From 9-11 February 2012, the RCSEd will host a celebration of the life and work of Lord Lister. Here, we highlight some of the talks from the programme which will place Lister’s pioneering work in a contemporary context. Visit the website: www.lister2012.com

‘Chips off the Old Block? Lister’s Life and his Students

Professor Marguerite Dupree, Professor of Social and Medical History at the University of Glasgow

While there will be many references to aspects of Joseph Lister’s life and work in the course of the conference, the purpose of this lecture is to set the scene. I will begin with an outline of the main features of Lister’s life and then focus in more detail on his teaching in Scotland about the overall theme of this meeting ‘surgical sepsis’. What did Lister teach his students? To what extent did his students put his teaching into practise? What was the significance of his students for his legacy?

In 1865, Lister first realised the surgical significance of Pasteur’s theories and in 1867 Lister reported his use of carbolic acid as an antiseptic. The Glasgow medical students, therefore, were the first audience for his antiseptic method, even before its dissemination in medical journals. Over the ten years to 1877 he published most of his articles on antisepsis and hundreds of students first at Glasgow and then Edinburgh universities (though not the women) attended his lectures (often more than once), with students witnessing his trials of one technique after another. At no other medical schools in Britain could he have addressed such large audiences. I will argue that examination of Lister’s teaching, the careers of the students he taught in Scotland and the ways many, though not all, of his students put his teaching into practise helps both to explain how antiseptic surgery spread throughout Britain and its Empire in the face of considerable opposition; and, to understand Lister’s legacy.

Lister’s position in the history of surgery is contentious today, but his importance as an iconic figure in the medical profession is secure. His career has always been more than the sum of his personal discoveries. Lister’s image and reputation was a complex construct, involving the scientific and moral reputation of the medical profession, as he came to embody the rise of surgery from a craft to a science and the rise of the profession to the pinnacle of esteem. Lister’s image was regularly polished by his admirers in old age and after death, but its origins were in his Scottish classes - in the experimental approach and moral example he conveyed, and above all in the immense confidence in the future of surgery he instilled, encouraging his students to take surgical risks – his former students were its creators and guardians.

Antisepsis in the 21st Century

Professor David Leaper, Past President of the Surgical Infection, Society of Europe and European Wound Management Association; Hunterian Professor and Zachary Cope lecturer

Lord Joseph Lister left us the legacy of antiseptic surgery which was replaced within a few decades by the principle of aseptic surgery. The latter may have endured but where would modern surgery be without antiseptics for disinfection of surgical teams’ hands and preoperative skin preparation of our patients? Recent trends in antibiotic resistance, related to the overuse and misuse of antibiotics – and coupled to the fact that few new antibiotics are in the pipeline – make a compelling reason to revisit antiseptics for a wider application in surgery.

The use of antiseptics for wound lavage and irrigation of soiled cavities, particularly the peritoneum, has rather fallen out of favour because of unsubstantiated toxicity. This has been strengthened by unhelpful meta-analyses which claim that the evidence-base is too weak to justify the cost of topical antiseptics in chronic wound care, particularly the widely appraised silver and polyhex-amethylene biguanide dressings (data which falls into the hands of our procurement managers!). Further hypothetical and totally uncorroborated views have suggested that antiseptics might select super-resistant organisms. Fortunately, this has been challenged in EU directives after critical analysis of accumulated evidence.

After Lord Lister hypothesised about Pasteur’s experiments on bacteria and spoilt wine and reflected on the use of phenol to treat sewage in Carlisle, he gave us an advance against the ever-present concern of surgical infection. Because of their disruptive cellular mechanisms there is probably no risk that antiseptics induce antimicrobial resistance. Antiseptics have much to offer in open wound care lavage and dressings, impregnated incise drapes and coated antimicrobial sutures and devices. I am certain Lord Lister would be pleased to see us revisiting the use of antiseptics in surgical care bundles.

The Sir Gordon Gordon-Taylor Memorial Lecture - War Wound: From Flanders Fields to the Helmand River Valley

Colonel Michael PM Stewart, Surgeon, HM Armed Forces and lately UK Defence Medical Services Consultant, Advisor in Trauma & Orthopaedics, CBE, Senior Consultant Advisor in Trauma & Orthopaedics

My theme is aspects of war surgery to which Sir Gordon and his surgical brothers made signal contributions in the Casualty Clearing Stations of the Western Front in the First World War. In this lecture, we will recall the lessons learned in the management of missile wounds at the beginning of the War. Foremost of these was that surgical minimalism, reliance on antiseptics and primary wound closure was woefully inadequate in the treatment of established wound infection in the life and limb threatening wounds inflicted by 20th century weaponry. A revision of surgical thinking was required. Thereafter, all war wounds were assumed to be contaminated, if not infected. Principles of surgical management were established to comprise early wound incision and exploration (debridement), excision of all non-viable and foreign material, and delayed wound closure. Lord Lister would have recognised these principles, as fundamental and vindication of his ideal of aseptic surgery.

In Helmand Province, over 70% of the war wounds involve the limbs, the great majority are the result of explosive munitions and wound infection remains today the greatest risk to the combat casualty who survives beyond the first few hours from point of wounding. This address will review current management of ballistic wounds and fractures in war and highlight the contribution of this generation of British Military surgeons who it might be said, in the words of Sir Gordon, ‘endeavour in their zeal to equal and surpass the veteran surgeons of a previous conflict’.

The Sir Gordon Gordon-Taylor address is given on behalf of RCSEng, Middlesex Hospital, RCSEd and the RACS to honour the memory of Sir Gordon Gordon-Taylor, one of the finest and most revered British surgeons of the 20th century.

Healthcare-associated infection

John MacFie, Professor of Surgery / Consultant Surgeon PGMI, University of Hull / Scarborough Hospital President, Association of Surgeons of Great Britain and Ireland

The problems of Healthcare Associated Infections and particularly hospital acquired infections have become a major concern to patients, healthcare workers and more recently politicians. There has been a great deal of publicity both on national radio/television and the national press with regards to apparent increasing rates of infection and more deaths associated with Methicillin Resistant Staphylococcus Aureus (MRSA) Clostridium difficile (C. diff).

It is no surprise to most clinicians that the increased rate of infection has been associated with an ever increasing number of admissions to hospital, a reduction in the length of stay and a reduction in the number of beds available to treat these patients. This has resulted in bed occupancies of 100% in many hospitals with decreased opportunity to clean the wards and the beds between one patient and the next.

There has been lack of clarity in the explanation as to why these infections have continued to increase and also lack of clarity as to why some of the remedies put in place have been introduced without good evidence base.

Lister was a perfectionist. He insisted on high standards for all his staff, both medical and nursing. I suspect he might look at modern care in the NHS and be disturbed at the lack of attention to hygiene by both individuals and organisations. I fear he would be shocked by the overcrowding of modern hospitals and the common place finding of bed occupancies of greater than 100%.

For booking details, visit: www.lister2012.com

Comments (0)

Subscribe to this comment's feed

Name

Email

Website

Comment

smaller | bigger

Subscribe via email (Registered users only)

I have read and agree to the Terms of Usage.

Add Comment