Medical Lives in the Age of Surgical Revolution (review)

Medical Lives in the Age of Surgical Revolution is the forty-third volume in the Cambridge Studies in Population, Economy and Society in Past Time series. Utilizing extensive databases and "a team of students," Crowther and Dupree follow a cohort of medical students—approximately one thousand each from the Universities of Glasgow and Edinburgh—who began their studies during the years 1866 to 1874. The time period was intentionally chosen to reflect the period after the passage of the British Medical Act of 1858 which brought about improved standards in the education and requirements for registration of British physicians. The years selected were of particular note because most of this group of students came under the influence of Joseph Lister, Professor of Surgery at the University of Glasgow from 1861 to 1869 and then Professor of Clinical Surgery at the University of Edinburgh from 1869 to 1877.

The authors use university and other public records to document the ages and social, educational, and geographic backgrounds of their cohort of students. The students' lives, as well as the courses they took and the faculty who taught them, are described in detail. The Universities of Glasgow and Edinburgh were the two largest centers of medical education in Britain in this era. Of particular note was the enrollment of the first women in medicine at the University of Edinburgh, most notably Sophia Jex-Blake, whose career is discussed in detail. Of the 1,938 original students, only 1,288 became registered practitioners in Britain, though some were known to have completed their education or practiced in other countries and some probably practiced without full qualification. Of particular interest is the discussion of the mortality rate among medical students and physicians—a rate which was higher than that of the general population. Crowther and Dupree estimate that between 85 and 107 of the original number died in their student days and note that the mortality rate among young physicians was high, observing that medicine was a high-risk occupation, particularly due to tuberculosis and other infectious diseases.

Joseph Lister (1827-1912) was among the first surgeons to recognize (by 1865) the significance of Pasteur's theories and by 1867 he had begun his attempts to produce a sterile surgical environment by the use of carbolic acid as an antiseptic. He continuously worked to improve his techniques, not hesitating to abandon what he considered unsuccessful, but continuing to rely on the use of carbolic acid for hand washing, to prepare the surgical field and in surgical dressings. Spraying carbolic acid solution in the air during surgical procedures was for a long time a mainstay of Lister's regimen. Perhaps most important was that he taught that microbes were the cause of surgical infection and that means must be used to minimize their presence and effects. The era of "Listerism," of antiseptic surgery, predated and overlapped the modern era of aseptic surgery which arose primarily from European centers. The authors point out that true asepsis really required that surgery be done in modern operating theaters and that in Britain during Lister's time, most surgery was still being done in patients' homes or physicians' offices.

Both in Glasgow and in Edinburgh, Lister was not the only professor teaching surgery to medical students. Early on, many other prominent surgeons not only strongly disparaged Lister's methods, but also doubted the germ theory. Students had the option of attending Lister's lectures and demonstrations or those of the other surgeons, but Lister was widely respected as a physician, was a good teacher, and was highly popular with students, most of whom to some degree became disciples of Listerism. As was true of most of his surgical contemporaries, Lister's elective surgery was largely limited to amputations and removal of skin and breast lesions. Surgeons trained in his era did little elective abdominal surgery.

One group which did not profit...