Until the middle of the nineteenth century, surgery was nothing more than butchering services provided by barbers or people with no formal medical training (some were even illiterate), which performed tooth extractions, bloodletting, enemas, and amputations without a thorough understanding of either human anatomy or infection causes. No wonder hospitals were called Houses of Death, where mushrooms and maggots thrived in dirty sheets and, sometimes, the flesh of patients. Most patients were tortured in surgeries until they died or miraculously survived. As there were no hygiene protocols and no knowledge of cross-contamination, usually a surgeon would conduct an autopsy, and with the same instruments, they would perform operations on living patients. Because chances of survival were so poor, patients often had to pay upfront for their surgeries.
Patients had no choice but to be awake the entire time. There are medical accounts that just describe the sheer screaming and struggles of patients against the knife.
[…] the more blood a surgeon had on his apron, the more seasoned he WAS said to be. It was a badge of honor. The thinking was, why wash your hands if they’re just going to get dirty again.
A Washington Post interview with Lindsey Fitzharris, a medical historian and author of the remarkable book The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine
A man laid on the operating table in one of our surgical hospitals is exposed to more chance of death than was the English soldier on the field of Waterloo.
Extract from JOSEPH LISTER’S ANTISEPSIS SYSTEM
The discovery of anaesthetics worsened the survival rates as surgeons would take even more risks as their patients would be oblivious to suffering. The operation theatres were frequently packed with medical students or curious people who would repeatedly shout for a better view, “heads, heads”, not unlike what would happen in the galleries of a playhouse.
One of the famous surgeons at that time was Robert Liston, who could take apart a man’s leg in thirty seconds.
Once called the “fastest knife in the West End”, Liston would operate in front of audiences, crowing: “Time me, gentlemen!” before hacking off the offending body part – without ever washing his bloody hands.
His most famous (and possibly apocryphal) mishap involved an operation during which he worked so rapidly that he took off three of his assistant’s fingers and, while switching blades, slashed a spectator’s coat. Both the assistant and the patient died later of gangrene, and the unfortunate bystander expired on the spot from fright. It is the only surgery in history said to have had a 300 percent fatality rate.”
Lindsey Fitzharris – The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine
But in Liston’s theatre audience, there was a man, Joseph Lister, who would create perhaps the most paradigmatic shift in medicine. Up until then, the theory of miasma was widely accepted. According to the miasma theory, contagious diseases such as tuberculosis, cholera, or yellow fever were caused by “bad air” or miasma. It was believed that miasma was produced by garbage, sewage or the rotting of dead animals. As long as there was somewhat air ventilation in hospitals, it really didn’t matter if surgeons never washed their hands, changed their street clothes while operating, or disinfected their instruments.
The French scientist Louis Pasteur thought that the spread of microorganisms or germs could explain infectious disease (the germ theory of disease). Joseph Lister was the first surgeon to apply the germ theory to surgery, finding ways to prevent wound infections. Lister would correspond with Pasteur about the germ theory, and he meticulously researched and experimented with inflammation caused by infection. He proposed ways to prevent germs from entering wounds by creating antiseptics, barriers between wounds and surroundings. According to Lister, surgeons should clean their hands, wear gloves and use chemicals to disinfect their spaces with carbolic acid.
But how would other surgeons react to these novel principles?
It was hard for people to believe, because here comes this young guy saying there’s these invisible creatures and you can’t see them with your eye, but they’re killing your patients.
Lindsey Fitzharris in dialogue with All Things Considered host Robert Siegel
As Neil deGrasse Tyson says,
The good thing about science is that it’s true whether or not you believe in it.
And germs couldn’t care less there were disbelievers.
Of course, seeing that number of surgery infections sharply fell and lives were saved changed some minds. But Lister successfully operating on Queen Victoria proved to be a catalyst for change. As Queen Victoria travelled to Scotland and was in excruciating pain from a large armpit abscess, she needed a surgeon. Lister was the closest surgeon, and he operated on Queen Victoria, following all the principles he discovered, sterilizing the operating area and accidentally spraying the queen in the face with carbolic acid.
She was not amused. But he … ends up saving her life. And because she allowed him to do this operation, she kind of gives her blessing to the antiseptic techniques and germ theory by default.
He joked later in life that he was the only man able to plunge a knife into the queen and survive that experience.
Lindsey Fitzharris in an NPR interview
When I think of all the perils surrounding us, wars, natural disasters, climate change, AI, I think of Lister. The impossible task of trying to reduce surgery mortality. How to fight an enemy if we don’t know what we are fighting? And when we discover the miasma theory is wrong, how to convince our colleagues old methods are killing patients? It was enough to drive a man mad. But Lister persevered. He lectured to new generations of students that could see first-hand how Lister’s ideas moved surgery from butchering to science.
At the end of the day, the discoveries are what endure, Charpentier [Emmanuelle Charpentier, the 2020 winner of the Nobel Prize in Chemistry, alongside Jennifer Doudna] says. We are just passing on this planet for a short time. We do our job, and then we leave, and others pick up the work.
Walter Isaacson – The Code Breaker
And yes, Listerine is related to Lister. He travelled to the United States to persuade American surgeons about the principles of antisepsis and how to apply them to surgical procedures successfully. An American doctor was inspired to create a mouthwash promoted with the slogan “kills germs that cause bad breath”, and he called it Listerine in honour of Lister.