Joseph Lister

12 Key excerpts on "Joseph Lister"

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  A History of Infectious Diseases and the Microbial World

  • Lois N. Magner(Author)
  • 2009(Publication Date)
  • Praeger

    (Publisher)

  Joseph Lister AND ANTISEPTIC SURGERY Surgery has undergone a remarkable transformation from one of the least re- spectable branches of medicine into one of the most successful and powerful areas of specialization. Although surgeons had performed difficult and challenging operations for hundreds of years, it was only during the nineteenth century that surgery was 54 A History of Infectious Diseases and the Microbial World radically changed by incorporating reliable methods for dealing with pain and in- fection. The introduction of general anesthesia in the 1840s and antisepsis in the 1870s made it possible for the great majority of patients to endure and survive major operations. Anesthetics made it possible for surgeons to perform more com- plicated operations than their predecessors, but even minor operations could lead to life-threatening infections. Throughout history, healers had adopted various substances for their supposed infection-fighting properties, but, as Robert Koch demonstrated, most of these so- called antiseptics and disinfectants were ineffective, and some were more destructive to human tissues than to microbes. As Florence Nightingale, pioneer of modern nursing and sanitary reform, often said, most of these agents were useless, except when their odor was so noxious that it forced people to open windows and bring fresh air into the sickroom. Thus, Joseph Lister’s demonstration of the value of a rigorous system of antisepsis, dedicated to killing the germs that might come into contact with a surgical wound, was a key factor in the evolution of modern surgery and the establishment of the hospital as the proper place for surgery and childbirth. Until hospitals adopted Lister’s antiseptic practices, these charitable institutions were dangerous places, almost invariably associated with bad air, filth, poverty, and high rates of infection.

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  Military Medicine

  From Ancient Times to the 21st Century

  • Jack E. McCallum(Author)
  • 2008(Publication Date)
  • ABC-CLIO

    (Publisher)

  Because of his nonconformist religious beliefs, Lister was not eligible for admission to either Ox- ford or Cambridge universities (both of which required membership in the Angli- can Church), so he completed his medical studies at the University of London in 1852. While still a student, he acquired an interest in histology, probably due at least in part to his father’s interest in microscopes. Lister took a position in Edinburgh as house sur- geon under James Syme in 1854, eventually marrying his professor’s daughter. By 1857 he had already published important papers on inflammation and blood coagulation. In 1860, Lister was named professor of surgery at the University of Glasgow. He had a busy surgical practice and was deeply depressed by the mortality rate from hos- pital infections such as tetanus, erysipelas, and gangrene. The mortality rate from am- putations in his own patients exceeded 45 percent in spite of using Syme’s silver su- tures, wound drainage, frequent dressing changes, and general cleanliness. Undoubt- edly, his poor results were due at least in part to his persistent belief in the efficacy of “laudable pus.” Looking for a solution, Lister immediately recognized the significance of Louis Pasteur’s proof that microorganisms could cause dis- ease. The French scientist’s use of heat to pre- vent bacterial growth was of little practical use in surgery, so Lister sought other ways to keep bacteria out of wounds. He tried cover- ing wounds with zinc chloride and various sulphites before stumbling on carbolic acid, which was in common use as a disinfectant for sewage. He described his use of carbolic acid–soaked dressings in his application for the chair of systematic surgery at the Univer- sity College of London in 1866 and in his 1867 On the Antiseptic Principle in the Practice of Sur- gery, which was widely criticized. M I L I T A R Y M E D I C I N E Lister, Lord Joseph

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  Surgical Revolutions

  A Historical and Philosophical View

  • Luis H Toledo-Pereyra(Author)
  • 2011(Publication Date)
  • WSPC

    (Publisher)

