Before Lister.

Press, Volume LXI, Issue 18552, 30 November 1925, Page 8

Before Lister.

The missed opportunities of science would make an interesting article, or perhaps a book. An example of quite unusual interest is described at length by Dr. G. D. Hindley in the current "Nineteenth Century." There can be few people who are aware that Lister's tremendous discovery of antiseptic surgery was in essence made in the thirteenth and fourteenth centuries, but was not taken up by the profession. It is a fascinating story, which like most records of medical progress is not without its moral. Surgeons, like the doctors of to-day, were a conservative set of men, and had inherited a tradition of wound treatment. Suppuration was conceived to be a natural condition, and so necessary was it considered that applications called suppuratives were applied to the wound. "The" pain, fever, and other compli- " cations of such treatment, to say "nothing of the death-rate, must have "been appalling. It is really not " very surprising, after all, that the " surgeon, the barber, the torturer, and "the executioner were all classed to- " gether in those days, and that some "bloated pluralists combined all four "offices." Theodoric, an Italian ecclesiastic-surgeon, who was born at the beginning of the thirteenth century, broke away from this tradition of filling the wound with dirty packings. He believed that suppuration was.neither necessary, inevitable, nor desirable. He closed the wound, and applied warm wine, which Dr. Hindley assumes had some antiseptic power, and, indeed, was as good an antiseptic as could be obtained. This method, which had limitless possibilities for the good of mankind, was inherited and improved- by Henri da Mondeville, one of the surgeons of the Court of France. He found that wounds could be made to heal by Theodoric's method, and proclaimed the fact with skill and energy.

Unfortunately, as has happened so frequently in the history of medicine, he not only could not convince the profession, but had to face bitter opposition. "It is very dangerous " for anj r surgeon to operate except "in accordance with the practice of "other surgeons," he writes in 1312. "We have indeed suffered great con- " tempt, and the most insulting epi- " thets from the public, and many " threats and menaces from our own " colleagues. From certain persons, " and even from doctors, every day and "' at each new dressing, 'we have '' put up witli discussions' and " violent expostulations." What a modern ring this has! Lister had to face .just such opposition.

When de Mondeville died this method of clearing the wound of foreign bodies, closing it, and applying warm wine, died with him, "and '•' suppurativa once more reigned " supreme in the surgical world." The amount of suffering caused by the rejection of the new method is utterly beyond calculation. Wc have become so used to antiseptic and aseptic methods that it is difficult to imagine a world in which all wounds were dirty and the Iranian constitution always had to fight against odds. Paracdsus, " that <rreat, wrong-headed, " theatrical person," had a glimpse of the truth. He proclaimed that wounds for the most part would heal if left alone. "It is the nature of flesh to "possess in itself an innate balsam, " which healeth wounds." It was left for the nineteenth century to show that suppuration was caused by bacteria, and that wounds would have the best chance of healing if the bacteria were killed or excluded. Perhaps, however, it is not very surprising that the rediscovery was so long delayed. Theodoric and de Mondeville lacked the scientific knowledge in which Lister worked. They knew nothing of the germ. They and other scientists before the modern age of discovery and research groped in the dark. Without Pasteur wc would not have had either antiseptic surgery or the conquest of malaria and yellow fever by the elimination of the mosquito. This was what made medicine and surgery and science generally in those former times a thing that looks almost hopeless to modern eyes. The nineteenth century was in these respects the most marvellous in history, and discoveries of all kinds came with a rush, for the reason that once certain indispensable work was done, a real torrent of results followed. Far more advance was made in a hundred years than had been made in all the previous thousands. We may learn two lessons from the tragic failure to accept the methods of Theodoric and de Mondeville. One is the infinite value of the open mind, which so many doctors still lack. The other is that discovery generally proceeds step by step, though the steps may sometimes be taken quickly. Science is like a coral reef, built up by the efforts of an army of •workers. This is exemplified alike in such medical discoveries as the treatment for diabetes and in the epochmaking work Of Sir Ernest Rutherford on the atom. Pioneers had gone ahead and cleared away the undergrowth.