A Time to Heal: The Diffusion of Listerism in Victorian Britain (review)

A Time to Heal: The Diffusion of Listerism in Victorian Britain. Transactions of the American Philosophical Society, by Jerry L. Gaw; pp. xii + 173. Philadelphia: American Philosophical Society, 1999, $25.00.

Amongst the useful features of Jerry Gaw's book is a substantial bibliography of works dealing with Joseph Lister and antiseptic surgery. Any historian addressing this crucial period in the history of surgery will find it difficult to avoid treading well-worn paths: Gaw's approach is to concentrate on the years from the late 1860s to the mid-1880s, when Lister's views, at first highly contentious, began to dominate the medical world. Unlike less fortunate medical heroes such as Ignaz Semmelweis, Lister reaped the rewards of fame during his lifetime. Although he received bitter criticism, his career was punctuated by memorials of passionate admiration, particularly from his former students. By the end of his life, his anniversaries and birthdays were the subject of international celebration, not least because so many of his students had moved into positions of power in Britain and abroad. Since his death, surgeons have regularly commemorated his achievement. His shrine in the museum of the Royal College of Surgeons in London states categorically that he was the greatest surgeon the world has known. Such enthusiasm is a tempting target for historians bent on exposing myth: Gaw does not present Lister in an entirely heroic light, but neither does he wish to cut him down to insignificance.

Gaw's approach is not biographical, though he includes an appendix of biographical information. He concentrates on the dissemination of Listerism through a variety of methods. The first two chapters, on hospital administration and social interpretations of disease, cover familiar territory, and indicate the kind of historical scene which framed Lister's theory. The movements for improving public health, and the improved sanitary arrangements of hospitals paved the way for his reception. Successive chapters deal with such themes as "professional tradition," "national competition," "theoretical orientation," and "experimental investigation" as factors in the diffusion of Listerism, mainly through the debates in the contemporary medical journals. Gaw's approach is thematic rather than narrative, with the unavoidable consequence that it is easier to follow the individual strands of argument than to see the whole period in perspective, but he does demonstrate the wide range of issues that influenced the reception of Listerism, including the importance of practical demonstration by Lister and his followers, and the technical problems associated with Lister's methods, particularly the carbolic spray.

Lister's own views present something of a problem. Because he insisted that his methods were based on a fundamental "principle" of antisepsis inspired by Louis Pasteur's germ theory, he also tried to argue that his practical approach was also infallible, whereas it is obvious that Lister was a supremely experimental surgeon who constantly modified his methods. He stuck to the principle of keeping germs out of wounds, and his techniques were a variable series of intricate defences including atmospheric sprays and elaborate bandages. Gaw disagrees with historians who try to dissociate the aseptic methods of later surgeons from Lister's cruder antiseptic experiments with carbolic acid. Both patients and surgeons suffered from this irritant substance, in spite of its effectiveness in reducing infections, and in later years Lister recognised that the spray was unnecessary. He was sceptical of certain aseptic procedures, such as sterilised garments for surgeons, and objected to the use of rubber gloves. But his followers, such as Watson Cheyne and William Macewen acknowledged their debt to him while leaving behind many of the practical details he had taught them. Gaw rightly notes that Listerian principles were not entirely superseded. They proved useful in conditions where strict asepsis was not possible, especially on the battlefield. Lister's house surgeon, John Chiene who, like most of the younger surgeons, abandoned the carbolic spray for aseptic methods...