A Popular History of Unpopular Things
A podcast that makes history more fun and accessible - we love all things gory, gross, mysterious, and weird!
A Popular History of Unpopular Things
The Victorian Houses of Death
Join Kelli as she talks about Victorian-era hospitals in London, known as the Houses of Death because of their fatality rates. These were the most unsanitary of places, and today we'll go into all the nitty-gritty details of what they looked like. We'll also learn about some of the gross surgeries that went on inside Houses of Death before going over how they changed with the advent of anesthetics and antiseptics.
Buckle up, this one is pretty gross. But hey - at least you get a break from cannibalism this week. No promises for the next topic ;)
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The Victorian Houses of Death\
Intro
Welcome to A Popular History of Unpopular Things, a mostly scripted podcast that makes history more fun and accessible. My kind of history is the unpopular stuff - disease, death, and destruction. I like learning about all things bloody, gross, mysterious, and weird.
Just a quick reminder that you can support me and the show on Patreon, just look up either A Popular History of Unpopular Things or APHOUT: A-P-H-O-U-T. And you can also now watch episodes on YouTube - so go subscribe to my channel there! I appreciate all the love and support :)
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So those of you who know me, were ever my students, or have listened to enough of my episodes, may know that my “thing” is disease history. I’ve always gravitated towards it - I’m not quite sure why, but it’s my thing. I love it. My favorite disease is of course the Black Death, but I’m saving that for a special episode coming up.
But my next favorite thing is probably disease in 19th century London, that’s the 1800s, because it was just so gross. I mean you’ve got cholera, gross poop water, sewage everywhere, a few crusaders trying to make germ theory a thing, the invention of things like antiseptics, the gradual use of anesthetics… It was a big century for medical advancement, which of course changed the face of disease history forever.
So in today’s episode, I want to talk about the Victorian Houses of Death - a fun name for hospitals in Britain, particularly London. You might think - but hey, Kelli, if it’s a hospital, it shouldn’t be a house of DEATH, right? Well no, my friend. The hospitals of nineteenth century Britain were not places you’d want to end up. They were infection factories. Imagine blood crusted surgeons, dirty tools, nary a washed hand in the place… the smell of sepsis, pus, death, and putrefaction lingering in every room, spectators crammed in to watch the morbid spectacle of a poor, unfortunate patient who would most likely die of postoperative infection. Limbs being sawn off. Surgeons ripping into your flesh with dirty knives, priding themselves on how quickly they could do a procedure, barely wiping down the bloodstained wooden operating table before restraining the next patient.
And like I said before, this was a time before anesthetics and antiseptics… meaning there was nothing to dull the pain, and nothing to prevent infection from setting in.
Would you want your leg sawn off, while still awake, without any pain meds, and no antibiotics to prevent infection afterwards? No. No you wouldn’t. But that is precisely what happened in the operating theater of the Victorian-era hospital. The House of Death.
So in today’s episode, we’re going to get gritty and gross. First, I’ve dive into the historical context needed to understand why this ended up becoming a turning point in the medical world - how did medicine get to this state? What kind of medicine did these surgeons practice? If you listened to my episode on either Corpse Medicine or the London Cholera epidemic, then you might already be up-to-date on this context. But it’s still important to understand the world of 19th century Victorian medicine before we go over some of the more disgusting and infamous stories from the time.
Then, once that’s all squared away, we’ll take a look at how and why things changed, and how we ushered in… cleaner times. We’ll talk about things like the earliest anesthetics and antiseptics. Germ theory. The melding of scientific advancements and the medical world. And ultimately, I think we’ll all be glad we’ll never have to see the inside of a Victorian House of Death.
And a generalized content warning, if you couldn’t already tell… this episode is pretty gory and gross.
So let’s get started!
Historical Context
Medicine in the beginning of the 19th century, that’s the 1800s, looked very different from the end of the 19th century. By the end, we’ve got anesthetics, antiseptics, we knew more about germ theory and how diseases spread… but in the beginning, none of that. In the beginning of the 19th century, medicine was still primarily based on the four humors and miasma theory.
Let’s talk about the four humors first.
The idea first came from the classical Greeks. Hippocrates, some time in the 5th to 4th centuries BCE, that’s the 400s to 300s, came up with the idea of four humors that govern your body’s internal homeostasis, emotions, and behaviors. From there, Galen expanded on the theory to explain how one might balance the humors to cure sickness.
The four humors are blood, yellow bile, black bile, and phlegm. I went into them in more detail in the episode on Corpse Medicine, so go listen to that one if you want a more in-depth explanation of how they all worked. But the general idea here is that when you are sick, one of those humors is out of balance. If you had a fever and a cough, your yellow bile was out of balance. To cure this, you focus on the opposite humor, which is phlegm. Yellow bile was considered hot and dry, and phlegm was cold and wet. So if you present with “hot and dry” symptoms, cure yourself with “cold and wet” - a cold bath, perhaps. Which would help a fever, and it’s happy accidents like this that are part of the reason the four humors theory went on for so long.
