In Episode 15 of Under The Knife, I explore the horrible reality behind dental practices from the past, including how dentures used to be made from the teeth of executed criminals, exhumed bodies, and sometimes even slaves.
On 12 November 1935, a Portuguese neurologist named Antonio Egas Moniz [below right] became the first individual to perform what would later be known as a lobotomy. Moniz’s work built upon that of the 19th-century Swiss psychiatrist, Gottlieb Burkhardt, who performed a series of operations in 1888 in which he removed sections of the cerebral cortex from six patients under his care at the Préfargier Asylum. Moniz’s early experiments involved drilling holes into patients’ skulls and pouring alcohol into the frontal cortex in order to sever nerves; and coring out regions of the brain with hollow needles.
Moniz’s lobotomy quickly became a popular treatment for various mental conditions, putting an end to the therapeutic nihilism that dominated the psychiatric profession in the Victorian era. Suddenly, doctors believed they could “cure” patients whom they had previously deemed beyond help. Within a decade, the lobotomy became so esteemed that Moniz was awarded a Nobel Prize for his role in developing it.
During this time, Moniz’s procedure was adopted (and adapted) by the American neuropsychiatrist Walter Freeman, who performed the first lobotomy in the United States in 1936. Freeman won acclaim for his technique, and people all over the country began lining up to get their lobotomies, including Rosemary Kennedy [below]—sister to the man who would later become President of the United States. Rosemary was described by members of her family as a rebellious child who was prone to violent mood swings while she was growing up. In November 1941, Rosemary’s father took her to see Freeman, who diagnosed the 23-year-old girl with “agitated depression” and suggested she undergo a lobotomy to correct her erratic behavior. [Interestingly, 80 percent of the lobotomies performed in the US in those early years were carried out on women].
Freeman performed the operation right then and there on Rosemary, without her mother’s knowledge. Shortly afterwards, it became clear that something had gone terribly wrong. Rosemary could no longer speak, and her mental capacity was equivalent to that of a toddler. Her father institutionalized her, telling people that his daughter was mentally retarded rather than admitting that her condition was due to a failed brain operation. It was only after his death decades later that the truth behind her condition was revealed. Rosemary never did recover her ability to speak coherently, and remained in care till her death in 2005 at the age of 86. She was the first of her siblings to die of natural causes.
The incident did little to damage Freeman’s reputation, who soon began looking for a more efficient way to perform the operation without drilling directly into the skull. As a result, he created the transorbital lobotomy in which a pick-like instrument was forced through the back of the eye sockets to pierce the thin bone that separates the eye sockets from the frontal lobes. This procedure—which later became known as the “ice-pick” lobotomy—could be performed in under ten minutes without anesthetic.
Freeman took to the roads with his ice-pick and hammer, touring hospitals and mental institutions around the country. He performed ice-pick lobotomies for all kinds of conditions, including headaches. Eventually, he began performing the operation in his van—which later became known as “the lobotomobile.” At one point, he undertook 25 lobotomies in a single day. He even performed them on children as young as 4 years old. Years later, one of them spoke of the frightful incident: “I’ve always felt different—wondered if something’s missing from my soul. I have no memory of the operation, and never had the courage to ask my family about it.”
Over the course of four decades, Freeman performed nearly 3,500 lobotomies despite the fact that he had no surgical training. Many of his patients often had to relearn how to eat and use the bathroom. Some never recovered. And, of course, there were fatalities. In 1951, one of his patients died when Freeman suddenly stopped to pose for a photo during the procedure. The surgical instrument slipped and went too far into the patient’s brain. Many others fell victim to a similar fate at the good doctor’s hands.
The lobotomy eventually came under attack from the medical community. By the 1970s, several countries had banned the procedure altogether. Freeman eventually retired the lobotomobile and opened a private practice in California. Contrary to popular belief, he never lost his license to practice medicine.
