Is the commonly told story of Lister's antisepsis a whiggish one?
Abstract: Joseph Lister is often seen as a hero of surgery, but his famous method of antisepsis was not solely his work alone. The commonly told account of the development of antisepsis displays several characteristics of whig history. This investigation will highlight these whiggish features, showing that Lister's original antiseptic technique was not without its failures and that there were other important figures who contributed to its development.

KEYWORDS Lister / Antisepsis / Whig history / Surgery
Article Type: Clinical report
Subject: Infection control (Methods)
Sepsis (Care and treatment)
Authors: Smart, Alexander
Khan, Wasim S.
Pub Date: 03/01/2012
Publication: Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2012 Association for Perioperative Practice ISSN: 1750-4589
Issue: Date: March, 2012 Source Volume: 22 Source Issue: 3
Geographic: Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom
Accession Number: 283274428
Full Text: Although Joseph Lister had a huge impact in the field of surgery with his method of antisepsis, the commonly told account of its development, where Lister is portrayed as the only important character in the story as he virtually 'single handedly revolutionised modern surgery' (Granshaw 1992), may be an example of whig history. In this essay, the commonly told story of antisepsis will be analysed in order to identify whether it possesses any of the characteristics of whig history.

The term 'whig history' was first coined by Herbert Butterfield in his book The Whig Interpretation of History in 1931. He defines it as 'the tendency in many historians to write on the side of Protestants and Whigs, to praise revolutions provided they have been successful, to emphasise certain principles of progress in the past and to produce a story which is the ratification if not the glorification of the present' (Butterfield 1931). This definition provides several characteristics of whig history which will be useful in identifying the extent to which the common story of antisepsis is whiggish.

The first characteristic of whig history is the emphasis of certain principles of progress. This often leads to the omission of certain events in the story, tailoring the story to meet the intentions of the historian. It allows the historian to create an easy path from the past to the present (Butterfield 1931), showing only the elements of progress and omitting any complexities in the story, making this type of history usually very inaccurate. The second trait of whig history which will be looked for is whether there seems to be a ratification or glorification of the present. As Butterfield says, 'it is part and parcel of the whig interpretation of history that it studies the past with reference to the present' (Butterfield 1931). Instead of attempting to view the past through the eyes of those who were living then, the whig historian tries to find similarities between the past and present. He is then able to construct a story depicting continuous progress over time to 'produce a scheme of general history which is bound to converge beautifully upon the present' (Butterfield 1931).

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Finally, the whig interpretation of history produces a division between the people involved in the story into those on the side of progress, and those who tried to hinder progress (Butterfield 1931), which can result in the creation of heroes and villains within history. The creation of a hero figure who is striving for progress distorts the truth by introducing bias on the side of the hero, and ignoring the role that others played in history. Such a division, with Lister portrayed as the hero, will therefore be searched for within the commonly told story.

The commonly told history of the development of antisepsis must also be described, so that it can be established whether it possesses any characteristics of whig history. Lister's biographies, such as those written by Richard B. Fisher (1977) and Douglas Guthrie (1949), books on the history of surgery and surgical lectures all tell the history of antisepsis in a similar fashion. They portray Lister as the sole hero of a surgical 'revolution', fighting against adversity to make his ideas and theories heard. They detail how Lister first came up with the idea of antisepsis, through the use of the then novel germ theory, proposed by Louis Pasteur, and consequently made surgery 'scientific' (Worboys 2000). The story then identifies how Lister made antisepsis applicable to surgery, with the application of carbolic acid to wounds, initially as a dressing in 1867 (Guthrie 1949) and then by spraying it onto the wound in 1871 (Fisher 1977). It continues with details of how the effect of Lister's new techniques were opposed by those who claimed that the lower mortality rates following surgery were as a result of improved cleanliness in hospitals, but then tell of how Lister finally won over his opponents.

The main focus of the commonly told story of antisepsis appears very much to be Joseph Lister, although this may be expected in Lister's biographies. However it seems that the story neglects many of the other individuals involved and the compromises made by Lister, and concentrates mainly on the scientific progress which was being made. Having now described the commonly told story of how antisepsis was introduced into surgery, it seems that there are definitely some aspects of this story which could be considered whiggish.

The first aspect which can be considered to be whiggish is the portrayal of Lister as the only character to play a key role in the incorporation of antisepsis into surgical procedures. The commonly told story of antisepsis disregards the work of several important individuals, without whom it may have been impossible for Lister to make his breakthroughs. One such individual is George Callender, a surgeon at St Bartholemew's Hospital, who claimed that he used an 'alternative, superior method' (Granshaw 1992) to antisepsis, which was termed 'cleanliness'. He advocated 'scrupulous cleanliness' (Granshaw 1992) of the wounds, as well as the patients and their surroundings, to ensure they were dirt-free, as opposed to the purely chemical actions of antiseptics, which had the aim of removing and preventing germs from the wound. His method of cleanliness had more success than Lister's in its application to surgery, largely due to its lower post operative mortality rates (Granshaw 1992).

Lister consequently amended his method of antisepsis, incorporating practices from the method of cleanliness, such as placing surgical instruments in carbolic lotion to clean them thoroughly (Granshaw 1992). This was the start of a compromise between antisepsis and cleanliness, which eventually led to the recognition of much of Lister's work, yet rendered Callender's work largely forgotten. Although Joseph Lister produced some brilliant work, the commonly told story 'whiggishly' elevates him to the heights of a hero whilst forgetting the work of others, such as George Callender, Ignaz Semmelweis, who worked on the first antiseptics during the 1840s (Blood and Guts: A History of Surgery 2008), and Thomas Spencer Wells, who in 1864 was one of the first to comment on the possibility that germs may be the cause of sepsis (Worboys 2000).

