Joseph Lister, Antiseptic Surgery and Antisepsis
Microbial Control With Phenol in Surgical Medicine
Mar 16, 2009
Joseph Lister, an English surgeon, was dedicated to studying the details of how broken bones heal. Simple fractures are bone breaks that do not pierce through the skin nor damage the muscle or connective tissues. Lister noted simple fractures heal without problems or complications. Compound fractures that broke through the skin were another story. These more severe fractures damaged connective tissue, muscle and skin and the tissues often became infected and diseased.
Infectious Disease Consequences of Fractures
Typical known pathogenic (disease-causing) bacteria are Staphylococcus, Streptococcus and Clostridium. Compound fractures often were followed by any one of the following: boils, abscesses, sepsis (blood-borne infection), tetanus or gas gangrene. No one knew the real causes of these diseases at this time in the history of microbiology.
Gas gangrene is a difficult, terrible disease of oxygen-deprived tissues. The clostridia grow and multiply in damaged tissue. The pathogen causes characteristic bubbling and blackening of skin, connective tissue and muscle. The bacteria produce potent enzymes and toxins that damage the host cells’ metabolism and cell membranes. Radical surgery often is required to save the victim’s life. As the gangrene continues to advance, amputation is the only recourse!
Pasteur’s Ideas About Microbes
Lister had read and heard of the famous experiments of Louis Pasteur. Pasteur proved that the air harbors living microbes; microbes do not appear spontaneously from nothing. Air currents carry microbes from one place to another. Wherever some airborne microbes land and stick, they may grow and multiply.
Lister also knew of Pasteur's findings with infected wines. This prompted Lister to think about the role of microbes in the process of tissue fermentation. Instead of Pasteur’s yeasts or contaminating lactobacilli feeding on grape sugar in a vat, microbes in people could use host cells, blood and nutrients to grow.
The Industrial Revolution in Europe resulted in many large cities. Cities teemed with people. Cities overflowed with much body waste and sewage. Wastes poured into streams and rivers from inadequate or poorly developed sewer systems. These rivers and streams greeted riverside pedestrians with a mix of noxious odors similar to that of sewers or smelly restrooms. In Carlisle, England carbolic acid (phenol) was used periodically to control the odor of the Thames River . The phenol worked quite well.
Lister and Phenol Antiseptic Surgery
Lister reasoned that the carbolic acid was controlling the microbes that contributed to the putrid odor and conditions in the water.
He reasoned that microbes in the air will land, similar to air-borne dust, on hospital surfaces and patients. Armed with these exciting thoughts Lister instructed all those working in surgery to begin to spray and douse the surgical environment with phenol. Phenol was sprayed onto patients' wounds, added to surgical instruments and the operating tables. Even the surrounding air was sprayed with a hand-held atomizers shown in the pictures below.
To the amazement and joy of all, within a short period of time phenol dramatically reduced the incidence of wound infections. Thus, in 1864 with the publication of Lister’s work, antiseptic surgery made its entrance into the world of medicine.
Modern Surgery and Operating Rooms
A modern operating room is a far cry from those of Lister’s day. Today, there are: sterile (no viable microbes) surgical gloves and masks, sterile drapes, special flooring and ceiling tiles, autoclaves, ovens and ethylene gas-sterilized catheters and sterile instruments, ultra-filtered air, ultraviolet germicidal lamps, and antibiotics.
The introduction of antiseptic surgery is considered one of surgery's major advances. In sanitized and antiseptic hospital environments living, potentially deadly, microbes are inactivated or destroyed. Patients are safer from primary and secondary microbial infections. Patients recover quickly and return soon to normal lives.
Lister accomplished all this in a simple and outstanding way.
Simple ideas can lead to great and beneficial consequences.
Sources and Resources
De Kruif, P. 1964. 30th printing. The Microbe Hunters. Pocket Cardinal. Pocket Books Inc. New York, N.Y. 342 pp
Read more:
- Microbiology Seeing Understanding the Unseen: Leeuwenhoek and Pasteur Microbiology Begins
- Robert Koch MD and Microbiologist:Infectious Disease Principles, Koch's Postulates Pure Culture Method
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