Causation and cleanliness: George Callender, wounds, and the debates over Listerism.

This article reexamines the surgical and historiographic debate over antisepsis and the germ theory through the work of the prominent London surgeon George W. Callender (1830-1879) and the statistical records of St. Bartholomew's Hospital. Surgeons in the mid-nineteenth century faced a rising incidence of wound infection and its systemic complications. Examining mortality and complication rates by type of wound, however, suggests that the extent of this crisis is often overstated. Callender himself occupied a frequently overlooked middle ground in the debate over Listerism. On the one hand, his program of cleanliness, which antedated Lister's work and extended from the wound to the ward, produced excellent and influential results. On the other, while he was never an explicit critic of the germ theory, his writings demonstrate why Lister's collapse of causation into a single etiologic agent was so difficult for surgeons to accept.