Antiseptic Surgery

Method of Changing a Psoas Abscess Dressing

Illustration

By: W. Watson Cheyne

Date: 1882

Source: Antiseptic Surgery: Method of Changing a Psoas Abscess Dressing. Figure 38 in Antiseptic Surgery: Its Principles, Practice, History and Results, by W. Watson Cheyne. London: Smith, Elder, 1882.

About the Author: William Watson Cheyne (1852–1932), a Scottish physician and surgeon famed for his pioneering work with British surgeon Joseph Lister (1827–1912) on the development of antiseptic surgery, was educated at King's College in Aberdeen and at Edinburgh University, from which he graduated in 1875. After a brief stay in Vienna, he was appointed house surgeon to Joseph Lister, who was then a professor of clinical surgery at the Edinburgh Royal Infirmary. At the same time, Cheyne was appointed to the position of demonstrator of anatomy at Edinburgh University, a post he occupied from 1876 to 1877. In 1877, Cheyne was promoted to the position of Lister's first house surgeon at King's College Hospital. After accepting positions of progressively increasing responsibility, Cheyne was appointed assistant surgeon and teacher of practical surgery in 1880; he became a surgeon with care of outpatients in 1887, surgeon and teacher of operative surgery in 1889, and professor of the principles and practice of surgery in 1902. He was a fellow or member of several prestigious royal and professional societies, including Fellow of the Royal Society (1902), Fellow of the Royal College of Surgeons (1879), Hunterian Professor at the Royal College of Surgeons (1888 and 1890–1892), and President of the Royal College of Surgeons (1914–1916). He held civilian military appointments, including civil consulting surgeon to British forces during the Anglo-Boer War between 1899 and 1902, and consulting surgeon to the Royal Navy in 1915. He was made a Knight Commander of the Order of St. Michael and St. George in 1916, elected a member of Parliament for the University of Edinburgh and St. Andrews in 1917, and was made a member of Parliament for the Combined Scottish Universities from 1918 to 1922. He was a prolific scholarly writer, and published textbooks, most of which were concerned with infections and infectious diseases. One of his most well-known works was Antiseptic Surgery: Its Principles, Practice, History and Results, published by Smith, Elder in London in 1882.

INTRODUCTION

Prior to the late 1800s, there were varying assumptions about the causes of disease. The predominant theory was that of spontaneous generation—the idea that many types of living matter could be spontaneously produced from non-living matter. For example, it was commonly believed that rotting meat could give rise to maggots.

The invention of the microscope by the Dutch scientist Anton van Leeuwenhoek (1832–1723) in the 1670s only served to reinforce the belief in spontaneous generation, since it allowed the observer to see many new forms of matter. The theory held that many new organisms, too tiny to be seen with the naked eye, could be produced spontaneously. For example, a small stem of hay, when initially observed under the microscope, looked like a simple hay stem. However, when left in water for a few days and then re-examined, the hay was observed to have produced many animalcules. Over time, spontaneous generation as the means of production of many organisms became the prevailing theory. This theory further held that air was necessary in order for this spontaneous generation of organisms to occur.

In the 1840s, shortly before the French bacteriologist Louis Pasteur's (1822–1895) groundbreaking work, Hungarian physician Ignaz Semmelweis (1818–1865) made an important contribution to the future development of germ theory. He concluded that handwashing before delivering a baby prevented the spread of childbed fever (infection after childbirth). Before Semmelweis developed his theory, physicians often moved directly from performing autopsies on women who had recently died of childbed fever to attend the next live birth. Semmelweis noted that this practice resulted in the new mothers contracting a virulent form of the fever, which often caused their deaths while still in the hospital. He was able to demonstrate that simple hand washing before deliveries prevented childbed fever. This was a crucial link in the experimental chain leading to the synthesis of germ theory.

Also in the 1840s, German anatomist Jakob Henle's (1809–1885) work led him to conclude that disease was caused by living particles that acted like parasites in human beings. In an attempt to identify the parasites, Henle set forth three postulates for the transmission of disease in human beings: 1) the parasite must be consistently present in someone who is sick; 2) the parasite can be isolated; and 3) the parasite can reproduce the disease when transmitted or administered to a healthy person. This provided another critical link to the development of germ theory.

