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Asepsis and Bacteriology: A Realignment of Surgery and Laboratory Science1

  • Thomas Schlich (a1)

Abstract

This paper examines the origins of aseptic surgery in the German-speaking countries. It interprets asepsis as the outcome of a mutual realignment of surgery and laboratory science. In that process, phenomena of surgical reality were being modelled and simplified in the bacteriological laboratory so that they could be subjected to control by the researcher’s hands and eyes. Once control was achieved, it was being extended to surgical practice by recreating the relevant features of the controlled laboratory environment in the surgical work place. This strategy can be seen in the adoption of Robert Koch’s bacteriology by German-speaking surgeons, and the resulting technical changes of surgery, leading to a set of beliefs and practices, which eventually came to be called ‘asepsis’.

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Corresponding author

*Email address for correspondence: thomas.schlich@mcgill.ca

References

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1. The translation is taken from Karel B. Absolon, Mary J. Absolon and Ralph Zientek, ‘From Antisepsis to Asepsis: Louis Pasteur’s Publication on “The Germ Theory and its Application to Medicine and Surgery”’, Review of Surgery, 27 (1970), 245–58. The original quote can be found in L. Pasteur, Théorie des germes et ses application. Lecture faite à l’Académie de Médecine (Paris, 1878), 16–17.

2. Worboys, Michael , Spreading Germs. Disease Theories and Medical Practice in Britain, 1865–1900 (Cambridge: Cambridge University Press, 2000), 156; Anna Greenwood, ‘Lawson Tait and Opposition to Germ Theory: Defining Science in Surgical Practice’, Journal of the History of Medicine and Allied Sciences, 53 (1998), 99–131.

3. This was true for Britain, see Worboys, op. cit. (note 2), 73–107, 150–92, for the US, see Thomas P. Gariepy, ‘The Introduction and Acceptance of Listerian Antisepsis in the United States’, Journal of the History of Medicine and Allied Sciences, 49 (1994), 167–206, but also for Germany, see eg. the most important German textbook for antisepsis, Johann Nepomuk Nussbaum, Leitfaden zur Antiseptischen Wundbehandlung, insbesonders zur Lister’schen Methode für seine Schüler und für praktische Ärzte (Stuttgart: Enke, 1879), and the papers of the main supporter of Lister’s antisepsis in Germany, Richard Volkmann (eg. his ‘Ueber den antiseptischen Occlusivverband und seinen Einfluss auf den Heilungsprocess der Wunden’, in Richard Volkmann (ed.), Sammlung klinischer Vorträge, Series on Surgery, vol. II (Leipzig: Breitkopf & Härtel, 1875)).

4. Worboys, op. cit. (note 2), 150.

5. Lawrence, Christopher and Dixey, Richard , ‘Practicing on principle: Joseph Lister and the germ theories of disease’, in Lawrence, Christopher  (ed.), Medical Theory, Surgical Practice: Studies in the History of Surgery (London and New York: Routledge, 1992), 153215: 206–7.

6. Worboys, op. cit. (note 2), 168, 174, 183.

7. Worboys, op. cit. (note 2), 186.

8. Eg. Worboys, op. cit. (note 2), 151. In Britain, there were attempts at emulating the German realignment of surgery and laboratory science in the 1880s and 90s, but they remained fragmentary, see Worboys, op. cit. (note 2), 170–86. Similarly in the US, see Gert Brieger, ‘American Surgery and the Germ Theory of Disease’, Bulletin of the History of Medicine, 40 (1966), 135–45: 142–5; Gariepy, op. cit. (note 3), 194–201.

9. On Britain, see Worboys, op. cit. (note 2), 172–92; on the US, see Brieger, ibid., 140.

10. Gariepy, op. cit. (note 3), 202–6: quote on p. 205.

11. Fox, N.J. , ‘Scientific Theory Choice and Social Structure: The Case of Joseph Lister’s Antisepsis, Humoral Theory and Asepsis’, History of Science, 26 (1988), 367–97; Lawrence and Dixey, op. cit. (note 5); Lindsay Granshaw, ‘“Upon this principle I have based a practice”: the development of antisepsis in Britain, 1867–90’, in John V. Pickstone (ed.), Medical Innovations in Historical Perspective (New York: St. Martin’s Press, 1992), 17–46; T.H. Pennington, ‘Listerism, its Decline and its Persistence: The Introduction of Aseptic Surgical Techniques in Three British Teaching Hospitals, 1890–99’, Medical History, 39 (1995), 35–60: 36–9, 42–3.

