Thursday, October 27, 2011

Thomas Jefferson, Joseph Lister and William Halstead

It's always good to see your "rellies" name in the headlines, even if the link is extremely tenuous!

I saw a headline labeled Thomas Jefferson University, and was immediately drawn to it, both for the name and the fact that someone had reduced wound infections by nearly 50%! It was serendipitous really that I had just finished reading a book about the introduction of painless surgery in the 19th Century. The death rate due to infection following surgery during this period was an astonishing 70 to 90%,  in fact "Laudable pus" was seen to be a healthy sign and a natural progression to normal wound healing!

Remember, prior to 1846 when Dr Joseph Lister introduced his aspectic techniques with carbolic acid, surgeons wore the same frock coats to each operation, and when surgery was over, they wiped their instruments on them to clean them. And it wasn't until 1889 (the year that my grandfather was born!) that Dr William Halstead in the US, introduced the wearing of rubber gloves during surgery. Actually, according to legend, he didn't introduce them to help reduce wound infections, but because the theatre nurse he "fancied" had terrible skin reactions to carbolic acid, and so he had them custom made for her as a "surprise" to protect her skin. It obviously worked so well that everyone started wearing them and the rest is history!

But back to Thomas Jefferson (not related sadly)  and the hospital named after him. Apparently by introducing a check list of 12 things to do to reduce infection rates, they had an astounding 50% reduction in wound infections after a surgical procedure known as a Whipple's operation. This is an operation that is performed for growths on the pancreas, both benign and malignant. The actions they took weren't big things either, amongst others they included:

  • smoking was banned at least 2 weeks prior to surgery
  • they clipped hair from the skin pre-op instead of shaving it off.
  • they used Chlorhexidine-alcohol skin preparation instead of iodine
  • they protected the skin edges meticulously during surgery
  • they changed gloves and gowns before closing the abdominal wound.
Historically, medicine progresses in small steps, and it's attention to the small things that often make the biggest difference.
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