Today, surgical lobotomies are no longer performed. The rise of drugs like thorazine make it easier to lobotomize patients chemically. In recent years, there have been calls for the Nobel Foundation to rescind Moniz’s prize that he received for developing the lobotomy, which has often been labeled one of the most barbaric mistakes of modern medicine.
Special thanks to Paul Koudounaris for bringing this fascinating subject to light for me when I was in Los Angeles this past April.
If you’re interested in the history of surgery, you can now pre-order my book, The Butchering Art. All pre-orders count towards first-week sales once the book 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. If you’re in the US, click HERE. If you’re in the UK, click HERE. Info on further foreign editions to come.
If you visit the Gordon Museum at Guy’s Hospital in London, you’ll see a small bladder stone—no bigger than 3 centimetres across. Besides the fact that it has been sliced open to reveal concentric circles within, it is entirely unremarkable in appearance. Yet, this tiny stone was the source of enormous pain for 53-year-old Stephen Pollard, who agreed to undergo surgery to remove it in 1828.
People frequently suffered from bladder stones in earlier periods due to poor diet, which often consisted of lots of meat and alcohol, and very few vegetables. The oldest bladder stone on record was discovered in Egyptian grave from 4,800 B.C. The problem was so common that itinerant healers traveled from village to village offering a vast array of services and potions that promised to cure those suffering from the condition. Depending on the size of these stones, they could block the flow of urine into the bladder from the kidneys; or, they could prevent the flow of urine out of the bladder through the urethra. Either situation was potentially lethal. In the first instance, the kidney is slowly destroyed by pressure from the urine; in the second instance, the bladder swells and eventually bursts, leading to infection and finally death.
Like today, bladder stones were unimaginably painful for those who suffered from them in the past. The stones themselves were often enormous. Some measured as large as a tennis ball. The afflicted often acted in desperation, going to great lengths to rid themselves of the agony. In the early 18th century, one man reportedly drove a nail through his penis and then used a blacksmith’s hammer to break the stone apart until the pieces were small enough to pass through his urethra. It’s not a surprise, then, that many sufferers chose to submit to the surgeon’s knife despite a very real risk of dying during or immediately after the procedure from shock or infection. Although the operation itself lasted only a matter of minutes, lithotomic procedures were incredibly painful and dangerous—not to mention humiliating.
The patient—naked from the waist down—was bound in such a way as to ensure an unobstructed view of his genitals and anus [see illustration below]. Afterwards, the surgeon passed a curved, metal tube up the patient’s penis and into the bladder. He then slid a finger into the man’s rectum, feeling for the stone. Once he had located it, his assistant removed the metal tube and replaced it with a wooden staff. This staff acted as a guide so that the surgeon did not fatally rupture the patient’s rectum or intestines as he began cutting deeper into the bladder. Once the staff was in place, the surgeon cut diagonally through the fibrous muscle of the scrotum until he reached the wooden staff. Next, he used a probe to widen the hole, ripping open the prostate gland in the process. At this point, the wooden staff was removed and the surgeon used forceps to extract the stone from the bladder. 
Unfortunately for Stephen Pollard, what should have lasted 5 minutes ended up lasting 55 minutes under the gaze of 200 spectators at Guy’s Hospital in London. The surgeon Bransby Cooper fumbled and panicked, cursing the patient loudly for having “a very deep perineum,” while the patient, in turn, cried: “Oh! let it go; —pray, let it keep in!’” The surgeon reportedly used every tool at his disposal before he finally reached into the gaping wound with his bare fingers. During this time, several of the spectators walked out of the operating theater, unable to bear witness to the patient’s agony any longer. Eventually, Cooper located the stone with a pair of forceps. He held it up for his audience, who clapped unenthusiastically at the sight of the stone.
Sadly, Pollard survived the surgery only to die the next day. His autopsy revealed that it was indeed the skill of his surgeon, and not his alleged “abnormal anatomy,” which was the cause of his death.
