Saving countless lives, the Lister way…

Did you know that mortality rates from major operations were slashed from around 40% in the second half of the 19th Century, to less than 3% by the end of the first decade of the 20th Century? Current estimates of global mortality rate following major surgery still hovers around 1-4%, suggesting that the vast changes in the medical landscape over the past 120 years hasn’t had a big impact in this specific matter. The drastic reduction that took place in the half a century before that was mainly down to one person. That man was none other than British surgeon Joseph Lister.

The second son of Isabella Harris and Joseph Jackson Lister, Joseph Lister was lucky in that both his parents played an active role in his education. His father, a wine merchant who identified himself as an amateur microscopist and physicist, instructed him in natural history and the use of microscopes. 

Picks his career before turning 16

The fact that his schooling took place in two institutions that emphasised more on natural history and science than most others of the time shaped his future. He was drawn to anatomy and had set his sights upon a surgical career even before he turned 16.

An excellent student, it was no surprise that Lister graduated with honours as a bachelor of medicine in 1852. He became a fellow of the Royal College of Surgeons the same year and became an assistant of James Syme – considered the finest surgical teacher of the time – during a visit to Edinburgh in 1853. Lister went on to marry Syme’s daughter Agnes (a botanist who also contributed immensely to Lister’s professional life in the form of an assistant) in April 1856 and was appointed surgeon to the Edinburgh Royal Infirmary by October the same year. 

New building, same old problem

Elected Regius Professorship of Surgery at Glasgow University in 1860, he was appointed surgeon to the Glasgow Royal Infirmary the following year. Here, he was also in charge of wards in the newly built surgical block, which the managers hoped would greatly reduce hospital disease (now known as post-operative sepsis or surgical sepsis, it is a serious complication that takes place when disease-producing microorganisms enter the bloodstream after surgery). 

That, however, didn’t turn out to be the reality. Lister himself reported that in the five years from 1861-65, nearly half of his amputation cases died from sepsis in the Male Accident Ward. It was here that Lister began his experimentation with antisepsis. 

Rather than go with the popular concept of miasma – direct infection by bad air – that dominated the time, Lister formed theories of his own based on observation and experimentation. He suggested that sepsis was caused by pollen-like dust, and though there’s no evidence to suggest that he believed the dust to be living organisms, he was pretty close to the truth.

Germ theory of disease

It was during this time that French chemist Louis Pasteur developed his germ theory of disease. He refuted the theory of spontaneous generation and instead hypothesised that the action of microorganisms were the cause of diseases. Lister, who was suspecting something like this himself, lapped onto it – even though it was much-doubted for years, or even decades.

Lister wrongly believed that germs were carried only by the air. He, however, rightly concluded that the microbes had to be destroyed before they entered a wound. In order to protect the region being operated from infection by the surgeon’s hands and instruments, he therefore sought to create an antiseptic barrier between the wound and the air. 

Having heard that carbolic acid, which had been advised as a wound dressing in 1863, had been effectively employed to clean foul-smelling sewers, Lister began to clean and dress wounds using a solution of this acid. The first such recorded antiseptic surgery took place on August 12, 1865. Unbeknownst to him, Lister laid the foundation for modern surgical practises. 

Free of sepsis

Starting from March 16, 1867, Lister published a series of six articles in The Lancet, making his results public and reporting that his surgical ward had remained free of sepsis. The mortality rate of Lister’s surgical patients in the three years before and after he started using antiseptic treatment fell from 46% to just 15%. The numbers highlighted the merit of On the Antiseptic Principle of the Practice of Surgery, as the articles collectively came to be known as. 

Lister’s theory remained controversial and misunderstood over the decade that followed and there was opposition to germ theory itself, and not just his carbolic treatment. His chance to win over the naysayers finally came in 1877 – the year he was offered the chair of Clinical Surgery at King’s College, London. 

On October 26, Lister performed the first successful surgery to mend a kneecap under antiseptic conditions. The patient, Francis Smith, had fallen from his cart and fractured his kneecap. The process of wiring together the patella is so complex that it had almost always resulted in infection and death previously. Lister’s successful operation, and the fact that Smith walked out of hospital three months later, pushed practitioners from around the world to accept that Smith’s methods did indeed enhance safety of operative surgery. 

Universal acceptance

Surgeons from across the globe came to see Lister operate and he was lucky enough to see his principle attain acceptance within his working life. He received many honours, both before and after his retirement from surgical practice in 1893, shortly after Agnes’ death. 

Lister died in 1912, having increased the safety of operations more than anyone else before or after him. His exact method of employing antiseptics is no longer used. But his principle that bacteria must never gain entry into an operation wound continues to be the cornerstone of modern surgical practice. 

Did you know?

When American physician and chemist Joseph Lawrence developed a formula for an antiseptic mouthwash in 1879, he named it in honour of Lister, a pioneer in antiseptic surgery. This mouthwash, as many of you might have rightly guessed, is Listerine, which remains in use even today.