.
We all owe these pioneers an incalculable debt of gratitude.
Dr Lindsey Fitzharris received her doctorate in the History of Science, Medicine and Technology at the University of Oxford and was a post-doctoral research fellow at the Wellcome Institute. She is the creator of the popular website The Chirurgeon’s Apprentice, and she writes and presents the YouTube series ‘Under the Knife’. She has written for the Guardian, the Lancet, the New Scientist, Penthouse, the Huffington Post and Medium, and appeared on PBS, Channel 4 UK, BBC and National Geographic.
Check if this excellent medical history is in stock at your local library by consulting the online catalogue at https://www.sllclibrary.co.uk/cgi-bin/spydus.exe/MSGTRN/OPAC/BSEARCH
304 pages in Allen Lane
First published 2017
ISBN 978-0241262498
Dr Lindsey Fitzharris