The four humors theory carried on through the Arab world in the 9th century, then into Europe in the 11th century and throughout the Medieval period. And it carried on through the early modern period, and into the industrial period. It was only in the mid-19th century when this was challenged. And a big part of why was the introduction of germ theory - the identification and belief of microorganisms as the reason for diseases and how they spread. But before this, the medical world believed in the miasma theory.
Miasma is essentially… bad air. Like walking around a big city and smelling the raw sewage, dirt, filth… that’s “miasma.” And they believed that the miasma was responsible for disease. It stems all the way back to Hippocrates again, so it’s tied to the four humors. And we know that’s not how science works, right? You don’t get sick because the air is stinky. And stinky air doesn’t cause one of your four “humors” to go unbalanced. You get sick because you came in contact with a microorganism, either bacterial or viral, that your body now has to fight off. And in fighting the germ off, your body will crank up the heat and cause a fever, or you might experience inflammation, right?
But these theories persisted for so long because it kinda could be attributed to what was happening. So for example. Let’s say you are down on your luck and living in squalor in Victorian England. Maybe you live in a Dickensian workhouse, which is the worst place to be - go listen to my episode on Jack the Ripper for more information on that. So you live in a dirty, run-down area. There are fleas everywhere, dirt on the streets, pots of urine and feces tipped over in the middle of the road, animal dung, rats… you get the picture. And the workhouse where you live and work is just an extension of this. Dark, dingy, nasty. You could imagine that people there smell “miasma” on the regular, right? It must reek. And when people got sick, then they were like well yeah, that makes sense, miasma. It smells rotten there, so people are getting sick from smelling it. But in reality, it’s not the smell that’s making people sick, it’s the source of the smell - germs, microorganisms, disease. But since we can’t see germs, we can’t see microorganisms with the naked eye, we didn’t really have the knowledge to believe anything different. All people knew was that where miasma persisted, people were often sick. So therefore, it must be the miasma.
And that is the world at the heart of today’s story. And I’ll be pretty much focusing on London here, but most Western cities operated in this way, with the belief in miasma theory and the four humors. And as such, medicine and surgery were not… super great. Because people didn’t understand about germs, they weren’t super paranoid about cleanliness in hospitals. They didn’t have the knowledge or science to understand that the dirty, blood-encrusted knife that you just used on Joe over there is covered in germs, and by not washing and sanitizing it, you are spreading Joe’s germs to Bob, and those germs will likely kill him with a post-op infection.
Now one more thing I want to talk about before we get into the Houses of Death themselves - how the medical world was structured.
At the top of the medical hierarchy were the doctors and physicians. They didn’t really treat patients all that much - they were in the upper echelons of society. They sat around and theorized a lot about what was wrong, and oftentimes would diagnose a patient without seeing them. Or they would visit a patient at home, listen to their ailments, and prescribe a treatment. They didn’t really get their hands dirty all too often.
It was the surgeons who got their hands dirty. Surgeons were trained through apprenticeships, and for a good chunk of the early modern period and the early industrial age, they didn’t necessarily go to medical school. This started to change in the first part of the 19th century. But traditionally, they were given on-the-job training as an apprentice. As Lindsey Fitzharris writes in her book, The Butchering Art, quote,
“The surgeon was very much viewed as a manual laborer who used his hands to make a living, much like… a plumber today. Before 1848, no major hospital had a salaried surgeon on its staff, and most surgeons (with the exception of a notable few) made very little money from their private practice.” End quote.
They were the butchers - the ones going in and amputating limbs, or ripping out teeth. Or removing things like kidney stones… by cutting into the bladder. And BOY do I have a disgusting story to share later that will make the men listening to this podcast cringe. For real. It’s… well you’ll see.
Underneath the surgeons were the apothecaries, the ones who mixed and dispensed drugs and medicines. We’d call them a pharmacist. But you still hear “apothecary” being used a lot in Europe. But a lot of the drugs in the early 19th century were pretty toxic, and included things like mercury. Which is bad. So oftentimes the drugs made things worse in the long run.
And then you might have a hybrid underneath that - the surgeon-apothecary - which is kind of like today’s general practitioner. The woman you might see at the urgent care place when you need to be seen and treated quickly, get a prescription for antibiotics, and move on.
Oh, this is a good time for a public service announcement - you only need to take antibiotics to cure bacterial infections. They don’t work on viruses. You shouldn't take them if you don’t have a bacterial infection, because they won’t work well over time and your body might become immune to it. And, if you are prescribed antibiotics, you need to take the entire course, because otherwise the bacterial infection might not go away, and it might come back and be more resistant to antibiotics. So, just… be safe out there.
