Let's Look At the Gruesome World of Victorian Medicine

Have you ever had surgery? I have, several times, actually. Odds are, if you're having an operation today, it took a good amount of time, and your surgeon had a mask and sanitized hands and tools. It was probably done in a well-lit, clean room, and in order to avoid pain and distress, you were probably put under anesthesia or given some kind of sedative medicine. Now, follow me back to the Victorian era, and forget literally all of those expectations. Now, in all likelihood, your surgery is in a dirty, dark room, observed by dozens of spectators, done with bloody hands and tools from the patients before you, fully awake, and all of it is done in a few minutes or less. In all likelihood, you might leave that hospital with one less limb, and there's a great chance that you won't survive recovery. This is the world of Victorian medicine, and today, I want to take you on a tour of this world, as well as introduce you to one of the most renowned and infamous surgeons of the era, Robert Liston. But before we get into it, just some quick disclaimers. I'm going to focus on the medicine of Victorian Western Europe and America, with an emphasis on Britain, specifically. This video is not going to cover literally everything there is to know about the subject. I can only fit so much into one video, as always. So, I think that everyone knows by now that life in Victorian cities was extremely hazardous, right? Despite some pointed efforts to improve the living conditions, things were very dire, especially for the lower classes who were forced to live in squalor. Some records show up to 30 people or more living in one-room housing in the worst cases. Now, things are going to get a bit nasty for a minute, but it's necessary for you to understand what people were living in and why, in order to understand why the hospitals were the way that they were. Indoor plumbing wasn't brought in until Thomas Crapper invented the flushing mechanism. Yes, that's his name. And that's why people call toilets crappers. So any water you used needed to be brought in from the outside, and most people did their business outside anyway. The lack of plumbing and inadequate sewer systems led to massive cesspools outside of people's homes, not to mention the horse poop in the streets. Because remember, there weren't cars yet, and the streets were often still dirt. So the waste and wet mud was... a situation. There were poor people whose entire jobs were poop collecting, because the waste would then be dried and sent to market to be purchased and reused by factories, tanneries, and farmers. Hey, at least they were resourceful. Over the course of a century, the population of London exploded to 6 million people. And with the rise in population, the wealthy could afford to leave the city to live in cleaner areas with more space. The city homes left behind were overpopulated, damp, dark, cold, and filled with bugs and rats. And not only did the city stink of waste and smoke, they also stunk of the dead. In a city built on top of ancient graves already, the ever-growing population of the deceased was quickly becoming a burden as mass graves became the norm. Between this and the fact that many green dyed clothing items, desserts, books, and wallpapers were loaded with arsenic, and bakers were selling people bread filled with chalk or sawdust, things are looking great, London. Now, I try to make an effort to present history as multifaceted. Things are not all bad at any point in history. There was still love and happiness and color. But let's face it, Victorian London always gives me a hard time. The fact is that life was much cleaner and easier for the wealthy who could afford lavish bathrooms and untainted water to keep clean. What reason did they have to fear it? And unlike the poor, rich people could afford to have doctors treat them at home where they were far less likely to die of infection. They could even afford to travel to the countryside to take in healing clean airs. And the poor couldn't. But, like, how did things even get to this point? I've talked about Victorian medicine a bit in both my Crimson Peak video and my Bram Stoker video, and I've explained how early modern Europe thought about pathogens in my Medieval Myths video. But let's take a refresher course on what exactly people believed. Like many aspects of the sciences, the Arabic world was way ahead of Europe in terms of accepting germ theory. Arabic scholars such as Ibn Sina, Ibn Khatima, and Ibn al-Khatib had theorized about bacteria since the late Middle Ages. And a couple Italian and Viennese scholars, Girolamo Fracastoro and Marcus von Plensis, followed suit in the 1500s and 1700s. It took me a solid five minutes to get those names out of my mouth. But for hundreds of years, Europe held on firmly to Galen's miasma theory, which said that disease and infection was actually caused by miasmas, or bad airs, which emanated from things that rotted. Miasma theory fit in with the humoral system of medicine, which