February 10th: Anniversary of the death of Joseph Lister, the father of modern surgery

The year is 1800 and you are lying in a hospital bed. You broke your leg and need surgery to set it. In other words, you’re dead.

You’re not literally dead of course, that comes soon, but not quite yet. Before then, you have to lie in a dirty hospital bed as the “good old surgical stink” fills the air. You have to watch a moustachioed surgeon, proudly sporting a blood-stained coat, as he extracts a metal probe from the gangrenous stump of an amputee that lies in the bed beside you. You watch him leave the patient screaming in agony before walking over to your bed and begin examining your leg with the same metal probe.

To cut a long and tragic story short, here is a summary of the events that follow.

Your leg gets infected

Your leg gets amputated

Your stump gets infected

The infection spreads to your blood

You die

 

Life in the 1800s is grim.

 

Dangerous times

If you cut your finger within 100 meters of a hospital you would probably get infected and die. People realised this and towards the middle of the 1800s there was a large movement to ban surgical procedures as they were deemed too dangerous.

Can you imagine a modern day procedure so dangerous that, if carried out, most of the medical community would try and ban it? I can’t. Just trying to think of such a procedure quickly leads your mind down a gory rabbit hole, but this was life in the 1800s.

In the mid 1800s a young doctor named Joseph Lister was working as a dresser for the renowned surgeon Sir John Erichsen. This meant that he was responsible for changing the bandages on Erichsen’s patients. One day, Lister was wheeling a patient outside; he had a deep wound on his shoulder that was oozing a steady stream of putrid yellow gunge. The smell coming from this type of wound was known as a miasma and was thought to be the cause of infections. If these miasmas were allowed to concentrate, especially with several patient in a ward then the infection would spread. For this reason patients were often taken outside with open wounds in order to purge the miasma and avoid the dangerous buildup of gas that could spread disease.

This didn’t sit well with Lister at all. He noticed that if wounds were properly cleaned and dressed, they healed regardless of how smelly the room was. He hypothesised that something was going on inside the wound and that miasma had nothing to do with it.

 

A stroke of brilliance

Lister was a scholar. One day he was reading a paper called “Recherches sur la putrefaction” by the French scientist Louis Pasteur. Pasteur claimed that food spoilage could be caused by microorganisms, even if oxygen wasn’t present. While reading Pasteur’s work, Lister came up with the idea that it wasn’t actually miasma that was causing infection, but microbes, exactly as Pasteur had described in food.

Makes sense, right? Well, not to the medical community at the time. Lister’s ideas were tantamount to heresy and he kept them to himself. He was in an ideal situation to test his hypothesis, but how should he do it?

Pasteur said that there are 3 ways to eliminate microorganisms:

Heat

No good. This required temperatures in excess of 70 degrees celsius. Lister thought the patients were suffering enough.

 

Filtering

Also not a great option; how do you put an infected wound through a filter?

 

Chemicals

This was the one for Lister since he could treat wounds with chemicals known to kill bacteria.

And he did. Lister knew that a nasty chemical called creosote was used to disinfect sewage and to stop wood from rotting. He took an extract of creosote called carbolic acid (now known as phenol) and started applying it to surgical wounds in his ward.

I imagine that would sting a bit.

As much as it may have stung, Lister’s patients began to get better. He noticed that treating the wounds and surgical instruments with carbolic acid, the mortality on the ward decreased. He couldn’t keep this finding to himself as it did not “seem right to withhold it longer from the profession generally”.[1]

He published two papers in the Lancet in March and July of 1867 and was met with brutal opposition. However, Lister was right and nobody could deny the results when his methods were tried in their own hospitals.

A great man

Joseph Lister

photo by AJC1 used under Creative Commons (CC BY-NC-ND 2.0)

Joseph lister addressed a huge problem in medicine, a problem causing agonising deaths and that lead to the medical community almost abolishing surgical procedures altogether. He applied Louis Pasteur’s “Germ Theory” to hospitals, which is still used today. He became famous and even in his retirement was consulted on the appendectomy of King Edward VII of England. He received numerous honours, he was president of the Royal Society, made a Baron by Queen Victoria, and even had two genuses of microorganisms named after him (Listeria and Listerella). His crowning achievement would have to be giving his name to the mouthwash brand Listerine.

listerine

Thanks to this great man and his even greater sideburns, if you went into hospital with a broken leg, you would come hobbling out with a bit of a phenol burn, but the fact that you could hobble out at all is nothing short of a miracle.

 

Reference

  1. Ackerknecht EH. A short history of medicine. Baltimore and London: The Johns Hopkins University Press; 1982

Feature photo by <p&p>photo used under Creative Commons (CC BY-NC-ND 2.0)

 

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