Bearing in mind that it is from the vitality of the atmospheric particles that all the mischief arises, it appears that all that is requisite is to dress the wound with some material capable of killing these septic germs, provided that any substance can be found reliable for this purpose, yet not too potent as a caustic. In the course of the year 1864, I was much struck with an account of the remarkable effects produced by carbolic acid upon the sewage of the town of Carlisle, the admixture of a very small proportion not only preventing all odour from the lands irrigated with the refuse material but, as it was stated, destroying the entozoa which usually infest cattle fed upon such pastures.
Lord Joseph Lister
The Then Prevalent Situation
It was the middle of the 19th century. Surgery was transforming; shedding behind years of ill-practised semi-barbarous methods. The general anaesthesia was introduced. It was gaining widespread acceptance and popularity. Yet, the postoperative mortality rates never dipped. The hygiene in hospitals remained dreadful. The patients were susceptible to infections. During those days, the doctors rarely risked open-cut surgeries.
The prevailing theory, the cause and spread of infections were attributed to 'miasma' or 'bad air'. It was believed gases (mainly oxygen) entered the body during surgeries and tainted the wound, causing tissue breakdown. In 1861, a biologist named Louis Pasteur proved the presence of living microbes in air; responsible for causing diseases invading humans, animals and other living hosts. In short, the Germ Theory. British surgeon and scientist, Dr Joseph Lister, studied Pasteur’s paper, and the thought conjured.
Can we prevent surgical infections by destroying the micro-organisms responsible?
Lister realized the gases had no role to partake. If pasteurization (in simple terms killing of germs) killed microbes, then chemicals were even more capable. In 1860 Jules Lemaire, a French doctor and pharmacist had published a paper rendering the use of carbolic acid to treat infections, i.e. it had antiseptic properties.
To test out his theory, Lister opted to perform a small experiment with a patient suffering from a compound fracture. There existed a profound difference between simple and compound fractures besides their apprehended names. In the first case, the skin was intact and in the second; the skin was broken and resulted in gangrene, then amputation.
FACT: Listerine mouthwash and the bacterium Listeria was named in Joseph Lister's honour.
He used a substance called German Creosote; then available as a 5% carbolic acid solution and used as sewage cleansing agent. A French pathologist, Charles Jacques Bouchard, had argued about the usage of creosote as antiseptic to treat diseases. Creosotes were chemicals typically derived from plant-based material and used as preservatives and later on as antiseptics.
A small undiluted amount was taken and poured onto the wound. This formed a crust with blood. Over the next few days, a fresh dosage was applied daily. The patient recovered with no infections.
That was when the world on the 12th of August 1865 saw a medical breakthrough. Joseph Lister had successfully performed the first antiseptic surgery. This experiment revolutionized and eventually paved the path of modern operative surgery.
He subsequently went on to treat several patients using carbolic acid as an antiseptic. This decimated the postoperative mortality rate from 40% to 15%, single-handedly with his remarkable research.
Fact: Dr Lister is considered the Father of Antiseptic Surgery. In actual truth, it was Ignaz Semmelweis; a Hungarian physician who introduced antisepsis into medical practice. But he gained no recognition for his work; his much deserved credit was offered posthumously.
Sensing the success rate around the 1870s, he started experimenting with surgical gauze imbued with new antiseptic materials. In an attempt to sterilize the wound, he went to the extremes of using carbolic acid-coated surgery uniforms and instruments. He even sprayed carbolic acid inside the operating room before procedure.
A device, the Donkey Engine was used; a long handle pump to spray carbolic acid gas. It went on to be a cause of mirth and ridicule. Lister stopped using it when he realized pathogenic microbes in the air were not plentiful.
Initially, Dr Joseph Lister met a mixed reception. On one hand, he was applauded for a revolutionary step and on the other ridiculed for his uptakes on antiseptic surgery. Many of his colleagues found his methods imposing, non-tactful and risky. But eventually, his approach prevailed.
He served as the bridge between an orthodox folly and a radical reformation. Though doctors have upgraded from his method of surgery, he will always be a checkpoint for a fundamental transformation in medical science.
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‘Ignaz Semmelweis’ | Britannica | Available on https://www.britannica.com/biography/Ignaz-Semmelweis
‘Joseph Lister’ | The Notable Names Database | Available at https://www.nndb.com/people/597/000091324/
‘Joseph Lister And The Story Of Antiseptic Surgery’ | Hektoean International- A journal of Medical Humanities | Summer 2014 | Available at https://hekint.org/2017/01/22/joseph-lister-and-the-story-of-antiseptic-surgery/
‘Louis Pasteur’ | The Notable Names Database | Available at https://www.nndb.com/people/580/000072364/
'Lister Joseph Quotations' | Today In Science History | Available at https://todayinsci.com/L/Lister_Joseph/ListerJoseph-Quotations.htm