theorized that your body is composed of four different fluids, or humors. Yellow bile, black bile, blood, and phlegm. And if any of these are out of balance, you can fall ill or go insane. And the humors can be put back in balance through various means. Here's where things started to fall into a vicious cycle. While despite common belief, people in the medieval period weren't afraid of washing with water, in the early modern era, the idea of water as spreading contagion through the pores picked up steam very quickly. And over time, people full body bathed with water less and less in favor of dry baths where you would rub yourself down with soap and a rough cloth. People knew that something was wrong with their water. There literally was. With the rise of factories and growing urban populations and no indoor plumbing, city waterways were rapidly becoming contaminated with waste, garbage, and other urban refuse. Not to mention, um, decomposing bodies. People literally didn't know how germs worked, nor that they existed yet. Microscopes existed by the Victorian era, but were often waved off as being useless. So a lot of people not only washed less than would be ideal, but they also recontaminated their own drinking water, having no idea what they were doing. In 1854, Broad Street in London experienced a violent outbreak of cholera, killing over 600 people. Before this, an obstetrician named John Snow had already had the suspicion that the contagion was being spread by people drinking infected water, but nobody would listen to him. After all, the British medical community at this time was a very much bros club that didn't like being told that they're wrong about things, but we'll get to that later. Obviously, cholera is caused by evil vapors, so what the **** is Dr. Snow talking about? Well, septic systems at this time were not fantastic, and the waste that floated into the Thames River could easily contaminate the supply of drinking water in the wells and pumps where people got their washing and drinking water from. After much experimentation, it was discovered that a mother had washed her baby's diapers and then dumped the dirty water into a cesspool a few feet from the Broad Street water pump, where everyone who had contracted cholera had gotten their water from. Did this entirely convince the medical community that my asthma theory is wrong? Absolutely not. But if daily life was as dirty and rife with bacteria as this, what was the state of the hospitals? Just as bad, actually. Hospitals were so awful that the public actually dubbed them houses of death, because you were so much more likely to die being treated at a hospital than you were at home. You may have been wondering why I'm wearing a grimy, gross-looking apron right now. Well, before white coats became the doctor's uniform, surgeons wore aprons covered in blood, guts, and brains. Yeah, they just walked around like that, because they saw these nasty-ass aprons as a token of honor of sorts. No gloves, no masks, they didn't wash their hands often, and also often used the same unwashed bloody tools on multiple patients in a row. I wonder why people are getting infections all the time. Medical students, much like today, had to learn about anatomy by dissecting cadavers. These dissection rooms were... disgusting. Covered in blood, organs, random body parts lying around, and here's where it gets worse. Yeah, somehow it gets worse. You can probably imagine that in these conditions, the medical profession wasn't for the faint of heart. Medical schools forced students to develop a sort of necessary inhumanity in order to cope emotionally with living every day, dissecting and operating on both the dead and the living, who, in the age before anesthesia, would scream and cry in agony during operations. Students began to see bodies as just objects, and many medical students surpassed indifference and went straight to treating corpses as props for practical jokes. They used severed arms and legs as mock weapons for sword fighting and hid them in places where they would shock the uninitiated. This disrespect for the dead was widely despised by the public, especially because the manner in which hospitals got these bodies to study was just as inhumane. Most of these bodies weren't donated by the deceased to science. They were stolen. During and far before the Victorian era, body snatching was big business for gangs looking to make money. These grave-robbing crews, often called resurrection men or resurrectionists, would steal into graveyards in the dead of night soon after new burials and dig up the newly deceased bodies, secretly bringing them to anatomists and doctors at the university hospitals for study. These bodies were almost universally robbed from the graves of the poor, and even more often, from the graves of poor people of color. The problem was so bad that those who could spare the money would bury their loved ones beneath cages to keep the resurrection men out. The resentment of the public towards the body snatchers came to a head