Book Review: The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine by Lindsey Fitzharris.

"Horrifying in its grisly detail of the unsanitary way of life in Victorian London but educational and surprisingly endearing towards the quiet man, Joseph Lister who would rise to become a star in the world of Medicine."
4 Stars
Pros: Detailed, Engrossing, Unflinching in the horrific health conditions in London in the 1800s
Cons: Sometimes too many people/hard to keep track of who was who, Some medical jargon was a bit complex for the average reader, By the end of the book, the petty arguments and disagreements between the numerous medical societies was tedious and annoying.

Full Review.
The book opens with a scene that's more befitting a horror movie than what you would apparently find back in Victorian London. It's an operating theater, the patient must have his leg amputated below the knee and everyone is crowded in for this particular procedure, because something radical and new is about to be used, Ether. This miracle concoction can apparently render the patient unconscious and spare him the pain of being awake while his leg is cut off. The use of Ether is successful, to the riotous applause of the crowd and during all of this, a quiet, unassuming man, Joseph Lister, sits in the theater and observes, fascinated.

Right off the bat this book doesn't pull any punches. The scenes of operation are grisly and horrific. Fitzharris gives examples of a few incidences when surgeries were performed without Ether, such as the removal of an eyeball, or when a young boy had to have his leg amputated and even on his death bed, he could still recount how many strokes of the saw it took before his leg "fell off." Six exactly. The reader is left stunned, sickened, fascinated and eager to learn more and Fitzharris is happy to oblige. 

We are introduced to, Joseph Lister, as a young boy, growing up as a Quaker. He was well learned in the classics, mathematics, science etc and would often spend hours in his childhood looking at specimens that he would collect of frogs, spiders etc, under his father's advanced (for that age) microscope. As he ages he explains to his father that he wishes to study medicine. And once he reaches adulthood, he heads off to London to pursue his career as a doctor.

The reader, along with Lister, is thrown headfirst into the horrors of city life in the 1800s. London is a dense, overpopulated and unimaginably filthy city. The poor live in squalor, their houses overflowing with garbage, sewage and all kinds of dirty, disgusting things. Lister, takes this all in stride. He begins his life as a medical student, watching surgeons perform operations and learning what life is like in the overcrowded city of London. Life in the city and life in the Hospitals are really not so very different. If someone is admitted, they are often assigned to a bed with dirty sheets, some sprouting mushrooms from the film of fungus left by other sick patients. These "death houses" are rife with infections that spread like wild fire. If a patient survived their surgery, they were more often than not, doomed to die from infection afterwards. Disease and death were so common in hospital wards that the name for the four main infections doomed to spread was called 'Hospitalism." You had the chance of suffering from Erysipelas, Gangrene (the necrosis of muscle/tissue), Septicemia (blood poisoning) and pyemia (development of pus filled abscesses). And doctors were also susceptible to these infections, since they weren't always so very careful with their surgical instruments. The smallest scratch could lead to infection and before you know it, the surgeon is dead. Lister begins studying as a medical student at University College Hospital and learns first hand the gruesomeness of the dissection theater and the dangers of surgery.

As time progresses, one night, he is suddenly called to action and forced to perform an emergency surgery, on his own when a woman comes to the hospital, having been stabbed in the stomach by her abusive, drunken husband. Her entrails are protruding from the wound and though the abdomen, as well as the chest and head, are no go zones for surgery, since surgeons are more capable of cutting something off than fixing something on the inside, Lister operates on the woman and saves her life. 