12. Pennington, ibid., 36.

13. Worboys, op. cit. (note 2), 186–7, 191.

14. Brieger, op. cit. (note 8), 145. On Buchanan, see also Gariepy, op. cit. (note 3), 203–4.

15. Latour, Bruno , ‘Give me a laboratory and I will raise the world’, in Karin D. Knorr-Cetina and Micheal Mulkay (eds), Science Observed. Perspectives on the Social Study of Science (London, Beverly Hills and New Delhi: Sage, 1983), 141–70; Joseph Rouse, Knowledge and Power (Ithaca and London: Cornell University Press, 1987), 95–111, calls the laboratory an ‘artificial microworld’. For this line of argument in connection with surgery, see also Thomas Schlich, ‘Surgery, Science and Modernity: Operating Rooms and Laboratories as Spaces of Control’, History of Science, 45 (2007), 231–56.

16. Greenwood, op. cit. (note 2), 103.

17. Gooday, Graeme , ‘Placing or Replacing the Laboratory in the History of Science?’ Isis, 99 (2008), 783–95: 786.

18. Pickstone, John V. , ‘Ways of Knowing: Towards a Historical Sociology of Science, Technology and Medicine’, British Journal for the History of Science, 26 (1993), 433458; Arleen Tuchman, Science, Medicine, and the State in Germany: The Case of Baden, 1815–1871 (New York: Oxford University Press, 1993); Timothy Lenoir, ‘Laboratories, medicine and public life in Germany, 1830–1849: ideological roots of the institutional revolution’, in Andrew Cunningham and Perry Williams (eds), The Laboratory Revolution in Medicine (Cambridge: Cambridge University Press, 1992), 14–71; Richard L. Kremer, ‘Building institutes for physiology in Prussia, 1836–1846: contexts, interests, and rhetoric’, in Cunningham and Perry (eds), idem, 72–109.

19. Bynum, William F. , Science and the Practice of Medicine in the Nineteenth Century (Cambridge: Cambridge University Press, 1994), 95103.

20. Gradmann, Christoph , Krankheit im Labor. Robert Koch und die medizinische Bakteriologie (Göttingen: Wallstein, 2005), 81.

21. Bulloch, William , The History of Bacteriology (New York: Dover, 1938), 198; Gradmann, ibid., 59–83.

22. Berger, Silvia , Bakterien in Krieg und Frieden. Eine Geschichte der medizinischen Bakteriologie in Deutschland 1890–1933 (Göttingen: Wallstein, 2009), 3536.

23. Gradmann, op. cit. (note 20), 59–83.

24. Koch, Robert , Untersuchungen über die Aetiologie der Wundinfectionskrankheiten (Leipzig: F.C.W. Vogel, 1878), 5; Berger, op. cit. (note 22), 39.

25. Koch, Robert , Untersuchungen über die Aetiologie der Wundinfectionskrankheiten (Leipzig: F.C.W. Vogel, 1878), figure 6 in the appendix. Courtesy of the Osler Library, McGill University, Montreal, Canada.

26. Berger, op. cit. (note 22), 39.

27. Koch, op. cit. (note 24), 4.

28. Gradmann, op. cit. (note 20), 97–103.

29. Koch, op. cit. (note 24), 1–9. On the representation techniques in more detail, see Thomas Schlich, ‘Linking Cause and Disease in the Laboratory: Robert Koch’s Method of Superimposing Visual and “Functional” Representations of Bacteria’, History and Philosophy of the Life Sciences, 22 (2000), 71–88.

