美国国家公共电台 NPR 'The Butchering Art': How A 19th Century Physician Made Surgery Safer

 

ROBERT SIEGEL, HOST:

Lindsey Fitzharris' new book is called "The Butchering Art." It is not about carving¹ meat for cooking. It's about surgery the way it used to be done. And it's about one surgeon in particular who changed the way it was done - Joseph Lister. In 19th-century England, Lister was the man who championed antiseptic surgery. And his story is one of great professional courage in the face of much opposition².

Lindsey Fitzharris joins us from London. Welcome to the program.

LINDSEY FITZHARRIS: Thank you. Thank you for having me.

SIEGEL: And first, describe what Lister did. What was his great achievement?

FITZHARRIS: Well, I always tell people that "The Butchering Art" is a love story between science and medicine because it's about the surgeon Joseph Lister. Some people are familiar with his name probably through the product Listerine, which he actually had nothing to do with. It was just inspired by his antiseptic techniques. But what he did was he took germ theory, a scientific principle, and he married it to medical practice. And he developed antisepsis or germ-fighting techniques in the operating year.

And all of that seems really obvious to us today, but of course people didn't understand that germs existed before Lister came along. And it was hard for people to believe because, you know, here comes this young guy saying that there's these invisible creatures. And you can't see them with your eye, but they're killing³ your patients. And so his great triumph was really getting surgeons to accept that germs existed and then also adopt antiseptic techniques in the operating theater.

SIEGEL: Now, your field is 19th-century medicine, which I suppose is easier on the stomach than writing about serial⁴ axe⁵ murderers, but not by a lot. I want you to describe surgery in, say, the 1850s in England when Joseph Lister entered the field.

FITZHARRIS: Well, the operating theaters were dingy⁶, dirty places. The surgeons wore these aprons⁷ that were encrusted with blood. They never changed them. They didn't wash their hands. They didn't wash their instruments. And these operating theaters were filled to the rafters with hundreds of spectators, some of them just curious bypassers (ph) who came in with tickets to see the life-and-death struggle play out on the stage. So there was no sense of hygiene⁸. This certainly wasn't a sterile⁹ place. And it was very, very different to how we operate today.

SIEGEL: And since the patient before anesthesia was wide awake during this, a surgeon's skill might be, say, in how quickly he could amputate a limb, not in whether that would be a successful operation or not.

FITZHARRIS: Yeah, exactly. I mean, we think of surgeons as being meticulous¹⁰ and careful and measured in the way they move today. But in the past, it was all about brute¹¹ strength and force. And there was this guy named Robert Liston. He was known as the fastest knife in the West End in Britain in the 1840s. And he could remove a leg in about a minute, which doesn't seem that bad.

But if you think about that, if you just sit there for a minute and think about your leg being sawed through - but of course it was crucial that they be fast because you could die of shock and blood loss. And the patients were terrified. One of his patients actually leapt off the table and runs into a closet. And Liston follows after him and tears the door off the closet and drags him back into the operating theater. So it was very, very different than how we operate today.

SIEGEL: Well, continuing for those who are still listening to our conversation, I wanted to draw attention to something you wrote about which I found very surprising after the introduction of anesthesia, which is the great revolution before Lister's introduction of antisepsis, that after anesthetics were introduced surgical¹² deaths or post-surgical deaths in hospitals went up.

FITZHARRIS: Yes. It actually became more deadly because they didn't have the struggling patient and they were more willing to pick up the knife. And they were more willing to go deeper into the body because their patients were unconscious. So actually, immediately following the discovery of anesthesia in the 1840s, surgery becomes a lot more dangerous. You see post-operative infection going way up. And the operating table sort of becomes this conveyor belt. And, you know, the table isn't washed down between patients. The instruments aren't washed down. The hands of the surgeons aren't being washed. So it was actually really horrific. And that's where Lister comes into this story.

SIEGEL: Lister applied¹³ the findings of the great French scientist Louis Pasteur. Disease, Pasteur found, is caused by germs. Lister used carbolic acid as an antiseptic. He published his findings. Ultimately, they're accepted. But in a plot twist worthy¹⁴ of a public TV period piece miniseries, Queen Victoria was a catalyst¹⁵ for wide acceptance of antiseptic surgery. Tell the story of the queen's surgery.

