SURGERY | Lister's first antisepsis article, March 16

Lord Joseph Lister of Lyme Regis (1827-
1912), Father of Modern Surgery

March 16, 2020 – As the world confronts the pandemic COVID-19 disease, antiseptic hygiene is becoming widely stressed. Wash your hands, wash your hands – soap and hot water, in a vigorous 20-second routine.

The theory behind it was first set forth in an article  published on this date in 1867 by the august British journal The Lancet. The author was Joseph Lister, later to become Lord Joseph Lister of Lyme Regis (1827-1912).

He is called the Father of Modern Surgery. He would be called Dr. Lister in the United States, but British surgeons like to acknowledge barbers as their professional ancestors by calling themselves just "Mr."

Born in 1827, Joseph Lister attended University College Hospital, London for his training, the only place he could go as a non-conforming Quaker. He became a professor of surgery at Glasgow University in 1860 and moved to Edinburgh in 1869, marrying the daughter of an Edinburgh professorial colleague, James Syme. He was 40 when he published his first installment of a now-historic series of six articles on antiseptic surgery.

At that time, putrefaction commonly followed operation, leading to the common report that "the operation was successful but the patient died." Lister read Louis Pasteur's study of the cause of fermentation in beer and milk and speculated that the same cause might lead to putrefaction in wounds. Authorities in nearby Carlisle were using creosote to deal with bad-smelling sewage because it reduced the odor. They discovered it also reduced disease amongst cattle and humans. Lister theorized that it was the carbolic acid in creosote that stopped the putrefaction, and that Pasteur's study provided an explanation.

Ridiculed at first, Lister experimented to prove his theory. He used dressings soaked in carbolic acid to cover wounds. The practical outcome of his work was that the rate of infection in his own operations was vastly reduced. After trying combinations with different emphasis of hand-washing, sterilizing instruments, spraying carbolic in the operating theater (he developed a carbolic spray) and antiseptic treatment of wounds, he steadily improved surgery survival rates. His first article of six appeared in The Lancet on this date in 1867. The last appeared in July.

Between 1864 and 1866, before his experiments and remedies, 46 percent of Lister’s surgical patients died; during the next three years, he brought the average down to 15 percent. Yet Lister was initially a prophet without honor in his own country. His work was accepted in Germany, but continued to be ridiculed in London (Scotland's science was still fair game for London opinion-shapers).

To promote his work, Lister accepted a post as Professor of Clinical Surgery at King's College Hospital, London in 1877. His teaching was finally accepted after his astonishingly successful "open" operation for fracture of the patella, the kneecap. A patient, Francis Smith, had fractured his patella a fortnight earlier. Lister wired together the separated fragments of his bone, a complicated process that previously might have been avoided because of the likelihood of "hospital disease." Lister showed how his antiseptic system “removed for ever the threat of hospital disease.”

Smith survived the operation and walked out of the hospital three months afterwards. Many people came to the hospital from far and wide to watch him operate (notices were posted in three different languages requesting no smoking in the hospital). In 1883, Lister was made a Baronet. In 1897 he was the first surgeon to become a peer, the 1st Baron Lister of Lyme Regis. Lyme Disease is indirectly named after the town attached to his title, since Connecticut's Lyme was named after the British one.