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Joseph Lister & Antiseptic Surgery

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Introduction

By the middle of the nineteenth century, post-operative sepsis infection accounted for the death of almost half of the patients undergoing major surgery. A common report by surgeons was: operation successfully but the patient died.

In 1839 the chemist Justin von Liebig had asserted that sepsis was a kind of combustion caused by exposing moist body tissue to oxygen. It was therefore considered that the best prevention was to keep air away from wounds by means of plasters, collodion or resins.

Joseph Lister, a British surgeon, doubted this explanation. For many years he had explored the inflammation of wounds, at the Glasgow infirmary. These observations had led him to considered that infection was not due to bad air alone, and that 'wound sepsis' was a form of decomposition.

Born on the 5 April 1827 in Upton, Essex, Joseph Lister was the son of the British physicist Joseph Jackson Lister.

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Early Life

After an early education at various Quaker schools he entered University College, London. After studying the arts he graduated and decided to take up medicine at the same  College. He enrolled in the faculty of medical science in October 1848. During this time he was taught by the eminent physiologist William Sharpey, recognised as one of the greatest surgical teacher of his day. Lister was a brilliant student and graduated a bachelor of medicine with honours in 1852. In October 1856 he was appointed as an assistant surgeon, at the Edinburgh Royal Infirmary, to James Syme, who's daughter he later married. The marriage, although childless, was a happy one, with his wife entering fully into Lister's professional life.

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At Glasgow Royal Infirmary

When the Regius Professorship of Surgery at Glasgow University fell vacant in 1859 Lister was selected from severn candidates. In August 1861 he was appointed surgeon at the Glasgow Royal Infirmary and put in charge of its new surgical building.

The hope was that the new building would decrease the number of deaths caused by what was then called hospital disease (now known as operative sepsis). This proved a vain hope when Lister reported that between 45 and 50 percent of his amputation cases died from sepsis between 1861 and 1865 in his Male Accident Ward. It was in this ward that Lister began his experimental work with antisepsis.

Having tried methods to encourage clean healing, with little, or no success, Lister began to form theories to account for the prevalence of sepsis. He discarded the popular concept of direct infection by bad air and postulated that sepsis might be caused by a 'pollen-like dust'. Although, there is no evidence to suggest he believed this dust to be living matter he was close to the truth.

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Germ Connection with wound sepsis

When, In 1865, Louis Pasteur suggested that decay was caused by living organisms in the air, which on entering matter caused it to ferment, Lister made the connection with wound sepsis.

A meticulous researcher and surgeon, Lister recognized the relationship between Pasteir's research and his own. He considered that microbes in the air were likely causing the putrefaction and had to be destroyed before they entered the wound.

In the previous year Lister had heard that 'carbolic acid' was being used to treat sewage in Carlise, and that fields treated with the affluent were freed of a parasite causing disease in cattle.

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Lister now began to clean wounds and dress them using a solution of carbolic acid.
He was able to announce at a British Medical Association meeting, in 1867, that his wards at the Glasgow Royal Infirmary had remained clear of sepsis for nine months.

Operation using Lister's carbolic spray invented in 1869 Although his methods initially met with indifference and hostility, doctors gradually began to support his antiseptic techniques. In 1870 Lister's antiseptic methods were used, by Germany, during the Franco-Prussian war saving many Prussian soldier's lives. In Germany, by 1878, Robert Koch was demonstrating the usefulness of steam for sterilizing surgical instruments and dressings.

German surgeons were beginning to practice antiseptic surgery, which involved keeping wounds free from micro-organisms by the use of sterilized instruments and materials.

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Opposition to Procedures

The 1870's were some of the happiest years of Lister's life, largely due to the
German experiments with antisepsis during the Franco-German War. His clinics
were crowded with visitors and eager students. Lister made a triumphal
tour of the leading surgical centres in Germany in 1875. On visiting America in 1876, however, he was only received with enthusiasm in Boston and New York City.

Opposition was great In England and the United States mainly against Lister's germ theory rather than against his "carbolic treatment." Edinburgh was regarded as a provincial centre, despite the ancient fame of its medical school. Surgeons were prepared to await for clear proof that antisepsis constituted a major advance.  Lister knew that before the usefulness of his work would be generally accepted he must convince London.

When, in 1877, he was offered the chair of Clinical Surgery at Kings College, Lister's chance came. A simple operation of wiring a fractured kneecap, entailing deliberate convertion of a simple fracture into a compound fracture, often resulted in generalised infection and death. On October 26 1877, Lister, for the first time, carried out the operation under antiseptic conditions. News of the operation was widely publicized arousing much opposition. Its success was instrumental in forcing surgical opinion throughout the world to accept that his method's greatly added to the safty of operative surgery.

Many honours now came to him.

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Honours

In 1883 Lister was created a baronet and made Baron Lister of Lyme Regis in 1897. He was also appointed one of the 12 original members of the Order of Merit in 1902.

In life, Lister was a shy, unassuming man and deeply religious. He joined the Scottish Episcopal Church as a young man. He was firm in his purpose, humbly believing himself to be directed by God. He was uninterested in social success or financial reward.

Lister saw the cumulation of his emphasis on the principle of preventative medicine with the opening of the Institute of Preventative Medicine in 1891.

His wife died in 1892 and Lister retired from general practice the following year.

He served as a President of the Royal Society from 1895 to 1900. He died on the 10 February 1912 in Walmer, Kent.