In the mid-19th century, the operating room was a place of last resort. While the introduction of anesthesia allowed surgeons to operate without inflicting agony, the post-operative period was plagued by a devastating, unseen killer. Patients frequently succumbed to severe infections, transforming hospitals into environments where the risk of death after surgery was alarmingly high. Any deep or complex operation carried a mortality risk of 40% to 60%, a grim statistic that overshadowed the surgeon’s technical skill. The historical problem was not the operation itself, but the lack of defense against the infections that inevitably followed.
The Surgical Crisis Before Antiseptics
Even skillfully executed surgery frequently led to a fatal condition known as “hospitalism.” This term described the rampant, epidemic infections, such as pyemia and “hospital gangrene,” that spread uncontrollably through hospital wards. These infections caused systemic sepsis that physicians were powerless to stop. The prevailing medical explanation for this post-operative decay was the miasma theory, which held that diseases were caused by “bad air” or noxious vapors arising from decaying matter.
Surgeons had no concept of cross-contamination, and practices were horrifying by modern standards. Instruments were rarely cleaned between operations, and the surgeon’s pus-stained coat was often a badge of honor. Pus formation was not seen as a sign of infection, but rather as a normal part of the healing process. This fundamental misunderstanding, coupled with the filthy conditions of the operating theaters, meant the environment intended to save lives was instead a reservoir of fatal disease.
Joseph Lister and the Germ Theory Connection
The transformation of surgical practice began with the English surgeon Joseph Lister, who worked at the Glasgow Royal Infirmary. Troubled by the high death rates in his wards, Lister sought a scientific explanation beyond the miasma theory. His turning point came in 1864 when he was introduced to the work of Louis Pasteur, who had demonstrated that fermentation and putrefaction were caused by airborne microscopic organisms. Pasteur’s experiments proved that decay resulted from living agents, not spontaneous generation.
Lister connected Pasteur’s findings on the spoiling of liquids to the putrefaction he observed in open wounds. He hypothesized that if tiny living particles could spoil wine and milk, they could also cause sepsis and gangrene in surgical patients. This realization shifted the focus from “bad air” to the invisible, living organisms carried by the air. Lister theorized that a chemical barrier was needed to destroy these microorganisms before they could enter the wound and initiate decay.
The Introduction of Carbolic Acid
To test his hypothesis, Lister needed a chemical agent that could kill germs without destroying the patient. He settled upon carbolic acid, or phenol, a substance then being used to treat sewage and wooden railway sleepers, known for its preservative properties. Lister reasoned that if it prevented decay in wood, it might prevent putrefaction in a wound. His initial application involved treating compound fractures, where the broken bone pierced the skin and was highly susceptible to infection.
Lister’s new method required meticulous attention to detail. He began by soaking instruments in a carbolic acid solution before the operation. He then used a concentrated lotion to clean the wound itself, covering it with a dressing soaked in a weaker solution to maintain an antiseptic barrier. Later, he introduced a steam-powered carbolic acid sprayer, sometimes called the “donkey engine,” which continuously misted the operating theater to kill airborne germs. Publishing his results in The Lancet in 1867, Lister showed a dramatic reduction in deaths from compound fractures, demonstrating the first measurable success of his antiseptic system.
The Immediate Global Shift to Antiseptic Surgery
Lister’s methods initially met resistance, particularly in Britain, where many surgeons were skeptical of a system based on an unseen “germ” and disliked the caustic nature of carbolic acid on their hands. However, the power of his statistics soon overcame the skepticism, as mortality rates for major operations plummeted from about 45% to around 15% in his wards. News of this success spread rapidly, first to Germany and then across Europe and to the United States, convincing surgeons to adopt the new principles.
The widespread adoption of Lister’s system fundamentally changed surgical philosophy from treating symptoms to preventing contamination. His antiseptic method, which focused on killing germs already present in the environment or the wound, laid the groundwork for the next major advancement: aseptic surgery. Aseptic techniques, pioneered by others, shifted the focus to preventing any germ from entering the operating field through the use of steam sterilization for instruments and dressings, sterile gloves, and gowns. This evolution, based on Lister’s initial disinfectant use, made safe, invasive surgery possible for the first time.