FITZHARRIS: That's right, yeah. The queen, she got very ill. She was up in Scotland and she got an abscess in her armpit. And it grew, and it grew. And Lister was the nearest surgeon who could operate. And so he came there to operate on this large abscess. And it could have easily turned fatal.

Lister came in with the carbolic acid. And at this time in his profession, he had developed this thing called the donkey engine, which was this big machine that sprayed carbolic acid all over and disinfected everything. And actually, the funny story is that one of his colleagues was spraying the carbolic acid and accidently sprayed it right into Victoria's face. She wasn't very amused. But he ends up lancing this abscess and draining it and ends up saving her life.

And because she allowed him to do this operation, she's - she kind of gives her blessing¹⁶ to the antiseptic techniques and germ theory by default. So it's a huge step for Lister. And he joked later in life that he was the only man to plunge¹⁷ a knife into the queen and survive that experience, so...

(LAUGHTER)

SIEGEL: You write something about Lister near the end of his career when he's been recognized. He's knighted. He's then ennobled for his pioneering antiseptic surgery. And there's a new idea, which is aseptic surgery, not just the use of antiseptic but surgical operations - believe it - in a sterile hospital room. And the great man isn't buying.

FITZHARRIS: Yeah. That's always a shocking thing for people when they find that out. Yeah, antiseptic is germ-fighting and aseptic is a germ-free environment, which is, of course, what we do in operating theaters today. The reason why Lister was against asepsis was because he didn't think that it was attainable¹⁸. He never really saw the hospital as being the only place where surgeons would operate because remember; in the 19th century, surgeons also operated in people's homes or they operated in offices. And in fact, you only really went to the hospital if you were very poor. It wasn't a place that the wealthy or the middle class would go to because they were so overcrowded and dingy and grimy.

SIEGEL: And your chances of not coming out alive were rather high also.

FITZHARRIS: Yes. Yes. And in fact, a lot of hospitals which - you would have to present money for your inevitable¹⁹ burial. That's how much they anticipated that you were going to die in these hospitals. So Lister, although asepsis - an aseptic environment would be ideal, he just didn't think that it was an attainable goal because surgeons would continue to operate outside of the hospital.

SIEGEL: Does your career studying 19th-century medicine - does it leave you feeling about how far we've come from these days? Or...

FITZHARRIS: Yeah.

SIEGEL: ...Are you astonished by just it was a couple of generations ago that people were born into this sort of notion of medicine and surgery?

FITZHARRIS: I know. I always - I joke to people that I'm here to destroy their romantic notions of what it was like to live in the past. And it wasn't too long ago. You're absolutely right. And to think about how far we've come - I hope that when people read my book, especially doctors and scientists themselves, that they realize that we might know the truth, so to speak. But how is that going to change in five years, 10 years, 15 years, 20 years? And that medicine and science are always changing. What we know about the body, even about the world, is always changing. And you have to kind of adapt and keep up with that like Lister was doing.

SIEGEL: Well, Lindsey Fitzharris, thanks for talking with us today.

FITZHARRIS: Thank you so much.

SIEGEL: Lindsey Fitzharris' new biography of Joseph Lister is called "The Butchering Art."

(SOUNDBITE OF THE BAD PLUS' "DO IT AGAIN")

1 carving   

n.雕刻品，雕花

参考例句：

• All the furniture in the room had much carving.房间里所有的家具上都有许多雕刻。
• He acquired the craft of wood carving in his native town.他在老家学会了木雕手艺。

2 opposition   

n.反对，敌对

参考例句：

• The party leader is facing opposition in his own backyard.该党领袖在自己的党內遇到了反对。
• The police tried to break down the prisoner's opposition.警察设法制住了那个囚犯的反抗。

3 killing   

n.巨额利润；突然赚大钱，发大财

参考例句：

• Investors are set to make a killing from the sell-off.投资者准备清仓以便大赚一笔。
• Last week my brother made a killing on Wall Street.上个周我兄弟在华尔街赚了一大笔。

