No Time for Statistics: Joseph Lister's Antisepsis and Types of Knowledge in Nineteenth-Century British Surgery.

This article documents Joseph Lister's reluctance to publish numerical material and aims at explaining his skeptical view about statistics through an investigation of his approach in its historical context. In this context, statistics was only one kind of evidence used in surgery, along with case histories and experimental results from the laboratory. They represent different "ways of knowing," anchored in different social, conceptual, and practical contexts. The account looks at Lister's approach to wound disease and analyzes how this relates to his attitude toward different types of evidence about surgical outcomes. For this, it also examines his contemporaries' approaches to fighting wound disease as well as their evaluation of different kinds of evidence. This article is a contribution to the history of Lister's antisepsis, but also to the history of the production and use of therapeutic knowledge in nineteenth- and early twentieth-century surgery more generally.

Inhibition of cyclooxygenase-1 and -2 activity in keratinocytes inhibits PGE2 formation and impairs vascular endothelial growth factor release and neovascularisation in skin wounds.

Inhibition of cyclooxygenase (Cox) enzymatic activity by non-steroidal anti-inflammatory drugs (NSAIDs) provides the molecular basis of analgesia following wounding or surgery. This study investigated the role of Cox activity in the regulation of vascular endothelial growth factor (VEGF) expression in keratinocytes and the formation of new blood vessels in acute wounds in mice. To this end, human HaCaT keratinocytes were stimulated with epidermal growth factor (EGF). EGF increased Cox-1 mRNA in the presence of the constitutively expressed Cox-1 protein in keratinocytes. EGF coinduced Cox-2 and VEGF165 mRNA and protein expression and an accumulation of prostaglandin E2 (PGE2 ) in cell culture supernatants. Inhibition of Cox isozyme activity by Cox-1 and -2 siRNA or ibuprofen reduced PGE2 and VEGF165 release from keratinocytes. In a mouse model of excisional wound healing, Cox-2 and VEGF165 expression were colocalized in the granulation tissue of acute wounds. Oral treatment of mice with the Cox-1 and -2 inhibitor diclofenac was associated with reduced levels of VEGF165 protein and an impaired blood vessel formation in acute wound tissue. In summary, our data suggest that a reduction of PGE2 -triggered VEGF165 protein expression in wound keratinocytes is likely to contribute to the observed impairment of wound neovascularisation upon Cox inhibition.

Surgical Innovation and the Multiple Meanings of Randomized Controlled Trials: The First RCT on Minimally Invasive Cholecystectomy (1980-2000).

This article uses the case of the first randomized controlled trial (RCT) evaluating laparoscopic cholecystectomy to investigate the introduction of minimally invasive surgery in the 1990s and explore the meaning of RCTs within the context of the introduction of a new surgical technology. It thus brings together the history of the use of laparoscopic cholecystectomy to remove the gallbladder, and the history of the RCT, shedding light on particular aspects of both. We first situate the RCT in the context of the history of the various treatment options for gallstones, or cholelithiasis, then characterize the specific situation of the rapid, patient-driven spread of laparoscopic cholecystectomy, and in a next step describe how the local context of laparoscopic cholecystectomy as a new technology made it possible and desirable to conduct an RCT, despite numerous obstacles. This article then shows that in order to capture and understand the rationale of an RCT it is worth it to explore the various levels and dimensions of its context, demonstrating how even the RCT as an ostensibly universal tool draws its meaning from its contexts and that this meaning goes beyond the simple determination of efficiency and safety, including, maybe most importantly, the control and management of new technologies.

"One and the Same the World Over": The International Culture of Surgical Exchange in an Age of Globalization, 1870-1914.

This paper examines the international exchange in surgery in the decades before World War I, a period of growing globalization in communication and transport. Focusing on Europe and North America, it looks first at the various means of exchange, especially surgical travel and the culture emerging around it and follows specific directions of exchange, from France and Britain, first to the German-speaking countries and finally to North America. Subsequently, the account turns to international organizations as an important means of exchange in this time period. The International Society of Surgery, in particular, provided a forum for a vivid internationalist discourse, which, however, stood in tension with simultaneous nationalist tendencies leading up to World War I. The paper finally discusses how the international exchange and communication at the time can be seen as an instance of modern surgeons claiming-and simultaneously trying to create-the global universality of surgical knowledge and practices, making sure that surgery is the same the world over.

