How do good ideas spread? Anesthesia spread rapidly, but, Atul Gawande notes, antisepsis did not:
In the eighteen-sixties, the Edinburgh surgeon Joseph Lister read a paper by Louis Pasteur laying out his evidence that spoiling and fermentation were the consequence of microorganisms. Lister became convinced that the same process accounted for wound sepsis. Pasteur had observed that, besides filtration and the application of heat, exposure to certain chemicals could eliminate germs. Lister had read about the city of Carlisle’s success in using a small amount of carbolic acid to eliminate the odor of sewage, and reasoned that it was destroying germs. Maybe it could do the same in surgery.
During the next few years, he perfected ways to use carbolic acid for cleansing hands and wounds and destroying any germs that might enter the operating field. The result was strikingly lower rates of sepsis and death. You would have thought that, when he published his observations in a groundbreaking series of reports in The Lancet, in 1867, his antiseptic method would have spread as rapidly as anesthesia.
Far from it. The surgeon J. M. T. Finney recalled that, when he was a trainee at Massachusetts General Hospital two decades later, hand washing was still perfunctory. Surgeons soaked their instruments in carbolic acid, but they continued to operate in black frock coats stiffened with the blood and viscera of previous operations — the badge of a busy practice. Instead of using fresh gauze as sponges, they reused sea sponges without sterilizing them. It was a generation before Lister’s recommendations became routine and the next steps were taken toward the modern standard of asepsis — that is, entirely excluding germs from the surgical field, using heat-sterilized instruments and surgical teams clad in sterile gowns and gloves.
So what were the key differences?
First, one combated a visible and immediate problem (pain); the other combated an invisible problem (germs) whose effects wouldn’t be manifest until well after the operation. Second, although both made life better for patients, only one made life better for doctors. Anesthesia changed surgery from a brutal, time-pressured assault on a shrieking patient to a quiet, considered procedure. Listerism, by contrast, required the operator to work in a shower of carbolic acid. Even low dilutions burned the surgeons’ hands. You can imagine why Lister’s crusade might have been a tough sell.
Anesthesia: Change the patient.
Antisepsis: Change the doctor.
Yeah, anesthesia was easier to sell.