Hospitals have not always been the places of cleanliness we know them as today. For centuries they were places where people were just as likely to die as they were to be cured. Even if a person was able to survive the ordeal of surgery without anaesthesia, the unsanitary conditions of operating rooms meant that a postoperative infection was likely to result in their demise. By the late 19th century this began to change, thanks to the work of English surgeon Joseph Lister.
Born in 1827, Lister graduated as a doctor in 1852 and spent much of his early career working in Scotland. It was there that he noticed a mortality rate of nearly 50% in patients following surgery. Infections in wounds resulted in fatal systemic inflammation known as sepsis and this phenomenon was so common in hospital settings that it earned the nicknames “ward fever” and “hospitalism”.
Infection was poorly understood at the time and most people subscribed to one of two alternative theories. The first was known as miasma and stated that infectious diseases were caused by impure air and noxious gases. The second was called contagionism and proposed that infections in wounds arose spontaneously by an unknown action of the tissue itself. Neither explanation connected the practices of doctors to the outcomes of surgery and although French chemist and microbiologist Louis Pasteur had demonstrated the existence of micro-organisms in the mid-1860s, germ theory was not yet accepted by the medical establishment.
After witnessing how patients with simple fractures survived whilst those with compound fractures in which the bones pierced the skin often died, Lister became convinced that infections in surgical patients were being caused by outside agents. After reading the work of Pasteur, he took measures to kill the pathogens that he believed were causing infections in wounds. Suspecting that it was an antiseptic, Lister diluted the carbolic acid used to treat sewage and applied it to dressings. He also used it to sterilise surgical equipment and wash his hands. He sprayed it around operating theatres to eliminate airborne pathogens and soaked catgut sutures in the solution in further attempts to reduce infection.
His techniques were remarkablly successful and the incidence of infection was drastically reduced. The death rate of Lister’s surgical patients fell from 45% in 1866 to just 15% by 1870. He took measures to eliminate pathogens that had already entered wounds and prevent others from entering sterile operating rooms (antiseptic and aseptic techniques).
After publishing his results in the Lancet, Lister’s work began to receive a great deal of attention. While some hailed his findimgs as a breakthrough in surgical technique, others viewed it with scepticism. His methods were not immediately adopted as it took over a decade of work before he could convince others of his theories and sanitary surgical procedures became accepted as common practice. Yet once doctors began paying better attention to hygiene in hospitals patient health dramatically improved and the field of surgery was able to advance rapidly. Joseph Lister continued to refine his surgical techniques for the rest of his life and was knighted for his services to medicine in 1883.
Unknown. (1902). Joseph Lister [Image]. Retrieved from http://commons.wikimedia.org/wiki/File:Joseph_Lister_1902.jpg?uselang=en-gb
Osborn, G. G. (1986). Joseph Lister and the origins of antisepsis. The Journal of Medical Humanities and Bioethics, 7(2), 91-105. Retrieved from JSTOR.