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In the brief span between 1846 and 1867, two discoveries swept away these two quandaries that had haunted surgery, thus allowing cancer surgeons to revisit the bold procedures that Hunter had tried to perfect in London.<\/p>\n\n\n\n
The first of these discoveries, anesthesia, was publicly demonstrated in 1846 in a packed surgical amphitheater at Massachusetts General Hospital, less than ten miles from where Sidney Farber\u2019s basement laboratory would be located a century later. At about ten o\u2019clock on the morning of October 16, a group of doctors gathered in a pitlike room at the center of the hospital. A Boston dentist, William Morton, unveiled a small glass vaporizer, containing about a quart of ether, fitted with an inhaler. He opened the nozzle and asked the patient, Edward Abbott, a printer, to take a few whiffs of the vapor. As Abbott lolled into a deep sleep, a surgeon stepped into the center of the amphitheater and, with a few brisk strokes, deftly made a small incision in Abbott\u2019s neck and closed a swollen, malformed blood vessel (referred to as a \u201ctumor,\u201d conflating malignant and benign swellings) with a quick stitch. When Abbott awoke a few minutes later, he said, \u201cI did not experience pain at any time, though I knew that the operation was proceeding.\u201d<\/p>\n\n\n\n
Anesthesia\u2014the dissociation of pain from surgery\u2014allowed surgeons to perform prolonged operations, often lasting several hours. But the hurdle of postsurgical infection remained. Until the mid-nineteenth century, such infections were common and universally lethal, but their cause remained a mystery. \u201cIt must be some subtle principle contained [in the wound],\u201d one surgeon concluded in 1819, \u201cwhich eludes the sight.\u201d<\/p>\n\n\n\n
In 1865, a Scottish surgeon named Joseph Lister made an unusual conjecture on how to neutralize that \u201csubtle principle\u201d lurking elusively in the wound. Lister began with an old clinical observation: wounds left open to the air would quickly turn gangrenous, while closed wounds would often remain clean and uninfected. In the postsurgical wards of the Glasgow infirmary, Lister had again and again seen an angry red margin begin to spread out from the wound and then the skin seemed to rot from inside out, often followed by fever, pus, and a swift death (a bona fide \u201csuppuration\u201d).<\/p>\n\n\n\n
Lister thought of a distant, seemingly unrelated experiment. In Paris, Louis Pasteur, the great French chemist, had shown that meat broth left exposed to the air would soon turn turbid and begin to ferment, while meat broth sealed in a sterilized vacuum jar would remain clear. Based on these observations, Pasteur had made a bold claim: the turbidity was caused by the growth of invisible microorganisms\u2014bacteria\u2014that had fallen out of the air into the broth. Lister took Pasteur\u2019s reasoning further. An open wound\u2014a mixture of clotted blood and denuded flesh\u2014was, after all, a human variant of Pasteur\u2019s meat broth, a natural petri dish for bacterial growth. Could the bacteria that had dropped into Pasteur\u2019s cultures in France also be dropping out of the air into Lister\u2019s patients\u2019 wounds in Scotland?<\/p>\n\n\n\n
Lister then made another inspired leap of logic. If postsurgical infections were being caused by bacteria, then perhaps an antibacterial process or chemical could curb these infections. It \u201coccurred to me,\u201d he wrote in his clinical notes, \u201cthat the decomposition in the injured part might be avoided without excluding the air, by applying as a dressing some material capable of destroying the life of the floating particles.\u201d<\/p>\n\n\n\n
In the neighboring town of Carlisle, Lister had observed sewage disposers cleanse their waste with a cheap, sweet-smelling liquid containing carbolic acid. Lister began to apply carbolic acid paste to wounds after surgery. (That he was applying a sewage cleanser to his patients appears not to have struck him as even the slightest bit unusual.)<\/p>\n\n\n\n