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June 17, 1867: Lister Cuts Clean, Saves Lives

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June 17, 1867: Lister Cuts Clean, Saves Lives
1867: British surgeon Joseph Lister performs the first surgery under antiseptic conditions. Death rates would plummet, but you should still be thankful you were born in the 20th century and not the 19th.
Lister was raised in a Quaker family and attended University College, London, because Britain's other universities required an oath of loyalty to the queen and the Church of England. While an assistant surgeon at the Edinburgh Royal Infirmary in Scotland, he befriended his boss and married the boss's daughter, Agnes Syme. As the daughter and wife of surgeons, she knew plenty about the subject and became a lifelong associate in her husband's research.
Surgery at the time was a pretty dangerous affair. Anesthesia had been introduced in the preceding decades, so patients were more comfortable during their operations and amputations. But post-surgical death rates ran 40 to 50 percent because of infection from "hospitalism," or "hospital disease," infections like septicemia.
Hospitals were notoriously unclean, but scientists were just beginning to make the connection between hygiene and infection. Hungarian physician Ignaz Semmelweis had discovered by 1847 that the simple act of obstetricians washing their hands in a chlorine solution could cut deaths from childbed fever from 10 percent to less than 2 percent.
But revolution, political unrest and hostile opposition from the medical establishment prevented widespread knowledge and adoption of the lifesaving practice. Lister had not heard of Semmelweis.
Lister became surgeon at the Glasgow Royal Infirmary in 1861 and immediately tried to do something about the high surgical mortality rate. With gangrene and other festering infections, surgical recovery wards certainly smelled bad enough, but Lister discarded the prevalent notion that "bad air" caused the infections. He theorized that a "pollen-like dust" might be settling in the wounds.
Then he read Louis Pasteur's 1865 report that living microorganisms cause matter to ferment and eventually rot. Lister saw how Pasteur's research connected to his own work. Microbes cause matter to putrefy. Wounds smell of putrefaction. Perhaps keeping the microbes off the wounds could prevent the deadly hospital infections.
Lister had also read how authorities in Carlisle, England, were using carbolic acid (phenol) to treat smelly sewage. That not only reduced the odor but reduced disease among both cattle and humans.
Bingo! If you're a genius. Or maybe just a solid scientist and dedicated physician in the right place at the right time. Lister was clearly the latter and perhaps the former, too.
Why not treat wounds with dilute phenol? Why not clean surgical instruments with dilute phenol? Why not even spray a phenol aerosol into the air of the operating theater?
Lister experimented on amputation patients at his hospital starting in 1865. Meeting with success, he widened the use to the setting of compound fractures, where a bone breaks through the skin with concomitant high risk of infection. By 1867, he performed a full surgical procedure.
Lister reported on his successes in 1867 in letters and two important scientific papers in The Lancet, "On a New Method of Treating Compound Fractures, Abscesses, Etc., With Observations on the Conditions of Suppuration" and "On the Antiseptic Principle in the Practice of Surgery." His 1867 reports acknowledged both Pasteur and the Carlisle work.
Lister reported that his surgical wards had remained free of sepsis for nine months. Between 1864 and 1866, Lister lost 46 percent of his surgical patients. From 1867 to 1870, he lost "only" 15 percent. By 1877, he'd dropped the death rate to 5 percent.
Lister's antiseptic practices met some resistance at first, but their success argued volumes, and they soon caught on wherever modern medicine was practiced. Queen Victoria made Lister a baronet in 1883 and elevated him to the peerage as Baron Lister of Lyme Regis in 1897. He was also one of the dozen original members of Britain's Order of Merit. Further honors include having both a pathogenic-bacterial genus (Listeria) and an antiseptic mouthwash (Listerine) named after him.
When King Edward VII came down with appendicitis two days before his planned coronation in 1902, the royal doctors consulted Lister before performing surgery. The king survived, and was crowned six weeks later. Edward VII later thanked Lister: "I know that if it had not been for you and your work, I wouldn't be sitting here today."
And perhaps you or I could say the same thing.
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