Robert Liston operating, by Ernest Board of Bristol (1877-1934), and this was one of the paintings he was commissioned to paint by Henry S. Wellcome circa 1912. Photo / Wellcome Collection
No drugs. No sedation. Half of those who underwent surgery in the 19th century didn't survive the experience. WARNING: Graphic.
Scottish surgeon Robert Liston was known as the "Fastest Knife in the West End," amputating a leg in under 30 seconds.
He was so incredibly strong and agile he was able to use his left arm as a tourniquet, while he wielded the knife in his right hand, as the patient writhed around, screaming in fear and agony.
Liston would keep both hands free by clasping a bloody knife between his teeth. He had learned to steel himself against the screams of those strapped to the operating table in the theatre, which was usually packed to the rafters with medical students and curious members of the public, attracted to the gore and sheer horror of the operation.
Once, when Liston brought down his knife to slice off a patient's leg, he was so focused on being speedy that he sliced off three of his assistant's fingers. And, as he swung the knife back up, he managed to slice a spectator's coat — causing him to collapse and die on the spot.
Both the patient and Liston's assistant later died of gangrene and the spectator who collapsed was discovered to have died of fright.
Half of those who underwent surgery in the 19th century didn't survive the experience. The operating theatres were no place for the squeamish; once Liston accidentally sliced off a patient's testicle along with the leg he was amputating.
The biggest problem was that hospitals had absolutely disgusting hygiene and sanitary conditions and most doctors refused to wash their hands — the idea that doctors could spread germs from patient to patient was scoffed at.
In fact, most doctors insisted on wearing their bloodied aprons all day, going from patient to patient, the aprons gathering more blood and muck, as a badge of honour.
But those disastrous times did not last forever and it was 173 years ago this month, a time when surgery was incredibly hazardous, that a young Quaker surgeon named Joseph Lister stepped forward with his theory about germs that would change the course of medical history.
No place for the squeamish
In the squalid, overcrowded hospitals of the 19th century, doctors were puzzled by the persistent infections that kept mortality rates incredibly high. In the days before general hygiene practices, hospitals were known as "the gateway to death" and surgery, particularly amputations, had a 300 per cent fatality rate.
Dr Lindsey Fitzharris is a medical historian and author of the best selling book, The Butchering Art, which is about the gruesome surgical practices of the time and Joseph Lister's quest to transform the grisly world of Victorian medicine.
Dr Fitzharris told news.com.au it was safer to be operated at home than in a hospital.
"I don't think it's possible to know how truly terrifying it must have been for people going under the knife during this period," she told news.com.au.
"When 12 year-old Henry Pace was told that he was going to have to have a leg removed without any anaesthetic in the 1820s, he asked the surgeon whether it would hurt. The surgeon, not wanting to alarm the boy, told him it would hurt no more than having a tooth pulled," Dr Fitzharris said.
"As a result, Henry Pace was completely unprepared for what awaited him. He was so awake, so aware of what was happening, that he remembered counting six strokes of the saw before his little leg fell off into the hands of the surgeon and was dropped with a sickening thud at a bucket beneath the table."
According to Dr Fitzharris, most deaths in hospitals were due to post-operative infections. For example, it was a time when most surgeons thought pus was a natural part of healing instead of a sinister sign of sepsis.
Operating theatres were always filled with medical students as well as others who'd paid for tickets to attend the gruesome operations. If you got a position close to the action, you risked being splattered with blood and other bodily fluids.
"People often raise an eyebrow when I tell them that members of the public bought tickets to the operating theatre during the 19th century but I remind them that tens of thousands flock to my Twitter and Instagram accounts in the 21st century for a similar reason: morbid curiosity.
"These places were theatres in the true sense. They were filled to the rafters with medical students and ticketed spectators, many of whom had dragged in with them the dirt and grime of everyday life.
"Surgeons rarely washed their hands or their instruments and carried with them a cadaverous smell which they jokingly referred to as 'Good Old Hospital Stink'.
"Beyond this, though, the Victorians were obsessed with science and many attended operations to witness the latest innovations and advancements," Dr Fitzharris said.
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Germs and anaesthesia
While Robert Liston was one of the most revered of all the surgeons, according to Dr Fitzharris, he was also quite the character.
"Once, a patient was brought into the operating theatre to have a bladder stone removed. It was a terribly painful and embarrassing procedure in the 19th century. Well, the patient took one look at Liston and decided he didn't want to go through with it.
"He jumped off the table, ran across the room and locked himself in a closet. Liston, all 6'2'' of him, chased the man down, ripped the door off the closet and dragged the poor guy back to the table," Dr Fitzharris said.
What's important to note is that following the discovery of anaesthesia in 1846, surgery became even more dangerous.
According to Dr Fitzharris, the surgeon, unaware that germs existed, was more willing to pick up the knife and go deeper into the body.
"As a result, post-operative infection rose. This is ultimately the problem which Joseph Lister solved. I like to think of him as a man who was thrust towards his own fate. He dropped out of medical school after contracting smallpox and suffering a mental breakdown, only to return at the urging of his own father," Dr Fitzharris said.
Antiseptic and germs
So how did Joseph Lister figure out what was causing post-operative infection in hospital patients?
According to Dr Fitzharris, Lister totally transformed the brutal world of the operating table and hospitals by applying the germ theory to medical practice and making the audacious claim that germs were the source of all infection.
"Lister applied Louis Pasteur's germ theory to medical practice through the development of antisepsis and he was able to save thousands of lives in his own time. And he continues to save people's lives today because we now operate with the knowledge germs exist," Dr Fitzharris said.
"Lister saved thousands of lives in his own time, everyone from his own sister (whom he performs a mastectomy on his own dining room table) to Queen Victoria."
Several surgeons vehemently opposed germ theory and Lister's antiseptic techniques, including American Samuel Gross, depicted in this painting by Thomas Eakins, titled The Gross Clinic.
"I like to say that The Butchering Art is a love story between science and medicine, as it was the first time that a scientific principle was applied to medical practice. And yet, most people are unfamiliar with Joseph Lister's name, except for the product Listerine, which wasn't even invented by him, nor was it used as a mouthwash in the nineteenth century. It was more commonly used to treat gonorrhoea: a fact that I'm pretty sure the Listerine company isn't too pleased I'm going around the world discussing."
Stomach churning operations
As a medical historian, there's not much that makes Dr Fitzharris' stomach churn, although she admits to feeling very deeply for the patients who had to undergo these terrible operations in the past.
"I do feel deeply for Lucy Thurston who was told in the 1840s that she was going to have to undergo a mastectomy without any anaesthetic. Before the operation commenced, the surgeon showed her the knife he was going to use and told her to prepare her soul for death.
"As it turned out, Lucy Thurston survived, and she later wrote to her daughter about the experience," Dr Fitzharris said.
"Reading her words about how the surgeon's hand was covered in blood up to the wrist was very difficult for me. She told her daughter that she was under his hand for nearly an hour and a half. It is unthinkable in the 21st century. The reason why I often describe procedures in such a visceral way is because I don't feel that I'd be doing the patients justice if I didn't explain to readers exactly how it must have felt."
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