  Lister was fully committed not only to clinical surgery but to research development as well. This full life, centered on surgery and research, never wavered. Lister Develops His Antiseptic Theory By 1860, Lister had begun to recognize the association of filth and unsan-itary conditions in the hospital wards with excessive mortality. In the wards of the Glasgow Royal Infirmary, hospitalism was rampant, and translated into diseases like septicemia, erysipelas and pyemia. What to do next? Lister was overwhelmed by the unacceptable mortality — near 50% — that char-acterized all hospitals in Europe. These unacceptable figures demonstrated 80 Chapter 9 that something new and special needed to be done. But what? Lister tried to understand this very real problem without any good answer at the beginning. The great awakening began in 1865 when Thomas Anderson, profes-sor of chemistry at the University of Glasgow, alerted Lister to the great works of the genius French chemist Louis Pasteur. 7 In his brilliant experi-ments Pasteur wrote of putrefaction, fermentation, living microorganisms, dust and air as having a direct relationship with one another. In his own reports, Pasteur recognized that putrefaction was a fermentative process due to living microorganisms present in dust and transported by air. A year before, in 1864, Lister had become aware that carbolic acid had destroyed entozoan that infected grazing cattle at the sewage property of Carlisle. Immediately thereafter, Professor Lister developed his own antiseptic the-ory based on Pasteur’s findings, as well as on his own experiments. Now, Lister had to prove that wound sepsis behaved and responded to treatment with some form of carbolic acid. The experiments would have to be car-ried out on patients. In August 1865 the human experiment began! The results were evi-dent and extraordinary since nine of 11 cases of compound fractures of limbs recovered.

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  Medical Theory, Surgical Practice

  Studies in the History of Surgery

  • Christopher Lawrence(Author)
  • 2018(Publication Date)
  • Routledge

    (Publisher)

  6

  Practising on principle: Joseph Lister and the germ theories of disease

  Christopher Lawrence and Richard Dixey

  Antiseptic surgery is simply a struggle with the causes of putrefaction. I have not mentioned the germ theory of infective disease at all. That has no essential bearing on the principles of antiseptic surgery. (William Watson Cheyne, 1882)

  Introduction

  Joseph Lister’s antiseptic system of surgical treatment was developed over a period of about thirty-five years between 1865 and 1900. From a variety of more or less critical perspectives, Lister’s theory and practice have been regarded as the foundations on which were built modern aseptic surgery and the conceptual framework deemed inseparable from it, the germ theory of disease. Versions of this story are well known to medical historians and, indeed, to a more general audience, and will be assumed in what follows. Here we argue that a crucial dimension of Listerian surgery has been ignored by historians: the pathological theories employed by Lister and his most important collaborator and publicist, William Watson Cheyne. Investigation of this limited area, we suggest, reveals the history of antiseptic surgery in a new light and demonstrates that many of the practical and theoretical origins of aseptic surgery were not Listerian. That the origins of aseptic surgery lie in non-Listerian traditions has been suggested by other authors.1 None, however, has explored the means by which the Listerians were so successful in representing their work as the sole legitimate precursor of modern surgery.2 The correct reconstruction of Lister’s pathological theories makes this possible. It also makes it possible to write the history of late Victorian surgery as a malleable cultural form, not as a practice whose details were determined by biological agents.

  Recovering Lister’s pathological theories is not an exercise in reconstructing an ossified body of ideas employed by Lister throughout his life. Although there are continuities, Lister continually modified his views. He did, however, always maintain that surgery was only practised properly when it was based on true, scientifically ascertained, pathological principles. This view, if not unusual at the time, was by no means universal. In the late 1860s Lister justified his practice by reference to a germ theory of putrefaction. By the mid-1870s this theory had been elaborated into a comprehensive account of the putrefactive origins of epidemic disease. At this time Lister invoked Pasteur’s experiments as the inspiration for the theory and practice of antiseptic surgery. In the late 1870s and early 1880s Lister and Cheyne began to remould their views in the light of the new, and quite different, German germ theory of infective disease. At first they subordinated German views to their putrefactive theory then, around 1880, the theory of infection was given equal and independent status. Finally, in the mid-1880s, putrefaction was subordinated to a germ theory of infection. In these years the experiments of German workers, notably Robert Koch, were increasingly cited as the basis of the theory and practice of antiseptic surgery. Theory and practice by now were both very different from their originals. In 1867 Listerian practice was directed to creating local conditions such that severe wounds involving bone damage might heal by granulation or by organisation in a clot. During the late 1870s and 1880s Listerians increasingly absorbed the techniques of their critics, such that, by 1900, most surgical practice was centred on the creation of a general environment in which such wounds might heal by simple apposition of their edges (first intention healing). Lister’s early ideas and practice, therefore, were by no means like his later ones, and the change from the one to the other was complex and contingent, not simple and necessary. Nevertheless by the 1890s Listerians could represent the practice of aseptic surgery which was based on the, by now recognisably modern, germ theory of infection, as deriving from a simple elaboration of early Listerian ideas and practice.

