Thank You Joseph Lister: A Review of The Butchering Art


One of the ways in which a correct revolutionary idea changes the world is when it becomes integrated into other fields allowing those new fields to leap forward via a shimmering green light provided by the original idea. This is how I think about the germ theory of disease as articulated by Louis Pasteur. Pasteur's pathbreaking identification, which stemmed from Pasteur's work with industrial concerns such as the manufacture of silk and the manufacture of wine, is arguably the most important idea in medicine. While it is obvious how such an idea would impact the diagnosis and control of infectious diseases -- an impressive feat in its own right -- the impact the germ theory had on surgery is also inestimable. 

The idea transmission belt, in this case, begins with Pasteur and ends with Joseph Lister. This topic is expertly explored by medical historian Lindsey Fitzharris in her book The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine. In this book, Fitzharris engrosses the reader with gruesome tales of what surgery was like in the 19th century: scary, dangerous, and often restricted to external maladies (as opposed to internal medicine which non-surgically treated diseases of the organs) because of these insurmountable facts about the profession. As she writes of Lister:

“He knew that for thousands of years, the ever-looming threat of infection had restricted the extent of a surgeon’s reach. Entering the abdomen, for instance, had proven almost uniformly fatal because of it.”

Today, entering the abdomen is routine...because of Lister.

Fitzharris makes it clear why it was Lister who was almost predestined for this task given his relentless interest in microscopy (his father was a renowned microscopist) and his effort to incorporate the microscope into clinical medicine. When one is about to do battle with invisible organisms that many don't believe exist, having an active mind that is familiar with the tools needed to see them as well as the existence of a microscopic world is essential.

Lister was faced with the seemingly unsolvable problem of surgical site infections -- something we still struggle with today -- and  worked to understand what caused surgical wounds to become inflamed and then rancid from some unknown source (e.g. spontaneous generation, the air). This mystery all unraveled when, in 1864, Lister was introduced to the ideas of Louis Pasteur via a chemistry professor, and "picked up the baton." Lister read Pasteur's works with the idea of extracting principles and findings that could help him explain the problem of surgical infections.

Pasteur, who was not a physician, recognized the enormous synergy that would result from such a man as Lister who could apply and test Pasteur's ideas. As Pasteur wrote: “How I wish I had … the special knowledge I need to launch myself wholeheartedly into the experimental study of one of the contagious diseases." Lister, when it came to surgical infections, was the one with special knowledge that Pasteur needed.

What followed was the application of carbolic acid, a chemical used to ward off putrid smells by sanitation workers, to surgical sites with success, the predictable backlash from the world, and the ultimate victory (Lister was eventually named Queen Victoria's personal surgeon after treating a severe abscess she developed) that we all benefit incalculably from.

All of this and much more, including the use of catgut sutures, is covered by Fitzharris in what is a very valuable book.

My favorite elements are the interactions between Pasteur and Lister -- just to witness two giants and heroes of mankind together is unimaginable to me. For example, in an effusive letter to Lister, Pasteur wrote: “I do not think that another instance of such a prodigy could be found amongst us here." While at a tribute honoring Pasteur, Lister said of Pasteur who he credited with "raising the dark curtain" which loomed over medicine:

“You have changed Surgery … from being a hazardous lottery into a safe and soundly-based science...You are the leader of the modern generation of scientific surgeons, and every wise and good man in our profession—especially in Scotland—looks up to you with respect and attachment as few men receive.” 

The occasion was described as “the living picture of the brotherhood of science in the relief of humanity.”

Lindsey Fitzharris deserves great praise for bringing this important and inspiring story to life. She clearly recognizes and values the achievements of these great minds and the importance of ideas in changing the world. This line of hers is one which will stick with me for a while: “But for all the opposition Lister faced, he was fighting the battle with like-minded people who recognized the revolutionary nature of his work.” 

Recognizing the revolutionary nature of Lister's -- or any other bold thinker's ideas -- is one way to give a reward to those whose value is priceless and Fitzharris, through this book, has helped our species to do that to Lister.