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Selling a Bloody Past

You've surely heard the quip before. "The past is a foreign country," it goes. "They do things differently there." A good line, all in all, the opening sentence of a 1953 novel by the British writer L.P. Hartley. Oh, it’s a little sententious maybe, but still funny. Pithy and memorable.

And sharp-edged, too, if we think about how we actually experience difference. Some people travel, determined to be delighted by the foreign, while some people travel, determined to be aghast. And so too with evaluating the past, that hardest to reach of tourist destinations. Some people study history to appreciate the conditions of those who lived differently from the way we live now. And some people study history to mock the backward fools who didn't realize how much they lacked in not being us—wonderful us—today.

Lindsey Fitzharris is very much of the camp that sees the past as a chamber of horrors, recountable mostly for the titillation it allows us, wonderful us. Her new book, The Butchering Art, is ostensibly a tale of the British surgeon Joseph Lister and his determined effort to teach Victorian doctors about Louis Pasteur's theory of germs. But before many pages have passed, readers will realize that The Butchering Art is actually the historian's equivalent of a slasher film. Fitzharris rubs her hands in glee to report that the Victorians were blood-soaked fools, indifferent to the suffering caused by their butchery masquerading as medicine.

The gore in the book, like the gore in a horror film, will be hard for the weak-stomached to take. And again like a horror film, The Butchering Art presents a cast of stock characters. Timing her book for Halloween advertising, Fitzharris gives us the melodrama of entrenched authority figures, wicked in their refusal of the new knowledge. A saintly hero, shy and diffident by nature but forced to battle by the evil that surrounds him. Sly criminals, as comic relief. And through it all, the blood and filth of the past, the one foreign culture we are allowed to despise.

In Fitzharris's telling, the story of the Victorian changes in surgery begins in 1846 with Robert Liston, the British doctor who championed the use of ether, medicine's first successful anesthetic. A perverse effect of Liston's efforts, however, was a rise in the number of surgeries and the length of time patients spent on the operating table. Through the 18th century and well into the 19th, surgeons were trained in speed, lopping off limbs in seconds and cutting out tumors in minutes. It was bloody, nasty work, but the butchery was the best available medical option.

The arrival of ether meant surgeons could dig deeper into the body, introducing more germs and more damage. The Butchering Art reports that the death rate from surgery in hospitals actually increased once doctors had a good anesthetic. Infection after surgery was common, and the unsterile hospitals killed thousands who might have survived their initial illness.

Enter Joseph Lister, the shy, stammering child of Quaker parents, who began his medical training in 1844. Arriving in Scotland, he joined the circle of the speediest of the old amputators, the great surgeon James Syme. Lister would eventually marry Syme's daughter Agnes and practice at the Glasgow Royal Infirmary, where he quickly became known as a champion of the poor.

Lister also dedicated himself to an attempt to understand why so many patients died after surgery. The high mortality rates didn't exactly lack explanation at the time. There were, in fact, two common explanations, neither of which had much explanatory power. The "contagionists" suggested that some agent must be passed from one patient to another. They had no notion of what that agent might be, but the analogy to the communicable diseases they knew seemed strong. Meanwhile, the "non-contagionists" took the scientific high ground, skeptical that mysterious and unproven magical agents were causing infection. The miasma of the cities, the foul sewer-reeking air, seemed enough to explain the rash of deaths, and they advised everyone who could afford it to flee the cities in the summer.

Others before Lister had attempted to apply Pasteur's research with a microscope, but they had been generally ignored. (The Austrian doctor Ignaz Semmelweis would eventually go insane, howling about hand-washing.) Lister focused his attention on the differences between patients who suffered compound fractures, in which a broken bone breaks through the skin, and those who suffered simple fractures, without the exposure of the body's interior. Pasteur's descriptions of bacteria allowed Lister to focus on the ways in which microscopic invaders were transmitted by hospitals and the current practices of surgery.

Workers in London's sewers had stumbled on the fact that carbolic acid could be used to diminish odors. They didn't understand why, but Lister did, and he used their discovery as the device for sterilization of the operating theater. In the summer of 1865, the surgeon had his ideal test case: an 11-year-old boy with a compound fracture. After Lister splashed carbolic acid on everything in sight—the patient, his own hands, the surgical tools, and the operating table—the boy survived not only the surgery but the dangerous post-surgical recovery.

In a series of reports in The Lancet and a lecture for the British Medical Association, Lister advocated spraying everything in the surgical arena with carbolic acid. He would advocate catgut for surgical stitches, too, since catgut would dissolve without the need to expose the body's interior to infection.

Lister did meet some opposition, which Fitzharris recounts in The Butchering Art with all the subtlety of Victorian melodrama. In truth, however, Lister's views gained rapid acceptance, aided by his indefatigable lecturing in Europe and the United States. Young doctors and medical students called themselves "Listerians" and idolized him—and why wouldn't they, since he was proving their stodgy old teachers wrong?

Joseph Lister was a hero, certainly, but he wasn't actually a hero in the hackneyed mold in which the popular Dr. Lindsey Fitzharris wants to cast him. Aren't we past the all-innovators-are-Galileo trope with which the history of modernity used to be taught? Rather than an occasion to mock the Victorians, Lister seems an occasion to praise them. Faced with new evidence in the rise of surgical mortality after the widespread use of ether, they came fairly quickly to adopt a new theory of germs to explain it—and came fairly quickly to change their medical practices in the light of the new theory.

Of course, that factual account would be unlikely to sell as well as a tale of the horrors that once existed, and Lindsey Fitzharris wants to give us a Halloween picture of the Victorians. She's visited the foreign country of the past and brought back with her a set of tourist pictures with which to teach us the bloodiness of those foreigners. The strangeness. The evil. The failure to be us, wonderful us.