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  Studies in the History of Science

  • E. A. Speiser, Otto E. Neugebauer, Hermann Ranke, Henry E. Sigerist, Richard H. Shryock, Evarts A. Graham, Edgar A. Singer, Hermann Weyl(Authors)
  • 2017(Publication Date)
  • University of Pennsylvania Press Anniversary Collection

    (Publisher)

  Every surgeon nowadays knows that the ap-plication of an antiseptic drug to the surface of an infected 7» HISTORY OF SCIENCE wound accomplishes very little. The exclusion of bacteria is the important thing. Lemaire's conception was therefore un-sound and Lister's was correct. Much of the confusion of the contemporary surgeons was due to the fact that Lister used car-bolic acid. He did not know of Lemaire's previous recommenda-tion of the use of that antiseptic until later. He selected it be-cause of its success in arresting the putrefaction of sewage which had been achieved at Carlisle. If he had employed some other substance doubtless much of the confusion would have been avoided. It is interesting that Lister did not know of Lemaire's writings until after many other surgeons knew of them. He was not a scholar and did not know the literature of his subject. Perhaps there is significance in that fact. He might have had less courage to pursue his own ideas. Gradually there was evolved the present-day method of aseptic surgery. The German von Bergmann played an important role in this development. The spray and the extensive use of anti-septic drugs were abandoned. For them was substituted the sterilization by steam of everything that comes into contact with the wound, such as the instruments, the ligatures, the towels, sheets, etc. Sterile rubber gloves, introduced by Halsted of Bal-timore, were worn by the surgeon and his assistants, as were also face masks to prevent the passage of bacteria to the wound from the mouth and nose. All of these newer developments were based upon the idea that disease-producing bacteria are not ordinarily present in the air but are transferred from person to person by direct contact, by droplets of nasal or buccal secre-tions, or by an intermediate agent such as an instrument. It was now possible to enter any part of the body without pain and with but little danger of infection.

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  Moments of Truth

  Four Creators of Modern Medicine

  • Thomas Dormandy(Author)
  • 2004(Publication Date)
  • Wiley

    (Publisher)

  Proponents of new ideas or ‘hobbyhorses’ may be carried away by their enthusiasm. Nobody could carry away people like Sir James Paget in London or Syme in Edinburgh. Lister’s advantages were of course reflections of his personality as much as of his position. Semmelweis was an impatient, temperamental and uncompromising Hungarian with few social skills and a wayward judgement of character. While Lister was often aggrieved by the incomprehension or hostility of his colleagues, he could never be provoked into intemperate or unprofessional pronouncements. When sorely tried, he would raise his eyebrows, turn his eyes to heaven and sigh. (He did this THE ANTISEPTIC PRINCIPLE 317 rather often. ‘We wilted when he did,’ one of his assistants later recalled.) He held firm views on many subjects but never publicly attributed unworthy motives to his adversaries, as Semmelweis often did. His whole being, even his unsmiling countenance, radiated righteousness: it was possible to think him mistaken but not to question his rectitude. Yet, with all these advantages, his path was not as smooth as it might appear in historical retrospect. The very first written communication relating to the antiseptic principle was linked to failure. During the first trial on compound fractures, the chair of systematic surgery at University College Hospital London fell vacant. Lister was not entirely happy in Glasgow and he remained hopeful that one day he might return to London. It was the family rather than metropolitan bustle that drew him south. In July 1866 he applied for the post. He also wrote to Lord Brougham, President of the College and the Hospital, asking for his support. He enclosed a specially printed notice of a new method of treating compound fractures. It referred to Pasteur’s work and described in some detail the carbolic acid regime. It mentioned five consecutive cases in which bony union had been uninterrupted and wound sepsis prevented.

