Lister's Carbolic Spray

 

Lister's Carbolic Spray

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Title: Lister's Carbolic Spray
Abstract: Arguably, antiseptics are one of the two most important developments in medicine in the 19th century; the other being anesthesia. Prior to the mid-19th century, if a patient did not die from the pain of an operation, there was a good chance that he or she would succumb to the ensuing infection instead. In many cases, gangrene set in before the wound healed and then there would be little that could be done to stop its spread. In some cases, patients endured repeated amputations on a leg in an effort to stop the infection reaching the body, sometimes to no avail. The first reliable method of preventing infection during an operation was developed by Dr. Joseph Lister (1827-1912).

Dr. Joseph Lister, a surgeon in Edinburgh, and later in London at King's College Hospital, was the first to use the carbolic spray in surgery. Lister, who studied the sepsis that confounded surgeons at the time, noticed that 6 out of 16 patients he operated on for tuberculosis of the wrist contracted and, subsequently, died of gangrene. A follower and strong ally of Dr. Louis Pasteur, Lister recognized that the gangrene was putrefaction and agreed with Pasteur that this was related to fermentation by living organisms. Since he believed these organisms were in the air, he became convinced that he must clean the air to keep the wound clear of organisms.

Through his research, Lister had heard that 'carbolic acid,' a coal-tar derivative used to preserve railway tracks and ships' timbers, was effective in controlling typhoid, which was spread in sewage, and in curing cattle of parasites. By cleaning wounds and dressing his patients with carbolic acid, Lister was able to keep his hospital ward in Glasgow free of infection for nine months. Lister's cloud of carbolic spray drenched the whole area, surgeon and all, and so killed the bacteria before they had a chance to invade the wound.

Advances in Antiseptic Surgery

Prior to the advent of antiseptic surgery, one of the most feared injuries was the compound fracture, a break in the bone where the sharp end of the broken bone pierces the skin. Because this injury so often resulted in death from infection, most doctors would immediately amputate the injured arm or leg. At this time, surgeons did not wear gowns or gloves, nor did they cover their hair with caps or their noses and their mouths with masks. As a result, the patient was in danger of infection, not from 'bad air' as was common belief, but from bacteria on the surgeon's uncovered hands, clothes, breath and hair.

Lister, in agreement with Pasteur, urged surgeons wash their hands and sterilize their instruments before operating. Despite significant resistance and annoyance at this "Scottish upstart," British and American hospitals gradually adopted the sterile procedures promoted by Lister. After the introduction of the use of carbolic spray in 1867, Lister published the results of his experiments in a seminal paper which appeared in The Lancet later that year: 11 cases of compound fracture with not one succumbing to sepsis.

However, surgeons themselves were not the only source of the contamination in surgery. Contributing to the problem, medical practices did not include instrument sterilization, and instruments were made of non-sterile metals with ivory or ebony handles. These sets, though beautiful, were not easily sterilized. With the advent of antiseptics and subsequent effort to maintain sterile conditions, surgical instruments were created to be less decorative and more easily sterilized by sprayed carbolic acid. This movement toward antiseptic and functional medical instruments marked then end of surgical use for these decorative sets.

Beyond the Carbolic Spray

By 1875, sterilization of instruments and the scrubbing of hands ands skin were widely practiced. Although some practitioners viewed carbolic acid spray as the embodiment of the Listerian theory and practice, its use began to wane by 1885. This was primarily because the carbolic acid proved to be caustic to the skin and body tissues, and sometimes caused poisoning. Many of the surgeons using the spray would experience bleached and numb skin, cracked nails, and sore lungs as they breathed in large quantities of the carbolic mist. Some surgeons became so ill that they abandoned using the spray entirely. Even Lister described it as 'a necessary evil incurred to attain a greater good,' and after many experiments, he found that boracic acid was a better antiseptic. In 1886, the first steam sterilizer was introduced in Germany and further hastened the abandonment of carbolic spray in surgery. The Johnson & Johnson Company later helped pioneer dry-heat and steam and pressure sterilization, and even the common "Bandaid," created by the same company, can be directly traced to Lister's influence on antiseptic use.

In the days before sterilization and antiseptics, the death rate from amputation was approximately forty percent. By 1910, it had dropped to less than three percent. When Pasteur, Lister's long-time ally, was publicly honored by his medical peers, he turned and bowed his head towards Lister, saying: "the future belongs to him who has done the most for suffering humanity." Because of his insistence in sterilization, Lister contributed to one of the movements that made one of the biggest improvements in medical practice and is regarded by many to be one of the most influential medical men of the 19th century.

An interesting note: Listerine mouthwash was named for Lister by Dr. Joseph Lawrence, as a tribute to the father of antiseptics.

Image 1 - "Influx" model carbolic spray, copper and brass with wood handle, by Matthews, London, ca. 1870, from the collection of the Warren Anatomical Museum, 20449.

Image 2 - Surgical Kit, nickel and gold plate with ivory handles, by Robert & Collin, Co., 1868, from the collection of the Warren Anatomical Museum, 20341.
URI: http://hdl.handle.net/10473/1817

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carbolic_sprayer.gif 62.30Kb image/gif ThumbnailLowerInGenHandler
instrument_set.gif 42.83Kb image/gif ThumbnailLowerInGenHandler

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