But over time, starting in 1815, surgeons went from poorly trained technicians ripping into flesh to modern surgical specialists. They were required to go to medical school, attend lectures, work in hospitals and get some hours in, do professional studies and clinical work… you know, be educated properly. And eventually, change would come, and things would get more sanitary. But before the medical world cleans up, hospitals were the most dangerous places to be treated. You’d be 3-5 times more likely to die in hospital than you would if you were being treated at home. They were dwellings of disease, mainstays of miasma, bastions of blood… houses of death.
The Houses of Death
So one guy I want to talk about in particular is Robert Liston, known as the fastest knife in the West End. Liston was a surgeon who towered over his peers at 6 feet 2 inches. And he was probably the most famous surgeon of his day because of his incredible knife skills; he was known for completing above-the-knee amputations in less than thirty seconds. And that’s from the initial incision to the sutures. Take a second to think about that - an entire amputation with sutures to seal it off in thirty seconds or less. That’s… I don’t know whether to be impressed or horrified. And I’m not just taking a stab here, he’d tell his medical students, quote, “Time me Gentlemen! Time me!”
So here are some stories associated with Robert Liston, the fastest knife in the West End. And I’ll give you a general warning here in case you’re listening to this with kids in the car - there’s a lot of mention of men’s anatomy coming up, okay? Just… so you know.
So let’s get right to the meat of that then - once, he sliced off a man’s testicles while doing a leg amputation because he was moving so quickly.
Another time - and this one is somehow even worse, and will make all the men listening to this really, really uncomfortable - he was removing a man’s bladder stone. First, he strapped the guy to the wooden operating table, because he was absolutely terrified and didn’t want to be there. Which is fair enough. And I’m mentioning wooden table on purpose because can you imagine how stained and germy a wooden operating table must have been? So since the stone was in the bladder, Liston was going to need to cut into the bladder to retrieve it. But he didn’t want to sever the intestines or any of the important bits down there, so he needed a guide rod to get him directly to the bladder. A guide rod in the form of a curved metal tube fed up the poor guy’s penis. He then inserted a finger into the rectum to feel for the stone, and once located, he pulled out the metal rod and replaced it with a wooden one. Inserted in the same way. This was another guide rod - a wooden one - that would make sure he didn’t cut too deep into the bladder and rupture everything else in there.
So once that wooden rod - and I’m repeating that over and over because can you imagine the potential splinters and micro cuts? - was inserted, Liston cut through the scrotum until he hit the rod. Then he used a probe to widen the hole he made in the scrotum - but in doing so, he ripped open the prostate gland. But he was able to get into the bladder, so he pulled the wooden penis rod out, took a pair of forceps, and removed the bladder stone. Then he stitched everything up.
All of this was done in sixty seconds.
Let’s just take a moment to think about that entire process happening fast enough to be done in sixty seconds. Metal guide rod in. Metal rod out. Wooden rod in. Cut through the scrotum. Slice the prostate. Widen the incision. Wooden rod out. Forceps in. Bladder stone out. Stitch it all up.
No anesthesia. No antiseptic. No antibiotics.
*Shudders*
And one last quick story - Robert Liston is known as the man who once had a 300% fatality rate during one surgery; according to the legend, he was moving his knife so quickly during an amputation that he sliced off three of his assistant’s fingers. He also sliced the shirt front of a spectator. The patient and the assistant both died of gangrene, and the spectator died of shock; three deaths during one man’s surgery. And the whole thing was only 2.5 minutes long. And while this is the most famous story told in association with the fastest knife in the West End, I’m not sure where the sourcing comes from. I did some digging, and the story appears in a book by Richard Gordon in a 1983 book titled “Great Medical Disasters,” but no contemporary primary sources can corroborate this. As far as I’m aware.
So these stories give us an idea of how terrifying the Houses of Death must have been. But according to Andrew Jones, Robert Nesbit, and Steven Holsten, in an article in the American College of Surgeons, Liston - for all his speed - was actually relatively clean compared to other surgeons. They wrote, quote,
“He was one of the few surgeons known to wash his hands prior to an operation… He always wore a clean apron for each operation, counter to the common practice of wearing the same apron caked with blood, pus, and filth as evidence of ability and experience.
He shaved surgical sites prior to incision, a practice recognized only within the past decades to increase the risk of surgical site infections. Surgical sponges had to be clean. His dressings were soaked with cold water only, not the salves and other nostrums that often harbored infection.” End quote.
But despite these precautions, many of his patients died too. Germs and post-op infections were the main killers. And these hospitals were absolute breeding grounds for illness. Like I said earlier - they were bloodstained, crusty, covered in germs, and stank of death. It was the absolute worst place to be if you were sick and needed a procedure done. I mean they even kept sawdust around the table to soak up the excess blood!
