In March of 1867, British surgeon Joseph Lister published a landmark article in the medical journal The Lancet announcing his antiseptic system for preventing infection. If effective, this practice promised to change surgery from a risky gamble to a safer intervention with real promise in treating disease. One-hundred and fifty years after Lister’s original article, Lindsey Fitzharris has produced a biography of Joseph Lister focusing on his invention. In 230 pages of popular history, Fitzharris takes readers from the pre-Listerian surgical theaters replete with pathogenic microorganisms and decaying bodies to sterile hospital wards filled with recovering patients.
Fitzharris approaches this topic with both an academic background in the subject as well as years of experience in communicating to popular audiences. She earned her Doctorate of Philosophy from Oxford in medical history, with a dissertation that explored the unrelated topic of John Webster’s 17th century Helmontian medical philosophy. She also writes two blogs on the history of medicine as well as creating and hosting the popular Youtube® series “Under the Knife,” where the 16 episodes command viewership in the tens of thousands and regale audiences on topics ranging from re-usable condoms to Abraham Lincoln’s assassination.
Fitzharris neither claims to advance scholarship nor to impart a new perspective as her footnotes, filled with citations to previous biographies (especially Godlee’s classic 1917 account) and other secondary sources—silently attest. Rather, she endeavors to bring a signal episode in the history of medicine to life.
The Butchering Art is clearly intended for a popular, not academic, audience. With over 30 book-length biographies of Lister and hundreds of articles by physicians and historians already filling card catalogues, there is little new to say about the man or his discoveries, and Fitzharris fails to break original intellectual ground. But Fitzharris neither claims to advance scholarship nor to impart a new perspective as her footnotes, filled with citations to previous biographies (especially Godlee’s classic 1917 account) and other secondary sources—silently attest. Rather, she endeavors to bring a signal episode in the history of medicine to life. Similar to Gerald Imber and Wendy Moore’s recent provocatively entitled biographies of William Halsted (Genius on the Edge) and John Hunter (Knife Man), Fitzharris combines a breezy style of prose, digestible chapters, and a thorough review of the literature to impart a fun story about a pivotal moment in history and the medical hero whose intellectual courage saves countless future generations. Her work aligns closely with popular science writer Mary Roach. Both use vivid language and provocative examples that simultaneously disgust the reader while keeping him/her intrigued in the story and turning the page to learn what happens next. Both have a tendency to bounce from anecdote to anecdote with occasionally weak links connecting them. But their style does enliven a potentially dry discussion of science into a story both entertaining and educational, and one sure to capture the attention of the reader.
Fitzharris approaches her topic chronologically, largely following the trajectory of Lister’s life. In a prologue, she discusses surgery in the mid-19th century, here building on the scholarship of Peter Stanley. This section, along with chapter 2 that noted “hospitals constantly reeked of piss, shit, and vomit” (46), serve as foil that Fitzharris uses later to contrast the improvements resulting from Lister’s system of antisepsis. No straw man, pre-Listerian surgery presented great risk to patients, with many hospitals suffering from post-operative mortality rates of 40-50 percent. Surgeons recognized the problem, and Fitzharris touches on a few of the proposed explanations and attempted solutions. In an era when physicians struggled to understand what caused disease, even interventions that successfully reduced mortality rates lacked a sound theoretical underpinning, often could not be reproduced, and they did not see widespread adoption.
Much of the early portion of the book progresses through Lister’s life. Lister’s father, himself a renowned microscope builder, helped instill a love of science and discovery in his Quaker son who went on, unusually for the time, to obtain an undergraduate degree in the liberal arts before matriculating into the relatively new medical school at the University College of London. Following a seemingly obligatory tour of the dissection hall (Fitzharris rarely avoids an opportunity to horrify her reader, even when it adds little to the overall narrative), we see Lister graduate and move to Edinburgh where he worked under the famous James Syme to learn surgery. In addition to continuing his scientific education, Lister fell in love with his teacher’s daughter, ultimately renouncing his Quaker faith to marry Agnes Syme. He and his father-in-law established both a personal and professional rapport; students called Syme “Master” and Lister “Chief.” As Lister gained more experience, he eventually obtained the position of Chairman at the neighboring University of Glasgow. As a surgeon, scientist, and teacher at Glasgow, he commanded the admiration of his patients and especially his students. He approached education and patient care with a seriousness and sense of purpose reflecting his Quaker upbringing and which contrasted sharply with the dramatic flourishes many of his surgical contemporaries evinced. Particularly following Lister’s publication on antisepsis, his students not only revered the man but also saw themselves as missionaries for his antisepsis, as Ann Crowther and Marguerite Dupree have documented. It is less clear that Lister actively sought to convert his students into an army of followers, as Fitzharris claims (196).