But the story didn’t end there. Word quickly got out about the botched operation. When Thomas Wakley [left]—the editor of The Lancet—heard of this medical disaster, he accused Cooper of incompetence and implied that the surgeon had only been appointed to Guy’s Hospital because he was nephew to one of the senior surgeons on staff. Wakley used the trial to attack what he believed to be corruption within the hospitals due to rampant nepotism. Outraged by the allegation, Cooper sued Wakley for libel and sought £2000 in damages. The jury reluctantly sided with the surgeon, but only awarded him £100. Wakley had raised more than that in a defence fund campaign and gave the remaining money over to Pollard’s widow after the trial. 
Bransby Cooper’s reputation, like his patient, never did recover.
If you’re interested in the history of pre-anesthetic and pre-antiseptic surgery, you can pre-order my book The Butchering Art in the US (click here) and in the UK (click here). Information of foreign editions to come!
1. Druin Burch, Digging up the Dead: Uncovering the Life and Times of an Extraordinary Surgeon (2007), p. 26. I am greatly indebted to his work for bringing this story to my attention.
2. Thomas Wakley, A Report of the Trial of Cooper v. Wakley (1829), pp. 4-5.
I’m thrilled to reveal the UK cover for my upcoming book THE BUTCHERING ART, which will be published by Allen Lane, an imprint of Penguin, on October 17th. The book tells the story of the surgeon Joseph Lister and his quest to transform the brutal world of Victorian surgery through antisepsis.
For those of you who are familiar with the US cover (right), you’ll notice a lot of similarities. The US cover features a painting by the 19th-century artist Thomas Eakins. It depicts the surgeon Samuel Gross, who didn’t believe in the existence of germs and made a point of not using Lister’s antiseptic techniques in the operating theater. The painting is dark and bloody, and the surgeons are all wearing their everyday clothing. These men are the last “butchers” of their profession – men who were lauded for their brute strength and speed, and who didn’t wash their hands or their instruments between operations.
In contrast, the UK cover (above) features a second painting by Eakins, this one completed a decade later after Lister triumphs and germ theory is finally accepted by the medical community. This painting is lighter, brighter, and there is a sense of cleanliness and hygiene (note: the publisher has stylized the original painting to give it a slightly modern look here). I think it’s brilliant that the US and UK covers are in conversation with one another. So here’s the important part! I would be HUGELY GRATEFUL if you would consider pre-ordering the book today if you’re in the UK. Pre-orders are especially crucial at the start of a writer’s career as they increase my chance at getting onto bestseller lists when the time comes. Click HERE.
And don’t forget you can also pre-order the US edition by clicking HERE. Info on further foreign editions to come!
The word “hysteria” conjures up an array of images, none of which probably include a nomadic uterus wandering aimlessly around the female body. Yet that is precisely what medical practitioners in the past believed was the cause behind this mysterious disorder. The very word “hysteria” comes from the Greek word hystera, meaning “womb,” and arises from medical misunderstandings of basic female anatomy.
Today, hysteria is regarded as a physical expression of a mental conflict and can affect anyone regardless of age or gender.  Centuries ago, however, it was attributed only to women, and believed to be physiological (not psychological) in nature.
For instance, Plato believed that the womb—especially one which was barren—could become vexed and begin wandering throughout the body, blocking respiratory channels causing bizarre behavior.  This belief was ubiquitous in ancient Greece. The physician Aretaeus of Cappadocia went so far as to consider the womb “an animal within an animal,” an organ that “moved of itself hither and thither in the flanks.”  The uterus could move upwards, downwards, left or right. It could even collide with the liver or spleen. Depending on its direction, a wandering womb could cause all kinds of hell. One that traveled upwards might cause sluggishness, lack of strength, and vertigo in a patient; while a womb that moved downwards could cause a person to feel as if she were choking. So worrisome was the prospect of a wandering womb during this period, that some women wore amulets to protect themselves against it. 