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  Germ Theory

  Medical Pioneers in Infectious Diseases

  • Robert P. Gaynes(Author)
  • 2023(Publication Date)
  • ASM Press

    (Publisher)

  But Lister’s most difficult task was convincing his 194 • Germ Theory: Medical Pioneers in Infectious Diseases colleagues that the underlying principle—microorganisms are responsible for the infections—was true and made all the fuss worthwhile. An additional four papers appeared in Lancet in 1867 that described his ideas, methods, and some results. Although the successful results today would be considered anecdotes, Lister described several cases and then, an unanticipated benefit in a September 1867 Lancet article: Since the antiseptic treatment has been brought into full operation, and wounds and abscesses no longer poison the atmosphere with putrid exhalations, my wards, though in other respects under precisely the same circumstances as before, have completely changed their character; so that during the last nine months not a single instance of pyremia, hospital gangrene, or erysipelas has occurred in them (10). The Chief of Surgery in Glasgow pressed ahead with his radical methods until he believed that he had sufficient experience with one procedure, amputations, to publish in Lancet. He summarized them in an 8 January 1870 article: Before the antiseptic period, 16 deaths in 35 cases; or 1 death in every 2½ cases. During the antiseptic period, 6 deaths in 40 cases; or 1 death in every 6½ cases (11). Lister concluded in his article, The antiseptic system is continually attracting more and more attention in various parts of the world; and, whether in the form which it has now reached, or in some other and more perfect shape, its universal adoption can be only a question of time (11). Lister was correct but a bit hasty in his conclusion. Members of the surgical profes- sion in his own country and in America would prove to be among the slowest to adopt his antiseptic system. But he would not use the Glasgow Infirmary as the pulpit from which he would preach his new gospel.

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  Browse's Introduction to the Investigation and Management of Surgical Disease

  • Norman Browse, John Black, Kevin Burnand, Steven Corbett, William Thomas, Norman Browse, John Black, Kevin Burnand, Steven Corbett, William Thomas(Authors)
  • 2010(Publication Date)
  • CRC Press

    (Publisher)

  3 Bacterial and viral infections John Black Infection impacts upon surgical practice in two main ways. First, many of the conditions treated by the surgeon are caused by infection, commonly bacterial but occasionally with other organisms. Second, safe surgical treatment is only possible if peri-operative infection is eliminated or controlled. It is nowadays taken for granted that operations are carried out in a clean environment rendered so by sterilization. However, as many infections come from organisms carried by the patient, infection remains a constant risk. Antibiotics are used frequently in the treatment and prevention of infections, but their very wide use and often abuse has resulted in the emergence of resistant strains of bacteria that cause major problems, particularly in the hospital environment. This chapter discusses the general principles of the investigation of infection in the surgical patient, particularly in the per-operative period, and the principles of management of those infec-tions. Other specific infections are dealt with later in the appropriate chapters. Virus infections rarely require surgical treat-ment, but patients suffering from conditions such as viral hepatitis and human immunodeficiency virus (HIV) present special problems, which are discussed below. ANTISEPSIS AND STERILIZATION Surgeons aim to carry out surgical operations in an environment free of bacteria. This may be achieved by: ■ asepsis : the concept of eliminating all bacteria from instruments and everything that might enter the operative area ■ antisepsis : the concept of reducing the number of bacteria, hopefully to zero by the use of antibacterial chemicals. Lister carried out the first clean operations at the end of the eighteenth century. Although bacteria were known to exist at that time, following the work of Pasteur some years earlier, Lister did not believe that bacteria caused infection and used phenol, an antiseptic, on purely empirical grounds.

