Pre-Order My Book! The Butchering Art

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I’m thrilled to reveal the cover for the US edition of my forthcoming book, THE BUTCHERING ART, which will be published by FSG on October 17th.

The book delves into the grisly world of Victorian surgery and transports the reader to a period when a broken leg could result in amputation, when giving birth in a squalid hospital was extraordinarily dangerous, and when a minor injury could lead to a miserable death. Surgeons—lauded for their brute strength and quick knives—rarely washed their hands or their instruments, and carried with them a cadaverous smell of rotting flesh, which those in the profession cheerfully referred to as “good old hospital stink.” At a time when surgery couldn’t have been more dangerous, an unlikely figure stepped forward: Joseph Lister, a young, melancholic Quaker surgeon. By making the audacious claim that germs were the source of all infection—and could be treated with antiseptics—he changed the history of surgery forever.

Many of you have been devoted readers of my blog since its inception in 2010, and I can’t thank you enough for your continued interest in my work. Writing a book has been the next logical step for a very long time. The idea of telling this particular story arose during a very difficult period in my life when my writing career was at risk. It is therefore with great pride (and some trepidation) that I am turning this book loose into the world, and humbly ask you to consider pre-ordering it. All pre-orders count towards first-week sales once THE BUTCHERING ART is released, and therefore give me a greater chance of securing a place on bestseller lists in October. I would be hugely grateful for your support.

Pre-order from any one of these vendors using the links below:

*Please note that THE BUTCHERING ART will also be published by Penguin in the United Kingdom, as well as several other publishers around the world. I’ll be revealing covers for these foreign editions in the coming months, along with information on where to buy a copy.

Under The Knife – Reboot!

It’s been 18 months since I’ve filmed an episode of my YouTube series, Under The Knife. But that ends today! Check out the trailer to the series reboot, which may or may not involve my severed head. A NEW episode is coming next week. If you haven’t subscribed to the channel, please do. You’ll be automatically entered to win macabre little trinkets before the launch of our next video.

My team and I have a lot of fun, quirky things planned for the series in the coming months. Under The Knife combines traditional storytelling techniques with animation, special effects, and artwork to bring the medical past alive. I hope you enjoy watching the new series as much as I enjoy filming it for you.

“We Have Conquered Pain!” The Uses & Abuses of Ether in History

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The surgical revolution began with an American dentist and a curiously sweet-smelling liquid known as ether.

Officially, ether had been discovered in 1275, but its stupefying effects weren’t synthesized until 1540, when the German botanist and chemist Valerius Cordus created a revolutionary formula that involved adding sulfuric acid to ethyl alcohol. His contemporary Paracelsus experimented with ether on chickens, noting that when the birds drank the liquid, they would undergo prolonged sleep and awake unharmed. He concluded that the substance “quiets all suffering without any harm and relieves all pain, and quenches all fevers, and prevents complications in all disease.” [1] Yet inexplicably, it would be several hundred years before it was tested on humans.

00_01_morton-inhaler-replica-mThat moment finally arrived in 1842, when Crawford Williamson Long became the first pioneer to use ether as a general anesthetic when he removed a tumor from a patient’s neck in Jefferson, Georgia. Unfortunately, Long didn’t publish the results of his experiments until 1848. By that time, Boston dentist William T. G. Morton had won fame by using it while extracting a tooth painlessly from a patient on September 30, 1846 [see Morton’s inhaler for administering ether, right]. An account of this successful procedure was published in a newspaper, prompting a notable surgeon to ask Morton to assist him in an operation removing a large tumor from a patient’s lower jaw at Massachusetts General Hospital. After the demonstration, someone nicknamed the surgical amphitheater the “Ether Dome,” and it has been known by this name ever since.

It was an incredible breakthrough. Up until that point, surgery had been brutally painful. The patient, fully awake, would be restrained while the surgeon cut through skin, tissue, muscle, and bone. Surgeons were lauded for their brute strength and quick hands. A capable surgeon could remove a leg in under a minute. But with the discovery of ether, the need for speed in the operating theater had now vanished.