Lister’s conceptualization of antisepsis stemmed from both his own experiences and the discoveries of French scientist Louis Pasteur. Lister certainly recognized the high post-operative mortality of even his own cases and used his background in microscopy to study the inflammation caused by surgical wounds. Courtesy of a colleague, Lister began reading the work of Pasteur who, among many other accomplishments, perfected the sterilization of milk products through a process that we still call “Pasteurization.” He also made several seminal contributions to what has become known as the germ theory of disease. First, he proved that microorganisms called yeast were responsible for fermentation. Second, he conclusively demonstrated that germs came from other germs—they did not magically appear or spontaneously generate. Lister then applied these principles to surgery: if microorganisms produced fermentation, then they might also cause inflammation. Furthermore, once germs were eliminated, the wound was safe.
Not everyone accepted Lister’s methods, and Fitzharris spends several chapters discussing the slow, discontinuous, contentious process by which antisepsis spread.
After covering several failures, Fitzharris discusses Lister’s first successful case on 11-year-old boy James Greenlees, who suffered a compound fracture of his leg after being run over by a streetcar. Lister applied carbolic acid on the wound to kill the germs and prevent infection, which saved young James his life and his limb. Lister spent two more years developing his technique and collecting data before presenting his results to skeptical medical audiences in a series of articles and speeches delivered around the world. Fitzharris blessedly spares us a recitation of the myriad forms, types, and variants Lister proposed to alter his antiseptic system over the years, although a more thorough discussion of his carbolic acid spray and the surrounding controversy surrounding its use would have benefited the manuscript. Moreover, her contention that it was the spray that “signaled Lister’s commitment” (209) to germ theory is simply not true—his entirely methodology and practice rested upon the inchoate idea of germs causing disease. (Historians have since complicated Lister’s understanding of the germ theory.)
Not everyone accepted Lister’s methods, and Fitzharris spends several chapters discussing the slow, discontinuous, contentious process by which antisepsis spread. While the conflict between the mercurial James Simpson (inventor of chloroform anesthesia) and Lister has the theatrical benefits of a fight between two leading surgeons, this dispute had little effect on the trajectory of antisepsis despite its prominence in The Butchering Art. Rather, entrenched opposition to a germ theory of disease severely limited acceptance. Admittedly a complex paradigm shift with an extensive literature surrounding it, the germ theory of disease nonetheless receives only superficial treatment in the book despite its critical role. Importantly, while Fitzharris acknowledges the barriers it placed to the adoption of antisepsis, she misses an opportunity to demonstrate how Lister’s success simultaneously convinced clinicians of the truth, importance, and utility of this etiological understanding.
Too often, academics are criticized for recondite prose explicating esoteric topics to the interest of a half-dozen experts in the field and no one else. Fitzharris successfully takes the opposite tact.
While the first half of the book nicely interweaves primary and secondary sources, the latter sections derive heavily from existing published accounts, like the repetition of Rutkow’s article in explicating Lister’s 1876 tour. Fitzharris particularly depends on Godlee’s biography, including a weak analysis of Lister’s initial resistance to the Germanic advance of asepsis. Reliance on these earlier biographies also contributes to a hagiographic treatment of Lister here that shortchanges the contributions of contemporaries like Pasteur and Robert Koch. It also ignores more recent literature on the importance of the localization of disease: Listerian antisepsis provided surgeons with the tools to operate safely, but for most diseases beyond trauma, surgeons lacked a reason to operate electively. Until the widespread acceptance of an ontological understanding of localized disease, surgery had limited room to expand.
Despite these flaws, Fitzharris does an admirable job in bringing an important and oft-forgotten episode in the history of surgery to light. Too often, academics are criticized for recondite prose explicating esoteric topics to the interest of a half-dozen experts in the field and no one else. Fitzharris successfully takes the opposite tact. Focusing on a man perhaps best known as the namesake for the mouthwash Listerine®, she uses gore and drama to enliven scientific history. Lister’s contributions fundamentally changed the practice of medicine and surgery and deserve greater attention; in The Butchering Art Fitzharris provides it.