Casebook

Entries in Lister’s surgical casebook 1877-8. King’s College London Archives.Lister’s casebooks (which were often written not in his own hand but in that of his assistants) afford a fascinating insight into the assumptions and practices of a medical world which he was helping to supplant. Besides offering sometimes colourful accounts of the incidents which led to injuries, they throw light on the relationship between patients and surgeons and on how this was changing, albeit slowly, through advances in surgical techniques.

The casebooks detail Lister’s hospital, not his private, patients. For such an eminent personage, Lister had surprisingly few private patients: many were deterred by his notorious unpunctuality and his preference for devoting time to scientific research. Given the insalubrious conditions of most pre-Listerian hospitals, many preferred to have operations at home. But this was not an option for the labouring classes, who provided most of the hospitals’ clientele, as Lister’s casebooks show (those who were destitute had recourse to workhouse doctors).

Entry dated 15 November 1883 from Lister’s surgical casebook 1877-8. King’s College London Archives.More often than not, patients sought medical help when their complaint (which could be a large tumour) was very far advanced. This arose from most patients’ fear of pain during surgery and death afterwards through post-operative infection. On these grounds many patients would not consent to surgery, as this opening shows. This had been entirely justified prior to Lister, but the advances of the mid-19th century - chloroform, antisepsis and asepsis - would overcome pain and reduce the risk of death. Lister’s casebooks show that a surgical revolution was in the making, but had not yet made its full impact on patients’ attitudes to surgery and medicine.

The reproduction from the casebook shown on the left indicates Lister’s concern for his patients’ welfare, even several years after the initial consultation. This solicitude, unusual then, was much remarked upon. Lister felt that most general practitioners were ignorant of antiseptic surgery, as many of them had been educated before the introduction of antisepsis, and could not be relied on to provide adequate aftercare.

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