30. Latour, Bruno , ‘Visualization and Cognition: Thinking with Eyes and Hands’, Knowledge and Society: Studies in the Sociology of Culture Past and Present, 6 (1986), 140.

31. Koch, op. cit. (note 24), 27–8; Gradmann, op. cit. (note 20), 84–90.

32. Gradmann, op. cit. (note 20), 84–90; Koch, op. cit. (note 24), 3. The gap was filled by Alexander Ogston, at that time assistant surgeon to the Aberdeen Royal Infirmary. Following Koch’s technical methods exactly, he examined abscesses in humans and determined their infective agents, see Bulloch, op. cit. (note 21), 149.

33. Gradmann, op. cit. (note 20), 90; see also 91–103.

34. On the history of the postulates, see Christoph Gradmann, ‘Alles eine Frage der Methode. Zur Historizität der Kochschen Postulate 1840–2000’, Medizinhistorisches Journal, 43 (2008), 121–48.

35. Bulloch, op. cit. (note 21), 226.

36. Koch, Robert , ‘Zur Untersuchung von pathogenen Organismen’, Mittheilungen aus dem Kaiserlichen Gesundheitsamte, 1 (1881), 148: 28.

37. Ibid., 22, 25.

38. Interestingly the emphasis on order and control was characteristic not only for bacteriology and surgery, but also for German military concepts of the time, Berger, op. cit. (note 22), 74.

39. Berger, op. cit. (note 22), 45.

40. Berger, op. cit. (note 22), 60.

41. Gradmann, op. cit. (note 20), 102; Koch, op. cit. (note 24), 26–7.

42. Gaffky, Georg , ‘Experimentell erzeugte Septicämie mit Rücksicht auf progressive Virulenz und accommodative Züchtung’, Mittheilungen aus dem Kaiserlichen Gesundheitsamte, 1 (1881), 80133: 82. On the shaping of Koch’s concept of specificity by medical concerns, see Olga Amsterdamska, ‘Medical and Biological Constraints: Early Research on Variation in Bacteriology’, Social Studies of Science, 17 (1987), 657–87.

43. ‘…die Controle der Aussaat sowohl, wie der Ernte …’ Gaffky, ibid., citation: 127, see also 116–7, 133.

44. Langenstein (Hamburg), Herr Carl , ‘Diskussionsbeitrag’, Verhandlungen der Deutschen Gesellschaft für Chirurgie, 27 (1898), 1617: 16.

45. Koch, Robert , ‘Ueber Desinfection’, Mittheilungen aus dem Kaiserlichen Gesundheitsamte, 1 (1881), 234283: 352.

46. Pennington, op. cit. (note 11), 38.

47. Dr Robert Koch, Dr G. Gaffky and Dr F. Loeffler, ‘Versuche über die Verwerthbarkeit heisser Wasserdämpfe zu Desinfectionszwecken’, Mittheilungen aus dem Kaiserlichen Gesundheitsamte, 1 (1881), 322–40. On the use of heat sterilisation as laboratory method, see eg. Koch, op. cit. (note 35), 17.

48. Worboys, op. cit. (note 2), 182.

49. About Koch’s students, see Berger, op. cit. (note 22), 12.

50. Worboys, op. cit. (note 2), 98–9.

51. Neuber, Gustav , Die aseptische Wundbehandlung in meinen Privat-Hospitälern (Kiel: Lipius & Tischler, 1886); Georg Ernst Konjetzny and Edward Heits, Gustav Adolf Neuber und die Asepsis (Stuttgart: Enke, 1950). Mikulicz attributed the beginning of asepsis to Neuber, but its development into a generally useable method he saw as a collective accomplishment, in which Bergmann and his student Schimmelbusch played a prominent role, see J. Mikulicz, ‘Ueber der neuesten Bestrebungen, die aseptische Wundbehandlung zu vervollkommnen’, Verhandlungen der deutschen Gesellschaft für Chirurgie, 27 (1898), 1–37: 1–2.

52. See eg. Granshaw, op. cit. (note 11), 27–40. On Neuber’s claim of British lineage for his approach, see G. Neuber, ‘Erfolge der aseptischen Wundbehandlung’, Verhandlungen der Deutschen Gesellschaft für Chirurgie, 32, II (1903), 264–80: 271–2.

