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The Idea of Surgeons Washing Their Hands is Only 150 Years Old

The world of surgery before that was much grosser and less effective

Joseph Lister's work was influenced by Louis Pasteur's work on fermentation. (iStock)
smithsonian.com

Not very long ago, you could die from a broken arm--and many did. That all changed with an idea we think of as pretty basic today: surgery needs to be sterile.

On this day in 1867, Joseph Lister, a forty-year-old doctor, published an article in The Lancet that fundamentally changed medicine. “An Address on the Antiseptic System of Treatment in Surgery” was a description of a new way of doing operations that he first presented in Glasgow, Scotland, where he practiced medicine.

At that time, the "germ theory" of disease was just a theory. Lister's innovation was simply to try to kill the germs.

Lister used a spray made of carbolic acid, on wounds, dressings and surgical tools. He also washed his hands. The acid killed the germs before they had a chance to cause infection, and the hand-washing kept new germs from being introduced. 

Lister described the positive outcomes that this new way of doing surgery had for his patients: Wounded limbs “which would be unhesitatingly condemned to amputation” because of the probability of infection “may be retained with confidence of the best results”; abcesses could be drained; wounds could heal cleanly and hospitals were generally healthier places to be.

“As there appears to be no doubt regarding the cause of this change, the importance of the fact can hardly be exagerrated,” he wrote.

Although British and American surgeons were irked by the “Scottish upstart,” according to Harvard University, “by 1875, sterilization of instruments and the scrubbing of hands were widely practiced.” Carbolic spray was exchanged for other antiseptics by 1885.

The reason for this relatively quick and thorough uptake was that circumstances were so profoundly bad in the field of surgery prior to Lister.

The reality of surgery before this idea is so gag-inducing that it seems amazing anybody lived through treatment. Operations were so dangerous to their patients that there were calls to stop performing them entirely, write Dennis Pitt and Jean-Michel Aubin for the Canadian Journal of Surgery.

“Bed linen and laboratory coats were not washed and surgical instruments were only cleaned before they were put away for storage,” they write. “The same probe was used for the wounds of all patients during rounds to look for pockets of undrained pus.” Pus and minor infection was just considered part of normal healing. A future president of the Royal College of Surgeons, J.E. Erichsen, went as far as to say “The abdomen, chest and brain will forever be closed to operations by a wise and humane surgeon.”  

Death rates were extremely high, particularly after compound fractures—the kind where the bone pokes through skin. “Because this injury so often resulted in death from infection, most doctors would immediately amputate the injured arm or leg,” Harvard writes. And even that often didn’t work—particularly because reliable anesthetic wasn’t around yet, meaning many people died from pain and shock during and after operations.

Lister’s initial result, which he documented in his address, turned heads right away: “11 cases of compound fracture with not one succumbing to sepsis.”

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