Surgical standards before antiseptics starkly contrasted to the surgical art today. Conditions were especially atrocious for amputations and for compound fractures in which the bones penetrated the skin and were exposed to the air. Patients who did not die from the surgery often died of postsurgical infections and subsequent blood poisoning. James Young Simpson, a Scottish surgeon and obstetrician who was the first to use chloroform as an anesthetic (see chapter 7), once said of surgical operations: “A man laid on the operating table in one of our surgical hospitals is exposed to more chance of death than the English soldier on the battlefield of Waterloo.” The mortality rate in hospitals after surgeries was 40–60%. During the American Civil War, the surgical fatalities were just as horrific as those from combat. A commonly used antiseptic in the battlefield was exceedingly corrosive nitric acid (HNO3— ouch!). However, in 1867, Joseph Lister’s use of carbolic acid, whose chemical name is phenol, as an antiseptic changed the prospect of surgery. In Greek, septic means “rotten.” Antiseptics, in turn, are substances used to treat a person to prevent the occurrence of infection. They are also known as germicides. Joseph Lister (1827–1912) was born to a Quaker family in southern England. His father, Joseph Jackson Lister, was a wine merchant and a wellknown microscopist. In his youth, Joseph Lister practiced surgery under the tutelage of James Syme in Edinburgh and married Agnes, his mentor’s daughter. He had to give up his religion because Quakers at that time did not allow marriages outside the faith. That turned out to be a worthwhile sacrifice, because his marriage brought him lifelong joy. Lister became a surgeon at Glasgow Royal Infirmary in 1860. He was acutely conscious of the appalling conditions in the infirmaries and determined to do something about postsurgical infections. In 1865, Lister was introduced to Louis Pasteur’s exploits with germs by Thomas Anderson, chair of the chemistry department at Glasgow. Afterward, he personally repeated all the experiments that Pasteur published. However, simple and direct applications of the Pasteurization process would not be ideal during surgery—after all, boiling patients would not be acceptable.
Outbreak of Legionnaires' disease in Glasgow Royal Infirmary: microbiological aspects