53. Buchholz, Arend , Ernst von Bergmann (Leipzig: F.C.W. Vogel, 1911), 245, 333, 413; Bulloch, op. cit. (note 21), 133–4.

54. For this and the following, see Ernst von Bergmann, ‘Die Gruppierung der Wundkrankheiten’, Berliner klinische Wochenschrift, 19 (1882), 677–9, 701–3: 678. On Bergmann’s status as an unknown surgeon at the time of his appointment, see Carl Ludwig Schleich, Besonnte Vergangenheit (Berlin: Rowohlt, 1921), 168.

55. The annual ‘Versammlung Deutscher Naturforscher und Ärzte’ was an important and prestigious forum for presentations to a larger elite public in the German-speaking world of the nineteenth century. Bergmann’s speech was subsequently published in the most important German non-specialised medical journal: Ernst von Bergmann, ‘Ueber antiseptische Wundbehandlung’, Deutsche medizinische Wochenschrift, 8 (1882), 559–61, 571–2. On the programmatic function of this speech, see Buchholz, op. cit. (note 52), 419.

56. Bergmann, ibid., 571.

57. Bergmann, ibid., 571.

58. Bergmann, ibid., 571.

59. Bergmann, ibid., 572.

60. For this and the following passages, see Friedrich Fehleisen, Die Aetiologie des Erysipels (Berlin: Theodor Fischer, 1883), quotes on pp. 14 and 15.

61. Bergmann, op. cit. (note 54), 571.

62. Ray Lankester, E. , ‘Koch and the Comma-Bacterium’, letter to the editor, Nature, December 25 (1884), 168–71.

63. Fehleisen, op. cit. (note 59), 16.

64. Buchholz, op. cit. (note 52), 416.

65. Bergmann’s assistant Kurt Schimmelbusch contributed to the disillusionment by furnishing the microscopic evidence that tuberculin did not have the expected effect on tuberculous tissue. Buchholz, op. cit. (note 52), 454–6; Gradmann, op. cit. (note 20), 187–8.

66. See eg. Paul Leopold Friedrich, Das Verhältnis der experimentellen Bakteriologie zur Chirurgie. Antrittsvorlesung gehalten am 10. Juli 1897 in der Aula der Universität Leipzig (Leipzig: Wilhelm Engelmann, 1897), 26–7.

67. Mikulicz, J. , ‘Ueber Versuche, die “aseptische” Wundbehandlung zu einer wirklich keimfreien Methode zu vervollkommen’, Deutsche medizinische Wochenschrift, 33 (1897), 409413: 409.

68. Schleich, op. cit. (note 53), 168–70; Buchholz, op. cit. (note 52), 428–36.

69. See eg.Rydygier, L. , ‘Einige Bemerkungen über die auf unserer Klinik geübte Methode der Anti- und Asepsis’, Wiener klinische Wochenschrift, 11 (1898), 993996.

70. Schlange’s recollections are cited by Buchholz, op. cit. (note 52), 430. About the connection with Neuber, see Konjetzky and Heits, op. cit. (note 50), 31–2.

71. Berger, op. cit. (note 22), 46.

72. Killian, H. and Krämer, G. , Meister der Chirurgie und die Chirurgenschulen im Deutschen Raum (Stuttgart: Thieme, 1951), 166. Gwer Reichen, Die chirurgische Abteilung des Bürgerspitals Basel zur Zeit der Antiseptik (Aarau: Sauerländer, 1949), 58.

73. Dr Garrè, ‘Zur Aetiologie acut eitriger Entzündungen’, Fortschritte der Medicin, 3 (1885), 165–72.

74. Killian and Krämer, op. cit. (note 71), 168.

75. Tröhler, Ulrich , Der Nobelpreisträger Theodor Kocher 1841–1917. Auf dem Weg zur physiologischen Chirurgie (Basel: Birkhäuser, 1984), 3135.

