Saturday, July 07, 2018

Victorian medicine remembered

From the London Review of Books, a review of thisThe Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine.

Go read the whole thing, but here are some highlights: 
Even the worst corner of the worst slum couldn’t compete with hospital wards and dissection rooms for filth. Berlioz trained as a doctor and recalled a visit to the ‘terrible charnel-house’ of a Paris dissecting room. ‘The fragments of limbs, the grinning heads and gaping skulls, the bloody quagmire underfoot and the atrocious smell it gave off’ made him feel ‘terrible revulsion’. Sparrows squabbled over morsels of lung; a rat gnawed at a vertebra. Berlioz jumped out of the window and ran home to take sanctuary in music. Surgeons took pride in aprons so dirty they could have stood up on their own; Robert Liston, who pioneered the use of anaesthesia, stored his instruments up his sleeve between surgeries to keep them warm. The mortality rate among medical students – who were liable to let the knife slip – was high: the surgeon John Abernethy concluded his lectures with a resigned ‘God help you all.’ When John Phillips Potter nicked his knuckle anatomising – at the dead man’s request – the circus performer the ‘Gnome Fly’, he swiftly succumbed to pyaemia, a kind of blood poisoning caused by the spread of pus-forming organisms which cause abscesses. The pus drained from his body could be measured by the pint.
 The Great Stink played a role in advancing the state of medical science:
... one of the strongest challenges to the anti-contagionist theory came not from a paper in the Lancet, but from the Great Stink of 1858. The Thames, by this stage little more than a sewer conveying effluent to the North Sea, began to emit a stench which, according to Faraday, could be observed ‘rolled up in clouds so dense that they were visible at the surface’. Londoners fled; there was a proposal that the Houses of Parliament be evacuated. And yet there were no epidemics that year, contrary to the expectations of proponents of the miasma theory.
 And then Lister got the idea of cleaning wounds with carbolic acid by a bit of luck:
Lister’s greatest advance was prompted by a newspaper report. In Carlisle, sewage engineers gagging at the smell of liquid waste spread over nearby fields had addressed the problem by covering it with carbolic acid, a substance used with indiscriminate enthusiasm for tasks including preserving ships’ timbers and preventing body odour. But a curious side-effect was observed: an outbreak of cattle plague in the carbolic-soaked fields was halted, the plague-causing parasites having been eradicated. Lister, who had abandoned his trials with potassium permanganate, quickly obtained a sample of carbolic acid. Shortly afterwards, treating a child whose leg had been shattered by a cart, he faced a choice: whether to amputate to forestall the inevitable gangrene, or to test his theory that carbolic acid could prevent infection. With the arrogance necessary to the practice of medicine, Lister decided to put carbolic acid to the test. Some weeks later the boy walked out of the hospital.
He then went on to treat Queen Victoria:
In a broadside reminiscent of those levelled at Darwin, one opponent castigated Lister for portraying nature as ‘some murderous hag whose fiendish machinations must be counteracted’. Nonetheless, when Queen Victoria could no longer bear the pain caused by an abscess under her arm, it was Lister who was summoned to Balmoral, accompanied by a copper pumping mechanism known as a ‘donkey engine’, which sprayed a fine mist of carbolic acid (including, to the horror of onlookers, into the queen’s face). The abscess and the surgical instruments were soaked in antiseptic; the pus was drained; the wound healed well; and Lister – with what one imagines to have been a rare flash of humour – declared himself ‘the only man who has ever stuck a knife into the queen’.

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