In the 19th century the most important advance in medical science was called (at the time) Listerism. Simply put, Joseph Lister, working with Louis Pasteur’s advances in microbiology and the discovery that bacteria cause putrefaction and infection, came to a conclusion: In a medical setting the first line of defense is to keep the patient isolated from all such bacterial agents. There were two ways to achieve this: Antisepsis (using chemicals, usually carbolic) or asepsis (using heat) to sterilize. In 1881 John Tyndall wrote
Living germs … are the causes of putrefaction. Lister extended the generalization of Schwann from dead matter to living matter, and by this apparently simple step revolutionized the art of surgery. He changed it, in fact, from an art into a science.
In 1876 Lister came to the U.S. to lecture about his findings.
In 1878 Dr. Lewis Stimson performed the first demonstration of an antiseptic surgery in the United States, using Lister’s antiseptic technique while amputating a leg.
In 1881 President Garfield died not from the bullet fired by an assassin but because the physicians treating him rejected Listerism and caused massive, systemic infection by probing his wounds with unsterilized instruments and dirty hands.
As the summer waned, Garfield was suffering from a scorching fever, relentless chills, and increasing confusion. The doctors tortured the president with more digital probing and many surgical attempts to widen the three-inch deep wound into a 20-inch-long incision, beginning at his ribs and extending to his groin. It soon became a super-infected, pus-ridden, gash of human flesh.
This assault and its aftercare probably led to an overwhelming infection known as sepsis, from the Greek verb, “to rot.” It is a total body inflammatory response to an overwhelming infection that almost always ends badly — the organs of the body simply quit working. The doctors’ dirty hands and fingers are often blamed as the vehicle that imported the infection into the body. But given that Garfield was a surgical and gunshot-wound patient in the germ-ridden, dirty Gilded Age, a period when many doctors still laughed at germ theory, there might have been many other sources of infection as well (Markel).
At least some people were paying attention, because in 1883 Dr. Stimson was asked to operate on former President Grant’s leg.
This photo was taken in the surgical amphitheater at Bellevue in the early 1880s. By modern standards it’s shocking (note especially the bloody floor), but it should have also been shocking to physicians in 1880. I’m sure medical historians have written about the factors that led American physicians to reject the findings of Pasteur and Lister, but my guess is that it was simple hubris.
Because there were physicians and surgeons who accepted scientific findings and practiced antisepsis and asepsis, I felt justified in having Anna and Sophie act like sensible human beings and wash their hands. And instruments. And everything else. In carbolic.
Cheyne, W. W. Antiseptic surgery: its principles, practice, history and results, London 1882.
Kessin, Richard H. and Kenneth A. Forde. “How Antiseptic Surgery Arrived in America.” P&S 2007. link.
Markel, Howard. The dirty, painful death of President James A. Garfield. PBS, September 16, 2016. link
Pennington, T. H. “Listerism, its Decline and its Persistence: The introduction of aseptic surgical techniques in three British teaching hospitals, 1890–99.” Medical history 39.01 (1995): 35-60.
Tyndall, J. Essays on the floating-matter of the air. London, 1881.