76. Karamehmedovic, Osman , Ernst Tavel (1858–1912). Bakteriologe und Chirurg in Bern (Bern: Hans Huber, 1973; ibid., 33–5. Interestingly in 1895 Kocher did not use the term ‘asepsis’, while in 1899 he did so to characterise his usual anti-infectious procedure: Theodor Kocher and Ernst Tavel, Vorlesungen über chirurgische Infektionkrankheiten (Basle: Sallmann, 1895); Theodor Kocher, ‘On Some Conditions of Healing by First Intention, with Special References to Disinfection of Hands’, Transactions of the American Surgical Association, 17 (1899), 116–42.

77. Kümmell, H. , ‘Die Bedeutung der Luft- und Contactinfection für die praktische Chirurgie’, Archiv für klinische Chirurgie, 33 (1886), 531547. On Kümmell, see Killian and Krämer, op. cit. (note 71), 206–7.

78. Fürbringer, Paul , Untersuchungen und Vorschriften über die Desinfektion der Hände des Arztes nebst Bemerkungen über den bakteriologischen Charakter des Nagelschmutzes (Wiesbaden: J.F. Bergmann, 1888), quote p. 3; Paul Fürbringer, ‘Zur Desinfection der Hände des Arztes’, Deutsche medizinische Wochenschrift, 14 (1888), 985–7; Paul Fürbringer and Dr Freyhan in Berlin, ‘Neue Untersuchungen über die Desinfection der Hände’, Deutsche medizinische Wochenschrift, 23 (1897), 81–5. On Fürbringer, see Julis Leopold Pagel, Biographisches Lexikon hervorragender Ärzte des neunzehnten Jahrhunderts (Berlin, Wien: Urban und Schwarzenberg, 1901), 567–8.

79. Hugo Davidsohn (I. Aus dem hygienischen Institut zu Berlin), ‘Wie soll der Arzt seine Instrumente desinficiren?’ Berliner klinische Wochenschrift, 25 (1888), 697–703. Hugo Davidsohn, Arzt in Berlin, ‘III. Die Benutzung des Koch’schen Dampfapparats für die Sterilisierung von Verbandstoffen’, Berliner klinische Wochenschrift, 126 (1889), 956–7. Davidsohn did not use the word ‘asepsis’ but presents his method of sterilisation and disinfection as a contribution to a new kind of antisepsis based on Koch’s bacteriology.

80. Worboys, op. cit. (note 2), 186.

81. Ackerknecht, Erwin , A Short History of Medicine (Baltimore: John Hopkins University Press, 1982), 191.

82. von Bergmann, Ernst , ‘Nachruf an Dr Kurt Schimmelbusch’, Berliner klinische Wochenschrift, 32 (1895), 730731: 730.

83. Schimmelbusch, Curt , Anleitung zur Aseptischen Wundbehandlung (Berlin: Hirschwald, 1892), 161.

84. Schimmelbusch, op. cit. (note 82); Bergmann, op. cit. (note 81).

85. von Bergmann, Ernst , ‘De l’asepsie substituée à l’antisepsie’, La semaine médicale, 10 (1890), 303.

86. Theodore Rake, Alfred , ‘Translator’s preface’, in Curt Schimmelbusch (ed.), The Aseptic Treatment of Wounds, translated from the 2nd German edn (London: Lewis, 1894), vii.

87. Schimmelbusch, op. cit. (note 82), 3.

88. Schimmelbusch, op. cit. (note 82), 166.

89. Schimmelbusch, Curt , ‘Die Durchführung der Asepsis in der Klinik des Herrn Geheimrath von Bergmann in Berlin’, Archiv für klinische Chirurgie, 42 (1891), 123171.

90. Schimmelbusch, op. cit. (note 82), 17.

91. Schimmelbusch, op. cit. (note 82), 79.

92. Schimmelbusch, op. cit. (note 82), 161.

93. Schimmelbusch, op. cit. (note 82), 49–67.

94. Schimmelbusch, op. cit. (note 82), 81.

95. Professor Dr Landerer, ‘Die Ursachen des Misslingens der Asepsis’, Verhandlungen der Deutschen Gesellschaft für Chirurgie, 27 (1898), 38–45: 38 (does not use the term ‘asepsis’).