On November 18, 1846, Dr. Henry Jacob Bigelow wrote about this groundbreaking moment in The Boston Medical and Surgical Journal. He described how Morton had administered what he called “Letheon” to the patient before the operation commenced. This was a gas named after the River Lethe in classical mythology which made the souls of the dead forget their lives on earth. Morton, who had patented the composition of the gas shortly after the operation, kept its parts secret, even from the surgeons. Bigelow revealed, however, that he could detect the sickly sweet smell of ether in it. News about the miraculous substance which could render patients unconscious during surgery spread quickly around the world as surgeons rushed to test the effects of ether on their own patients.

The term “etherization” was coined, and the use of ether in surgery was celebrated in newspapers. “The history of Medicine has presented no parallel to the perfect success that has attended the use of ether,” a writer at the Exeter Flying Post proclaimed. [2] Another journalist declared: “Oh, what delight for every feeling heart… the announcement of this noble discovery of the power to still the sense of pain, and veil the eye and memory from all the horrors of an operation…WE HAVE CONQUERED PAIN!” [3]

5A curious by-product of all this was the ether parties that sprang up all over the world. Thomas Lint, a medical student at St. Bartholomew’s Hospital in London, confessed: “We sit round a table and suck [on an inhaling apparatus], like many nabobs with their hookahs. It’s glorious, as you will see from this analysis of a quarter of an hour’s jolly good suck.” [4] He then went on to describe several “ethereal” experiences he and his fellow classmates had while under the influence of the newly discovered substance.

Ether wasn’t just inhaled. It was also drunk, like alcohol. In Ireland, the substance replaced whiskey for a while, due to its low cost (a penny a draught). After drinking a glass of water, “ethermaniacs” would take a drop of the drug on their tongues while pinching their noses and chasing it with another glass of water. Taken this way, ether hit the user hard and fast. Dr. Ernest Hart wrote that “the immediate effects of drinking ether are similar to those produced by alcohol, but everything takes place more rapidly.” [5] Recovery was just as swift. Those taken into custody for drunken disorderliness were often completely sober by the time they reached the police station, with the bonus that they also suffered no hangover. In this way, 19th-century revelers could take draughts of ether several times a day, with little consequence. [6]

Today, the “Ether Dome” at Massachusetts General Hospital has become a national historic landmark [pictured below], visited by thousands of members of the public each year. Although surgeons haven’t operated there for well over a hundred years, the room is still used for meetings and lectures at the hospital. The Ether Dome looks more or less like it did 165 years ago. Display cases at either end of the room contain surgical instruments from Morton’s day, their blades dull and rusted with age. At the front of the room an Egyptian mummy lords over the phantom audience. One can almost detect the sweet smell of ether in the air from so long ago.

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1. Quoted in Steve Parker, Kill or Cure: An Illustrated History ofMedicine (London: DK, 2013), 174.
2. “Etherization in Surgery,” Exeter Flying Post, 24 June, 1847, 4.
3. London People’s Journal, 9 January, 1847.
4. Punch, or The London Charivari (December 1847), 259.
5. Quoted in David J. Linden, Pleasure: How Our Brains Make Junk Food, Exercise, Marijuana, Generosity & Gambling Feel So Good (Viking, 2011), 31.
6. Sterling Haynes, “Ethermaniacs,” BC Medical Journal (June 2014), Vol. 56 (No.5), 254-3.

Disturbing Disorders: FOP (Stone Man Syndrome)

F1In a letter dated 14 April 1736, the surgeon John Freke (picture below) wrote to the Royal Society regarding a highly unusual case involving a patient at St Bartholomew’s Hospital in London.

A boy, who looked ‘about Fourteen Years old’, had come into the hospital to ask ‘what should be done to cure him of many large Swellings on his back’. These growths—some of which had started to develop three years prior—were now as large as a ‘penny loaf’. Freke continued with his description of this horrifying condition:

They arise from all the Vertebrae of the Neck, and reach down to the Os Sacrum; they likewise arise from every Rib of his Body, and joining together in all Parts of his Back, as the Ramifications of Coral do, they make as it were, a fixed bony Pair of Bodice.

