Statistics and the British controversy about the effects of Joseph Lister’s system of antisepsis for surgery, 1867–1890
Statistics and the British controversy about the effects of Joseph Lister’s system of antisepsis for surgery, 1867–1890
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关于约瑟夫·李斯特手术消毒系统效果的统计数据和英国争议，1867 年至 1890 年
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发表时间：
2015
影响因子：
17.3
通讯作者：
U. Tröhler
中科院分区：
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作者：
U. Tröhler
在他的修正主义著作《糟糕的医学》中。自希波克拉底以来，医生就一直在伤害人类，历史学家大卫·伍顿（David Wootton）声称，约瑟夫·李斯特（Joseph Lister，1827-1912）通过在手术中引入石炭酸防腐剂，成为第一位将“科学”与医学实践相结合，从而延长生命的医生：“李斯特由此开始了现代医学史，其定义是基于以发展科学理解为基础的治疗方法的不断改进，而令人惊讶的是，这就是手术”（第 227 页）。伍顿指出，李斯特的所作所为有“科学”动机。尽管他确实确信“生命体”导致了伤口化脓，但鉴于他遇到的所有挑战（见下文），他并不太关心他的方法背后的理论，只要人们使用它即可。伍顿提到了“李斯特主义的外科革命”（第 229 页），但沃博伊斯之前已经表明，李斯特主义并没有引起外科革命；相反，李斯特主义并没有引起外科革命。相反，这种观点是 1880 年之后“李斯特主义者”创造的（第 83 页）。所谓的从消毒（李斯特）到无菌（科赫、德国和瑞士外科医生）的顺序可能过于简单化，因为后者可以追溯到早期的“清洁学校”，大多数外科医生以某种方式将其与消毒措施结合起来。伍顿对李斯特作品及其影响的庆祝性介绍很常见，但过于简单化了。事实上，关于李斯特消毒系统的效果存在相当大的争议。正如历史学家指出的那样，这场斗争至少在英国持续了十多年。 1867 年至 1879 年间英国医学会的年会以及医学媒体都对此进行了追踪。这场争论中的论点长期以来一直被具有不同观点的历史学家描述和背景化（例如，参见尼科尔森和卡特赖特的参考书目）。李斯特主义的理论原则，即由细菌引起的伤口疾病（感染、腐败、坏疽）在欧洲大陆更容易被接受，这可能是因为法国的勒梅尔和意大利的博蒂尼已经使用石炭酸来预防和治疗伤口疾病。在本文中，我重点关注英国提出的支持或反对抗菌方法有益效果主张的证据类型。特别令人感兴趣的是所使用的数值数据的种类和作用。我首先检查李斯特最初报告的性质，然后重新评估他在格拉斯哥皇家医院（GRI）病房的短期死亡率统计数据，与该医院所有外科病房的死亡率统计数据进行比较，然后考虑更长期的观点。我提出了李斯特是否、如何以及为何选择他的数据的问题。最后，我看看李斯特主张的重要反对者是如何提出他们的论点的。研究结果将揭示外科史上这一重大病例发生所依据的证据的认知状态。
In his revisionist book Bad medicine. Doctors doing harm since Hippocrates, historian David Wootton claims that, by introducing antisepsis with carbolic acid in surgery, Joseph Lister (1827–1912) was the first doctor to merge ‘science’ with the practice of medicine with resulting prolongation of life: ‘Lister thus begins the modern history of medicine, defined in terms of constant improvements in therapy grounded in developing scientific understanding, and it is striking that it is surgery’ (p. 227). Wootton points out that Lister had a ‘scientific’ motive for doing what he did. Although it is true that he was convinced that ‘living bodies’ caused wound suppuration, in view of all the challenges he encountered (see below), he did not care too much about the theory underlying his method provided people used it. Wootton refers to ‘Lister’s revolution in surgery’ (p. 229), but Worboys had shown previously that there had been no surgical revolution caused by Listerism; rather this view was created by ‘Listerians’ after 1880 (p. 83). The alleged sequence antisepsis (Lister) to asepsis (Koch, German and Swiss surgeons) is probably too simplistic in that the latter can be retraced to the earlier ‘cleanlinessschool’, which most surgeons combined in one way or another with antiseptic measures. Wootton’s celebratory presentation of Lister’s work and its influence is quite common, but it is an oversimplification. In fact, there was considerable controversy about the effects of Lister’s system of antisepsis. As historians have pointed out, this fight was to last for over a decade, at least in Britain. It can be followed in the annual meetings of the British Medical Association between 1867 and 1879 as well as in the medical press. The arguments in this controversy have long been described and contextualised by historians with varying perspectives (see, for example, bibliograpies in Nicolson and Cartwright). The theoretical principles underlying Listerism, that is that germs caused wound diseases (infection, putrefaction, gangrene) were more readily accepted in continental Europe, perhaps because carbolic acid had already been used to prevent and treat wound disease by Lemaire in France and Bottini in Italy. In this article, I focus on the type of evidence that was presented in Britain in support of, or against, the claims of beneficial effects of the antiseptic method. Of particular interest are the kinds and role of numerical data used. I begin by examining the nature of Lister’s initial reports, then reassess the short-term mortality statistics from his wards in the Glasgow Royal Infirmary (GRI) compared with those of all surgical wards of the Infirmary, and then consider a longer-term perspective. I raise questions about whether, how and why Lister selected his data. Finally, I look at the way important opponents of Lister’s claims presented their arguments. The results will shed light on the epistemic status of the evidence on which this momentous case in surgical history took place.