96. Mikulicz, op. cit. (note 50), 2.

97. Mikulicz, op. cit. (note 66), 409.

98. Mikulicz, op. cit. (note 50), 3.

99. Herr Helferich (Greifswald), ‘Diskussionsbeitrag’, Verhandlungen der Deutschen Gesellschaft für Chirurgie, 27 (1898), 23–25: 24. A similar argument had been brought forward by Lister himself in 1891, see Pennington, op. cit. (note 11), 39.

100. Killian and Krämer, op. cit. (note 71), 187.

101. Mikulicz, op. cit. (note 50), 1–2.

102. Friedrich declared his research to be about the question of whether surgeons should use antisepsis or asepsis. Professor Dr P.L. Friedrich, ‘Die aseptische Versorgung frischer Wunden, unter Mittheilung von Their-Versuchen über die Auskeimungszeit von Infectionserregern in frischen Wunden’, Verhandlungen der Deutschen Gesellschaft für Chirurgie, 27 (1898), 46–68: 47. For a similar British example in the same time period, see Worboys, op. cit. (note 2), 190. The terms became so polemically charged that Neuber felt he should come to the defence of the ‘old antisepsis’ against the disparaging remarks against it in an 1898 discussion, see Herr Neuber (Kiel), ‘Diskussionsbeitrag’, Verhandlungen der Deutschen Gesellschaft für Chirurgie, 27 (1898), 19–21. Some surgeons explicitly rejected the term ‘aseptic wound treatment’, for example Anton Wölfler in 1897, who wanted to replace it by the term ‘atoxic antisepsis’, see A. Wölfler, ‘Ueber Operations-Handschuhe’, Beiträge zur klinischen Chirurgie, 19 (1897), 255–9: 255.

103. Mikulicz, op. cit. (note 66), 411.

104. Mikulicz, op. cit. (note 66), 411.

105. Mikulicz, op. cit. (note 66), 411.

106. Mikulicz, op. cit. (note 50), 5. This was something that Schimmelbusch had recommended in his Guide, Schimmelbusch, op. cit. (note 82), 157.

107. Mikulicz, op. cit. (note 50), 5.

108. Garrè (Rostock), Herr , ‘Diskussionsbeitrag’, Verhandlungen der Deutschen Gesellschaft für Chirurgie, 27 (1898), 2223: 22.

109. Mikulicz, op. cit. (note 66), 412; Mikulicz, op. cit. (note 50), 3; Johann Mikulicz, ‘Das Operiren in sterilisirten Zwirnhandschuhen und mit Mundbinde’, Centralblatt für Chirurgie, 24 (1897), 713–19: 716. On Flügge, see Berger, op. cit. (note 22), 45–6. Flügge’s compendium, Dr C. Flügge, Grundriss der Hygiene für Studierende und Praktische Ärzte, Medicinal- und Verwaltungsbeamte (Leipzig: Veit, 1889), was completely based on Kochian bacteriology.

110. Mikulicz, op. cit. (note 66), 412; Mikulicz, op. cit. (note 50), 3; Mikulicz, ‘Das Operiren’, ibid., 716; Schimmelbusch, op. cit. (note 82), 153.

111. Schimmelbusch, op. cit. (note 82), 153–7, quote p. 158.

112. Eg. Rydygier, op. cit. (note 68), 995.

113. Fraenkel, Alexander , ‘Congresseindrücke vom 27. Congress der deutschen Gesellschaft für Chirurgie in Berlin’, Wiener klinische Wochenschrift, 21 (1898), 419421: 420; Alexander Fraenkel, ‘Einige Bemerkungen über Neuerungen der “aseptischen” Technik’, Wiener klinische Wochenschrift, 10 (1897), 653–5.

114. Mikulicz, op. cit. (note 50), 36.

115. Andrew Mendelsohn, J. , ‘Cultures of Bacteriology. Formation and Transformation of a Science in France and Germany, 1870–1914’ (unpublished PhD dissertation: Princeton University, Princeton 1996), 442–75.