4 serial   

n.连本影片，连本电视节目；adj.连续的

参考例句：

• A new serial is starting on television tonight.今晚电视开播一部新的电视连续剧。
• Can you account for the serial failures in our experiment?你能解释我们实验屡屡失败的原因吗？

5 axe   

n.斧子；v.用斧头砍，削减

参考例句：

• Be careful with that sharp axe.那把斧子很锋利，你要当心。
• The edge of this axe has turned.这把斧子卷了刃了。

6 dingy   

adj.昏暗的，肮脏的

参考例句：

• It was a street of dingy houses huddled together. 这是一条挤满了破旧房子的街巷。
• The dingy cottage was converted into a neat tasteful residence.那间脏黑的小屋已变成一个整洁雅致的住宅。

7 aprons   

围裙( apron的名词复数 )； 停机坪，台口（舞台幕前的部份）

参考例句：

• Many people like to wear aprons while they are cooking. 许多人做饭时喜欢系一条围裙。
• The chambermaid in our corridor wears blue checked gingham aprons. 给我们扫走廊的清洁女工围蓝格围裙。

8 hygiene   

n.健康法，卫生学 （a.hygienic）

参考例句：

• Their course of study includes elementary hygiene and medical theory.他们的课程包括基础卫生学和医疗知识。
• He's going to give us a lecture on public hygiene.他要给我们作关于公共卫生方面的报告。

9 sterile   

adj.不毛的，不孕的，无菌的，枯燥的，贫瘠的

参考例句：

• This top fits over the bottle and keeps the teat sterile.这个盖子严实地盖在奶瓶上，保持奶嘴无菌。
• The farmers turned the sterile land into high fields.农民们把不毛之地变成了高产田。

10 meticulous   

adj.极其仔细的，一丝不苟的

参考例句：

• We'll have to handle the matter with meticulous care.这事一点不能含糊。
• She is meticulous in her presentation of facts.她介绍事实十分详细。

11 brute   

n.野兽，兽性

参考例句：

• The aggressor troops are not many degrees removed from the brute.侵略军简直象一群野兽。
• That dog is a dangerous brute.It bites people.那条狗是危险的畜牲，它咬人。

12 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。

13 applied   

adj.应用的；v.应用，适用

参考例句：

• She plans to take a course in applied linguistics.她打算学习应用语言学课程。
• This cream is best applied to the face at night.这种乳霜最好晚上擦脸用。

14 worthy   

adj.(of)值得的，配得上的；有价值的

参考例句：

• I did not esteem him to be worthy of trust.我认为他不值得信赖。
• There occurred nothing that was worthy to be mentioned.没有值得一提的事发生。

15 catalyst   

n.催化剂，造成变化的人或事

参考例句：

• A catalyst is a substance which speeds up a chemical reaction.催化剂是一种能加速化学反应的物质。
• The workers'demand for better conditions was a catalyst for social change.工人们要求改善工作条件促进了社会变革。

16 blessing   

n.祈神赐福；祷告；祝福，祝愿

参考例句：

• The blessing was said in Hebrew.祷告用了希伯来语。
• A double blessing has descended upon the house.双喜临门。

17 plunge   

v.跳入，(使)投入，(使)陷入；猛冲

参考例句：

• Test pool's water temperature before you plunge in.在你跳入之前你应该测试水温。
• That would plunge them in the broil of the two countries.那将会使他们陷入这两国的争斗之中。

18 attainable   

a.可达到的，可获得的

参考例句：

• They set the limits of performance attainable. 它们确定着可达到的运行限度。
• If objectives are to be meaningful to people, they must be clear, attainable, actionable, and verifiable. 如果目标对人们是具有意义的，则目标必须是清晰的，能达到的，可以行动的，以及可供检验的。

19 inevitable   

adj.不可避免的，必然发生的

参考例句：

• Mary was wearing her inevitable large hat.玛丽戴着她总是戴的那顶大帽子。
• The defeat had inevitable consequences for British policy.战败对英国政策不可避免地产生了影响。