The War on Germs Dead — Distinguished His Practice
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enter this harrowing world? As Fitzharris shows, it was mostly down to his power- ful sense of service to humanity, and passion for natural sciences. Medicine married the two. Lister was The Butchering exposed to science Art: Joseph early on, through his Lister’s Quest to father Joseph Jackson Transform the Lister, a wine merchant Grisly World of and keen microscopist Victorian Medicine who was eventually LINDSEY FITZHARRIS Scientific American/ elected a Fellow of Farrar, Straus and the Royal Society. The Giroux: 2017. younger Lister arrived at University College London in 1844 with one of his father’s micro- HEALTH scopes, a much better instrument than his teachers had. Throughout his career, his sci- entific interests and meticulous microscopic examination of tissues — living, diseased and The war on germs dead — distinguished his practice. Initially, Lister focused on the manage- ment of surgical wounds, striving to under- Tilli Tansey hails a history of Joseph Lister’s drive to stand normal healing and develop new ways vanquish post-operative infection and putrefaction. of treating and monitoring post-operative patients. He routinely examined recovering wounds, taking samples and experiment- ith antimicrobial resistance apron. Although instruments might be ing with dressings. Most surgeons, who becoming a real threat in routine sharpened for swifter slicing, they (and regarded infection as unavoidable, scoffed. surgery, it is salutary to contem- surgeons’ hands) were rarely washed. One But Lister was not alone. Oliver Wendell Wplate the early Victorian operating theatre. famous, possibly apocryphal account of an Holmes in Boston, Massachusetts, and Ignaz Pain and death were the norm, the surgical operation by surgeon Robert Liston recorded Semmelweis in Vienna and Budapest also brutality matched by the torments of post- a 300% mortality rate. The patient died; an accumulated evidence in favour of it. operative infection and putrefaction. In The assistant, fingers sliced off during high-speed Fitzharris notes that a turning point came Butchering Art, medical historian Lindsey surgery, died of gangrene; and an observer in 1864, when Lister discovered the work of Fitzharris ushers us into that realm. had a fatal heart attack. Louis Pasteur on the microorganisms that Fitzharris’s focus is the work of surgeon Large urban hospitals had higher mortal- cause fermentation and putrefaction. Lister and medical researcher Joseph Lister ity rates than country practices. Four major believed that air-borne organisms could (1827–1912) in developing and promoting infections were accepted as largely inevita- infect wounds, and realized that precaution- anti septic surgery. In the early nineteenth ble: septicaemia, erysipelas, gangrene and ary treatment might destroy them. After century, London, Edinburgh and other pyaemia. There was disagreement about the much experimentation, he heard that engi- British cities had built large municipal hos- causes. One theory blamed the circulation neers used carbolic acid to reduce the smell pitals to treat the poor. Operating theatres of ‘miasma’, or ‘bad air’; the other centred on from rotting waste. Tests led him to conclude were arenas in which the spectacle of life and contagion, the transmission of some poison. that this was a perfect antiseptic for instru- death was often viewed by a jostling crowd. Rudimentary anaesthesia, first used in Britain ments, clothes and hands, and, diluted with As Fitzharris vividly relates, the patient was in 1846, actually increased mortality rates for olive oil, for the treatment of wounds. He strapped to an operating table bearing resi- some years; surgeons performed ever-bolder designed an atomizer to maintain a fine mist dues of earlier procedures. The surgeon wore operations, with no way to control infection. of it throughout operations. Many profes- street clothes, or an ancient, blood-encrusted Why would Lister, a serious and sensitive sionals derided his methods, and some con- Quaker with an aptitude for the arts, want to sidered them quackery; others failed to follow NEW IN The Ancient Origins of Consciousness: How the Brain Created Experience PAPERBACK Todd E. Feinberg and Jon M. Mallatt (MIT Press, 2017) Psychiatrist Todd Feinberg and biologist Jon Mallatt draw on evolution, neurobiology Highlights of this and philosophy to trace the roots of consciousness back some 540 million years season’s releases. to the ‘Cambrian explosion’ in animal diversity. Comparing vertebrates and invertebrates, they chart the evolution of sense, memory and consciousness since the birth of complex brains, and explore questions such as whether fish feel pain, and which sense developed first: sight or smell? 