BIRTH | "Wash Your Hands" Joseph Lister

Joseph Lister (1827-1912)

April 5, 2020 – This day in 1827 was born Joseph Lister, the man who first preached "wash your hands, wash your hands" to prevent the spread of disease. He is called the father of antiseptic medicine and was born in Upton, England.

As the world confronts the pandemic COVID-19 disease, the importance of antiseptic hygiene is becoming widely known as a life-and-death daily matter. Soap and hot water, over a vigorous 20 seconds.

The theory behind this was first outlined in an article on antisepsis published in 1867. It outlines the discovery of antiseptic surgery in the august British journal The Lancet.

The author was Joseph Lister, or Lord Joseph Lister of Lyme Regis (1827-1912). His contribution to surgical methods is so fundamental he is also referred to as the Father of Modern Surgery. He would be 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 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. In 1861 he was appointed to the Glasgow Royal Infirmary, which had just built a new surgical wing to reduce the high 45-50 postsurgical mortality rate (operation successful, patient died).

The theory at the time was that putrefaction following an operation because of a miasma in the air. But Lister noted that the mortality rate from "ward fever" didn’t drop in the new Glasgow infirmary building. Lister theorized that the infection was caused not by a miasma but by an invisible dust, like pollen. Since the new building didn't improve the post-operative mortality rate,  he thought the solution might be to put a barrier between the patient and the surrounding air.

Lister moved to Edinburgh in 1869, marrying the daughter of an Edinburgh professorial colleague, James Syme, bringing with him the putrefaction puzzle. Why didn't the Glasgow hospital building's cleanliness help reduce post-operative mortality? Lister read Louis Pasteur's study of the cause of fermentation in beer and milk (the first pasteurization test had been completed in 1862) and speculated that this might be the cause of wound putrefaction.

Authorities in nearby Carlisle were using creosote to clean bad-smelling sewage because it reduced the odor. They discovered it also reduced disease amongst cattle and humans. Lister applied Pasteur's study as an explanation of carbolic acid's effectiveness in stopping the putrefaction. He experimented with dressings soaked in carbolic acid to cover wounds. The outcome was that the rate of infection was vastly reduced. He experimented with hand-washing, sterilizing instruments and spraying carbolic in the operating theater. He developed a carbolic spray. His antiseptic treatment of wounds improved surgery survival rates. His first article appeared in The Lancet in March 1867, soon before his 40th birthday. The last of his six articles appeared in July.

Between 1864 and 1866, before the use of antiseptic treatment, 46 percent of Lister’s surgical patients died. In contrast, from 1867 to 1870, only 15 percent died, and he eventually got the mortality rate down to 5 percent. Yet Lister was initially a prophet without honor in his own country. His idea of invisible germs was mocked. His work was accepted in Germany, where it was seen to work, but it was ridiculed in London.

To be fair to the European medical profession (h/t to E.P.), Hungarian Ignaz Semmelweis was the first to preach handwashing, based on his obstetric work in the 1840s when he noticed that the patients managed by doctors did much worse than those managed by midwives despite the doctors being more scientific and carrying out post-mortems on the mothers that died. He decided the doctors were carrying something lethal on their hands from the dead to the living and, sensibly enough, recommended they wash whatever it is off their hands.

Doctors didn't want to believe that they had been violating their Hippocratic oath by carrying illness from one patient to another and they dismissed Semmelweis as crazy (he did spend time in a mental institution), so it is fair to give Lister the credit for being the first not only to preach handwashing but to get others to listen. To answer his London critics, Lister put his head on the mouth of the British medical lion and accepted a post as Professor of Clinical Surgery at King's College Hospital in 1877.

Lister's breakthrough in convincing the English medical establishment of his theories occurred when he performed a successful "open" operation for fracture of the patella (kneecap). The patient, Francis Smith, had fractured his patella a fortnight earlier. Lister wired together the separated fragments of his bone, a complicated process that showed how the antiseptic system “had removed for ever the threat of hospital disease”. Smith survived the operation and walked out of the hospital 3 months later. Lister’s fame spread.

Many people came to the hospital to watch him operate, and notices requesting no smoking in the hospital had to be posted in three different languages. 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.