The Surgeon Who Dramatically Lowered Operative Mortality Rates
The Surgeon Who Dramatically Lowered Operative Mortality Rates
The surgeon, a 38-year-old man, was professor of surgery at a prestigious university. He belonged to an elite surgical society and was widely respected for his research and teaching abilities. This case report describes how his management of a patient transformed the surgical practice.
Case Presentation: The patient, an 11-year-old boy, was run over by a cart. At the time of admission to a large urban medical center, he was alert, awake, but in considerable pain. Physical examination revealed a compound fracture of the midportion of the left tibia and fibula. There appeared to be no other injuries.
At the time, because of the high incidence of fatal gangrene, the conventional "evidence-based" treatment for open fractures was immediate amputation of the injured extremity. Instead of amputation, the surgeon opted for a highly unconventional approach -- reduction of the fracture and application of a new type of moist protective dressing.
Four days later, when the surgeon changed the dressing, the surgeon, the patient, and the hospital staff were astonished to observe a clean wound with no signs of gangrene. The surgeon noted superficial wound irritation caused by the dressing, but the patient was eventually discharged with a sound, well-healed, functional left leg. A few years later, the surgeon published the results of this and similar cases in a high-impact medical journal.
Who was the surgeon?
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<p>Joseph Lister</p><br/><b>Discussion</b><br/><br/><p> The surgeon was Joseph Lister (1827-1912) (Figure 1). Appointed professor of surgery at the University of Glasgow, Glasgow, Scotland, in 1860, he soon became surgeon-in-chief at the Glasgow Royal Infirmary -- a position that he occupied at the time when he treated James Greenlees, the patient described above. Lister had a sustained interest in compound fractures because they carried an unacceptably high risk for gangrene. Because gangrene was nearly always fatal, the accepted mid-19th-century treatment for lower extremity compound fracture was amputation, even though the operation was a formidable undertaking with a mortality rate of at least 50% for thigh amputations.<sup type="ref">[1]</sup> Lister's new concept was to prevent contamination of the wound overlying the compound fracture with an occlusive dressing containing carbolic acid -- a strong antiseptic. Not all of his early cases were successful, but the mortality rate with Lister's treatment was much lower than with amputation, and most patients retained a functional extremity.<br/><br/><img src="/webmd/professional_assets/medscape/images/content/fullsize/migrated/510/946/ms510946.fig1.gif"/><blockquote><b>Figure 1.</b> Portrait of Joseph Lister, the acknowledged father of antiseptic surgery.</blockquote></p><p>Surgeons were slow to adopt Lister's new ideas. European surgeons became enthusiastic only when Lister's methods saved the lives of many soldiers during the 1870-1871 Franco-Prussian War. American surgeons accepted the new concept only after it was popularized by William Halsted. However, Lister lived to see his new concepts change surgical practice, unlike Ignaz Semmelweiss (1818-1865), a Hungarian physician who had similar ideas but who became insane (in some accounts perhaps because his concepts were never accepted). It is ironic that Semmelweiss died at age 47 from an overwhelming infection resembling puerperal sepsis -- the disease that he had studied so intensively.</p><p>Today, Lister's fame rests upon his concept of antisepsis, which eventually led to the more advanced concept of asepsis. However, Lister made several other important contributions to surgery: He invented several instruments, including today's commonly used blunt-tipped "bandage" scissors, and, most importantly, he popularized the use of absorbable catgut ligatures.</p>
The surgeon, a 38-year-old man, was professor of surgery at a prestigious university. He belonged to an elite surgical society and was widely respected for his research and teaching abilities. This case report describes how his management of a patient transformed the surgical practice.
Case Presentation: The patient, an 11-year-old boy, was run over by a cart. At the time of admission to a large urban medical center, he was alert, awake, but in considerable pain. Physical examination revealed a compound fracture of the midportion of the left tibia and fibula. There appeared to be no other injuries.
At the time, because of the high incidence of fatal gangrene, the conventional "evidence-based" treatment for open fractures was immediate amputation of the injured extremity. Instead of amputation, the surgeon opted for a highly unconventional approach -- reduction of the fracture and application of a new type of moist protective dressing.
Four days later, when the surgeon changed the dressing, the surgeon, the patient, and the hospital staff were astonished to observe a clean wound with no signs of gangrene. The surgeon noted superficial wound irritation caused by the dressing, but the patient was eventually discharged with a sound, well-healed, functional left leg. A few years later, the surgeon published the results of this and similar cases in a high-impact medical journal.
Who was the surgeon?
Ambrose Pare
John Hunter
William Halsted
Joseph Lister
View the correct answer.
<p>Joseph Lister</p><br/><b>Discussion</b><br/><br/><p> The surgeon was Joseph Lister (1827-1912) (Figure 1). Appointed professor of surgery at the University of Glasgow, Glasgow, Scotland, in 1860, he soon became surgeon-in-chief at the Glasgow Royal Infirmary -- a position that he occupied at the time when he treated James Greenlees, the patient described above. Lister had a sustained interest in compound fractures because they carried an unacceptably high risk for gangrene. Because gangrene was nearly always fatal, the accepted mid-19th-century treatment for lower extremity compound fracture was amputation, even though the operation was a formidable undertaking with a mortality rate of at least 50% for thigh amputations.<sup type="ref">[1]</sup> Lister's new concept was to prevent contamination of the wound overlying the compound fracture with an occlusive dressing containing carbolic acid -- a strong antiseptic. Not all of his early cases were successful, but the mortality rate with Lister's treatment was much lower than with amputation, and most patients retained a functional extremity.<br/><br/><img src="/webmd/professional_assets/medscape/images/content/fullsize/migrated/510/946/ms510946.fig1.gif"/><blockquote><b>Figure 1.</b> Portrait of Joseph Lister, the acknowledged father of antiseptic surgery.</blockquote></p><p>Surgeons were slow to adopt Lister's new ideas. European surgeons became enthusiastic only when Lister's methods saved the lives of many soldiers during the 1870-1871 Franco-Prussian War. American surgeons accepted the new concept only after it was popularized by William Halsted. However, Lister lived to see his new concepts change surgical practice, unlike Ignaz Semmelweiss (1818-1865), a Hungarian physician who had similar ideas but who became insane (in some accounts perhaps because his concepts were never accepted). It is ironic that Semmelweiss died at age 47 from an overwhelming infection resembling puerperal sepsis -- the disease that he had studied so intensively.</p><p>Today, Lister's fame rests upon his concept of antisepsis, which eventually led to the more advanced concept of asepsis. However, Lister made several other important contributions to surgery: He invented several instruments, including today's commonly used blunt-tipped "bandage" scissors, and, most importantly, he popularized the use of absorbable catgut ligatures.</p>
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