Lister's Work Research Articles

The Public Health Leader Who Brought Antisepsis to William Halsted.

William Halsted wrote to aging surgeon, Stephen Smith, in 1919, that he remembered the lessons Smith had taught him, "when I walked with you through the wards of Bellevue Hospital." Smith was an early advocate of Joseph Lister's antiseptic method, and because of his public health work, he was also an early advocate of environmental hygiene and microbial control based on the unproved germ theory. While Lister's work at the time emphasized germ-killing around the operative site with carbolic acid (antisepsis), Smith adopted and encouraged surgical practices at Bellevue that would be hallmarks of the germ-preventing (asepsis) surgical approach that fully developed after German bacteriologic discoveries in the mid-1880s, and with which Halsted is historically identified. Some physicians and historians have emphasized temporal and conceptual differences between Lister's antisepsis and German asepsis, but Smith and Halsted's experiences argue that surgical asepsis was the evolutionary outcome of germ theory-based surgical changes that began well before scientific proof arrived.

George Hogarth Pringle and the mystery of the first antiseptic operation in Australia.

George Hogarth Pringle, later an associate of Joseph Lister, was born in Kintail, Scotland in 1830. In 1854, he worked as a dresser at the Royal Infirmary, Edinburgh with Joseph Lister. After serving in the Crimean War, he settled in New South Wales and began practice in Parramatta. In October 1867, Pringle performed the first operation in Australia using the antiseptic principles advocated 6 months previously in the first of a series of articles published in The Lancet by Joseph Lister. Mystery surrounds how Pringle was able to adopt Lister's principles so quickly. Lister and Pringle had been friends in Edinburgh and previous writers have hypothesized that the two men corresponded whilst another has suggested Pringle was using antiseptic principles prior to Lister's work being published. Both these scenarios are unlikely. The Lancet appears to have been available in Australia within 4 months of publication. The conjunction of an appropriate case and the arrival of a recent copy of The Lancet highlighting Lister's work is the likely source of Pringle's decision to apply antiseptic principles.

Illustrating microorganisms: Sir William Watson Cheyne (1852-1932) and bacteriology.

Sir William Watson Cheyne is largely known to medical history as Lord Lister's 'trusted assistant'.1 He spent a lifetime defending Joseph Lister's (1827-1912) antiseptic principle in the wake of scepticism and misunderstanding. However, his main contribution to Lister's work was in the embryonic field of bacteriology in the 1870s-1890s, which brought him into contact with continental researchers, particularly Robert Koch (1843-1910). In this field, Cheyne built an independent reputation as an assessor, chronicler and promoter of continental laboratory methodology. He pioneered bacteriological training in British teaching hospitals and incorporated laboratory testing into case notes as standard procedure. This paper reconsiders Cheyne's contribution to the development of bacteriology in British medicine at the end of the 19th century. It examines his motives in promoting new laboratory techniques and the methods he used to embed them in hospital procedure. It also considers how he continued to use bacteriological arguments to keep the Listerian antiseptic principle on the medical agenda well after Lister withdrew from active involvement in the field.

Lister's relationship with patients: 'A successful case'

An important aspect of Joseph Lister's work that has received relatively little attention is his relationship with patients. However, a manuscript written by one of his patients, Margaret Mathewson's ‘A Sketch of Eight Months a patient, in the Royal Infirmary of Edinburgh, A.D. 1877’, provides detail about the surgeon as seen ‘from below’—that is, by a charity patient. Although excerpts from Mathewson's ‘Sketch’ have previously been published, an earlier version of the ‘Sketch’ has only recently been identified as such. That earlier version represents Lister not only as actively concerned with patient education, but also as strongly supportive of patients' rights, encouraging ward patients to report maltreatment at the hands of the staff.