36 | NATURE | VOL 550 | 5 OCTOBER©20 201717 Mac millan Publishers Li mited, part of Spri nger Nature. All ri ghts reserved. ©2017 Mac millan Publishers Li mited, part of Spri nger Nature. All ri ghts reserved. AUTUMN BOOKS COMMENT Lister’s instructions and could not replicate SUSTAINABILITY his results. The eminent surgeon James Paget’s 1869 declaration in The Lancet that Lister’s system was “no good” was damning. However, Lister’s reputation in Britain was China’s path to ecotopia ultimately sealed by one high-profile patient: Queen Victoria. By 1871, he was the most Xuemei Bai critiques a critique of the country’s renowned surgeon in Scotland, and success- eco-city initiative. fully treated his royal patient for a large under- arm abscess at Balmoral Castle. In 1876, Lister demonstrated his technique at the Inter- t’s easy to get a sense of China’s rapid His perspectives are national Medical Congress in Philadelphia, urbanization: overwhelming numbers indeed often contra- Pennsylvania, convincing many US sceptics. and breathtaking images abound. In dictory, sometimes Massachusetts General Hospital, which had I40 years, the country’s urban population drastically. banned his methods for years, became the has quadrupled to about 800 million, and Williams declares first US hospital to endorse their use. its cities have tripled in number, to 657. To that the concept of Lister received numerous honours and seek urban development with better eco- the eco-city is ill- awards: a peerage, the Order of Merit and nomic, environmental and social outcomes, defined. That is fair. presidency of the Royal Society. Moreover, China has introduced many branding and He then says that this Britain began to obsess over cleanliness. The accrediting schemes. China’s Urban vagueness allows flourishing commercial companies of the late One is the eco-city. By 2016, at least Revolution: China to misrepre- nineteenth century rushed to make products 220 cities, towns, prefectures and districts Understanding sent itself as the eco- Chinese Eco-Cities to satisfy the trend, including carbolic smoke had received the national accreditation for AUSTIN WILLIAMS city capital of the balls (for nasal inhalation, to flush out infec- their socio-economically beneficial and Bloomsbury Academic: world. Some of his tions), fumigators, soaps and the enduring ecologically ‘clean’ features such as renew- 2017. criticisms are just, oral antiseptic Listerine. Lister’s place in the able energy and water recycling. There is so and are reflected in history of surgery was assured. Widespread much information on China’s urban mosaic China. Several high-profile planned eco-cit- adoption of his techniques exemplified the that it’s hard to make sense of it. ies, such as Dongtan near Shanghai, are still acceptance of germ theory; in time, there In China’s Urban Revolution, architect unbuilt; projects can end up as box-ticking; was a shift from antisepsis (germ-killing) to and writer Austin Williams attempts to do development may take priority over sustain- asepsis (germ-free). Ironically, as Fitzharris so, probing the country’s eco-city experi- ability. However, Williams often interprets reveals, Lister resisted this: he believed that ment against the background of its socio- local malpractices or failures as pertaining asepsis would be impossible in the home, economic realities. The speed of change in to China as a whole, and links them to per- where the wealthy and middle classes were China makes it extremely challenging to ceived underlying politics. What I miss is a treated. He failed to realize that he had sown grasp what is happen- serious critique on why the seeds for the rise of the hospital as a place ing and why: the social projects fail, and what for the specialist care of all, not just the poor. and political context can can be learnt. The book The Butchering Art is well researched and lose relevance rapidly, ECO-CITIES ARE bolts anecdotes and written with verve. Fitzharris takes some and so become risky fragmented (but valu- licence with speculative conversations, to reference in as little ABOUT RECOGNIZING able) facts into sweeping thoughts and emotions, and a few anachro- as a decade. Williams political or ideological nisms irk. For example, University College should be commended PROCESS conclusions, often with- (called the modern ‘UCL’ throughout) did for trying. He promises AND out in-depth analysis. not have a ‘campus’; neither did nineteenth- a nuanced view that Williams looks at century physicians see non-hospital patients is neither sinocentric EFFORT. Chinese eco-cities and in their ‘offices’. Nevertheless, this is a fine nor biased towards the their contexts through read full of vivid detail, prompting thought- West — enticing for the lens of Western envi- ful reflection on the past, and the challeng- those who seek insights ronmental thinking. He ing future, of surgical practice. ■ beyond blind criticism or blind optimism. compares progressive Western scholarship Unfortunately, the book falls short of this on sustainability (such as biologist Rachel Tilli Tansey is emeritus professor of medical promise. Williams asserts that it is a “politi- Carson’s work in the 1960s) with main- history and pharmacology at Barts and The cal assessment” of China’s eco-urban initia- stream practice in China at the time, and London, Queen Mary University of London. tives, and that his exploration may “give rise frames it as the West vs China.