in New York in 1788, when according to many versions of the tale, some boys playing in a playground near the New York hospital climbed a ladder to look into the dissection room, and one of the surgeons waved a severed arm at the boy, who became convinced that it was the arm of his recently deceased mother. The boy ran home in panic to tell his father, and the father flew into a rage, going to check his wife's coffin at the cemetery. Finding it empty, he and his friend marched down to the hospital, armed with shovels and picks. Colonel William Heth recounted later, the cry of barbarity, etc., were soon spread. The young sons of Galen fled in every direction. One took refuge in a chimney, the mob razed, and the hospital apartments were ransacked. In the anatomy room were found three fresh bodies, one boiling in a kettle, the two others cutting up, with certain parts of the two sexes hanging up in the most brutal position. The circumstances, together with the wanton and apparent inhuman complexion of the room, exacerbated the mob beyond all bounds, to the total destruction of every anatomy in the hospital. By the next day, a mob was running around the city, searching for doctors, medical students, and bodies, yelling, Bring out your doctors! At the end of the violence, about 20 people were left dead. As if this wasn't bad enough, many dissections of these bodies were done as theatrical public viewing events. People could take a seat in the dark anatomical amphitheaters of the university hospitals, and watch as renowned surgeons took them apart. Voyeurism of this sort wasn't limited to the dead. Often, regular surgeries were done in these amphitheaters, on view in front of dozens of medical students and visiting doctors or donors. And in those days, anesthesia wasn't yet commonplace. So the most that patients could do during surgery was bite down on something and scream, or they were given something like alcohol, laudanum, or opium. So you can imagine that speed was essential to avoid prolonged agony. Which brings me to one of the most famous surgeons of this era who, for better or for worse, was the fastest surgeon around. Robert Liston. Robert Liston, not to be confused with Joseph Lister of Listerine fame, was born October 28th, 1794. Everybody clap! We're talking about another Scorpio. Now just take a minute to prepare yourself, because almost everything about this man feels like being punched in the face with information. Robert Liston was six foot two, and apparently completely shredded. Like, he had an unreal amount of strength. So imagine this massive, hulking strong man walking around these dirty hospitals, and he's also one of the most renowned surgeons of the time. Because not only is Liston strong as hell, he's also one of the fastest surgeons around. So much so that a colleague said, The gleam of his knife was followed so instantly by the sound of sawing as to make the two actions appear simultaneous. Surgery at this time was incredibly risky. For the most part, surgeons wouldn't operate on anything in the torso, because the patients would almost certainly die. Liston himself wrote at least three books, and one of which is a collection of his lectures. And they don't exactly endorse getting all up in the internal organs. But appendages were fair game, because it was more likely that you could control infection, or else simply cut the limb off if things went south. And that's exactly what surgeons frequently did. Why do you think they used to call doctors old sawbones? This is why I feel like historical dramas don't feature nearly enough amputees. Do you know how many amputees there were running around in the Victorian era? A lot. In any case. Until December 21st, 1846, when Robert Liston performed a successful surgery using ether as an anesthetic on the patient, thus marking the beginning of its popular use, but not the first use, speed was essential in minimizing the physical suffering of patients. And Liston's speed was legend. Not only that, but he refused to use a proper tourniquet, because apparently his left arm was so strong, he'd just use that and clamp his big meaty claw down to stop the blood flow. I mean, really. He could reportedly remove a leg in less than 30 seconds, and held his bloody knife in between his teeth when he needed to use his hands. Surgery was bravado and theater for Liston, often entering the surgical theater and loudly shouting, Time me, gentlemen! Sometimes the speed was detrimental though, like in the most famous story about Liston, the surgery that had a 300% mortality rate. This story may or may not be apocryphal, but we might never know for certain. In any case, according to the story, during one of Liston's surgeries, his flailing supersonic buff arms were moving so fast, he took off three of his assistant's fingers, slashed the coat of a spectator, and in some versions of the story, they say it was one of his balls. The patient and the assistant died of gangrene, and the spectator died of shock on the spot. But hey, to his credit, he was one