'The Days of Brilliancy are Past': Skill, Styles and the Changing Rules of Surgical Performance, ca. 1820-1920.

This paper examines how, over the course of the nineteenth and early twentieth centuries, the appreciation of skill in surgery shifted in characteristic ways. Skill is a problematic category in surgery. Its evaluation is embedded into wider cultural expectations and evaluations, which changed over time. The paper examines the discussions about surgical skill in a variety of contexts: the highly competitive environment of celebrity practitioners in the amphitheatres of early nineteenth-century Britain; the science-oriented, technocratic German-language university hospitals later in the century; and the elitist surgeons of late nineteenth and early twentieth-century United States with their concerns about distancing themselves from commercialism and cheap showmanship. For analysing the interaction of surgical practices with their various contexts the paper makes use of the concept of 'performance' and examines how the rules of surgical performance varied according to the prevailing technical, social, and moral conditions. Over the course of the century, surgical performance looked more and more recognisably modern, increasingly following the ideals of replicability, universality and standardisation. The changing ideals of surgical skill are a crucial element of the complex history of the emergence of modern surgery, but also an illuminating example of the history of skill in modern medicine.

Why did Alfred Blalock and Helen Taussig not receive the nobel prize?

BACKGROUND: From the 1940s to the 1960s, the number of cardiac surgeons nominated for the Nobel Prize for Physiology or Medicine grew rapidly. These nominations pinpoint major developments ranging from the first closed extracardiac operations to the era of complete intracardiac repair and treatment of congenital heart diseases. The aim of this article is to present the motivations for the numerous Nobel Prize nominations for the cardiac surgeon Alfred Blalock and the pediatric cardiologist Helen B. Taussig, and to show why the Nobel committee finally chose not to award them for the development of the Blalock-Taussig shunt. METHODS: The authors have gathered and analyzed files on Blalock and Taussig from the Nobel Prize archive for Physiology and Medicine in Solna, Sweden. RESULTS AND CONCLUSIONS: More than forty scholars, primarily from the United States and Europe, nominated Blalock and Taussig for the Nobel Prize for Physiology or Medicine. Such a strong transatlantic support is rare for nominated surgeons. The authors discuss why the number of Nobel Prize nominations for cardiac surgeons in general reached a climax around the 1950s and formulate open research questions on why relatively few surgeons have received the prestigious prize for the development of surgical procedures.

"Highly qualified loser"? Harvey Cushing and the Nobel Prize.

Neurosurgery, in particular surgery of the brain, was recognized as one of the most spectacular transgressions of the traditional limits of surgical work. With their audacious, technically demanding, laboratory-based, and highly promising new interventions, prominent neurosurgeons were primary candidates for the Nobel Prize. Accordingly, neurosurgical pioneers such as Victor Horsley and, in particular, Harvey Cushing continued to be nominated for the prize. However, only António Egas Moniz was eventually awarded the prestigious award in 1949 for the introduction of frontal lobotomy, an intervention that would no longer be prize-worthy from today's perspective. Horsley and Cushing, who were arguably the most important proponents of early neurosurgery, remained "highly qualified losers," as such cases have been called. This paper examines the nominations, reviews, and discussions kept in the Nobel Archives to understand the reasons for this remarkable choice. At a more general level, the authors use the example of neurosurgery to explore the mechanisms of scientific recognition and what could be called the enacting of excellence in science and medicine.

Negotiating technologies in surgery: the controversy about surgical gloves in the 1890s.

This article examines the controversial discussions about surgical gloves in the German-language countries in the 1890s. Analyzing the controversy as a contradiction between two important strategies of modern surgery, manual control and aseptic control, it looks at the various ways surgeons dealt with the conflict. Most important, they tried to resolve the problem by designing gloves that reconciled the two conflicting control strategies. This perspective helps to better understand the lengthy process of negotiation and the detailed discussions in the decades before surgical gloves became a standard element of modern operating equipment.

Asepsis and bacteriology: a realignment of surgery and laboratory science.

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'.