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  Purity and Pollution

  Gender, Embodiment and Victorian Medicine

  • A. Bashford(Author)
  • 1998(Publication Date)
  • Palgrave Macmillan

    (Publisher)

  Many surgeons came to utilise antisepsis simply as an alternative surgical technique. for which Ihere were appropriate and inappropriate cases. 13 Others developed an empirically-based failh in carbolic to prevent Ihose infections which plagued hospitals and surgeons' slatistics, again without any necessary subscription to the idea of germs. Christopher Lawrence and Richard Dixey have suggested that a major inconsistency in the received story about Lislerism is the fact that there was not one but many compeling theories on germs and wound putrefaction in Ihe laie nineteenth century. These authors have convincingly argued that Lister's early (186Os) germ theory of putrefaction (after Pasteur) was quite different to, if not inconsistent with , his late nineteenth-century germ theory of infection (after Koch). Lister and his supporters, they suggest, successfully remoulded their initial anliseptic praclices and their research to fit subsequent theoretical developments in microbiology and bacteriology. Antisepsis is often understood to have been the immediate theoretical and practical precursor to modern aseplic lech- niques ofsurgery. Even at t he turn ofthe century, there was already a standard account that lhe new aseptic techniques were a natural development of Listerian antisepsis. 14 But according to Lawrence and Dixey, Listerian praclice came to be seen as the revolutionary precursor to asepsis not by virtue of an actual link, but because advocates managed to connect it successfully and in a sense retrospectively with the idea of 't he' germ theory: ' Listerians could represent the practice of aseptic surgery, which was based on the by now recognisably modern germ theory of infection, as deriving from a simple elaboration of early Listerian ideas and It is sug- gested by them, and by several other med ical historians, that aseptic surgery actually emerged from non-Listerian traditions.

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  Louis Pasteur

  His Life and Labours

  • René Vallery-Radot(Author)
  • 2014(Publication Date)
  • Perlego

    (Publisher)

  'Boracic acid has this immense advantage, that it can be applied in large doses—3 to 4 per cent.—without causing the slightest pain. It has therefore become, in our practice, the agent continually and successfully used for injections. I also have recourse to a solution of boracic acid to produce large evacuations after the operation of breaking up stones in the bladder (lithotrity). I never omit to use this antiseptic agent in operations where breaking up is required, and I never wash the bladders of lithotritised patients with any other substance. I have also had good results from copiously washing the bladders and the wounds of patients on whom lithotomy has been performed with boracic acid. I always finish the operation by prolonged irrigations with a solution of from 3 to 4 per cent.'

  It was not only into France and Germany that Pasteur's ideas penetrated; in England, surgery borrowed from Pasteur's researches important therapeutic applications. In 1865 Dr. Lister began in Edinburgh the brilliant series of his triumphs in surgery by the application of his antiseptic method, now universally adopted. In the month of February 1874 in a letter which does honour to the sincerity and modesty of the great English surgeon, he wrote to Pasteur as follows:—

  'It gives me pleasure to think that you will read with some interest what I have written about an organism which you were the first to study in your memoir on lactic fermentation. I do not know whether you read the 'British Medical Journal;' if so, you will from time to time have seen accounts of the antiseptic system which for the last nine years I have been trying to bring to perfection. Allow me to take this opportunity of sending you my most cordial thanks, for having, by your brilliant researches, demonstrated to me the truth of the germ theory of putrefaction, thus giving me the only principle which could lead to a happy end the antiseptic system.'

  Pasteur followed with lively interest the movement of thought and the successful applications to which his labours had given rise. It was a realisation of the hopes he had ventured to entertain. Already, in 1860, he expressed the wish that he might be able to carry his researches far enough to prepare the way for a profound study of the origin of diseases. And, as he gradually advanced in the discovery of living ferments, he hoped more and more to arrive at the knowledge of the causes of contagious diseases.

