Just in time for Halloween, we interviewed Lindsey Fitzharris, a medical historian who has spent years unearthing the details of 19th-century surgery.
It was a terrifying period: Chances of post-surgery survival were so low that hospitals often forced patients to pay upfront. The concept of hygiene was completely foreign, with vermin and bugs living alongside patients in medical wards. Surgeons proudly reused the same stained tools and blood-soaked aprons in operation after operation.
But perhaps most horrifying, there was no anesthetic.
“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,” said Fitzharris, whose newly published book on the subject is titled “The Butchering Art.”
The author, who holds a doctorate in the history of science and medicine from Oxford University, will be delivering a Halloween night lecture on Tuesday at the Smithsonian Institution's S. Dillon Ripley Center.
We asked Fitzharris to describe the scariest aspects of Victorian-era surgery. She had plenty from which to choose.
Surgeons in that era were more prized for speed and ferocity than skill. Many didn’t attend university or medical school, Fitzharris noted. Some were even illiterate.
One of the more renowned surgeons in 19th-century London was Robert Liston, who was something of a cross between a carnival barker and cattle-floor butcher.
It was said that he could take apart a man’s leg in 30 seconds. During one of his most infamous operations, he was said to have been moving so fast, he accidentally took off his assistant’s fingers and slashed a spectator’s coat. The spectator was said to have died of fright, and the assistant and patient later succumbed to gangrene infection.
“It was the only surgery with a 300 percent mortality rate,” Fitzharris said.
One man who came to Liston to have a bladder stone removed ended up fleeing from the surgeon and locking himself into a bathroom. Liston, who at 6-foot-2 was a towering man for that time, broke down the door and dragged the patient screaming and kicking back to the operating room, where he tied him up and began cutting him open.
The lack of anesthesia made every operation tantamount to sheer torture. In her research, Fitzharris found accounts of not only patients going out of their minds during operations, but also surgeons breaking down and crying beforehand because of what the procedures would entail.
In one 1840s account that Fitzharris unearthed, a woman named Lucy Thurston writes to her daughter about undergoing a mastectomy. The surgeon came to her bedroom, showed her the knife and told her to prepare her soul for death. Then, for the next hour and a half, he and she were completely covered in blood from the operation.
“When you consider how painful it all was, you can see why many patients often avoided surgery altogether unless [their condition] was really life-threatening,” Fitzharris said.
Lack of hygiene
Surgeons seldom washed their hands or tools before operations. “In fact, the more blood a surgeon had on his apron, the more seasoned he WAS said to be. It was a badge of honor,” Fitzharris noted. “The thinking was, why wash your hands if they’re just going to get dirty again.”
There was a “cadaverous smell” to many of these doctors. The same held true of hospitals, which often employed bug catchers — paid more than doctors — to rid beds of lice and other creatures.
The wealthy had surgery done at home, with the survival rate much higher there than in hospitals. Bacteria, infections and gangrene so often claimed patients’ lives that at one point, some in the British medical community discussed burning down particularly filthy hospital buildings as the only way to solve the problem, Fitzharris said.
Surgery was often a public affair. People in the Victorian era were obsessed with the idea of progress and science. And in an age long, long before movies and television, many would attend surgeries for the entertainment value of seeing the struggle between life and death — much like the bear-baiting and cockfighting that also took place at the time. Even royalty would come to see particularly interesting operations.
Because bacteria was an unknown concept, the crowds often carried with them the grime of the streets. Operating theaters could be so crowded that the floor had to be cleared before the surgeon could proceed.
Dawn of a new age
In her book, Fitzharris chronicles how during the second half of the 19th century, a young surgeon named Joseph Lister changed the course of medical history.
Amid the growing crisis of hospital and surgery patients dying left and right, Lister bought into an emerging theory of invisible germs and began experimenting with different chemicals.
Eventually, he came up with a way to turn carbolic acid into an antiseptic spray that could clean wounds and disinfect instruments. The British medical community fought him.
“It’s difficult to imagine the pushback he faced,” Fitzharris said. “This is a young man coming along and telling respected surgeons that they have actually been dooming the very patients they’re trying to help. And that there are these invisible creatures called germs that are killing all of them.”
Lister eventually traveled to the United States to try to persuade American surgeons. He encountered skepticism here as well, but eventually succeeded in swaying them.
In fact, his legacy lives on in American society, Fitzharris said. “A man who was in the audience that day hears his talk about antiseptics and names the cure-all he creates after Lister.”
Thus was born the mouthwash Listerine.