Stand: Joanna Bourke reviews The Butchering Art by Lindsey Fitzharris

Silas Weir Mitchell was one of the most prominent physicians in 19th and early-20th century America, famous for his research on phantom limbs. In his youth, however, his father wanted him to become a surgeon. There was one major problem: Mitchell lacked courage. In his unpublished autobiography, he admitted that surgery was “horrible to me. I fainted so often at operations that I began to despair”.

Anaesthetics had not been invented when Mitchell started his medical training and, to the end of his life, he was able to conjure up memories of watching a surgical procedure being carried out on a female patient. She had to be held down “by strong men” and “the screams, the flying blood jets – and the struggle were things to remember”. The “terribleness” of this event proved to Mitchell that he “had neither the nerve nor the hand which was needed in those days for those operations”.

Mitchell’s faintheartedness – which he regarded as cowardice – does not appear in Lindsey Fitzharris’s The Butchering Art, but it captures the essence of her history: that is, the bloody, unhygienic nature of early surgery and the slow progress towards surgical knowledge and reform. Although Fitzharris is primarily concerned with the physician Joseph Lister’s quest for safer, antiseptic surgery, she is particularly brilliant in evoking scenes of early surgical theatres. They were crowded with students and voyeuristic spectators; the floor was deep in blood-soaked sawdust; the stench of spilt guts and blood was overwhelming. And patients screamed in agony.

In such a hades, speed was of utmost importance. The surgeon Robert Liston, for example, was a renowned for being able to remove a limb within 30 seconds; in order to speed things up, he would clench the knife in his teeth between procedures.

When he was young, Joseph Lister sat at the back of Liston’s theatre, watching him operate 
and becoming increasingly awestruck by his skill. Liston’s early adoption of anaesthetics also impressed Lister, but he recognised that pain was only one of the terrors of surgery. Sepsis regularly killed patients. Ulcers, gangrene and septicaemia often proved fatal.

But what caused such infections? No one knew. There were various theories, including the idea that contagion was caused by some kind of “invisible bullet” or by an “animalcule”, which was a vague term for any small organism. Still others – usually dubbed “anti-contagionists” – believed infections were transmitted by “miasma”, or the airborne stench of dirt and decay. It was a logical inference, given the filthy air circulating in hospitals of the time.

Lister was determined to find the underlying cause of inflammation and infection. With the help of his wife, he conducted experiments on living frogs and other organisms. Gradually, he came to understand the processes that caused inflammation and the coagulation of blood.