The womb continued to hold a mystical place in medical text for centuries, and was often used to explain away an array of female complaints. The 17th-century physician William Harvey, famed for his theories on the circulation of the blood around the heart, perpetuated the belief that women were slaves to their own biology. He described the uterus as “insatiable, ferocious, animal-like,” and drew parallels between “bitches in heat and hysterical women.”  When a woman named Mary Glover accused her neighbor Elizabeth Jackson of cursing her in 1602, the physician Edward Jorden argued that the erratic behavior that drove Mary to make such an accusation was actually caused by noxious vapors in her womb, which he believed were slowly suffocating her. (The courts disagreed and Elizabeth Jackson was executed for witchcraft shortly thereafter.)
So what could be done for hysteria in the past?
Physicians prescribed all kinds of treatments for a wayward womb. These included sweet-smelling vaginal suppositories and fumigations used to tempt the uterus back to its rightful place. The Greek physician Atreaus wrote that the womb “delights…in fragrant smells and advances towards them; and it has an aversion to foetid smells, and flees from them.” Women were also advised to ingest disgusting substances—sometimes containing repulsive ingredients such as human or animal excrement—in order to coax the womb away from the lungs and heart. In some cases, physical force was used to correct the position of a wandering womb (see image, right). For the single woman suffering from hysteria, the cure was simple: marriage, followed by children. Lots and lots of children.
Today, wombs are no longer thought to wander; however, medicine still tends to pathologize the vagaries of the female reproductive system.  Over the course of several thousand years, the womb has become less of a way to explain physician ailments, and more of a way to explain psychological disfunction—often being cited as the reason behind irrationality and mood swings in women. Has the ever-elusive hysteria brought on by roving uteri simply been replaced by the equally intangible yet mysterious PMS? I’ll let you decide.
You can now pre-order my book THE BUTCHERING ART by clicking here. THE BUTCHERING ART follows the story of Joseph Lister as he attempts to revolutionize the brutal world of Victorian surgery through antisepsis. Pre-orders are incredibly helpful to new authors. Info on how to order foreign editions coming soon. Your support is greatly appreciated.
1. Mark J Adair, “Plato’s View of the ‘Wandering Uterus,’” The Classical Journal 91:2 (1996), p. 153.
2. G. S. Rousseau, “‘A Strange Pathology:’ Hysteria in the Early Modern World, 1500-1800” in Hysteria Beyond Freud (1993), p.104. Originally qtd in Heather Meek, “Of Wandering Wombs and Wrongs of Women: Evolving Concepts of Hysteria in the Age of Reason,” English Studies in Canada 35:2-3 (June/September 2009), p.109.
3. Quoted in Matt Simon, “Fantastically Wrong: The Theory of the Wandering Wombs that Drove Women to Madness,” Wired (7 May 2014).
4. Robert K. Ritner, “A Uterine Amulet in the Oriental Institute Collection,” Journal of Near Eastern Studies 45:3 (Jul. 1984), pp.209-221. For more on the fascinating subject of magical amulets, see Tom Blaen, Medical Jewels, Magical Gems: Precious Stones in Early Modern Britain (2012).
5. Rousseau, “A Strange Pathology,” p. 132.
6. Mary Lefkowitz, “Medical Notes: The Wandering Womb,” The New Yorker (26 February 1996).
The following blog post relates to my forthcoming book THE BUTCHERING ART, which you can pre-order here.
Today, we think of the hospital as an exemplar of sanitation. However, during the first half of the nineteenth century, hospitals were anything but hygienic. They were breeding grounds for infection and provided only the most primitive facilities for the sick and dying, many of whom were housed on wards with little ventilation or access to clean water. As a result of this squalor, hospitals became known as “Houses of Death.”
The best that can be said about Victorian hospitals is that they were a slight improvement over their Georgian predecessors. That’s hardly a ringing endorsement when one considers that a hospital’s “Chief Bug-Catcher”—whose job it was to rid the mattresses of lice—was paid more than its surgeons in the eighteenth century. In fact, bed bugs were so common that the “Bug Destroyer” Andrew Cooke [see image, left] claimed to have cleared upwards of 20,000 beds of insects during the course of his career.