He continues his studies, plagued by the idea of infection running so freely within the hospitals. He studies multiple specimens of many different types under his father's famous microscope but can come up with no solution. He progresses in his medical career and goes to study abroad, stopping in Edinburgh at the insistence of a fellow Surgeon, where he meets the "Napoleon of Surgery", a James Syme. Lister begins to study under the man's tutelage and learns a great deal but he is also introduced to the frustrating and confusing world of Hospital politics. He learns first hand how difficult it can be to be promoted by a board of men who are not actually doctors. Some of them are politicians, others businessmen, and the head of the board is in fact, a shoemaker. So their prowess in medicine is nil but they get to decide the fate of Joseph Lister and his future in medicine in Edinburgh. And though his ideas are thought "radical" and "progressive" they decide to promote him to a Faculty position and they even let him present "cases", leading his medical students through the wards of the hospital to observe real, live patients and the injuries that they suffer from.

It is now we see that Lister is not only a very gifted physician and scientist but also a very gentle, kind and compassionate human being. During a time when patients were more or less seen as a body that needed something hacked off, Lister shows humanity and gentleness towards those suffering. He helps transport patients from surgery back to the ward, helps dress them, cleans their wounds and genuinely cares about their comfort. They are not numbers or statistics to him, they are people and he genuinely wants to help them.

It is also during this time that, though mortality rates within hospitals are at an all time high, people are starting to learn. Some doctors who are again thought to be dangerously radical in their thinking, come to the conclusion that perhaps it is not "miasma" or "bad air" that spreads infection from patient to patient; hat perhaps, it is the doctors themselves. It is, after all, common practice for a physician to  go from the dissecting room; having just performed an autopsy on a fresh, still decomposing corpse, to the maternity ward to help a woman deliver a baby. And all of this is done, of course, without washing their hands, changing their clothes or doing anything that we, in modern days, deem absolutely necessary. The idea that doctors could be spreading these infections is outrageous to some, who lash out at those who dare to voice such an opinion. Others though, like Lister, find themselves intrigued by the idea and decide to delve deeper to see if they can't figure out a way to stop the growing problem.

Lister learns of Pastuer's discovery with germs and his theory that small, living organisms are in fact the cause of infection. He begins to experiment with the idea of antiseptic and makes leaps and bounds with using carbolic acid as a disinfectant agent before and after surgery; packing wounds and watching, amazed, as they heal without infection, His prowess is truly tested when his sister comes to him with a lump on her breast and he performs a mastectomy and she miraculously, and thanks to his use of sterile bandaging and carbolic acid, survives the procedure.

Though his system of "antisepsis" continues to be criticized by the older generation of surgeons, the newer generation of medical students praise and revere Lister. They follow his every procedure to a T and Lister is pleasantly surpised to see that the mortality rates in Edinburgh hospitals aer dropping dramatically, thanks to his policy.

Even after operating on Queen Victoria himself, his theory is still under fire. But over the years, Lister's critics quiet or just die off altogether and his influence begins to spread. As he grows into old age, he watches as new products that bear his name, such as "Listerine" are introduced. And though sometimes the use of carbolic acid isn't always the best way to go about things, for the most part, Lister sees his life work come to fruition. And in the end, isn't that what we all want? To know that we somehow made a difference.

I have a feeling that even when his processes and procedures were under fire, Lister was proud to see that his "radical" idea was eventually accepted and that surgery was no longer an art of  butchery but one of precision, meticulousness and one that actually helped people heal without having to sever limbs.

Though the non-stop hospital policies and criticisms of Lister's works get tiresome by the end of the novel, it is essential to show that even when the general populace thought him a quack, there were few who believed in him and took the steps needed to help medicine become the phenomenal field it is today.

Fitzharris is brutal, ghastly and detailed in her depictions of the horrible incidences that were common in Victorian London, but that's most of what makes this book so morbidly enjoyable. I read it in a day and though sometimes the medical jargon and theories were lost on me, for the most part, it was an entertaining and educational read. To find out where Listerine came from was also a chuckle worthy bonus.

I would recommend this book to anyone who works in the medical field (it'll make you grateful for the hygienic practices we have today), to anyone who is fascinated in the gruesome, gory details of life in Victorian London and to anyone who enjoys learning how history was made.