Old School Surgery Is Discussed In "The Butchering Art"

Nov 1, 2019

There was a time when surgeries were a spectacle and one of the most unsanitary events you've ever seen. That's until a Doctor named Joseph Lister changed their ways. Author Dr. Lindsey Fitzharris came to the University of Wyoming this week to discuss her award winning and gory book The Butchering Art.

Bob Beck: I wanted to just start off this interview and just ask you how much fun was surgery, way back when?

Linsey Fitzharris: Not very fun at all. You know, I call it the original 'Fear Factor' if anybody's watched that TV show, being strapped to the operating table without any anesthesia, and certainly before we understood germ theory was awful. At these operations were nothing more than slow moving executions. They were really painful and of course the post-operative infection rate was very high.

Beck: Did they ever work? I mean, obviously some people survived.

Fitzharris: Yeah, yeah, some people. It's hard to know mortality rates because this is before hospital statistics. And a lot of surgeons didn't want to admit when their patients were dying in high numbers, but certainly it did work sometimes. But again my book, The Butchering Art is really about the moment that germ theory becomes accepted into medicine, which is a hugely critical moment because before then, the surgeon rarely washed his hands or his instruments. And he carried around this cadaverous smell of rotting flesh, which they called good old hospitals stink. So these places didn't just look different, or feel different, they smelled different, and that the surgeon he didn't wash his hands because he didn't understand germ theory. So why would you wash your hands in between patients if they were just going to get dirty again? And as a result, post infection was so high and these people were dying incredible numbers in these hospitals.

Beck: Dr. Joseph Lister had been studying this for a long time. Is he the one that essentially discovered germs?

Fitzharris: So yeah. My book is about Dr. Joseph Lister. And if you're out there and you're wondering why that name sounds familiar and you're not sure why, it's because of the product Listerine. So Lister was a British surgeon and he came to Philadelphia in the 1860s. And he gave this talk about antiseptic and germ theory and there was a man in the audience who was inspired he created this product Listerine. It wasn't used as a mouthwash in the 19th century, it was actually used were commonly to treat STDs. So not something that I endorse, but certainly something that Listerine was originally used for. But Lister is the father of antiseptic surgery. So what he did was he took Louis pastures germ theory, and he applied it to medical practice. It's the first time that a scientific principle was ever applied to medical practice. So I like to call this book the love story between science and medicine. It's the birth of scientific surgery.

Beck: And to be clear, as you said before they didn't do anything, didn't wash your hands and you have a quote from a doctor who said in fact gentlemen don't pass diseases on.

Fitzharris: No, yes that's absolutely right. In fact on the cover of my book is a famous painting by a man named Thomas Eakins and it's called the Gross clinic because the man on it is Samuel Gross and he so didn't believe in Lister. He also didn't believe in germs that he would slam the door behind him. And he would say there Mr. Lister's, germs can't get in anymore. And so he really just that and you can see it in this painting. He's wearing his street clothes, they're sticking their filthy fingers into this wound. There's a woman in that painting, she's wearing black and covering her face. She's the mother of the patient. She's wearing black because she expects her son to die. So this was really an awful period. And in fact, it was so bad that it was seriously suggested the only way to control hospital infection was to burn the hospitals down from time to time and just start anew and so you think about this critical period and Joseph Lister stepped into the scene, it was very hard for people to accept germ theory. And it's hard for us to understand that today. But if you imagine this young guy telling you that there are these invisible little creatures, and they exist, and they're killing your patients, and you need to do these kinds of methods to prevent this from happening, it was a hard pill for surgeons to swallow.

Beck: Well let's have some fun here. So tell us a little bit about what an operating room might look like if I was to have surgery?

Fitzharris: Yes, well, one of my favorite spaces is the old operating theatre in London. It's the second oldest in the world, it still exists. And these were incredibly small spaces, sort of a semicircular stands around the operating table, and they would have been filled to the rafters with ticketed spectators. People actually bought tickets to see the life and death struggle play out before them. And of course, the Victorians were carrying the grime and dirt of everyday life with them. So these weren't very sterile or hygienic places. Before the discovery of ether in 1846, the patient would have been very alert, there is this kind of myth that the patient would have been drunk, but actually alcohol would make your blood thinner. So you certainly wouldn't want the patient to be drinking too much before an operation. And they were they were restrained sometimes before ether, they were sat in a chair, a very high chair so that your feet dangled, so you couldn't brace against the knife.

Beck: What would an amputation be like? What would happen there?

Fitzharris: Well, one of my favorite stories is a guy named Robert Liston. Robert Liston was the fastest knife in the West End, he was 6-2, he could hold you down with his left arm and he could take off your leg in under 30 seconds, which is exactly what you'd want your surgeon to do in a pre-anesthetic era. Now in order to remove the leg…so if you ever see a Victorian operating table, they tend to be very low to the ground. And people think that's because the Victorians were shorter which there's an element of that. But actually, when you want to take the leg off, when you start to saw, you're going to want to push your body into it. So you don't want the table to be too high. You don't want to cut it like you would cut it steak. So these tables were very low. And they actually the Victorians understood that very well they would push into the amputation. They obviously you can imagine it was very bloody, they had these hooks that they had to pull the arteries down to tie them off. And all of that in under 30 seconds is pretty incredible feat.

Beck: So I how did Lister get people around his way of thinking.

Fitzharris: It was a long, slow burn, I'm trying to get this movie made. I joke that I'm going into Hollywood and trying to convince them that a Quaker surgeon from the 19th century deserves a Hollywood feature. But he's so important. He saved more lives than any other person to ever live. Because if you extrapolate what we do today, knowing now about germ theory, but he really he turned to the younger generation, and he was able to change their hearts and minds. And they became known as the Listerians and they went out and they spread the gospel of Lister. And that's ultimately how the change happened, but it took 20 to 30 years and it happened slower in America than it did in other parts of Europe.

Beck: Your book by all the reviews is viewed as gross. And you've got some very exotic detail… you want to give us one story before we let you go?

Fitzharris: I'll tell this story. Going back to Robert Liston, so he used to hold these knives, these bloody knives in his mouth as he was switching instruments to really underline how far we've come. And one time as he was operating so quickly, he accidentally took off his assistant's finger and as he was switching blades, he cut the coat of a spectator and it was said that the assistant died of gangrene, the patient died of gangrene and a spectator died right then and there of fright. And it's jokingly referred to as the only operation with a 300% mortality rate. So if you're going to fail, you should fail big.

Beck: The book is called The Butchering Art and thank you for joining us.

Fitzharris: Thank you so much for having me on.