Revolutionary Antiseptic Technique
AH 9 Block 13-3-2018
It was October 26, 1877 in King’s College and a boy had fractured his patella, or kneecap. A few decades ago doctors would have deemed his case of hopeless, advising him to amputate. But it was 1877– the height of surgical advancements!– and there was an alternative option– wiring his patella was proposed.
Wiring his patella entailed a deliberate conversion of a simple fracture into a compound fracture, which were often associated with infection and even death. The procedure itself was deemed preposterous by the public and other medical professionals, receiving harsh criticism. The boy would surely die of infection.
But his doctor remained confident in his procedure. The doctor had invented antiseptic technique, which would prevent contamination of the surgical equipment and infection of the wound. He used carbolic acid to create antiseptic conditions to perform the surgery. The conditions made the surgery was a success!
The surgeon to perform this controversial surgery was Joseph Lister, an innovative and influential surgeon. His creation of antiseptic treatment, based off of germ theory, was the influential innovation surgical history. It had revolutionized surgery, allowing complex surgeries to be performed, lowering mortality rates and increasing the safety of procedures.
Joseph Lister, Baron Lister of Lyme Regis was born on April 5, 1827 in Upton, Essex, England. He was the son of Joseph Jackson Lister and Isabelle Harris. Both his father and his mother took an active part in his education, teaching him natural history and how to use a microscope. He received formal schooling in two Quaker schools which emphasized science and natural history.
By age 16, Joseph Lister decided he wanted to pursue a career in the medical field-specifically to become a surgeon. He attended the University College in London and became House Surgeon at University College Hospital in 1856, after receiving a Bachelor of Honors with Medicine in October 1852.
He got his fellowship in Royal College of Surgeons and studied under James Syme, a renowned surgeon in Edinburgh. He later becomes Syme’s son-in-law after marrying his daughter, Agnes Syme.In his early years as a surgeon, he researched inflammation, which was considered a specific disease at the time. He studied the microscopic healing of wounds, specifically the mechanism of coagulation of blood and blood vessels during the first stages of inflammation.
This served as a background to his work in wound dressing and his development of antiseptic treatment.He worked as a dresser for Sir Erichsen, a physician that believed that wounds become infected due to bad air. The miasma theory claimed that concentrated bad air can infect the wound. But in dressing the wounds, he had realized that when wounds were cleaned, some had healed. Early in his career he had not believed in miasma, a popular theory of the time in the medical field.He was appointed Regius Professor of Surgery at the University of Glasgow at the age of 33, in August 1861.
Though he was a professor, he did not attain Glasgow Royal Infirmary privileges till a year later, his request initially denied. He became in charge of the Male Accident Ward, a new surgical block.Many patients in the Male Accident Ward suffered compound fractures, which was commonly treated with amputation. Lister observed that 45 to 50 percent of amputation patients died from sepsis between 1861 and 1865. Later he read Louis Pasteur’s paper on germ theory, a theory that stated microorganisms cause infection.
Lister hypothesized that the same process that caused fermentation was also involved in wound sepsis. He postulated that sepsis was caused by pollen-like dust. He believed the only mode of contamination was by air. To disinfect wounds, he applied carbolic acid, which was commonly used to disinfect sewage at the time. He sprayed carbolic acid in the air, onto the equipment, and onto the wound to disinfect and prevent infection or contamination.
He used this method on the the patients of his ward for several years. Using phenol as an antiseptic reduced the mortality rate of the Male Accident Ward to 15 percent in 4 years.His practice was very different than of his peers. Others in the medical field did not wash bed linens and lab coats, using the same equipment for patients.They had believed that infection and contamination was caused by “bad air, as the miasma theory entailed, and hence did not see the reason for sterile equipment and techniques.
As a result when he published two papers on antiseptic technique on the Lancet in March and July 1967, his colleagues criticized his methods. The source of doubt was because the microorganisms were not visible to the naked eye, and hence did not exist. His work was misunderstood and his colleagues demanded proof. He altered the administration of the carbolic acid, spraying it now with a machine he called a donkey engine.
The donkey engine increased efficiency of the application of carbolic acid. He increasingly used this method on surgeries and the results were positive. Patients approved of his methods. Germany, the United States, and eventually Great Britain accepted and adopted his approach to antiseptic technique.
In 1871, he operated on Queen Victoria, who had a large abscess on her armpit. Lister lanced the abscess with a sharp tool, drained the pus, dressed the wound, and treated it with carbolic acid. The queen approved of Lister’s methods involving carbolic acid. This nod of approval from the queen of the United Kingdom encouraged his peers in the medical field to accept antiseptic technique.
Though his technique was not accepted during a majority of his lifetime, antiseptic treatment revolutionized surgical procedures. Infection and contamination of the wounds was less common. Surgery was no longer dangerous, lowering mortality rates and increasing success rates. It is quite a feat to dispute a widely popular medical theory and to continue practicing though his colleagues ridiculed his technique.
He was creative, too, using phenol, a carbolic acid used to disinfect sewage, to dress wounds. His work revolutionized medicine, a field that is slow to change. Though his techniques are no longer used, it served as the gateway to develop better antiseptic and aseptic techniques. His ability to be nonconformist to popular belief and create antiseptic technique was the most innovative occurence of the 20th century.10 Intriguing Facts About Joseph Lister. (2017, September 12).
March 01, 2018, from http://mentalfloss.com/article/503311/10-intriguing-facts-about-joseph-lister
Science Museum. Brought to Life: Exploring the History of Medicine. (n.d.). Retrieved March 01, 2018, from http://broughttolife.sciencemuseum.org.uk/broughttolife/people/josephlister
Pitt, D., ; Aubin, J. (2012, October). Retrieved March 01, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468637/
Cartwright, F. F. (2017, November 16). Joseph Lister.
Retrieved March 01, 2018, from https://www.britannica.com/biography/
Joseph-Lister-Baron-Lister-of-Lyme-RegisFulton, A. (2017, October 13). ‘The Butchering Art’: How A 19th Century Physician Made Surgery Safer. Retrieved March 01, 2018, from https://www.npr.org/sections/health-shots/2017/10/13/557367840/the-butchering-art-how-a-19th-century-physician-made-surgery-safer
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