In spite of token efforts to make them cleaner, most hospitals remained overcrowded, grimy, and poorly managed. The assistant surgeon at St. Thomas’s Hospital in London was expected to examine over 200 patients in a single day. The sick often languished in filth for long periods before they received medical attention, because most hospitals were disastrously understaffed. In 1825, visitors to St. George’s Hospital discovered mushrooms and wriggling maggots thriving in the damp, soiled sheets of a patient with a compound fracture. The afflicted man, believing this to be the norm, had not complained about the conditions, nor had any of his fellow convalescents thought the squalor especially noteworthy.
Worst of all was the fact that a sickening odor permeated every hospital ward. The air was thick with the stench of piss, shit, and vomit. The smell was so offensive that the staff sometimes walked around with handkerchiefs pressed to their noses. Doctors didn’t exactly smell like rose beds, either. Berkeley Moynihan—one of the first surgeons in England to use rubber gloves—recalled how he and his colleagues used to throw off their own jackets when entering the operating theater and don ancient frocks that were often stiff with dried blood and pus. They had belonged to retired members of staff and were worn as badges of honor by their proud successors, as were many items of surgical clothing.
The operating theaters within these hospitals were just as dirty as the surgeons working in them. In the early decades of the nineteenth century, it was safer to have surgery at home than it was in a hospital, where mortality rates were three to five times higher than they were in domestic settings. Those who went under the knife did so as a last resort, and so were usually mortally ill. Very few surgical patients recovered without incident. Many either died or fought their way back to only partial health. Those unlucky enough to find themselves hospitalized during this period would frequently fall prey to a host of infections, most of which were fatal in a pre-antibiotic era.
In addition to the foul smells, fear permeated the atmosphere of the Victorian hospital. The surgeon John Bell wrote that it was easy to imagine the mental anguish of the hospital patient awaiting surgery. He would hear regularly “the cries of those under operation which he is preparing to undergo,” and see his “fellow-sufferer conveyed to that scene of trial,” only to be “carried back in solemnity and silence to his bed.” Lastly, he was subjected to the sound of their dying groans as they suffered the final throes of what was almost certainly their end.
As horrible as these hospitals were, it was not easy gaining entry to one. Throughout the nineteenth century, almost all the hospitals in London except the Royal Free controlled inpatient admission through a system of ticketing. One could obtain a ticket from one of the hospital’s “subscribers,” who had paid an annual fee in exchange for the right to recommend patients to the hospital and vote in elections of medical staff. Securing a ticket required tireless soliciting on the part of potential patients, who might spend days waiting and calling on the servants of subscribers and begging their way into the hospital. Some hospitals only admitted patients who brought with them money to cover their almost inevitable burial. Others, like St. Thomas’ in London, charged double if the person in question was deemed “foul” by the admissions officer.
Before germs and antisepsis were fully understood, remedies for hospital squalor were hard to come by. The obstetrician James Y. Simpson suggested an almost-fatalistic approach to the problem. If cross-contamination could not be controlled, he argued, then hospitals should be periodically destroyed and built anew. Another surgeon voiced a similar view. “Once a hospital has become incurably pyemia-stricken, it is impossible to disinfect it by any known hygienic means, as it would to disinfect an old cheese of the maggots which have been generated in it,” he wrote. There was only one solution: the wholesale “demolition of the infected fabric.”
To read more about 19th-century hospitals and Joseph Lister’s antiseptic revolution, pre-order my book THE BUTCHERING ART by clicking here. Pre-orders are incredibly helpful to new authors . Info on how to order foreign editions coming soon. Your support is greatly appreciated.
1. Adrian Teal, The Gin Lane Gazette (London: Unbound, 2014).
2. F. B. Smith, The People’s Health 1830-1910 (London: Croom Helm, 1979), 262.
3. John Bell, The Principles of Surgery, Vol. III (1808), 293.
4. Elisabeth Bennion, Antique Medical Instruments (Berkeley: University of California Press, 1979), 13.
5. John Eric Erichsen, On Hospitalism and the Causes of Death after Operations (London: Longmans, Green, and Co., 1874), 98.
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.