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Surgical antisepsis and asepsis established the standard of using scientific evidence to determine surgical practice. The microbiological discoveries of Louis Pasteur (1822-1895) were the inspiration for Joseph Lister's (1827-1912) use of carbolic acid as an antiseptic on surgical wounds. German and Swiss surgeons invented aseptic surgical practice based on the studies of Robert Koch (1843-1910), a life-saving revolution in medicine as profound as anesthesia. Together they changed human history, sparing millions the horrors of hospital gangrene and making the entire body accessible to surgical intervention. In the United States, surgeons followed the lead of their brethren across the Atlantic. Americans, characteristically pragmatic, naturally resisted what they saw as unnecessary complexity in Listerism. Once they accepted germ theory, the undeniable scientific evidence led to the rapid acceptance of asepsis. Among the wide-ranging effects of this transition in practice were the creation of the current model of the academic department of surgery and the modern concept of surgical professionalism.
Antisepsis
Michael worboys's book, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865-1900 (Cambridge, Cambridge University Press, 2000), reviewed germ theory in Scotland and England in the mid-to-late 19th century, particularly the development of Listerism and the debate that surrounded its adoption.1 surgeons before Lister struggled with the problem of hospital gangrene, invasive infections that complicated surgical operations and swept through hospital wards with a frightening mortality. In 1869, James Y. Simpson, professor of midwifery at the University of Edinburgh and famous for the discovery of the anesthetic properties of chloroform, late in his career surveyed the hospital deaths in England and Scotland hospitals. For amputations of the thigh and leg, large hospitals in London and Edinburgh had mortality rates of 64.4 and 54.8 per cent, respectively, mostly from invasive surgical wound infections. He wrote, "The man laid on an operating-table in one of our surgical hospitals is exposed to more chances of death than the English soldier on the field of Waterloo" (ref. 2, p. 818). The surgeon was not immune. A mere scratch in the autopsy room or operating theater could develop into an invasive infection, gangrene, and death.3
The catchall term for the horrifying mortality was hospitalism, epidemics that swept through overcrowded facilities, especially in large urban hospitals. Lister's patients fared particularly poorly....