In the mid-19th century, hospitals in Britain were widely feared as places where patients went to die rather than recover. Before the acceptance of germ theory, Victorian medicine operated within a framework that misunderstood the true causes of infection. As a result, sanitation procedures were largely nonexistent: Surgeons did not wash their hands, instruments were never sterilized, and surgeons’ bloodstained clothing was not washed. This idea is best encapsulated by the idea of “hospitalism,” which The Butchering Art describes as the “four major infections that plagued hospitals in the 19th century” (erysipelas, gangrene, septicemia, and pyemia) whose presence were “increasingly blamed on the establishment of large urban hospitals wherein patients found themselves in close contact with one another” (53). In other words, conditions were so dire within hospitals that they became defined by the diseases they created and cultivated. Often, these diseases were significantly worse than the conditions people were hospitalized for, creating a distrust in hospital care and a crisis surrounding the care they were supposed to administer.

These hospital conditions were part of a much broader public health crisis. Britain’s rapid and largely unregulated industrialization during the early to mid-1800s transformed cities such as London, Glasgow, and Edinburgh into densely populated industrial centers. Factories burned enormous quantities of coal, releasing soot and sulfur dioxide into the atmosphere and producing the thick smog that stood over cities. Coal also powered domestic heating, meaning that pollution even came from private homes. During the 1800s, statistics show the drastic increase in the use of coal, noting its increase from “2,985,000 tons of coal” in the 1700s “to 21 million tons by 1890,” largely due to “new technologies along with market forces” (Basdeo, Stephen. “Old King Coal.” VictorianWeb.org, 19 Jan 2023). Sanitation infrastructure lagged behind population growth, allowing human and animal waste to accumulate in streets or drain into rivers that doubled as sources of drinking water. The River Thames became so polluted that the summer of 1858 produced the infamous “Great Stink,” a colloquial name for the overwhelming stench and pollution that had become commonplace along the banks of the river. The combination of industrial pollution, inadequate sewage systems, and overcrowded housing created an environment in which infectious disease flourished, both inside and outside hospital walls.

The dangers of this environment are central to Fitzharris’s narrative. Lister witnesses reeking operating theaters and deadly erysipelas outbreaks at University College Hospital, and he later confronts persistently “unhealthy” (139) surgical wards in Glasgow situated next to a graveyard. These experiences fuel his progression from simple “cleanliness and cold water” (145) tactics to a scientifically grounded antiseptic system. While previous methods like occlusion dressings failed to curb infection, Lister’s carbolic acid regimen eventually eliminated pyemia and gangrene from his wards. His work thus provided the crucial clinical counterpart to civic sanitation, tackling the microbial threats at the patient’s bedside that broader sanitary engineering could not reach. Placing Lister’s work against the backdrop of hospitalism and sanitary issues in Victorian England explains why antisepsis represented more than a technical improvement; it marked a turning point in the relationship between medicine, science, and public health.