Lister's Antiseptic Surgery (1865): Carbolic Acid Saves Lives

Antiseptic surgery began on 12 August 1865, when the Glasgow surgeon Joseph Lister dressed a boy’s open fracture with lint soaked in carbolic acid. Inspired by Louis Pasteur’s discovery that microorganisms cause decay, Lister set out to kill germs before they could infect surgical wounds. His method cut deaths after operations dramatically and changed surgery from a dangerous gamble into a modern science.

Surgery before Lister

By the 1860s anaesthesia, first demonstrated on Ether Day in 1846, had made longer operations possible. Yet patients still died in huge numbers after surgery from infections known as hospital diseases: sepsis, gangrene, erysipelas and pyaemia. In many hospitals, a third or more of amputation patients died.

Surgeons operated in blood-stained frock coats, reused dressings and rarely washed instruments between patients. Pus in a wound was often regarded as a normal stage of healing. Most doctors blamed infection on “miasma”, bad air arising from decay, and believed it could be reduced only by ventilation.

A few voices had warned otherwise. In Vienna, Ignaz Semmelweis had shown in 1847 that handwashing with chlorinated lime cut deaths from childbed fever, but his findings were largely rejected.

Joseph Lister and the germ theory

Joseph Lister was born on 5 April 1827 in Upton, Essex, into a Quaker family. His father, Joseph Jackson Lister, was a wine merchant and an amateur scientist who improved the microscope. Lister studied at University College London, trained in Edinburgh under the surgeon James Syme, whose daughter Agnes he married in 1856, and in 1860 became Regius Professor of Surgery at the University of Glasgow.

At the Glasgow Royal Infirmary, Lister was troubled by the high death rate in his wards. In 1865 the Glasgow chemistry professor Thomas Anderson drew his attention to the work of Louis Pasteur, who had shown that fermentation and putrefaction were caused by living microorganisms carried in the air and on surfaces.

Lister concluded that wound infection was a form of putrefaction caused by germs. Pasteur had suggested killing microbes by heat, filtration or chemicals; heat and filtration were impossible for a wound, so Lister looked for a chemical. He learned that carbolic acid (phenol) had been used to treat sewage in Carlisle, reducing its smell and the illness of cattle grazing on treated fields.

The first antiseptic cases

Compound fractures, in which broken bone pierces the skin, were especially deadly, and amputation was often the only option. On 12 August 1865 an 11-year-old boy, James Greenlees, was brought to the infirmary after a cart had run over his leg. Lister cleaned the wound and covered it with lint soaked in carbolic acid.

The wound healed without infection, and after about six weeks the boy was able to walk out of hospital. Lister went on to treat further cases. Not all patients survived, and early on he had to learn how to use the acid without causing severe burns, but the pattern was clear.

In 1867 Lister published his results in a series of articles in The Lancet, “On a New Method of Treating Compound Fracture, Abscess, etc.”, beginning in March. In August that year he explained his ideas to the British Medical Association in Dublin in a paper published as “On the Antiseptic Principle in the Practice of Surgery”.

Lister’s reasoning was as important as his results. He argued that it was not the air itself, nor oxygen, that caused wounds to putrefy, as many surgeons assumed, but living germs carried in the air and on hands, instruments and dressings. If those germs could be destroyed or kept out, a wound should heal cleanly, as simple fractures beneath unbroken skin usually did.

He also observed that his wards became healthier. Before antisepsis, his Glasgow wards had suffered repeatedly from pyaemia and hospital gangrene; after he adopted the new method, he reported that these infections largely disappeared, even though the buildings and their crowding remained the same.

Refining the method

Lister extended antisepsis to every stage of an operation. Instruments were soaked in carbolic solution, surgeons washed their hands in it, and wounds were covered with layered antiseptic dressings. He also developed absorbable ligatures of catgut treated with carbolic acid, to tie off blood vessels without leaving infected threads.

From about 1871 he introduced a carbolic steam spray that filled the air around the operating table with a fine mist, intended to kill airborne germs. The spray was unpleasant for surgeons and patients and was later shown to be unnecessary; Lister abandoned it in 1890 as evidence grew that contact, not air, was the main route of infection.

Resistance and acceptance

Acceptance was slow. Many British surgeons doubted the germ theory, found the methods time-consuming, or claimed good results with cleanliness alone. German surgeons adopted antisepsis more quickly, particularly during and after the Franco-Prussian War of 1870–1871, and their results helped persuade others.

Lister moved to Edinburgh in 1869 and to King’s College Hospital, London, in 1877, where he demonstrated his methods in the capital. In 1871 he drained an abscess for Queen Victoria at Balmoral, using carbolic spray. Robert Koch’s identification of specific disease-causing bacteria from the 1870s and 1880s gave the germ theory solid proof, and opposition faded.

Key people

• Joseph Lister (1827–1912): surgeon who developed antiseptic surgery in Glasgow, Edinburgh and London.
• Louis Pasteur (1822–1895): French chemist whose studies of fermentation and putrefaction inspired Lister; the two men later corresponded warmly.
• Thomas Anderson (1819–1874): Glasgow professor of chemistry who introduced Lister to Pasteur’s work.
• James Greenlees: the 11-year-old boy whose compound fracture was the first case treated with carbolic acid in August 1865.
• James Syme (1799–1870): Edinburgh surgeon, Lister’s teacher and father-in-law, an early supporter of his methods.

Consequences and legacy

Lister reported that mortality in his amputation cases fell from around 45 percent in 1864–1866 to about 15 percent in 1867–1869. These were small numbers from a single surgeon’s wards, but the improvement was dramatic and repeated elsewhere.

By the 1890s antiseptic surgery was giving way to aseptic surgery, which focused on keeping germs out entirely through steam-sterilised instruments, gowns, masks and rubber gloves. This built directly on Lister’s principle. Together with anaesthesia, it made possible abdominal, chest and brain surgery that had previously been fatal.

Lister received many honours. He was made a baronet in 1883 and in 1897 became Baron Lister, the first doctor raised to the peerage, and he served as President of the Royal Society from 1895 to 1900. He died at Walmer, Kent, on 10 February 1912. His work was part of the same revolution as Pasteur’s later rabies vaccine.

Timeline

• 1827, 5 April: Joseph Lister is born in Upton, Essex.
• 1860: Lister becomes Regius Professor of Surgery at Glasgow.
• 1865: Thomas Anderson introduces Lister to Pasteur’s work.
• 1865, 12 August: Lister treats James Greenlees with carbolic acid dressings.
• 1867, March: First of Lister’s articles appears in The Lancet.
• 1867, August: Lister presents “the antiseptic principle” in Dublin.
• 1877: Lister moves to King’s College Hospital, London.
• 1890: Lister abandons the carbolic spray.
• 1912, 10 February: Lister dies in Walmer, Kent.

Why it matters

Lister turned the germ theory into a practical method that saved countless lives. His insistence that wounds must be protected from microorganisms underlies every modern operating theatre, and it made surgery, for the first time, reasonably safe.