The Butchering Art
- Apr 22, 2018
- 3 min read
How I came across this book: Christmas gift
Favorite Line from the book:
Fame is no plant that grows on mortal soil.
“Truth from his lips prevailed with double sway, and fools, who come to scoff, remained to pray.” Oliver Goldsmith
I love reading surgical history books as it reminds me of the giants on whose shoulders my profession has been built over the course of many centuries. Lindsey Fitzharris recounts the grueling and gory Victorian era when the mortality from any surgery was almost hundred percent. It would be another hundred years before Alexander Fleming would discover penicillin serendipitously in 1928. Surgeons were praised more for the speed of surgery than accuracy, correctness or scientific rigor. Robert Liston, an eminent surgeon in London, was famous for performing an amputation in less than a minute (his personal best was 28 seconds). Unfortunately, his speed was also his curse. On one occasion, he sliced off his assistant’s finger and splashed an onlooker with the patient’s blood. His assistant and patient died from an infection a week later, and the unfortunate bystander passed away on the spot from shock – the only surgery in history with three hundred percent mortality. The concept of bacteria and germs causing infection had not even be discussed in medical books or journals at that point. The hospitals were as dirty as the town itself. The operating theatre reeked of patient’s blood as no one realized the significance of cleaning them. Surgeons would operate on multiple patients without cleaning their hands in between cases. It would be another century before surgical gloves, popularized by William Halsted, would come in regular practice. Joseph Lister was a genius amongst this period who wheeled the profession of surgery from a butchering art to a healing practice. He reduced the mortality from surgical infection dramatically by introducing the concept of aseptic surgery.
Joseph Lister, born in a Quaker family, was very shy and humble. The constant support from his father Jackson Lister and his mentors turned him into a confident young surgeon. Lister’s father had gained fame for developing the optical microscope. Watching Robert Liston perform his electric-fast amputations in the University College London hospital had inspired Lister to become a surgeon, but it was his father who helped him in shaping his career especially through his microscope. Over the course of next three decades, Lister performed multiple methodological experiments, including advocating carbolic acid (phenol) to clean instruments and surgical wounds, using sterile catgut (derived from sheep's gut) in surgery, and championing cleanliness in hospitals.
Lister will always be remembered as the ‘father of aseptic surgery.’ His excellence did not come from his brilliant mind but his persistence in the face of failure. He failed to get the surgical job at any of the university hospitals in his first attempt – London, Edinburgh or Glasgow. Many of his experiments failed, which led Lister to continuously innovate and change his clinical practice. He faced multiple criticisms from his colleagues in Britain and America about aseptic surgery. It took him almost forty years before he could convince everyone that infection from germs was one of the most important cause of death after surgery. Lister himself was working on the shoulder of some giants. Professor James Syme, a Scottish surgeon, famously called the ‘napoleon of surgery,’ who was Lister's father in law, mentored and taught him the craftsmanship of surgery. Louis Pasteur, a French biochemist, propagated the principle of ‘fermentation and germ theory,’ which influenced Lister to apply it in his surgical practice. Jackson Lister, his father, put the microscope in his hands, which was the key in proving Pasteur's germ theory in postoperative infection. Before his death, Lister asked in his will that all his personal belongings should be burned as he wanted the world to remember him for his scientific achievements rather than his personal life. Thankfully, his wish was not carried out. While we all have much to thank Lord Joseph Lister, the father of modern surgery, the genius himself did not realize the ‘power of the other’ and the giants who had helped him shape the future of surgery.
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