You Had to Be a Little Insane to Be a Surgeon in the 1800s

If hospitals make you nervous, your paranoia isn't entirely unjustified. A recent study by researchers at Johns Hopkins Medicine found that medical errors are the third leading cause of death in the US, behind heart disease and cancer. But here's the good news: You don't live in the 19th century, when the number one cause of death was doctors. It wasn't getting sick that killed you, it was the well-meaning men with blood-splattered coats and terrifying bone saws who didn't really see the point of washing their hands.

You won't find a more grisly and entertaining account of just how horrible it was to have even a minor injury 150 years ago than The Butchering Art, the first book by medical historian Lindsey Fitzharris. It tells the story of Joseph Lister, a pioneering surgeon with a simple idea: Maybe every patient doesn't need to die because hospitals are so fucking filthy.

The book is brimming with jaw-dropping minutiae of medicine's gory days. If you get a little freaked out by hospitals today, you'll either be comforted or lightheaded to learn that during the Victorian era, most hospitals had "the unmistakable smell of rotting flesh, which those in the profession cheerfully referred to as good old hospital stink." The doctors weren't helping the unsanitary conditions, shuttling between surgeries with "shreds of flesh, gut, or brains" splattered on their scrubs.

Fitzharris, who bills herself as a "Purveyor of Gruesome History," isn't just dabbling in the genre; she's made a career of it. A Chicago native who moved to England to study medical history at Oxford, she started the surgical "blood and gore" blog The Chirurgeon's Apprentice—with 2 million readers and counting—and the YouTube channel Under the Knife, where she digs up more fun facts about medical blood and piss drinking than you ever realized you wanted to know.

We called Fitzharris just before her book launch at the Mütter Museum in Philadelphia, which the author excitedly told us contains oddities like a necklace of genital warts and a 74-pound ovarian tumor. Whether she'll be reading while wearing STD jewelry remains to be seen.

Here's what I got from your book in a nutshell: 19th-century Victorian surgery was nothing but rivers of pus and filth and it's a miracle the human race survived. Does that sound about right?
That's perfect. It's weird because when enough time passes, everything becomes comical. But these were real people and they were really dying, and they were actually having their legs sawed off.

But if you found the right surgeon, it could take less than a minute of unspeakable agony.
That's why [pioneering surgeon] Robert Liston was so popular. I originally thought about writing the book about him, because he was such a forceful, colorful character during 19th century medicine. But he doesn't really bridge any transformative moments.

Except for surgical speed.
That's right. Before surgeries, he used to say "Time me, gentlemen." He was this huge guy, six foot two inches tall, which was really imposing at the time. He was also really strong. One of my favorite stories about him is when one of his patients was about to get on the operating table and decided at the last minute, "Nope, not doing this." So he took off running.

A pretty rational decision.
Entirely rational. He locked himself in a closet and Liston, just to make everything more nightmarish, ran after him and ripped open the door and dragged this poor guy back to the table. Can you imagine that happening today? Your surgeon chases you down the hall and drags you into a surgery?

Was this the same surgery when he accidentally cut off an assistant's fingers?
No, it's a different one. He was moving so fast during a surgery that he took off three of his assistant's fingers. And he slashed the coat of a spectator while he was changing instruments. The assistant died of gangrene, the patient died of gangrene, and the guy who was watching died of fright. It was the only surgery in history with a 300 percent fatality rate.

It seems like to be a successful doctor during the 19th century, you had to be a psychopath. Is that fair?
I think so, yeah. And not just because of the pain they inflicted on patients. They were knowingly exposing themselves to so much danger. This was before any understanding of germ theory. As medical students, they'd dissect cadavers that weren't preserved in a sterile environment, that were sometimes dug up from graves and may've died from very infectious diseases. You get a lot of stories of medical students cutting their finger and then inadvertently infecting themselves with bacteria from the bodies and getting septicemia and dying within days. It was a profession with a really high mortality rate. And when they made it through that hell and became doctors, they weren't even getting paid all that well. So there had to be an element of insanity to go into medicine.

Most of my favorite parts were the small details and side-stories. Like the doctor sucking out the blood from a patient's neck wound.
[Laughs] I love that.

The way you describe it, I'm just going to read directly from the book. "After three mouthfuls, the patient's pulse quickened."
Right?

That could be vampire porn.
It totally could!

Somebody also lost a testicle during an amputation.
Whoops! That happened. I suppose if you're getting an amputation in the 19th century, you'd be happy to pull through with one testicle. If you get your life at the end of it, you're doing okay. You have to cut your losses, literally, during that period. Life was very cheap back then. You could break your leg and end up dying.

Why are we so fascinated with this stuff? It can't just be the gore. Is it that humans could be so cruel to each other while having such good intentions?
That could be. There was a lot of death in the pursuit of saving lives.

It's well-intentioned incompetence.
But I think it also speaks to how pain is so universal. It's something everybody understands. And it connects us to a past that we couldn't otherwise really relate to. Life is so much different now than it was then. But we all know pain. We understand physical pain, and that desperate hope that our doctors will be able to save us. There's a commonality there that pulls people into these stories.

Are you afraid of doctors?
Not really. My mom had breast cancer. Actually, the book is being released on October 17th, which just so happens to be the five year anniversary of my mother's double-mastectomy. And I was with her for the operation. While she was having it done, I was doing research on 19th century mastectomies. It used to take an hour and a half of cutting into the breast tissue, and you're just sitting there, enduring it. When my mom woke up, I told her everything. "Look how lucky you are!"