116. Berger, op. cit. (note 22), 91.

117. Andrew Mendelsohn, J. , ‘From eradication to equilibrium: how epidemics became complex after world war I’, in Lawrence, Christopher and Weisz, George  (eds), Greater than the Parts. Holism in Biomedicine, 1920–1950 (New York, Oxford: Oxford University Press, 1998), 303331.

118. Representation, see Berger, op. cit. (note 22), 94, who cites Ferdinand Hueppe (1852–1938), an early ‘dissident bacteriologist’. On the relationship of practical medical problems with the bacteriological reorientation, see Amsterdamska, op. cit. (note 41), 671–5.

119. Berger, op. cit. (note 22), 91–130.

120. Fraenkel, ‘Einige Bemerkungen’, op. cit. (note 112), 654; on Hueppe as a dissident, see Berger, op. cit. (note 22), 92–6.

121. Pagel op. cit. (note 77), 553–4; Paul Friedrich, ‘Vergleichende Untersuchungen über den Vibrio Cholerae asuaticae (Kommabacillus Koch), mit besonderer Berücksichtigung der diagnostischen Merkmale desselben’, Arbeiten aus dem Kaiserlichen Gesundheitsamte, 8 (1893), 87–134; Paul Friedrich, ‘Eine Heizvorrichtung des Mikroskops zu bakteriologischen Untersuchungen’, Arbeiten aus dem Kaiserlichen Gesundheitsamte, 8 (1893), 135–9.

122. Friedrich, op. cit. (note 101), 60.

123. Friedrich, op. cit. (note 65), 8–14.

124. Lockwood, Charles Barrett , Aseptic Surgery (Edinburgh: Young, J. Pentland, 1896), 96.

125. Mikulicz, op. cit. (note 50), 37.

126. von Manteuffel, W. Zoege , ‘Gummihandschuhe in der chirurgischen Praxis’, Centralblatt für Chirurgie, 24 (1897), 553556: 554. Specifically on gloves, see Thomas Schlich, ‘Manual Versus Aseptic Control: the Controversy about Surgical Gloves in German Surgery in the 1890s’, Bulletin for the History of Medicine, 87 (forthcoming).

127. Worboys, op. cit. (note 2), 189.

128. English, Peter C. , Shock, Physiological Surgery, and George Washington Crile. Medical Innovation in the Progressive Era (Westport, CT: Greenwood Press, 1980), 30.

129. Halsted, William Stewart , ‘Ligature and Suture Material’, Journal of the American Medical Association, 60 (1913), 11191126: 1119.

130. Worboys, op. cit. (note 2), 182, cites C. Keetley, Index of Surgery (London: Smith, Elder, 1881), 33.

131. Lockwood, op. cit. (note 123), 193.

132. Quoted after Tröhler, op. cit. (note 74), 37.

133. Friedrich, op. cit. (note 65), 28.

134. Halsted, William , ‘The Training of the Surgeon’, The Annual Address in Medicine, delivered at Yale University, New Haven, CT, June 27, 1904, first published in Johns Hopkins Bulletin, xv (1904), 267–75, reprinted in William S. Halsted, Surgical Papers (Baltimore: Johns Hopkins Press, 1924), 512–31: 530. For another US example (Arthur Tracy Cabot) see Brieger, op. cit. (note 8), 145.

135. Worboys, op. cit. (note 2), 182.

136. Worboys, op. cit. (note 2), 186.

137. Worboys, op. cit. (note 2), 192.

138. Schlich, Thomas , The Origins of Organ Transplantation: Surgery and Laboratory Science, 1880s–1930s (Rochester, NY: The University of Rochester Press, 2010).

I thank Christoph Gradmann, Oslo, Ulrich Tröhler, Berne and the participants of the Colloquium of the Johns Hopkins University Graduate Program in the History of Science, Medicine and Technology for commenting on previous versions of the paper. I am also grateful to Hubert Steinke, Berne, for making source material available to me.

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Asepsis and Bacteriology: A Realignment of Surgery and Laboratory Science1

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