Sanitation Surgery

* In 1867, Dr. Joseph Lister introduced sanitation in surgery, but not without a big fight with the leading surgeons of nineteenth-century England. His paper, “On the Antiseptic Principle in the Practice of Surgery”, was read before the British Medical Association in Dublin, Ireland. His noteworthy summary concluded; Since the antiseptic treatment has been brought into full operation, my wards though in other respects precisely the same circumstance as before, have completely changed their character, so that during the last 9 months not a single instance of pyemia, hospital gangrene or erysipelas has occurred in them.

* Dr. Listers contribution outraged the leading surgeons of the day. An 1869 conference of the BMA devoted the surgery address to a scathing attack on the antiseptic theory. What presumptuous London surgeon would believe a lowly provincial from Scotland who was telling them how to improve surgical protocol?

* As evidence of similar incredible intolerance in the United States, U.S. Senator Paul Douglas related the following story, which was recorded in the Congressional Record in 1963. I spent part of 1923 with Dr. W.W. Keen. In the Civil War he was a surgeon and had seen many men die from the suppuration of wounds after he had operated. He went to Scotland and studied under Lister. He was referred to as a crazy Listerite. He was denied an opportunity to practice in every hospital in Philadelphia. Finally there was one open-minded surgeon in the great Pennsylvania General Hospital. He said, “Let us give this young fellow a chance!” So they let him operate.

* No one died from infection under Keen. Keen began to chronicle the results in statistical articles. He was threatened with expulsion from the Pennsylvania Medical Society. This was in the 1890s. Finally he was accepted as the greatest surgeon in the United States.



* Which supports and barriers were in play?

* What were the dynamics?

* Who, or what, won the Tug-of-War?

* Discuss the outcome with your friends and family.

* Use Post #4 as a reference for the dynamics, and the relationships, between supports and barriers.