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Glasgow After Lister

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Glasgow After Lister

From Glasgow, Lister returned to Edinburgh in 1869 to take up the position of the Professor of Surgery at the university, taking over from his father-in-law and previous mentor, James Syme. Although he was no longer working in Glasgow, the legacy of his antiseptic work was everpresent and evolving. 

When Lister was teaching in the 1860s and 70s his ideas were extremely radical, and were a complete disruption to received opinion. At first, very few of his contemporaries agreed with or accepted his ideas. Students were often caught in a divisive atmosphere, taking classes of Lister and his opponents. Lister’s commitment to his new antiseptic principles and practice was extreme and unwavering. “One student calculated that Lister spent about 75% of his teaching time on explaining the details of surgical dressings.” (R. Hamilton Russell, 1927)

Men such as Sir Hector Clare Cameron, Sir William Macewen, and James Hogarth Pringle were advocates for Lister's antiseptic practice, which received a lot of skepticism from other Glasgow practitioners. Hector Cameron was Professor of Clinical Surgery at the University of Glasgow and President of the Royal College of Physicians and Surgeons of Glasgow from 1897 to 1900. Cameron had studied under Lister as a student and eventually became his house surgeon at the Royal Infirmary in 1868. 

James Hogarth Pringle is a rather unsung hero in the history of surgery. Born into a medical family, his father was an associate and lifelong friend of Lister who brought antisepsis to Australia where he worked. Pringle worked alongside William Macewen at the Glasgow Royal Infirmary and was, along with Macewen, a pioneer of asepsis. He was also an advocate for the training of women in medicine, but is probably best known for his invention of the "Pringle Manoeuvre" to limit blood loss during liver surgery. 

Macewen's Osteotomes

Asepsis

Inspired by Lister's work into the antiseptic principle, practitioners continued to perfect clinical practice and the prevention of wound contamination. Evolving from a complete disinfection of germs in the environment, practitioners wanted there to be a complete absence of germs in the surgical theatre and on surgical instruments themselves. This would be the ultimate goal in surgical cleanliness and hygiene. 

The difference between asepsis and antisepsis ultimately comes down to infection. If germs have already made contact with a wound, antiseptic efforts are applied to destroy them. Aseptic techniques are performed to prevent any infection from occurring in the first place. Although the introduction of antiseptic chemicals into surgical practice has saved billions of lives since its introduction, it did cause some problems at the start. Most of the chemical solutions that Lister used were irritants, meaning that the wounds of the patients would become irritated and the skin of the hands of the surgeons would become cracked and damaged.  

Willliam Macewen, one of Lister's previous students and colleagues, developed his own aseptic practice that was based on the principles of Lister's antiseptic practice. As well as encouraging his staff to wear lab coats and gloves, Macewen designed his own surgical instruments in such a way as to limit the ability of germs to settle on them. The most famous example of this is his osteotome. 

Macewen requested a set of osteotomes to be made for him by a Glasgow blacksmith, T. H. Macdonald. Made out of one sheet of stainless steel, the osteotome contained no grooves, divets, or pores for germs to settle in. This meant that the osteotome could easily be sterilised by boiling water between operations. 

Macewen goes into detail about the design and manufacture of these instruments in an article published in the British Medical Journal in 1879: 

"I have had several sets of instruments manufactured for me, but the most trustworthy and satisfactory have been made by Mr. Macdonald, who put himself to some trouble to carry out my instructions concerning them, and also in determining the exact temper necessary...They are finely polished, not for appearance, but because the finer the surface the less opportunity will organic matter have of becoming adherent and afterwards decomposing." (Macewen, BMJ, 1879).

In a letter to John Comrie, John MacIntyre (who established the world's first X-ray department at the Glasgow Royal Infirmary) warns of the danger of comparing the two great practitioners that were Lister and Macewen: 

"Will you allow me to say that I hope you did not misunderstand me at the Lunch when I ventured to point out the danger of raising comparisons between Lister and Macewan. Of course both men- especially Macewan- have been so recent that it is difficult to think of what future historians may say about their relative value. Of this you may be quite certain, however, that Lister made men like Macewan possible, for the original discovery, based on Pasteur's work, made all general surgeons' work possible and in that lies the great reputation he made."