Joseph Lister and the performance of antiseptic surgery

This article highlights a neglected feature of Joseph Lister's work, namely how, in addition to promoting germ theories and the principles of the antiseptic system, he also devoted much time and effort to communicating the performative aspects of antisepsis and of the many other surgical innovations that he developed. Attention to ‘detail’ and striving for ‘improvement’ were crucial to Listerian practice, and he sought to convey his credo in three main ways: first, his publications aimed at ‘bringing the subject out in the same sort of way as it had been worked out by himself’; second, he set out strict protocols and information on materials and methods, yet also encouraged surgeons to improvise; and third, he made himself an exemplar of a new form of professionalism, which made constancy and vigilance in practice a moral duty for surgeons.

Causation and Cleanliness: George Callender, Wounds, and the Debates over Listerism

This article reexamines the surgical and historiographic debate over antisepsis and the germ theory through the work of the prominent London surgeon George W. Callender (1830-1879) and the statistical records of St. Bartholomew's Hospital. Surgeons in the mid-nineteenth century faced a rising incidence of wound infection and its systemic complications. Examining mortality and complication rates by type of wound, however, suggests that the extent of this crisis is often overstated. Callender himself occupied a frequently overlooked middle ground in the debate over Listerism. On the one hand, his program of cleanliness, which antedated Lister's work and extended from the wound to the ward, produced excellent and influential results. On the other, while he was never an explicit critic of the germ theory, his writings demonstrate why Lister's collapse of causation into a single etiologic agent was so difficult for surgeons to accept.

Two Views : Bad Medicine: Doctors Doing Harm Since Hippocrates

Reviewed by: Two Views: Bad Medicine: Doctors Doing Harm Since Hippocrates Jeffrey P. Brosco Two Views: Bad Medicine: Doctors Doing Harm Since Hippocrates. By David Wootton (Oxford: Oxford University Press, 2006. xvi plus 320 pp. $25.00). 1. An ancient theme in the history of medicine is the story of the enlightened physician overcoming ignorant and stubborn colleagues. In the mid 20th century a few scholars began to use history of medicine to understand broader social and political issues, and today most professional historians eschew simple tales of progress. David Wootton, a professor of history, seeks to revive the progress narrative but focus on physicians' mistakes in order to improve today's medical practice. He fails on all counts. Wootton argues that modern medicine began in 1865 when English surgeon Joseph Lister used antisepsis to improve outcomes. By applying germ theory to medical practice, Lister finally fused science and practice to prolong life. Wootton frequently reminds us that the microscope and germ theories were available for 200 years before Lister, so generations of physicians and scientists deserve our scorn: "the whole of medicine before 1865 was caught up in a fantasy world" (12). There's trouble with this approach from the beginning, as Wootton doesn't keep his pledge to judge doctors based on therapeutic effectiveness. Hippocrates may have been able to set bones and lance boils, but his fantastic theory of humors apparently cancels out credit for any effective manual interventions. Similarly, battling wounds with an alcohol-containing substance was merely good luck, given ancient physicians' ignorance of bacterial causes of infection. Later heroes in the usual histories of medicine similarly deserve no praise. Supporters of William Jenner's smallpox vaccine did not publicize the risks of vaccination, and scholars discovering scurvy took too long to understand their results and disseminate their work. What accounts for the longevity of the "fantasy world" that enveloped medi- cine before 1865? Wootton tells us that it was culture, which he explains this way: "the medical profession had set its face against the new research" (135). Wootton never defines "culture" more precisely, except to say that the "best doctors and best scientists failed to acknowledge the importance of the microscope" (240). In the closest Wootton comes to providing evidence for this explanation, we learn that medical authorities finally accepted John Snow's ideas about contagion because "intellectual fashions had changed against miasmatic theories" (210). Later in the book Wootton suggests that "germ theory succeeded... because it demonstrated a capacity to prolong life" (255-56). He offers no proof other [End Page 481] than Lister's case series of surgical successes in the 1860s. But Lister's work did not include a randomized, controlled clinical trial, the standard which Wootton applies throughout the book. (At one point Wootton tells us that "Homeopathy, we can be sure, would have outperformed Hippocratic medicine in a trial" p.68-69.) The Lister thesis has other problems as well. It turns out that Lister himself operated in a frock coat that carried infection, and that he probably didn't have "the slightest idea as to how to implement" a policy of asepsis (227). Wootton further suggests that English doctors didn't generally act on Lister's work until after 1935, and the French were completely lost: "without the discovery of diphtheria serum [in 1894] it is perfectly possible to imagine germ theory continuing to develop in opposition to French medicine, not within it" (255). So why does Lister get credit for something he didn't prove and many didn't follow? If merely putting germ theory together with a change in therapeutics gets the palm, then Wootton should instead highlight the Italian physicians who stopped blood-letting in the late 1600s based on their ideas of contagion. But Wootton apparently prefers slander to logic. Wootton alleges that "millions of lives could have been saved" if only Alexander Fleming had followed through on the implications of penicillin in 1929 (246-47). Two paragraphs later we learn that Lister himself apparently saved the life of his nurse with a penicillin-like substance in 1884 but decided not to pursue the therapy. Wootton doesn't seem to recognize that Lister is...

