EDINBURGH’S old nickname was justified: Auld Reekie did smell dreadful. At the same time, overcrowding and appalling sanitary conditions meant disease was rife, so it’s little wonder the population believed infections were spread by polluted air, or “miasma”.

Therefore it’s fitting that Joseph Lister, the great Victorian doctor who made surgery safe through antiseptics, and who proved disease was spread by germs not poisonous air, made his name in Edinburgh.

He was a London medical student in the 1840s, those grim days when a surgeon was little more than a suave butcher. This was the age of “medical voyeurism”, where crowds would push into the operating theatre to watch the surgeon at work, the horrified audience gasping and fainting as limbs thumped to the floor. The surgeon was a performer with a flashing blade.

In this book, a biography of Lister which also embraces popular science and colourful history, Fitzharris takes on the role of those old theatrical butchers. She is an aficionado of agony, titillating the reader with monstrous anecdotes, and, like the Victorian audience, her readers will be both fascinated and appalled. With relentless descriptions of brutal surgery, the pages begin to feel warm and wet with blood.

The horror of surgery eased in 1846 when Robert Liston discovered ether, allowing patients to be anaesthetised. “The age of agony was nearing its end”. Before anaesthesia, Liston “had learned to steel himself against the cries and protests of those strapped to the blood-spattered operating table.” One terrified patient fled the theatre and locked himself in a lavatory. Liston “broke the door down and dragged the screaming patient back to the operating room”.

People were right to be scared. Before Lister introduced hygiene and antiseptics, surgery was dirty and performed only in desperation. “The surgeon, wearing a blood encrusted apron, rarely washed his hands or his instruments and carried with him into the theatre the unmistakeable smell of rotting flesh — also known in the profession as “good old hospital stink”.

Despite being an advance, anaesthesia initially made operations more dangerous by emboldening the surgeon, and if pain had been vanquished, filth had not. Hospitals remained “houses of death”. Surgeons practised their techniques in dissection rooms with “rats nibbling on bleeding vertebrae and the swarms of sparrows pecking at the leftover scraps of spongy lung tissue”, and when the patient was put to bed he might find mushrooms sprouting in the damp, soiled sheets. Even if they survived the grubby surgery a patient was likely to fall victim to “hospitalism”: infectious disease like pyemia, gangrene and erysipelas.

Why were patients dying, asked Lister? An operation might be a success and yet, days later, the invalid would succumb to disease. Where were these “hospitalisms” coming from? Lister noted that a fracture might heal easily, but if the injury was such that the bone pierced the skin then infection usually followed, so perhaps something was entering the wound? Was it “poison in the air”?

Lister, energised by Pasteur’s new “germ theory”, advocated cleanliness but soon realised good hygiene couldn’t prevent germs entering a wound, so he focused instead on killing them before they could start an infection. He just needed to find the right antiseptic, and finally settled on carbolic acid which was then being used to control the smell of rotting rubbish in Carlisle.

His first successful use was in 1865 where he treated a young boy called James Greenlees whose leg had been crushed on a Glasgow street. He cleaned the wound, soaked it in carbolic acid, then covered it with a tin cap to prevent the antiseptic from evaporating. To his joy, no infection occurred and the young boy’s life and leg were saved.

Despite his success, the London medical establishment was frosty. If Lister, and his ideas on germs, were correct then great surgeons had been “inadvertently killing patients by allowing wounds to become infected with tiny, invisible creatures”.

We’re lucky that Lister did his great work in Scotland which was more tolerant of experimentation, joining the Edinburgh Royal Infirmary in 1853, and then Glasgow’s Royal in 1861. Despite sneers at “the semi-scientific Scotch”, the system in Scotland was conducive to research as Glasgow and Edinburgh had one large hospital each, both tied to their universities as teaching hospitals, whereas the London medical community was fragmented. Also, dreadful as it may seem, Edinburgh’s “body snatchers” meant her surgeons were able to gain “an enviable global reputation for trailblazing surgery”.

This is a lively read, constantly entertaining, and although the writing is often florid (“When other surgeons refused to operate, the Scotsman was at hand with his knife poised”) the literary ostentation suits the book because Fitzharris is an unapologetic showman. I imagine her as a ringmaster, inviting us to roll up and read if we dare.

The Butchering Art: Joseph Lister’s Quest to Transform the Brutal World of Victorian Medicine by Lindsey Fitzharris is published by Allen Lane, priced £16.99