And it’s not like the surgeons didn’t know how dangerous these surgeries were. And that’s part of the reason why Liston worked so quickly - a fast operation meant less time exposed, and less blood loss. And since patients didn’t get any painkillers or anesthetics, then a faster procedure would also benefit the patient.
But things would start to change during Robert Liston’s career as the fastest knife in the West End with the introduction of ether as an anesthetic.
Anesthetics, Antiseptics and Germ Theory
Other than the whole 300% fatality rate story, Liston’s other really famous surgery took place on December 21st, 1846 at the University College Hospital in London. The first surgery in Britain that used ether.
According to Dr. Fitzharris, ether was discovered in 1275 but wasn’t used for its anesthetic properties until 1540 by a German botanist. From there, Paracelsus experimented with ether on chickens, noting that it knocked them out but didn’t hurt them. And if Paracelsus sounds familiar, I mentioned him originally in my episode on Corpse Medicine and again on the Dancing Plague in Strasbourg, 1518! Those came out back in early 2023, so if you’re new, you might have missed them. Go check those out!
The first use on a person was in the US by Crawford Williamson Long - a dentist who extracted a tooth while the person was given ether. And once this first trial was successful, Liston decided to try it on one of his patients.
The man in question was Frederick Churchill, a butler with a bone infection - chronic osteomyelitis of the tibia. He’d seen Liston several times before the surgery in question. In one of those, Liston opened him up and poked around inside the leg, but that just caused more infection, so he needed an amputation. After Liston’s assistant knocked him out with the ether, he yelled out “Now, gentlemen, time me!” and got to work. It took only 28 seconds to amputate and suture the now-amputated limb. And the timing by itself is incredible, but the people watching were used to the quick timing. What was more impressive was that Churchill didn’t wake up during surgery. He wasn’t screaming in pain. Reportedly, when he did come to, he asked when the surgery would begin!
Now sitting in the audience of this surgery was an aspiring medical student named Robert Lister. Does his name sound like something? Lister? Listerine?
Joseph Lister was impressed by the anesthetic, but was more interested in the post-operative infections that killed a good chunk of patients. The age of pain was over with the invention and efficacy of ether, but that didn’t stop people from getting and dying from infections.
In fact, death by post-op infection got worse for two decades after ether was first used. As Fitzharris puts it, quote,
“With their newfound confidence about operating without inflicting pain, surgeons became ever more willing to take up the knife, driving up the incidences of postoperative infection and shock.”
Surgeons were still using the same instruments on each patient without cleaning them, spreading infection from one person to another. And this is what Joseph Lister focused on - how to reduce the rate of infection and the spread of that infection.
I also have to mention that there was a huge cholera outbreak in the years after ether but before antiseptics, which also contributed to the rising death rates in London. The whole John Snow Broad Street Pump story was in the mid 1850’s, so that’s right in there too. If we take a step back and place this in context, the London cholera outbreak of 1854 also raised a lot of questions about the origin and spread of disease. If you haven’t listened to my episode on that, go have a listen! That was a fun one. I like disease.
In the decade after cholera, and two decades after the first use of ether as an anesthetic, we finally see the first antiseptics on the scene in London. But we actually have to go back to a scientist named Louis Pasteur if we’re talking antiseptics now. Louis Pasteur might sound familiar because he pioneered the process of pasteurization - heating liquids to a high temperature to kill off any bacteria, then cooling it. It’s what happens to most milks, right? But he was also a big proponent of germ theory - the idea that microorganisms cause disease, not miasma. And so, Pasteur spent his scientific career focusing on microbiology. He’s also known for the rabies vaccine and the vaccine for anthrax - not the band - so thanks Louis Pasteur!
After his study of antiseptics, he determined that washing wounds with carbolic acid helped kill the microorganisms that cause disease. He then recommended that surgeons wash their hands, clean their instruments, and do their best not to bring microorganisms from one patient to another.
Building off of this, Joseph Lister helped pioneer carbolic acid, in the form of phenol, as a disinfectant. By using phenol to clean off instruments, wipe down the operating table and other things in the surgical room, and even soak bandages that would cover up wounds, Lister was able to help reduce the rate of postoperative deaths. By 1910, mortality rates from post-op infections fell from 40% to only 3%; this helped prove germ theory and show that it was, in fact, microorganisms causing disease. And by killing off the bad germs with antiseptics, cleaning instruments, washing hands, and treating bandages, it was possible to keep more patients alive.
Thank goodness for that. I’m so glad we live in the 21st century and not the 19th century.
Outro
Thanks for joining me for this episode of A Popular History of Unpopular Things. My name is Kelli Beard, and I hope you’ve enjoyed the story of The Victorian Houses of Death. Thank you for supporting my podcast, and if you haven’t already checked out my other episodes, go have a listen!
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