Martin Lister (1639–1712) and Fools' Gold

Seventeenth-century physician Martin Lister is best known for his work in natural history and participation in the early Royal Society. However, little attention has been focused upon Lister's work in chemistry, the most salient examples being his analysis of pyrites or “fools' gold” near mineral springs in the De Fontibus medicatis Angliae Exercitatio of 1684 (Exercises on the healing springs of England), his contributions to the Philosophical Transactions in the 1670s and 1680s, and his unpublished manuscript “A Method for the History of Iron, Imperfect.” He defined pyrites more specifically as “ironstone marcasites” which were “nothing else but a body of iron disguised under a vitriolic varnish”; “vitriol” referred to iron (II) sulfate which occurred as a weathering product of pyrites. This paper demonstrates that an understanding of Lister's work on pyrites and vitriol is best attained by placing him in the intellectual context of the seventeenth-century chemical debate about minerallogenesis. Lister believed that the volatile exhalations of pyrites and its vitriol in the air were important in the transformation of matter, and he subscribed to the sixteenth- and seventeenth-century theory of witterung (weathering) or ore exhalations as an explanation for the formation of minerals. Despite his allegiance to the theories of witterung, I will illustrate that Lister made use of his interests in natural history to go one step beyond them, postulating that the sulfurous exhalations from pyrites were responsible for the heating of hot springs, as well as meteorological and geological effects.

Leslie Klenerman (ed.), The evolution of orthopaedic surgery, London, Royal Society of Medicine Press, 2002, pp. x, 246, illus. £20.00 (paperback 1-85315-469-5).