The next whiggish characteristic to be looked for is the depiction of continuous progress from the past to the present, by highlighting certain events of progress whilst neglecting to mention the events that prevented progression. This trait of whig history is found, to a certain extent, within the commonly told story of antisepsis. The commonly told story does mention some of the hindrances to progress which Lister faced, such as the reluctance of many surgeons to accept the theory behind Lister's method of antisepsis. However, it does so in a way that depicts Lister as the proponent of progress, which reinforces Lister as the hero of the story. Furthermore the road to the acceptance of antisepsis was a very long one, and the actual rate of progress made was much slower than is commonly portrayed. The story also doesn't expose the range of compromises which Lister made in order to gain support for his method of antisepsis. He incorporated several practices from the method of cleanliness, and it has been said that the practise which resulted from this compromise, known today as asepsis, seems to have more in common with the method of cleanliness than antisepsis (Granshaw 1992). Although the omission of such obstacles to progress may make for a better story, this whiggish interpretation of the history of antisepsis creates a false impression of continuous scientific progress with the hero trying to convert others to his 'revolutionary' way of thinking.

The way in which the history of antisepsis is written also favours those who helped progress over those who were seen to prevent it. This division between the 'good guys' and the 'bad guys' in the development of antiseptic surgery is historically inaccurate, and is a characteristic of whig history. During the 1860s and 1870s, when Lister was attempting to implement antisepsis into surgery, there were those who supported his method and those who opposed it. At the time, both of these groups believed that their opinions and actions were helping to progress science. It is only with hindsight, and the knowledge that the theory behind Lister's work was correct, that historians tend to side with the proponents of antisepsis. It is important, therefore, for a historian to attempt to see the past through the eyes of those who were living then, rather than to allow the present to cloud their judgement and introduce bias. A further example of this in the commonly told story is the way in which the opponents of antisepsis are made to seem ignorant in their refusal of antisepsis, as they did not believe in germ theory (Granshaw 1992). There is no consideration given to the fact that, at that point in time, germ theory was a very new idea and was completely alien to how most scientists thought. This interpretation of the past with direct reference to the present is therefore another characteristic that makes the commonly told account of the development of antisepsis more whiggish.

From this analysis it is evident that there are definitely elements of the story which are whiggish. However, despite this inaccurate representation of the development of antisepsis, it can be argued that this whiggish interpretation does have an important benefit. The creation of Lister as a scientific hero provides inspiration to current and future scientists. A completely accurate history of antisepsis would probably not have the same effect, as it would have shown that the progress made by Lister was not as spectacular because of the considerable concessions he made regarding his method of antisepsis. Furthermore the glory resulting from the success of antisepsis would have been shared among several individuals, and perhaps Lister would not have been seen as the scientific hero who had revolutionised surgery. Therefore it becomes apparent that the role of the historian is not only to portray the past accurately, but also to create hero figures who can serve to inspire further progress.

Conclusion

In conclusion, it has been shown that the commonly told story of the development of antisepsis displays whiggish characteristics. This makes the story fairly inaccurate, mainly because it omits events which prevented scientific progress. Although whig history creates a readable and, at times, inspirational story, history should help serve as a template for the future, so that previous mistakes can be learned from and so that further progress can be made. Therefore, it is of greatest importance that history is documented accurately, even if it is at the expense of creating as many heroical figures. Nevertheless, even if the commonly told story of antisepsis was not told whiggishly, Lister would most probably still be considered a scientific hero. The practice of asepsis, a combination of antisepsis and cleanliness, would not have been possible without the constant work and dedication of Lister. Not only did he make surgery safe, but he also made surgery 'scientific' (Worboys 2000) by applying Pasteur's germ theory to it. There is no doubt that Joseph Lister is indeed a hero of science, and although there were other individuals who played a key part in the development of asepsis, the contribution that Lister made to surgery was invaluable.

References

Blood and guts: a history of surgery 2008 [VHS video] BBC Four

Butterfield H 1931 The Whig interpretation of history London, G Bell

Fisher RB 1977 Joseph Lister, 1827 -1912 London, MacDonald and Jane's

Granshaw L 1992 'Upon this principle I have based a practice'. The development and reception of antisepsis in Britain, 1867 - 90 In: Medical innovations in historical perspective Pickstone JV (ed) Basingstoke, Macmillan In association with the Centre for the History of Science, Technology, and Medicine, University of Manchester

Guthrie D 1949 Lord Lister, his life and doctrine Edinburgh, Livingstone

Worboys M 2000 Spreading germs: disease theories and medical practice in Britain 1865 - 1900 Cambridge, Cambridge University Press

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Provenance and Peer review: Unsolicited contribution; Peer reviewed; Accepted for publication August 2011.

Correspondence address: Mr W Khan, Clinical Lecturer, University College London Institute of Orthopaedic and Musculoskeletal Research, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP. Email: wasimkhan@doctors.org.uk

About the authors

Alexander Smart BSc

University College London Medical School, London

Wasim S Khan MBChB, MSc, MRCS, PhD

Clinical LecturerUniversity College London Institute of Orthopaedic and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore

No competing interests declared
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