Lister's antiseptic surgery

In the 1860s, surviving surgery did not guarantee surviving the hospital. Postoperative wound infections, particularly the complex of conditions then called hospital gangrene, erysipelas, and pyemia, killed a large share of patients who came through the operation itself. At some hospitals, amputation mortality exceeded 40 percent, and the deaths were blamed on bad air, overcrowding, or an ill-defined entity called "hospitalism." Surgeons washed their hands between patients, if at all, and operated in street clothes. The idea that microorganisms caused these deaths had no traction in most operating rooms.

In 1865 the Glasgow chemistry professor Thomas Anderson pointed Joseph Lister, a surgeon at Glasgow Royal Infirmary, to Pasteur's work on germs in the air. Lister reasoned that if airborne microorganisms caused putrefaction, destroying them before they reached a wound should prevent the infection that followed. He chose carbolic acid, which had been used to treat sewage in Carlisle, and Anderson supplied a crude form of it. Beginning in 1865, Lister packed the wounds of compound fractures with lint soaked in the acid, at first undiluted; these injuries then carried very high infection rates because the skin was broken and bone was exposed.

His 1867 Lancet series described eleven compound fractures treated this way: nine patients recovered, one died of hospital gangrene, and one needed an amputation. Later in 1867 he reported that for nine months no case of pyemia, hospital gangrene or erysipelas had occurred on his wards. In a later report he put deaths after amputation on his wards at about 45 percent before the antiseptic method and about 15 percent after it.

Adoption was neither immediate nor uniform. Critics complained that the method kept changing, from crude carbolic acid to carbolized oil, carbolic putty, watery solutions and plasters, and results in other hands were inconsistent. Some prominent surgeons rejected germ theory outright; in New York, Dr. Gouley of Bellevue Hospital denounced the method as nonsense. In 1876 Lister traveled to Philadelphia for the International Medical Congress, where he was president of the surgical section; until then antiseptic surgery had made little impression on American surgeons.

Lister moved to Edinburgh in 1870 and used a carbolic spray during operations and dressings from then until 1887. In Germany, Ernst von Bergmann and Carl Schimmelbusch replaced carbolic acid with mercury bichloride in 1880 and adopted steam sterilization of dressings in 1886, the basis of aseptic surgery. Lister was made a baronet in 1881, and in 1897 he became the first British surgeon raised to the peerage.