Did she appreciate that?
She said, "I hate you." [Laughs] "You're a terrible daughter."

It maybe wasn't the best time.
No, I thought it was the perfect time. She survived this and didn't feel a thing. I made her read all these horrible stories, just to give her some context. A few years later, she found another lump in her chest. So we went to her surgeon's office, and he said, "I don't think it's anything but I can remove it right now. It won't hurt at all." I looked at her and said, "That's crazy, don't believe a surgeon when they say it's not going to hurt."

Were you right?
Totally. It hurt. And I was all up in there. I was like, "Can I take a picture for my blog?" The surgeon was posing for me as he's removing this weird growth from my mom's chest.

Do you drive your parents crazy?
Constantly.

Are you the one at Thanksgiving who's like, "Did you know they used to make dentures from the teeth of executed criminals?" And your relatives are like, "Could we please just talk about politics or sex?"
All the time. They just hate it. They're horrified by me when I come home. It's not just my family either. I did another interview a few days ago, and we were at the Ritz in New York, and I realized I was in the lobby of this super fancy hotel, talking really loudly in my Chicago accent about people's testicles being chopped off. I could feel the eyes of everybody glaring at me. But really, I think my goal is to arm people with gross medical stories, so if they ever end up at a cocktail party with nothing to say, or trapped in a conversation they'd rather get out of, they can whip out the testicle story, or announce how Listerine was originally sold as a gonorrhea cure, and you're suddenly free.

Or the person says, "Tell me more."
Yes, exactly. If they recoil in disgust, you were wasting your time. But if they're into it…

Maybe you've found a soul mate.
I think it should be on Tinder. Forget the photos. You tell a horrible story about some atrocity from medical history, and if they're into it, you go on a date.

Here's the cocktail party fodder you've given me: There was a No Nose Club for people who'd lost their noses to syphilis.
Yeah, everybody loves that.

Everything about it is hard to fathom. I didn't even realize that you could lose your nose because of syphilis.
It's part of what happens if it's left untreated in the tertiary stage. During the 18th and 19th centuries, the disease was so rife and so many people were losing their noses because of it that these social clubs popped up in London, where you could get together with other people who'd lost their noses and toast the fact that you all had syphilis. There's a newspaper clipping from that time describing the get-togethers and the guy who started it, and it said something like, "Well he eventually died, as you would." The No Nose Clubs was unhappily dissolved after this guy's death. But I love that this guy existed, and he tried to celebrate this rather horrific disease.

You shared a sweet no-nose syphilis story on your blog, which feels like it has the makings of a great rom-com.
[Laughs] Oh yeah.

You called it "Syphilis: A Love Story." Can you give us the highlights?
Well, this woman contracted syphilis from her first husband, who then died. She went on to marry another guy, but her face was so disfigured that she had to wear a prosthetic nose. Her new husband said he loved her regardless, so she could take the fake nose off.

So romantic.
We're going to ignore the part where she almost definitely infected him with syphilis and killed him.

Maybe you leave that part out of the studio pitch.
When you look back into surgical records, people justified things in weird ways. A surgeon would write, "A patient came in and said he brushed up against his maid and thinks he might have syphilis."

That might not be exactly how it happened.
"I fell down in a ditch and now I might have syphilis!"

It has nothing to do with all the prostitutes he's been sleeping with.
It never does.

In your research, did you find any stories that were too gruesome even for you?
Not really. I'm okay with words. I had a chance to go see an autopsy once and I passed. I wasn't ready for the reality of it, and the smell.

I've been to one, and the smell is really beyond anything you can prepare yourself for.
See, I don't want that. That freaks me out. It's like the difference between going to a haunted house or watching a scary movie. I can watch the scary movie, but the hands on experience, no way. When I was writing the book, it was hard sometimes when I thought about the people and the emotional reactions of not just the patients but the surgeons. It's not just flesh and bone, it's human beings suffering from incredible agony. But if you can separate yourself from that, and focus on the visceral aspects of what was happening, I love it. The blood spurting everywhere, and the testicles being lobbed off by accident, it's all amazing.

You get really evocative with your writing, like when you talk about a surgeon slicing into a corpse and releasing "a powerful mixture of fetid smells that would cleave to the inside of the nostrils for a considerable time." Is that conjecture? Are you making a lucky guess?
Well, sometimes the details come from other historical records, so you're piecing things together. There's probably a universality to the smells in the dead houses where medical students were dissecting bodies. The French composer Hector Berlioz, who started out as a medical student, shared a lot about his experiences at these places. He jumped out of the window the first time he went to a dead house because he couldn't take the sights of all these bodies lying around.

You mentioned that in your book, right? He said somethings about the "heads smirking"?
Right, right. Everything about it disturbed him. But it's funny—and this wasn't in the book—but Hector becomes so accustomed to it that he eventually started picking off pieces of cadavers and throwing them to the birds and mice in the dead house. He saw it as perfectly humane. "These poor creatures are hungry, I'm going to feed them a bit of brain, a bit of flesh." It's interesting how the first reactions are usually one of horror, because it was horrible, but when you spend enough time around decomposing bodies, it starts to seem normal. You don't see the horror anymore.

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