Lister’s antiseptic system, explained first in The Lancet in 1867, relied on carbolic acid as an antiseptic to exclude airborne infection. This was achieved by packing and covering wounds with lint and gauze soaked in carbolic acid, then layering these with tin and plaster. The result was a 15 percent reduction in post-surgical infections. Lister’s system was well received in Europe, but widely critiqued in Britain. By the 1880s, though, declines in the rates of post-operative infection were convincing many of the benefits of antiseptic practice.
Photo: Operation using Lister carbolic spray from Antiseptic surgery. National Library of Medicine, History of Medicine Division, #A013357.
After learning that carbolic acid had been used successfully to treat sewage in Carlisle (England), Lister selected carbolic acid as his favoured antiseptic. Although he was not the first to discover carbolic acid, he popularized its use in the medical field.
Photo: Carbolic Acid Bottle (c.1890), Museum of Health Care, #010020404.
In 1871, Lister recommended that a carbolic acid solution be sprayed in operating rooms during surgery to kill the bacteria in the air around the surgical site. Over 10 years, Lister experimented with different atomizers to perfect the distribution of carbolic acid solution around the surgical site. A donkey engine (pictured here) mounted the atomizer on a tripod and was easy to use, but difficult to transport.
Photo: Lister’s donkey engine. Wellcome Library, London, #V0027898EL.
The steam sprayer (above) was the ultimate solution, because of its ability to create a sizable vapour cloud with minimal effort. This method was used until 1887, when Lister renounced it based on findings that most air-borne bacteria were not pathogenic, nor removed by the spray.
Photo: Carbolic Steam Sprayer (c.1900), Museum of Health Care, #997002442.
Lister continually sought to improve his antiseptic system, experimenting with different dressings and antiseptic solutions, as well as testing the potencies that would keep germs out of the wound but not irritate the skin. Antiseptic putties and lac plaster coatings were tried before Lister discovered muslin gauze infused with carbolic acid and paraffin.
Photo: Lister’s Carbolized Gauze. Wellcome Library, London.
Lister also created carbolized catgut in 1866, an antiseptic suture that is absorbed by the body. Previously, sutures had been conduits to infections because the ends were left long to facilitate removal. By soaking the catgut in antiseptic (top image) and cutting the ends short at the knot, something possible because the sutures did not need to be removed, Lister’s sutures prevented infection.
Photo: Creative Commons Catgut in carbolic oil prepared by Lister. Wellcome Library, London.
Lister strongly promoted the use of instrument sterilizers, such as the one above from 1883, which cleaned instruments as they were dipped into an antiseptic solution. He also supported the aseptic method of steam sterilizing instruments because it achieved the ultimate goal of eliminating bacteria.
Photo: Instrument Sterilizer (c.1883), Museum of Health Care, #997037046.
Lister argued that instrument design and materials should facilitate sterilization. He spoke against the use of porous materials, such as woods and ivories, in favour of metals. The two amputation saws shown here demonstrate the change in materials and elimination of decoration that occurred after the antiseptic revolution.
Photo: Amputating Saw (1840-1880), Museum of Health Care, #1997.2.11.
Charriere’s Amputating Saw (1900-1930), Museum of Health Care, #1977.5.9.
Aseptic practices were introduced first in the 1880s, and include thermal sterilization and the use of surgical gowns and masks to exclude surface-born germs. Lister believed that both anti- and aseptic practices were necessary for the safety of the patient. He sought to kill germs that had entered the wound, as well as to exclude germs from the site — a practice continued today as physicians and surgeons incorporate both into daily practice.
Photo: Surgical Gown (1921), Museum of Health Care, #1981.10.2.
Despite agreeing with some aseptic methods advanced in the 1880s, Lister never supported the use of surgical gowns, masks or gloves. Rubber gloves and gauze masks, such as the one pictured here, only rose in popularity at the turn of the twentieth century.
Photo: Face Mask (1910), Museum of Health Care, #1972.15.81.