This volume, edited by an orthopaedic surgeon, contains contributions from fellow surgeons as well as practitioners of neighbouring fields such as radiology and engineering. The chapters are organized into four sections: after a survey chapter on orthopaedic surgery from the eighteenth to the twentieth century, section one on ‘Major advances in the twentieth century’ deals with arthroplasty of the hip and the knee, arthroscopic surgery and orthopaedic trauma. The second section, entitled ‘The scientific background’, contains chapters on biomechanics, biomaterials, and orthopaedic radiology, whereas the third section under the title ‘Fragmentation of orthopaedic surgery’ covers various specialized subfields, such as hand and spine surgery. The last section consists of only one chapter, ‘Orthopaedics in 2050’, and is devoted to the field's future. The editor and authors have clearly spent a lot of time and energy on this book, their specialized knowledge and experience being an invaluable resource. The amount of material accumulated is daunting, the degree of medical expertise used to evaluate it impressive. Medical historians who are interested in the technical aspects of orthopaedic surgery will thus be delighted to find so many useful leads collected in one place. However, doctors are not historians and one should not expect this book to meet the standards of professional historical practice. Problems arise when the authors depart from their fields of expertise and turn to more general historical subjects. This is most obvious in the survey chapter, which contains a number of factual errors and historical misjudgements. Thus, the importance of Lister's work does not really lie in the application of Pasteur's discoveries, nor was Johannes Muller the founder of scientific medicine in Germany. In both instances it is easy to see how the misconceptions came about and how they could have been prevented by a conversation with a medical historian. Similarly, consultation of an expert in medical history could have steered the authors away from their reliance on encyclopaedia articles and general textbook chapters toward relevant literature on the subject. To mention one example, Roger Cooter's seminal work on Surgery and society in peace and war: orthopaedics and the organization of modern medicine, 1880–1948 (Basingstoke, 1993) is not quoted anywhere in the volume. The evolution of orthopaedic surgery shows the degree to which historians and medical practitioners live in different intellectual worlds. Like most medical practitioners, the authors of this volume assess past events according to present standards. This is what scientists and doctors usually do in the introductory section of their scientific articles. There they comment on previous work, evaluating it as to its strengths and weaknesses in order to create a suitable context for presenting their own work. It is in this sense, then, that books like the present one are best understood. Such contributions by medical practitioners are certainly useful and deserve to be praised: on the factual level, they offer a lot of information to the historian. Moreover, they provide a source for understanding practitioners' aims and objectives. However, as long as the agendas differ so much between historians and doctors, and as long as there is so little co-operation between them, volumes like this one cannot be seen as a meaningful contribution to the critical analysis of past developments that historians of medicine are striving for.

Richard von Volkmann 1930-1889

Volkmann was born August 17, 1830, at Leipzig, the son of a professor of anatomy and physiology at the University of Halle. With this family background, it is not surprising that he embarked on a medical career. All his life was associated with the University at which his father taught. In 1856, he was appointed deputy to the surgical clinic of Professor Blasius and, in 1867, he achieved the Chair in Surgery. After a time in military service during the Franco-Prussian War, he returned to his own hospital to confront the ravages of sepsis, having been familiar with Lister's work (Dis Colon Rectum 1982;25:173–178). He was so successful in applying the Listerian method that it was to Volkmann's unit that surgeons came from throughout the world to learn his methods. Lister's concepts were received most enthusiastically in Germany. Volkmann's primary interests were in orthopedics and in general surgery. He emphasized the importance of open drainage and widening of wounds, and made other contributions to the management of hydatid cyst of the liver, intra-abdominal abscess, ulcer disease, tuberculous arthritis, joint dislocation, and compound fractures. His improved operation for excision of the rectum (the subject for this Classics presentation) is less familiar to surgeons than that of his pupil, Kraske (Dis Colon Rectum 1984;27:499–503). His name is recognized primarily because of his description of the esoteric entity of the pathophysiology of ischemic muscle contracture. Volkmann was a striking figure, with long “dundreary” whiskers. He was truly aristocratic in appearance. Besides being a master surgeon with an enormous private practice, he was a superb orator. He could lecture fluently in several languages, including Latin. He was also well-recognized and extremely popular throughout Germany as a published writer of poems and fairy tales for children. A visitor to the clinic that he designed commented in 1879 that the most striking feature was the terrazzo paving, constructed in such a manner as to permit efficient drainage. This was extremely important, since flushing the wounds with carbolic solution from gardening pots was always employed during the procedure. Sepsis was so pervasive a problem that it was routine to perform three or four excisions of the hip joint in children each week. Wolkman died of pneumonia on November 28, 1889, while accompanying a patient for a consultation to Jena, in what is now East Germany.

The contributions of infection control to a century of surgical progress

Although many surgical procedures were well-developed in principle before 1867, their application for the treatment of human disease was limited because of a mortality rate from postoperative infection alone of about 50%. It was the eventual acceptance of Lister's work and the development of the aseptic-antiseptic ritual that allowed operative therapy to be successful and made modern surgery possible. The background leading to the development of aseptic-antiseptic rituals is discussed.

The contributions of infection control to a century of surgical progress.

