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It took less than three ain wide acceptance in medicine It took more than thirty years for antisepsis to be accepted Why? Both discoveries addressed the, infection was an even greater probleh primitive, certainly worked What accounts for the difference in speed of acceptance?

Scientific understanding is not part of it At the time the two innovations were proposed, neither could be explained And thoughunderstand antisepsis, we still cannot explain why anesthetic gases kill pain

Nor is diffusion of information a problem News of antisepsis spread as quickly as news of anesthesia Lister's techniques idely and hotly debated in every Western country

The answer see with individuals rather than groups Anesthesia was dramatic, it produced a positive effect, and it could be seen working in the individual On the other hand, antisepsis was passive, not draative in the sense that it tried to prevent an effect, not produce one It was coeon to half-heartedly try the lengthy, exasperating techniques on one or two patients, find that the patients still becaeneralize from this experience to conclude the systeainst theroup effects-the notion, for example, of a "controlled clinical trial" in all its statistical ramifications-is very recent indeed

Nonetheless, antisepsis eventually beca of contributions to sterile operative technique Williaeon, is credited with introducing rubber gloves for surgery in 1898 Special gowns to replace street clothes came at the turn of the century Masks were not common until the late 1920's

Ultimately, antibiotics provided the final powerful tool Thus, in the space of a century, surgical enerally 80 per cent at the time of the Civil War, was cut to 45 per cent by Listerianyears, until it is now about 3 per cent in e to zero are being explored In recent years, the evolved ritual of tiloves, and masks has been criticized Various studies have indicated that scrubbing does not clean the skin, but just loosens the bacteria on the hands, loves have holes in theowns are permeable to bacteria, especially if they become wet (as they often do in the course of operation); that doorways sealing off operating roo places for the at present to see a clear trend, but it is likely that the ritual will be strongly eons theely because postoperative infection is no longer a major problem In fact, the ery is not the operation but the anesthesia

One wonders why this was not always so, especially in view of early e J C Warren recalls that during the Civil War period:

Theseand to a free use of alcohol, were not favorable subjects for the administration of ether, and I have still a vivid recollection of my efforts as a student and a house pupil at the hospital [1865-6] to etherize these patients "Going under ether" in those days was no trifling ordeal and often was suggestive of the scrie of a football team rather than the quiet decoru table No preliht necessary, except possibly to avoid the use of food for a certain time previous to the adminstration Patients ca table and had to take their chances They were usually etherized at the top of the staircase on a little chair outside the operating theater, as there was no roole which ensued, I can recall often being forced against the bannisters with nothing but a thin rail to protect hts But however powerful the patient e ca subject was carried triu rooh the erous Profound anesthesia was difficult to accomplish and serious complications, Warren says, "were not coery has come a full circle, from the time when anesthesia opened new horizons to the time when anesthesia provides a serious hazard to operation It is the kind of ironic twist that one frequently encounters in medical history

A classic example of the full circle is the story of appendicitis This is a very old disease-Egyptian mummies have been found who died of it-but it was never accurately described until 1886

During eons ell aware of diseases which produced pain and pus in the right lower quadrant of the abdomen Some atte the abscess But results were not encouraging and in 1874 the English surgeon Sir John Erickson said that the abdomen was "forever shut froeon" Note that pain was not a consideration here-surgical anesthesia was nearly thirty years old Rather it was the fact that pus collections in the abdomen were not understood and did not appear to be helped by surgical intervention

Twelve years later, an MGH pathologist nainald H Fitz, who had traveled in Europe and studied under the great Gerist Rudolf Virchow, published the results of an intensive study of 466 cases of "typhlitis" and "perityphlitic abscess," as the disease processes were then rather vaguely called Fitz concluded that what the surgeon found at operation-a large area of inflamed bowel and widespread pus in the abdominal cavity-had resulted fro "appendicitis," he created, in effect, a new disease

The new disease was not readily accepted by the medical profession Nor was Fitz's assertion that proper treatment required operation before rupture, instead of afterward Today the idea of "operative intervention" is coenerally the last resort, not the first

Even after his clinical description of appendicitis was accepted, the surgical treatment remained a matter of dispute In many hospitals, appendectomy was considered a bizarre procedure of questionable value In 1897, when Harvey Gushing was a house officer at Johns Hopkins (after having interned at MGH and having seen several appendectonosed appendicitis in hiues to operate; both Halsted and Osier advised against it Finally, however, the surgeons gave in and agreed to do the procedure Gushing did all the rest: he admitted himself to the hospital, perforras, wrote his own pre-operative and post-operative orders It was said that he would have performed the operation himself as well, had he been able to devise a way to do so