Freke ended the letter by adding that the boy ‘had no other Symptom of Rickets on any Joint of his Limbs’. [1]

F4What Freke was describing is a rare condition now known as fibrodysplasia ossificans progressiva (FOP). A mutation of the body’s repair mechanism causes fibrous tissue—muscle, tendon and ligament—to ossify when damaged (pictured right: torso of man suffering from FOP). Although FOP is not fatal, most die young, starving to death after their jaws freeze shut or suffocating when new bone develops, making it impossible to breathe.

Freke was the first to describe the condition in detail. However, a French physician by the name of Gui Patin may have come across FOP in the 17th century when he wrote to a colleague that he ‘saw a woman today who finally became hard as wood all over’. [2]

F3Today, FOP affects approximately 3,300 people worldwide, or 1 in 2 million. A more recent example showing the effects of the disease can be found in the Mütter Museum in Philadelphia. In 1938, a 5-year-old boy named Harry Raymond Eastlack broke his leg while playing with his sister. Shortly afterwards, bone growths began to develop on the muscles of the boy’s thigh. Within years, the condition began to spread throughout Harry’s body so that by his mid-20s, his entire vertebrae had fused together. In 1973, Harry died of pneumonia, just four days before his 40th birthday. By that time, his body had completely ossified. Even his jaw locked up, leaving only his lips to move. Before he died, Harry had agreed to donate his body (pictured above, both alive and after death) to the museum for further scientific research, where it continues to be studied today.

Given the rarity of the condition, I was surprised to find an 18th-century skeleton showing the tell-tale signs of FOP in the Hunterian Collection at the Royal College of Surgeons in London. And yet there it was, catalogued simply as RCSH/P 804.

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I wondered: whose bones were these? And how did they end up in the hands of the anatomist, John Hunter (below), for whom the collection is named after?

It turns out that when the surgeon, George Hawkins, died suddenly in 1783, he left behind a collection of anatomical specimens that were then auctioned off. Amongst them was the skeleton of an adult male with an excessive number of bony outgrowths on his rather twisted frame. Hunter—always on the lookout for rare and unusual specimens—purchased the skeleton for the extraordinary sum of 85 guineas. [3]

F6Records at the Royal College of Surgeons describe the skeleton as belonging to a 39-year-old man named Mr Jeffs. Hunter’s assistant, William Clift, later reported that he had been told that the skeleton had been buried for seven years before it was procured, presumably by Hawkins. According to Hunter,  this was ‘evident from the state of the softer parts of most of the bones’. [4]

Was this the body of the young boy whom had sought Freke’s help in 1736? If the boy was indeed 14-years-old, as Freke had guessed, that would put his death sometime around 1761. Add to that 7 years before his skeleton was recovered, and it is very possible the specimen now residing in the Hunterian Collection once belonged to the boy described in the letter.

F7Of course, like so many of the specimens residing in medical collections today, we will never be able to confirm the skeleton’s former identity. What I can say with some degree of certainty is that he must have suffered greatly in the 18th century. With no real way to manage his pain, everyday life would have been excruciating. It is also likely that he would have been unable to work at the end of his life. Depending on his financial circumstances, this could have been just as crippling as his debilitating condition.

Today, Mr Jeffs ‘stands’ next to Charles Bryne, the famous Irish Giant (right). Visitors to the Hunterian are often mesmerised by Byrne’s 7’7’’ frame, and rarely cast more than a fleeting glance at the twisted skeletal remains next to him.

Hidden in the shadows of something much bigger than himself, Mr Jeffs is to visitors what he likely was to surgeons in his day: a passing curiosity. His story, however, warrants further attention, for FOP remains incurable. There is still much to be learned from Mr Jeffs and his skeletal remains.

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1. Philosophical Transactions of the Royal Society 41 (January, 1753): pp. 369 – 370.
2. Qtd in Thomas Maeder, ‘A Few Hundred People Turned to Stone,’ The Atlantic (Feb., 1998). I cannot track down the original source for this quote; although I do know that most people incorrectly date this letter to 1692. Gui Patin died in 1672, and his letters were posthumously published in 1692.
3. L. W. Proger & J. Dobson, comps., Descriptive Catalogue of the Pathological Series in the Hunterian Museum of The Royal College of Surgeons of England, vol. 2 (1972), pp. 68-70.
4. Ibid.