In 1859, the young French chemist Louis Pasteur entered a contest sponsored by the French Academy of Sciences, in which the best experiment proving or disproving the theory of spontaneous generation would set the course for the future of science. Pasteur designed an experiment in which meat broth was boiled in a flask, and the neck of the flask was heated and bent into an s-shape. His belief was that air could reach the surface of the broth, but airborne microorganisms would be trapped in the neck of the flask by the effects of gravity. Pasteur discovered that no microorganisms grew in his broth. However, when the flask was tilted so that the broth reached the low spot in the neck where he postulated that the microorganisms had settled, the broth quickly became cloudy with microorganisms attaching themselves to the broth and beginning to reproduce. While it was already known that boiling killed microorganisms, it had not been known that air alone was insufficient to initiate contamination. Pasteur's experiment showed that the air was simply the transport mechanism for the contaminants. Pasteur won the contest. He definitely and simultaneously disproved the theory of spontaneous generation, and also proved that microorganisms exist in air.

As a result of further work, Pasteur also discovered that some microorganisms needed air in order to grow (aerobes), while others could grow without it (anaerobes). Finally, in 1864, Pasteur postulated his theory that infectious diseases are caused by living organisms called "germs." This was the first explication of germ theory, one of the most important contributions ever made to medical science.

Joseph Lister studied the work of Semmelweis, Henle, and Pasteur, and developed a series of theories and techniques for the prevention and control of infection during surgical procedures. He called these techniques the antiseptic method, or antisepsis. Antiseptic methods are universal in health care today for preventing the occurrence and spread of infection.

PRIMARY SOURCE

ANTISEPTIC SURGERY

See primary source image.

SIGNIFICANCE

Sir Joseph Lister is the seminal figure in the development of antiseptic surgery. He was in charge of the surgical wards at the Glasgow Infirmary in Scotland. Lister was quite horrified by the conditions he found at the infirmary, and even more so by the enormous post-surgical mortality rate. Gangrene and sepsis, both typically fatal, were common after surgical procedures due to the general lack of hygiene common in medical facilities at that time (the early 1860s). Both gangrene and sepsis are attributable to a lack of cleanliness in the wound area.

In 1865, Lister read one of Pasteur's scientific papers concerning the germ theory of disease. He theorized that if germs caused infection and disease, the best way of preventing disease would be to kill the germs before they could come into contact with the surgical wound site. Lister called the technique of killing microbes before they could cause infection (sepsis) the "antiseptic principle." He tried applying carbolic acid to open wounds to see if that prevented the development of infection. In addition, he used an apparatus that sprayed a carbolic acid mist continuously on the surgical area during operations. He found that both of these techniques were extremely successful and wrote about them at length in his famous text, Antiseptic Principle of the Practice of Surgery.

Lister instituted stringent antiseptic principles and procedures into the hospital routine, as well as in the operating room. He required all staff to wash their hands before operations and to use clean instruments and wound dressings. As a result of the use of Lister's techniques, the rate of wound infections and post-operative fatalities decreased dramatically. Word of his successes spread throughout the medical and scientific communities, and both his fame and the use of his antiseptic techniques increased. Lister's name now is synonymous with the initiation of hygienic conditions in hospitals and with the development of early theories of antiseptic surgery.

The progression of scientific knowledge from spontaneous generation to the discovery of microbes, the germ theory of disease, and the development of the antiseptic method paved the way for modern medical and surgical techniques, the control of infection, and modern public health measures to curtail the spread of disease.

FURTHER RESOURCES

Web sites

Access Excellence. "The Slow Death of Spontaneous Generation (1668–1859)." 〈http://www.accessexcellence.org/RC/AB/BC/Spontaneous_Generation.html〉 (accessed October 20, 2005).

Bayer Pharmaceuticals Corporation. "A Brief History of Infectious Disease: Causes of Infection." 〈http://www.bayerpharma-na.com/healthcare/hc0107.asp#henle〉 (accessed October 20, 2005).

Bayer Pharmaceuticals Corporation. "A Brief History of Infectious Disease: The Germ Theory of Disease and the Beginning of Bacteriology." 〈http://www.bayerpharma-na.com/healthcare/hc0108.asp〉 (accessed October 20, 2005).

Bayer Pharmaceuticals Corporation. "A Brief History of Infectious Disease: Germs (Bacteria & Viruses)." 〈http://www.bayerpharma-na.com/healthcare/hc0109.asp〉 (accessed October 20, 2005).

Science and Technology. "Joseph Lister & Antiseptic Surgery." 〈http://web.ukonline.co.uk/b.gardner/Lister.html〉 (accessed October 20, 2005).