  Nevertheless, he hesitated long before definitely engaging himself in this direction. 'I am neither doctor nor surgeon,' he used to repeat with modest self-distrust. But the moment came when, notwithstanding all his scruples, he could no longer be content himself to play the part of a simple spectator of the labours started by his studies on fermentation, on spontaneous generation, and on the diseases of wines and beer. The hopes to which his methods gave rise, the eulogies of which they were the object, obliged him to go forward. In February 1876 Tyndall wrote to him thus:—

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  Medical Progress and Social Reality

  A Reader in Nineteenth-Century Medicine and Literature

  • Lilian R. Furst(Author)
  • 2012(Publication Date)
  • SUNY Press

    (Publisher)

  Although Koch’s tuberculin was not a cure for tuberculosis, as he had hoped, he was awarded the Nobel Prize for Medicine in 1905. A research institute was named after Koch in Germany in 1891, parallel to that established in France in 1888 named after Pasteur, prominent to this day. By the end of the nineteenth century, bacteriology had become an important facet of medical science (see Arrowsmith’s fight against the plague [see “Plague” in chapter 7]). Still, public response to laboratory science remained mixed in the later nineteenth century, tending toward skepticism and even suspicion (Stevenson, Dr. Jekyll and Mr. Hyde [see chapter 6]). For while microscopy and analytical chemistry had relatively early diagnostic application in seriological tests, practical benefits to pa- tients in the form of decisive interventions in the course of acute non- surgical diseases were for long scant. Antisepsis, Asepsis, and Anesthesia Germ theory was basic too in revolutionizing surgery in the second half of the nineteenth century. Up to then it had been a brutal business, consisting mainly of amputations, which were performed with the ut- most speed while the patient was partially numbed by large amounts of liquor. Surgeons wore the same blood-sodden frock-coats year after year, and all the postoperative wounds in a ward were dressed with the same sponge from the same basin of water. Under these circumstances it is not surprising that the postoperative mortality rates ranged from 24 to 60 percent according to the hospital. Indeed, wound infection was consid- ered an inevitable stage following surgery, for it was thought to be caused by the entry of oxygen into the tissue through the incision. This prevailing belief in the concept of oxygen-induced putrefaction was contested by the British surgeon Joseph Lister (1827–1912), the son of the Lister who had devised the achromatic microscope.

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  The Therapeutic Revolution

  Essays in the Social History of American Medicine

  • Morris J. Vogel, Charles E. Rosenberg, Morris J. Vogel, Charles E. Rosenberg(Authors)
  • 2017(Publication Date)
  • University of Pennsylvania Press Anniversary Collection

    (Publisher)

  Fourth, in the context of the argument presented here, I regard tech-nique as being of perhaps even greater importance than any purely notional implications of bacteriology. 6 Hence bacteriologic technique looms larger in the discussion than anything so nebulous as germ theory. T o the physician, whether he was laboratory or bedside-oriented, it was the appeal of technique, the routine and habitual stuff of his workaday exis-tence, which determined where he fell on the spectrum between those two orientations. 7 Nowhere were the tensions dictated by these instrumental 94 Russell C. Mautitz possibilities better captured than in the fictionalized account of the career of Martin Arrowsmith, presented to a receptive post-Flexnerian American public by Sinclair Lewis in 1924. 8 In Arrowsmith and his colleagues we find alternative attempts to resolve the tension between the importance of laboratory medicine to the clinician and his need to distance himself from it. T H E N I N E T E E N T H C E N T U R Y Among members of the American medical community, the need to mea-sure carefully one's intellectual and social distance from the pure culture of science was little in evidence in 1876. In that year of the Centennial, Joseph Lister visited the United States, proselytizing for his new applica-tion of the germ theory to surgical disorders. It is becoming rather clear that the 1870s, and even the 1880s, represent too early a period to look for intellectual or institutional meaning in American bacteriology. Lister's incursion into the United States met an exceedingly ambiguous response, in fact, and might better be conceived in terms of the transfer of a clinical technique, a matter of praxis, rather than of a body of knowledge rooted in scientific theory. 9 It is not surprising, then, to discover that in 1876, the noted American practitioner Edward Clarke, in his Centennial retrospect on Practical Medicine, gave barely a nod to laboratory investigation.

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