Apr 052016
 

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Today is the birthday (1827) of Joseph Lister, British surgeon and a pioneer of antiseptic surgery. Lister successfully introduced carbolic acid (now known as phenol) to sterilize surgical instruments and to clean wounds, which led to a reduction in post-operative infections and made surgery safer for patients. Lister came from a prosperous Quaker home in West Ham, Essex, England, a son of Joseph Jackson Lister, a pioneer of achromatic object lenses for the compound microscope.

He attended University College, London, one of only a few institutions which accepted Quakers at that time. He initially studied botany and obtained a bachelor of Arts degree in 1847. Then he registered as a medical student and subsequently entered the Royal College of Surgeons at the age of 26. In 1854, Lister became both first assistant to and friend of surgeon James Syme at the Edinburgh Royal Infirmary in Scotland.

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In 1867, Lister championed the use of carbolic acid as an antiseptic, such that it became the first widely used antiseptic in surgery. He first suspected it would prove an adequate disinfectant because it was used to ease the stench from fields irrigated with sewage waste. He presumed it was safe because fields treated with carbolic acid produced no apparent ill-effects on the livestock that later grazed upon them. He subsequently left the Quakers, joined the Scottish Episcopal Church, and eventually married Syme’s daughter, Agnes. On their honeymoon, they spent 3 months visiting leading medical institutes (hospitals and universities) in France and Germany. By this time, Agnes was enamored of medical research and was Lister’s partner in the laboratory for the rest of her life.

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Until Lister’s studies of surgery, most people believed that chemical damage from exposure to bad air was responsible for infections in wounds. Hospital wards were occasionally aired out at midday as a precaution against the spread of infection via the air, but facilities for washing hands or a patient’s wounds were not available. A surgeon was not required to wash his hands before seeing a patient because such practices were not considered necessary to avoid infection. Despite the work of Ignaz Semmelweis and Oliver Wendell Holmes, Sr., hospitals practiced surgery under unsanitary conditions. Surgeons of the time referred to the “good old surgical stink” and took pride in the accumulated stains on their unwashed operating gowns as a display of their experience.

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While he was a professor of surgery at the University of Glasgow, Lister became aware of a paper published by the French chemist, Louis Pasteur, showing that fermentation and food spoilage could occur under anaerobic conditions if micro-organisms were present. Pasteur suggested three methods to eliminate the micro-organisms responsible: filtration, exposure to heat, or exposure to chemical solutions. Lister confirmed Pasteur’s conclusions with his own experiments and decided to use his findings to develop “antiseptic” techniques for wounds. As the first two methods suggested by Pasteur were inappropriate for the treatment of human tissue, Lister experimented with the third and began to test the efficacy of carbolic acid when applied directly to wounds.

Lister began by testing the results of spraying instruments, surgical incisions, and dressings with a solution of carbolic acid, and found that the solution swabbed on wounds remarkably reduced the incidence of gangrene. In August 1865, he applied a piece of lint dipped in carbolic acid solution on to the wound of a seven-year-old boy at Glasgow Infirmary, who had sustained a compound fracture after a cart wheel had passed over his leg. After four days, he renewed the pad and discovered that no infection had developed, and after a total of six weeks he was amazed to discover that the boy’s bones had fused back together, without the danger of suppuration. He subsequently published his results in The Lancet in a series of 6 articles, running from March to July 1867.

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He instructed surgeons under his responsibility to wear clean gloves and wash their hands before and after operations with 5% carbolic acid solutions. Instruments were also washed in the same solution and assistants sprayed the solution in the operating theater. One of his additional suggestions was to stop using porous natural materials in manufacturing the handles of medical instruments.

Lister left Glasgow in 1869, returning to Edinburgh as successor to Syme as Professor of Surgery at the University of Edinburgh and continued to develop improved methods of antisepsis and asepsis. Amongst those he worked with there, who helped promulgate his work, was the senior apothecary and later MD, Dr Alexander Gunn. Lister’s fame had spread by then, and audiences of 400 often came to hear him lecture. As the “germ theory of disease” became more widely accepted, it was realized that infection could be better avoided by preventing bacteria from getting into wounds in the first place. This led to the rise of sterile surgery. On the centenary of his death, in 2012, Lister was considered by most in the medical field as “the father of modern surgery”.

Lister retired from practice after his wife, who had long helped him in research, died in 1893 in Italy, during one of the few holidays they allowed themselves. Studying and writing lost appeal for him and he sank into religious melancholy. Despite suffering a stroke, he still came into the public light from time to time. On 24 August 1902 Edward VII came down with appendicitis two days before his scheduled coronation. Like all internal surgery at the time, the appendectomy needed by the King still posed an extremely high risk of death by post-operational infection, and surgeons did not dare operate without consulting Britain’s leading surgical authority. Lister obligingly advised them in the latest antiseptic surgical methods (which they followed to the letter), and the King survived, later telling Lister, “I know that if it had not been for you and your work, I wouldn’t be sitting here today.”

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Lister died on 10 February 1912 at his country home in Walmer, Kent at the age of 84. After a funeral service at Westminster Abbey, he was buried at West Hampstead Cemetery, London in a plot to the south-east of central chapel.

Lister was a champion of Pasteur’s germ theory which was highly controversial at the time, and Lister’s work dramatically improved its acceptance. His ideas were monumentally helpful not only in hospitals, but also in kitchens in the days before refrigeration. Isabella Beeton writes of the antiseptic qualities, not especially scientifically, of wood smoke, salt, and acids, in her recipes for preserving meats. Nowadays we are fully aware of the need for cleanliness and disinfectants in the kitchen especially in the prevention of cross contamination of foods via utensils and work surfaces. The kitchen can be just as deadly a place as the operating room if proper precautions are not observed – not to mention places where eggs, meat, fish, fruits, and vegetables are prepared and packaged commercially.

Here’s an example from Beeton:

CITRON.—The fruit of the citron-tree (Citrus medica) is acidulous, antiseptic, and antiscorbutic: it excites the appetite, and stops vomiting, and, like lemon-juice, has been greatly extolled in chronic rheumatism, gout, and scurvy. Mixed with cordials, it is used as an antidote to the machineel poison. The candied peel is prepared in the same manner as orange or lemon-peel; that is to say, the peel is boiled in water until quite soft, and then suspended in concentrated syrup (in the cold), after which it is either dried in a current of warm air, or in a stove, at a heat not exceeding 120° Fahrenheit. The syrup must be kept fully saturated with sugar by reboiling it once or twice during the process.

Here’s her recipe for a pudding sauce that was certainly pretty antiseptic by her lights – containing alcohol, sugar, and citron:

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WINE SAUCE FOR PUDDINGS.

  1. INGREDIENTS.—1/2 pint of sherry, 1/4 pint of water, the yolks of 6 eggs, 2 oz. of pounded sugar, 1/2 teaspoonful of minced lemon-peel, a few pieces of candied citron cut thin.

 Mode.—Separate the yolks from the whites of 5 eggs; beat them, and put them into a very clean saucepan (if at hand, a lined one is best); add all the other ingredients, place them over a sharp fire, and keep stirring until the sauce begins to thicken; then take it off and serve. If it is allowed to boil, it will be spoiled, as it will immediately curdle.

Time.—To be stirred over the fire 3 or 4 minutes; but it must not boil.

Average cost, 2s.

Sufficient for a large pudding; allow half this quantity for a moderate-sized one.

 

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