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Bulletin of the History of Medicine 74.3 (2000) 618-619



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Book Review

"A Time to Heal": The Diffusion of Listerism in Victorian Britain


Jerry L. Gaw. "A Time to Heal": The Diffusion of Listerism in Victorian Britain. Transactions of the American Philosophical Society, vol. 89, pt. 1. Philadelphia: American Philosophical Society, 1999. xii + 173 pp. Ill. $25.00.

"Very old wine in new bottles" might have been a good second subtitle for this book. The old wine is Listerism: a catchall for a heterogeneous collection of practices, statistics, and theories that were gradually perceived (created, even) by the end of the nineteenth century as a single historical entity. The new bottle is diffusion: a passive model of change borrowed from physics by way of sociology. The model, at least as I understand it from Jerry Gaw's use of it (since it is never developed theoretically), has no dynamic element but is a taxonomy of "factors" (Gaw's word) that encouraged or impeded the spread of the entity "Listerism." Such factors include "medical administration," "professional tradition," "technical evolution," "theoretical orientation," and "final assimilation" (though quite how final assimilation can be a factor in diffusion is not clear).

Essentially what this slim book presents is a very familiar story with very familiar evidence. The primary source references show us what we already knew: that roughly between 1867 and 1880 some surgeons invoked Lister's name to justify all or some of their practices, statistics, and theories, and others did not. [End Page 618] This, indeed, is the only thing that can usefully define "Listerism" before it became successfully identified with a germ theory of the type promoted by Koch and the surgical practices said to be based upon it. Gaw also tells the familiar tale of the increasing invocation of Lister's name in a world of professional unification, animal experimentation, nursing and hospital reform, and so forth. This broader narrative is deeply flawed by uncritical and myopic recourse to a weird variety of secondary sources: many of them respected, many quite untrustworthy. Rather than catalog these flaws, I signal Gaw's lack of familiarity with his subject by his curious assertion that before John Hunter surgery was "the hobby of barbers" (p. 3). A final historiographic essay on writings on Lister, which is generous about my own work, I cannot comment on, since a couple of key consecutive sentences in what I take to be partial rebuttal I do not understand. The first of these is: "Even the success enjoyed by some who used aseptic methods would not have had a scientific context apart from Lister's antiseptic practice and Pasteur's theory on which it was founded" (p. 144).

It is time to move on from simply using surgeons' stories about their successes and failures with carbolic dressings as the sole evidence for the superiority of Lister's methods. Listening uncritically to Listerians (a much more useful analytical tool than Listerism) and their understanding of the massive transformation of late-nineteenth-century surgery is not sufficient to explain the latter. Listerians might not be the devil, but they do have all the best tunes. I hope this can be said these days without being misunderstood. It is certainly not an accusation of dishonesty on their part, and it is emphatically not a denial (nor admission) of the claim that carefully applied chemical dressings were superior to other means in reducing surgical mortality in the late nineteenth century. It is a plea for neutrality in a medical debate that is over, and a call for evenhandedness in a historical enquiry that has scarcely begun. Of course the Listerians' narratives support their claim, which is why it is time to go beyond these stories without necessarily discounting them. We need to understand why intelligent, highly skilled surgeons like Samuel Gross, William Savory, and Lawson Tait would have no truck with Lister's approaches. For a start, we need much more detailed statistical studies of regions, and of individual hospitals where possible. Such studies may...

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