Saturday, March 12, 2005

Today's History Lesson

On (trauma) call today, stuck in the I thought I'd indulge in a little history lesson. This is sort of like therapy for me, knowing that many of the smartest docs in history failed, and did so frequently.

One of the most famous surgeons in all of medicine was Joseph Lister, well known to medical students as the father of antiseptic technique. Prior to his time, the "four horsemen of infection" overran surgical wards -- septicemia, pyemia with disseminated abscesses, "hospital" gangrene, and erysipelas. Things were so bad that Sir James Simpson was led to state

"The man laid on the operating table in one of our surgical hospitals is exposed to more chance of death than the English soldier on the field of Waterloo."

The results that Lister was able to achieve were, quite frankly, revolutionary in their importance to the care of the surgical patient. They were not, however, universally recognized or adopted at first. There is no better illustration of this than the differences that can be seen in the two most famous American medical paintings ever produced, Thomas Eakins' "The Gross Clinic" and "The Agnew Clinic," which are located above this post.

Dr. Samuel Gross, the senior statesman of American surgery, was an outspoken opponent of Listerism, and refused to employ antiseptic principles. Hence the 1875 "Gross Clinic" painting accurately reflect the operation being performed with a total lack of antisepsis -- Gross wears the traditional blood-caked black frock, there are no drapes, etc......9 years after the publication of Lister's landmark papers.

Fast forward 13 years to the 1889 "Agnew Clinic" painting. David Hayes Agnew and all of his assistants are dressed in clean white coats and the patient is clearly draped in a much more antiseptic fashion. What a difference a few years, and a little hubris makes.