Lister Publishes His Theory on Antiseptic Surgery

Date 1867

Joseph Lister’s promotion of antiseptic surgery challenged other physicians to adopt procedures that would eventually effect a revolution in medicine by saving the lives of thousands of patients.

Locale Glasgow, Scotland

Key Figures

• Joseph Lister (1827-1912), English surgeon
• Louis Pasteur (1822-1895), French discoverer of the germ theory of disease
• Ignaz Philipp Semmelweis (1818-1865), Hungarian physician who was an early discoverer of the principle of antisepsis
• Sir James Young Simpson (1811-1870), Scottish physician who opposed Lister’s principles

Summary of Event

Joseph Lister was the son of Joseph Jackson Lister, a Scottish optician, but he himself was interested in the study of medicine and obtained his medical degree in 1852. He then became assistant to James Syme, professor of clinical surgery at the University of Edinburgh. Lister held a responsible position as a lecturer and assistant surgeon in the university hospital, but he found time to occupy himself with his own researches in medicine and the causes of death that occurred after seemingly simple surgical procedures. One of the directions in which his research led him was to the problems of inflammation and death-causing infection after surgery.

Nineteenth century surgery was a precarious undertaking. The problem of pain during operations had been solved by the introduction of anesthetics such as chloroform and ether. However, there remained the so-called hospital diseases—often fatal infections that commonly appeared shortly after successful surgery. Surgeons did not know what caused these diseases, but many assumed that death was inevitable. Modern medical histories divide the nineteenth century into two periods: pre-Listerian, when surgery patients often died from infections, and Listerian, after the acceptance of antiseptic procedures promoted by Lister, Louis Pasteur, and Ignaz Philipp Semmelweis.

Apart from tetanus, the hospital diseases included gangrene, erysipelas, pyemia, and septicemia, all of which could cause death or leave patients permanently debilitated or disabled. All four were also epidemic. During the so-called erysipelas season in America, which lasted from January until March, surgery was avoided. In Great Britain, all surgery came to a complete halt when gangrene became epidemic within a hospital. In addition to these diseases that followed surgery, there was puerperal fever, which often affected women who gave birth to their children in hospitals; it was usually fatal.

Semmelweis, a Hungarian doctor who joined the staff of a Vienna hospital in 1846, concluded that puerperal fever came from within hospital wards, not from outside. He further concluded that the fever was carried by doctors and medical students who transmitted it to mothers during prenatal examinations. The answer was higher standards of cleanliness in hospitals and the disinfecting of examiners’ hands before touching patients. Semmelweis made enemies, however, and although hospital mortality statistics showed that his antiseptic methods saved lives, his methods failed to gain acceptance. Semmelweis was astute in his judgment. In 1847, he insisted that all who attended surgery wash their hands in chloride of lime. This procedure reduced surgical deaths from 15 percent to 3 and then to 1 percent. Lister apparently did not find out about the work of Semmelweis until years after his own discovery.

In 1864, while Lister was lecturing and practicing surgery in Glasgow, he became acquainted with Pasteur’s work on putrefaction. He believed that some of his questions might be answered by a study of Pasteur’s works. This turned out to be so, for Lister conducted, for his own satisfaction, Pasteur’s experiments and realized that Pasteur’s germ theory also applied to hospital diseases. What he now needed to find was an agent that would kill germs (microbes) before they could penetrate deeply into body tissues.

The actual word “microbe” was not formally introduced to the medical community until February 26, 1878, when a military surgeon named Sedillot published a treatise on the treatment of purulent infection, a very common problem in military surgery. In that same paper Sedillot wrote,

We shall have seen the conception and birth of a new surgery, a daughter of Science and of Art, which will be one of the greatest wonders of our century and with which the names of Pasteur and Lister will remain gloriously connected.

Lister obtained some carbolic acid, which he knew had been used successfully to treat garbage in the city of Carlisle. One of its remarkable effects had been to stop the sickening of cattle who grazed in fields near the city’s garbage dumps. In 1865, he used carbolic acid on his first patient, but the man died. The next four cases were all very serious surgical problems, but they all survived, thanks in part because they did not develop any of the hospital diseases. Afterward, Lister continued to treat surgical cases with carbolic acid solutions and bandages. Lister soaked his bandages and cotton wool in carbolic acid, and carbolic vapor was blown over his hands and patients’ wounds during surgery. Wounds were then wrapped in carbolic-soaked towels, and surgical instruments were kept in carbolic solutions. In 1867, Lister presented his evidence in an article published in The Lancet , the journal of British medicine: “On a New Method of Treating Compound Fracture, Abcess, etc.”

Significance

A considerable opposition was mobilized against Lister, particularly by Dr. James Young Simpson. However, as increasing numbers of physicians adopted Lister’s methods, opposition collapsed, and antiseptic surgery gained general acceptance. The work of Louis Pasteur from 1844 to 1895 was to affect the medical field in England, Germany, and France. In the United States, the Mayo Clinic used the surgical and antiseptic techniques developed by Pasteur and refined by Lister.

The impact of antisepsis on war wounds saved thousands of lives. After centuries of losing casualties to infection, the use of Listerian methods made it possible to save lives and limbs. Much was to be learned from the results of wounds received in different battle conditions. Pre-Listerian surgeons had to learn different methods of wound treatment to suit the different places in which they worked. For example, researchers noticed that bacteria that flourished in damp conditions diminished in arid lands. Methods were argued, and as bacteria were identified, the doctors who were convinced that bacteria was the cause worked with diligence to use antisepsis to save lives.

Bibliography

Cameron, Hector Charles. Joseph Lister: The Friend of Man. London: William Heinemann, 1949. English view of human attitudes toward antisepsis.

Cartwright, Frederick F. Development of Modern Surgery. London: Arthur Barker, 1967. History of surgery from the early nineteenth century through the 1960’s by an English physician. Cites many examples of failures and successes as surgical techniques were developed.

Debré, Patrice, Louis Pasteur. Translated by Elborg Forster. Baltimore: Johns Hopkins University Press, 1998. Exploration of the life and work of the discoverer of germ theory by a French immunologist. Describes Pasteur’s experiments in simple, understandable language.

Dormandy, Thomas. Moments of Truth: Four Creators of Modern Medicine. Hoboken, N.J.: John Wiley & Sons, 2003. Biographies of four physicians and scientists who made major contributions to the advancement of medical science, including Joseph Lister and Ignaz Philipp Semmelweis.

Gaw, Jerry L.“A Time to Heal”: The Diffusion of Listerism in Victorian Britain. Philadelphia: American Philosophical Society, 1999. History of the adoption of Lister’s antiseptic surgery techniques in mid-nineteenth century Britain.

Guthrie, Douglas. Lord Lister: His Life and Doctrine. Baltimore: Williams and Wilkins, 1949. Detailed look at Lister’s accomplishments and their profound impact on the medical professions.

Mactavish, Douglas. Joseph Lister. New York: Franklin Watts, 1992. Comprehensive biography of Joseph Lister’s life and work.