of the few surgeons at the time who actually washed his hands before operating and wore clean aprons, so you win some, you lose some. It was due to his innate sense of cleanliness that Liston had one of the lowest mortality rates of the surgeons at the time. Except, you know, that one time. But as much as speed saved the patient from prolonged pain, Liston, like many doctors at the time, had to make some pretty mind-boggling behavioral decisions in order to save lives. In one case, a patient who needed a bladder stone removed was so terrified that he ran from the operating room and locked himself upstairs in the bathroom. Liston, obviously, chased him down, broke the door down, and forcibly dragged the man screaming back to the operating room, where he strapped him down before performing and completing the surgery in exactly one minute. Haha, fastest knife in the West End. This is especially jarring considering the fact that he would also often postpone an operation if patients were too scared, and said, I quote, "...it is of utmost importance to attend to the state of the patient's mind and feelings. He ought not to be kept in suspense, but encouraged and assured, and his apprehensions must be allayed." I wish I understood anything about this man's mind. When the serial killing duo Williams, Burke, and Hare were going around Edinburgh killing people and supplying bodies to surgeons for pay, one of those surgeons was Robert Knox. Liston confronted Knox about this by, duh, tackling the man to the ground. But at the same time, Liston himself employed a gang of body snatchers, so where does the good ethics begin and end here? I'm pretty sure it never actually began. In any case, Liston was an incredibly complicated man. He contributed quite a lot to the advancement of medicine, but he was also a huge scary weird man with an incomprehensible moral compass. Either way, I definitely had to give him his own section. Something that definitely contributed to the medical community's reluctance to change can be in part due to the fact that it was a very insular kind of bros club. Women weren't allowed to become doctors unless they managed to disguise themselves well enough, and some doctors were genuinely trans men like Dr. James Berry, so that's super awesome. I'd like to give him his own video in the future. There were very few doctors of color in the main hospitals, and the ones that were there faced constant racism from their peers. James McCune Smith was the first Black American man to hold a medical degree and run a pharmacy and did some incredible abolitionist work. Doctors like John Alcindor, who was from Trinidad and practiced in Edwardian Britain, and the American doctors John Henry Jordan and Edward Ramsey were pioneering Black doctors who had to face far more hurdles than their white counterparts in order to sustain their medical practices. In America, doctors were required to join the AMA, which claimed that it didn't discriminate, but still left membership decisions to the whims of the local chapters, which definitely did. And Black doctors often couldn't access specialized training. In response, the NMA was formed in 1895 and still exists today. Women were often denied access to medical professions outside of nursing because it was simply widely believed that AFAB people weren't physically, intellectually, or emotionally equal to men. Over the course of the Victorian era, male doctors began to replace illegitimate midwives and hospitalized the birthing process. It wasn't until the late end of the Victorian era that white women in Britain gained access to being doctors, but this was frequently due to the fact that they could benefit colonialism through evangelistic presences in the colonized territories. Niran Hassan writes, Women negotiated and engaged with the project of the empire through their privileged access to domestic native spaces and cultural traditions and their representations of them. But, also for these women, access to the discourses of modern medicine resulted in the production of a new realm of women's work overseas that could allow women to challenge and shape the field of colonial medicine. Women travelers were influenced and regulated by medical ideas at the same time as they borrowed, applied, and sometimes shaped them. The inclusion of women in colonial realms simultaneously challenged, restructured, and influenced imperial progress, while women often bore the burden of serving as examples of English cultural norms. Within colonial spaces, women could function as active agents of cultural exchange, particularly within the domestic realm. It's a sad reality, but as with so many aspects of history, white women attempted to gain social advancements by leaning into white supremacy. So, you can imagine how, in this environment, many white male doctors were very comfortable with the state of their profession, as well as their place in it, and tended to eschew anyone who rocked the boat too much. As soon as Ether took off after Liston's legendary operation in 