The mid-19th century presented a grim reality for surgical patients. Despite anesthesia advancements, operations often led to severe complications and high mortality. A lack of understanding about infection meant surgical environments were not conducive to healing. This dire situation set the stage for a groundbreaking medical transformation.
The Peril of Pre-Antiseptic Surgery
Before widespread antiseptic adoption, surgical wards were overwhelmed by “hospital diseases” like sepsis, gangrene, and erysipelas. Patients often succumbed, with mortality rates for major operations, including amputations, reaching 40% to 50%. The prevailing miasma theory attributed diseases to “bad air” from rotting organic matter. This led to ventilation efforts, but did not address microscopic infection causes.
Operating theaters were unsanitary; surgeons performed procedures in unwashed clothes. Instruments, sponges, and dressings were reused without sterilization, carrying infectious agents. Pus formation was mistakenly considered a natural part of healing. This environment made surgery a desperate gamble, where surviving the initial procedure was only the first hurdle.
Joseph Lister’s Path to Discovery
Joseph Lister, a British surgeon, observed alarming infection rates in the 1860s and sought a different explanation for frequent, fatal post-surgical complications. His observations of wound putrefaction led him to Louis Pasteur’s work, which demonstrated microorganisms caused fermentation and decay. Lister hypothesized these airborne microbes caused infections in open wounds, leading to “hospital diseases.”
Driven by this insight, Lister sought a chemical agent to destroy unseen organisms without harming patient tissues. He learned carbolic acid (phenol) was used to treat sewage and reduce cattle disease, suggesting its effectiveness. In 1865, Lister began experimenting, applying carbolic acid to wounds, instruments, and as a spray in the operating room. His early cases, particularly a severe compound fracture, showed remarkable success, published in The Lancet in 1867.
The Mechanism of Antiseptic Action
Carbolic acid (phenol) functions as an antimicrobial, denaturing proteins and disrupting cell membranes. Applied to tissues or surfaces, it kills or inhibits bacteria, preventing infection. Unlike aseptic techniques that prevent germs from entering a sterile field, antiseptic methods destroy existing germs with chemicals.
Lister’s method used carbolic acid in various forms: solutions for washing hands and instruments, and diluted sprays for surgical air. He also applied carbolic acid-soaked dressings directly to wounds, creating a protective barrier. Though his carbolic spray was discontinued due to irritant effects, the core principle of using chemicals to destroy germs laid the foundation for modern infection control.
Revolutionizing Medical Practice
Lister’s antiseptic methods transformed surgical outcomes. His approach dramatically reduced post-operative infections like sepsis, gangrene, and erysipelas, which previously claimed many surgical patients.
Mortality rates for major operations dropped from around 40% to less than 3% by 1910, and for amputations, from about 50% to 15%. This improvement shifted surgery from a dangerous last resort to a safer, more effective treatment.
Despite initial skepticism from some who found his methods complex or did not grasp germ theory, Lister’s successes led to widespread adoption. Surgeons, particularly in Germany, embraced his principles, observing dramatic reductions in patient mortality.
His work established the importance of controlling microorganisms in surgery, paving the way for modern aseptic techniques like instrument sterilization and sterile field maintenance. This ultimately saved countless lives and reshaped medical practice.