Although many surgical procedures were well-developed in principle before 1867, their application for the treatment of human disease was limited because of a mortality rate from postoperative infection alone of about 50%. It was the eventual acceptance of Lister's work and the development of the aseptic-antiseptic ritual that allowed operative therapy to be successful and made modern surgery possible. The background leading to the development of aseptic-antiseptic rituals is discussed.

A critical study of lister's work on antiseptic surgery

The work of Pasteur on alcoholic and lactic acid fermentation demonstrated that minute organisms (germs) caused these fermentative changes. Lister applied these basic findings in the introduction of his antiseptic system. Its principles were based on the destruction of germs by antiseptics (carbolic acid) to prevent their entering the wound or spreading after surgery. Lister's work on antisepsis was therefore based on the germ theory of disease. The believers of the germ theory defended Lister's theories whereas the nonbelievers of the germ theory created an atmosphere of resistance to Listerism. The work of Koch in 1878 on the etiology of traumatic infective diseases contributed greatly to the acceptance of Lister's antiseptic principles. By the mid 1880s there was a rapid increase in the use of antiseptic technics, soon followed by the introduction of aseptic methods and rapid progress in surgery.

The meaning of lord Lister's work.

The meaning of lord Lister's work.

LONDON

<h3>Surgery in the Future: "Hominal Physiology"</h3> At the opening of the winter session of Guy's Hospital, Lord Moynihan delivered an address on "Surgery in the Immediate Future." He repeated his claim that surgery as a craft had almost reached its limits and said that he was unmoved by the criticisms which it had provoked. Under the caption "Surgeons as Prophets" it was pointed out (The Journal, Aug. 4, 1928, p. 332) that the same prophecy had been made by Erichsen nearly fifty years ago and proved to be quite erroneous, for Lister's discovery had not yet "revolutionized surgery," roentgen rays had not been discovered, and the procedures for viewing the interior of the hollow organs had not been introduced. Lord Moynihan on the present occasion said that the full fruit of Lister's work had now been gathered. Almost every organ had been made accessible to the surgeon; operations on these

Lister as I Knew Him.

In the early seventies Dr. Leeson was for several years a dresser and clerk in Professor Lister's wards in Edinburgh, at the time when Lister's work was just being recognized in the world at large and when he was fighting against the apathy and opposition of his colleagues in the British Isles. Leeson, therefore, takes us back to the most interesting part of Lister's career. He is one of the few men living who, of his own knowledge, could do this. Lister is one of the Olympians of medicine; from his peculiar service he is one of the great figures of all times. We cannot now have too many intimate details of him, his surroundings and his work; as time goes on such knowledge will become even more valuable. It is highly desirable, therefore, that we should have this book from one who worked with him in his prime. It

Anti-Vivisectionists and Protective Medicine in the Army

It is wonderful to what follies anti-vivisection will betray those who believe in it. The American Red Cross. has been involved in a lawsuit by some of the American anti-vivisectionists, who are endeavouring to prevent it from doing, medical research on active service. This research would be, almost all of it, bacteriological; it would be inoculations of small rodents in the direct course of the work of the Red Cross for the Army; but the anti-vivisectionists seem to care more for the rodents than for the Army. Dr. W. W. Keen, of Philadelphia, one of the very foremost of American surgeons, whose name is well known, among our own physicians and surgeons, has written an admirable, article in Science of February 22 last on this attempt to interfere with the work of the Red Cross. He tells again some of the oft-told truths the facts of the protective treatment against typhoid, of the protective treatment against tetanus, of the results-of Lister's work, and so forth. He points put that the anti-vivisectionists in his country all these many years have done nothing, absolutely nothing;, to lessen disease or to save life either in animals or in man; and he quotes the statement made by forty-one American medical officers on active service in France: “We feel that anyone endeavouring to stop the Red Cross from assisting in its humanitarian and humane desire to prevent, American soldiers from being diseased, and protecting them by solving the peculiar new problems of disease with which the Army is confronted, is in reality giving aid and comfort to the enemy.”