1846, surgeons suddenly gained a lot more confidence in performing surgeries that were previously too risky to take on. They got knife happy. Having defeated the looming specter of operational pain, they now felt comfortable cutting into the torso and doing more invasive procedures. The issue was, well, the hospitals were still nasty dirty, and so, big shocker, the number of patient deaths spiked dramatically in the years following the introduction of Ether. The public's confidence in these houses of death was already bad, but now it was abominable, and doctors just couldn't understand why an internal break or wound often didn't become infected, but a small tear of the skin could take someone's life. The more these questions added up, the more miasma theory just didn't add up. Some doctors leaned into the theory still, believing that you could prevent infection by removing all the air from a wound through a process called occlusion, which Robert Liston thought was extremely dumb. Regardless, the medical community thought something about hospitals were the problem and began trying to fix it. They made efforts to keep wound dressings clean and fresh and to change the bed linens, but with the numbers of patients in hospital wards increasing rapidly due to both patients suffering from infection after risky surgeries, as well as patients suffering injuries from the rapid industrialization of the cities, it was really hard to keep up. There were already some doctors who firmly believed that better cleanliness was somehow the answer to the problem, like Joseph Lister, who went on to use carbolic acid as an antiseptic. Doctors like Alexander Gordon, Ignat Semmelweis, and Oliver Wendell Holmes would all make the connection that patients' deaths in hospitals were not connected to miasmas, but rather some sort of toxic substance being transferred from doctor to patient. What could it be? These doctors were disregarded and sometimes attacked by the medical community, who not only hated the idea that they were wrong, but also didn't appreciate being accused of carrying the diseases that they sought to heal. Really rich coming from the guys who wear aprons covered in blood and guts. Semmelweis himself became enraged at his detractors, so much so that he was institutionalized for the rest of his life. But god, all the man wanted was for people to wash their damn hands. In 1858, the Great Stink of London happened, and it's exactly what it sounds like. A massive, cartoonish cloud of stink arose from the River Thames and permeated everything within a mile. So obviously a big stink cloud of bad vapors is going to cause an epidemic, according to miasma theory, right? Oh, what's that? An epidemic never happened? I'm making a complete what of myself? Yeah, the idea that maybe miasmas aren't exactly the problem started to catch on in the mid-1800s. Enter Louis Pasteur, who had spent years performing experiments and observing microorganisms under his microscope and recording how they reproduced. Let's just put you right here, Louis. Yeah, that's good. He was decried by many in the scientific community for making fantastical claims. Some doctors latched on, though, including Joseph Lister, who used this research in his experiments to figure out how to use carbolic acid as an antiseptic. The issue was, because germ theory was at the core of Lister's research, many doctors railed against him, too, despite the extremely promising results of his tests. One of Lister's assistants recalled, Truly, over time, the effects of Lister's antiseptic method couldn't be ignored any longer, especially after he successfully operated on an abscess that Queen Victoria had. By the 1870s, many hospitals had accepted reality and made efforts to install proper ventilation and perform better in more regular cleanliness systems. I mean, seriously, the difference in cultural attitude towards cleanliness in the early Victorian era versus the end of it is extremely stark. Being clean became a bit of an obsession, as we can see from the explosion in new antiseptic hygiene products that flooded the markets. London installed a sewer system, indoor plumbing became a thing, though, as usual, much slower for the poor, and people slowly stopped being afraid of bathing in and drinking water. Because, over time, there wasn't much to be afraid of anymore. Thanks for watching, folks. I promise the next video will be a lot less gross and scary. Also, there are a lot more of you here now than there were when I last posted, so I want to wish all of you and the new crowd a welcome. I'm glad you're here, and I hope you enjoy your stay. If you want to read more about this topic, I highly recommend The Butchering Art by Dr. Lindsay Fitzharris. It's really good, as you can see. I've read it a few times. And it was a big help in writing this video. As usual, my sources are in the outro. On that note, seriously, this outro is really relevant to the subject matter today, so wash thy hands, wear thy mask, and take a moment to appreciate just how far medicine has come.