Review by the Rev Ian Dewar, Lead Chaplain, University Hospitals of Morecambe Bay NHS Foundation Trust.
This is not a book for the fainthearted, nor is it intended to be. The very title gives you a clue and tells you that the book is intended for general readership, not the specialist. And nor should it be. The story of surgery and anatomy belongs in the public domain because that’s where it began, in the public domain.
Surgery always had an audience and was not short on the theatrical but is also had an existential power. As the prologue points out, in the early 19th century: ‘operating theatres were gateways to death’ and death is described in some detail. Or rather, not death, but the process leading up to death. A lively prose works well on the imagination: viz, ‘Liston could remove a leg in less than thirty seconds, and in order to keep both hands free, he often clasped the bloody knife between his teeth while working.’ Not quite the NHS!
Yet this is necessary to give power to the story that is being told. Joseph Lister, born in April 1827, was to transform surgery, thanks not just to his intelligence and drive, but to a good family and a father who gave his son a microscope and the context of ‘the healing power of nature’, although not in any homeopathic sense, a practice of which he was great opponent. Emotional and psychological stability with an enquiring mind are attributes that are more and more difficult to cultivate in a time-starved society such as ours, where every answer to a question – complex or simple – needs to be reduced to a soundbite in order to be heard.
The wider context
In terms of the wider context, in 1848 Parliament had to pass the Public Health Act. London itself was a place where ’churchyards where bursting at the seams with human remains’ and, before the Act: ‘many streets in London were effectively open sewers’. Here is a strong link to Lancaster. In 1845 one of Lancaster’s most famous sons, Richard Owen (1804 – 1892), anatomist, founder of the Natural History Museum and coiner of the word dinosaur, recommended construction of a sewerage system within Lancaster, based on plans of his colleague, Edmund Sharpe (1809–1877) and for a new cemetery to be constructed and utilised away from the town where the soakage could not enter the wells. Sound similar?
These were the early days of ‘microbiology’ with people just beginning to understand how infectious disease might be spread and there was great overlap in disciplines.
At times, accounts of anatomy sound like the recalling of a nightmare and yet into this nightmare walked Lister (and others): ‘The cadaver tested the courage and composure of anyone who dared set foot inside the deadhouse... For the uninitiated, the dissection room was a waking nightmare.’
Personal struggle
But the story of Lister and his impact on anatomy, surgery and medicine is not one of ‘medicine’ or ‘science’, as we have come to understand those terms. It is one of personal struggle. This is exemplified in Lister’s own brush with death and the contraction of smallpox that forced him to wrestle with a vocation to the ministry (Lister was a devout Quaker who later in life converted to the Scottish Episcopal Church in order to marry) or a vocation to science where he believed his gifts would allow him to live his faith to greater effect. This should not be overlooked. It is people – warts and all that change the world!
Our debt to the dead
Until the anatomy Act of 1832, dissection was only permitted on the bodies of executed murderers. After this date it was possible for people to leave their bodies to science. Prior to then, well, history is never straightforward. ‘The unpalatable truth was that without the body snatchers and the thousands of corpses they had procured for anatomists during the previous decades, Edinburgh would not have established its enviable global reputation for trailblazing surgery.’
I say all this not to shock, but to highlight. History is never simple, and the benefits that we have today do not have a pristine past. Lister spent a significant portion of his life working in Edinburgh and benefited greatly from the university. Is that wrong? How do we assess the past in the light of the present?
Opposition
If history is never simple, what about human relationships? Lister received a good deal of scepticism about his ideas on how infections spread, not all of it motivated by a pure interest in science, and yet it is all this messy history and all these messy acts of ego, that make this story so fascinating.
It is history, warts and all, with people, warts and all, that we have to engage with.
Lister became the first person to apply Germ Theory to surgery, by taking one scientific interest – microscopes – into a field where there was great deal of ambivalence bordering on hostility to its use. It was a cross fertilisation of ideas. He allowed himself to be driven by a personal faith (philosophy, if you like) and asked what difference he could make to life. He lived with failures, tried different solutions and continued until he hit on the right answer. Above all, he persevered.
The impact of the book
It might seem that the purpose of the book is trace the success of the medical and scientific endeavour. But for this reviewer, that’s not the case. When Lister died in 1912, he had genuinely changed the world.
How had he done this? In 1876: ‘Five years after operating on the queen, Lister was ready to face his critics in America.’ Whatever its source, Lister had courage. What is courage? As C. S. Lewis put it: ‘Courage is not simply one of the virtues but the form of every virtue at the testing point, which means at the point of highest reality.’
All of Lister’s virtues were put to the test and he found a way through. He was a man of courage.
This book may not be for the faint hearted, but it is for the brave!