On the Antiseptic Principle in the Practice of Surgery
Wounds rot because germs from the air settle in them — kill the germs, and surgery stops killing.
For most of history, surviving the surgeon's knife was only half the battle — the wound that followed could still kill you. Lister found out why, and how to stop it.
The big idea
In the 1860s, surgery was a gamble. An operation might go perfectly, and then, days later, the wound would swell, fester and turn septic, and the patient would die. Surgeons accepted this 'wound sepsis' as bad luck or bad air. Joseph Lister, a surgeon in Glasgow, read the work of the French scientist Louis Pasteur, who had shown that rotting and fermentation are caused by tiny living organisms — germs — floating in the air.
Lister made the leap: wounds don't rot because of the air itself, but because of the germs the air carries into them. Kill those germs at the wound, and it need not rot at all. He used carbolic acid — a strong-smelling chemical then used to treat sewage — to clean wounds, dressings, instruments and hands, and the deaths stopped.
How it came about
Lister was professor of surgery at Glasgow Royal Infirmary, where the wards were so deadly that surgeons sometimes thought patients were safer being operated on at home. Hunting for the cause of post-operative infection, he came across Pasteur's papers and recognised a connection no one else had drawn. He chose carbolic acid because he had heard it killed the stench of sewage-treated land — reasoning that whatever destroyed the agents of decay there might do the same in a wound.
He tested it first on compound fractures — the worst cases, where the bone breaks the skin and infection was almost certain. Limbs that would have been amputated healed. He published his principle as a short address in 1867. Surgeons resisted for years — his careful hand-washing and dressing rituals looked fussy, and his statistics were doubted — but the results won out.
Why it mattered
Before Lister, operating deep inside the body was nearly suicidal; the abdomen, chest and skull were almost untouchable because infection was certain. Antiseptic surgery, and the aseptic technique it grew into, made all of modern surgery possible — from appendectomies to heart transplants. The sterile operating theatre, with its scrubbed hands, gowns and instruments, is Lister's idea, and it has saved more lives than almost any single advance in medicine.
A way to picture it
Think of a wound like fresh fruit left on a counter. It doesn't rot because the air touches it; it rots because invisible spores and microbes settle on it from the air and multiply. You needn't seal anything — just make the surface a place where nothing living can take hold (the way salt or vinegar protects food), and the fruit keeps. Lister's carbolic acid did exactly that for an open wound: it didn't shut out the air, it made the wound a surface where airborne germs could not survive.
Where it sits
Lister stands between two giants already in this Library. Pasteur had shown that micro-organisms cause fermentation and decay; Lister took that idea out of the wine vat and into the wound. A few years earlier, John Snow had traced a London cholera outbreak to a single water pump, arguing that an invisible agent — not bad air — spread disease, the same shift from 'miasma' to a real, physical cause. After Lister, Robert Koch would prove that specific germs cause specific diseases, and Fleming would later find a mould that kills bacteria from within. Antisepsis is the hinge where germ theory first paid off at the operating table.
In the course of an extended investigation into the nature of inflammation, and the healthy and morbid conditions of the blood in relation to it, I arrived several years ago at the conclusion that the essential cause of suppuration in wounds is decomposition brought about by the influence of the atmosphere upon blood or serum retained within them, and, in the case of contused wounds, upon portions of tissue destroyed by the violence of the injury.
But when it had been shown by the researches of Pasteur that the septic properties of the atmosphere depended not on the oxygen, or any gaseous constituent, but on minute organisms suspended in it, which owed their energy to their vitality, it occurred to me that decomposition in the injured part might be avoided without excluding the air, by applying as a dressing some material capable of destroying the life of the floating particles.
The material which I have employed is carbolic or phenic acid, a volatile organic compound which appears to exercise a peculiarly destructive influence upon low forms of life, and hence is the most powerful antiseptic with which we are at present acquainted.