Joseph Lister

Following the groundbreaking discovery of germ theory by Louis Pasteur, Joseph Lister, a pioneering Scottish surgeon, found a way to combat infection in the operating theatre, revolutionising surgery. By introducing antiseptic techniques, Lister dramatically reduced the risk of postoperative infections, which had been a major cause of death for patients.

Infection in Surgery Before Antiseptics

Before the advent of Pasteur's germ theory and the development of antiseptics, infection was a significant risk during surgery. Germs could easily enter wounds during procedures, and with no antibiotics available, infections often led to death. Surgeons, while skilled in performing operations, had no effective method for preventing infections that arose after surgery.

Joseph Lister’s Contribution

Joseph Lister was deeply influenced by the work of Louis Pasteur, who had demonstrated that germs caused disease. Building upon this knowledge, Lister began to experiment with chemicals that could kill these harmful microbes. He chose carbolic acid, a substance known for its disinfectant properties, and began soaking bandages in it before applying them to surgical wounds. His experiments showed promising results: not only did carbolic acid help prevent infection, but it also aided in the healing of wounds.

Lister's next step was to introduce a carbolic acid spray in the operating theatre. This spray was applied using a pump, and it sterilised the air and the surgical instruments during an operation. The application of carbolic acid to both the patient and the surgical environment helped reduce the chances of infection, making surgeries much safer.

Impact of Antiseptic Surgery

The results of Lister's use of carbolic acid were impressive. He reported a dramatic drop in the mortality rate of his patients. Before the introduction of antiseptics, the death rate following surgery in his hospital was around 40%. After using carbolic acid, the rate fell to just 15%. This was a significant improvement, marking a major step forward in making surgery safer for patients.

Opposition to Carbolic Acid

Despite the evident success of carbolic acid in reducing infections, not all surgeons were convinced or pleased with its use. There were several reasons for opposition:

• Some surgeons complained that carbolic acid irritated their eyes and skin, making it uncomfortable and difficult to perform delicate surgical procedures.
• The instruments soaked in carbolic acid became slippery, which posed a challenge for surgeons during operations.
• The spraying machine itself was sometimes seen as cumbersome and distracting, making it harder for surgeons to focus on the task at hand.

These issues led to some resistance from the medical community, even though Lister’s methods were proven to be effective in reducing infections.

Aseptic Surgery and Further Improvements

In response to the difficulties posed by carbolic acid, further improvements in surgical practice were developed. One key advancement came from American surgeon William Halsted, who sought a solution to the irritations caused by carbolic acid on the skin. After speaking with a nurse who had developed dry skin from frequent exposure to carbolic acid, Halsted approached a rubber company to create gloves that could be worn during surgery. These rubber gloves protected the surgeon’s hands and prevented the acid from causing discomfort.

Halsted’s introduction of rubber gloves led to the development of aseptic surgery, a technique aimed at ensuring the complete sterilisation of all surgical tools, equipment, and even the surgeon’s hands. In aseptic surgery, the focus was on preventing any germs from being introduced into the surgical area. This approach eliminated the need for carbolic acid during the procedure, as it sought to create an entirely germ-free environment. Aseptic techniques were a huge step forward, making surgery cleaner, safer, and more effective.

Blood Loss and the Discovery of Blood Groups

Another significant challenge in surgery was the loss of blood during operations. Large amounts of blood loss could lead to shock or even death, especially during complex surgeries. This issue was addressed in 1901 when Austrian immunologist Karl Landsteiner discovered blood groups. This discovery made it possible for blood transfusions to be safely carried out, as doctors could match the donor’s blood with the patient’s blood type.

Blood transfusions became a crucial development in surgery, as they allowed patients to survive longer and more complex operations. This breakthrough made it possible for surgeons to carry out more advanced and lengthy procedures, which would have been too risky before the discovery of blood groups.

Conclusion

Joseph Lister’s introduction of antiseptic techniques, particularly the use of carbolic acid, played a pivotal role in reducing infection rates in surgery. Though initially met with resistance, his methods eventually became standard practice, revolutionising surgical safety. The subsequent developments in aseptic surgery, along with Karl Landsteiner’s discovery of blood groups, further advanced the safety and complexity of surgical procedures. These innovations laid the foundation for modern surgery, making it far safer and more effective than ever before.