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The death rate of those having surgery in the mid 17th century was very high, almost half of all those having leg amputations died. This era of surgery was very unusual as although the development of anaesthetics was a massive step forward, the death rate soared. This was because surgeons began to undertake more complicated surgery and spend longer doing it, this meant there was a much greater risk of infection – especially when the instruments and operating theatres were rarely, if ever, cleaned.
Infection was very high risk and not only because of the lack on cleanliness. When arteries were being tied off often nothing more than ordinary string and there was little chance of keeping germs from spreading in these theatres because that was what they were – theatres. Many students every day would come to them and watch and learn about surgery, with so many of them so near the operation they couldn’t be a good thing – but no body knew this.
Semmelweiss’ ideas on cleanliness
Ignaz Semmelweiss had noticed that there was an unusually high death rate amongst women after childbirth and realised that mothers whose children were delivered by a mid-wife usually survived unlike those who had there offspring delivered by medical students. Semmelweiss thought that if only the students washed their hands before entering the maternity wards they may save many lives, he made them do this and it worked.
Unfortunately Semmelweiss was ignored, he called those who did not wash their hands ‘murderers’ and so many called him a crank and a fanatic.
Many thought he was mentally unstable and unfortunately it was many years before what he did became widespread and was adopted by others in the profession.
Joseph Lister’s key breakthrough
Lister was born in Essex in 1827, his father studied microscopic organisms and after studying medicine at the London University he became a house surgeon to a leading Scottish surgeon – James Syme – whose daughter he married in 1856. After becoming professor of surgery at Edinburgh University and King’s College London he became president of the Royal Society, he later died in 1912.
Pasteur had shown that micro organisms are suspended in the air at all times and Lister realised that this might be what induces the decomposition of an injured body part after an operation. Lister realised that if he could somehow produce a material that could destroy these organisms he could avoid infection.
Lister then invented the carbolic spray as his solution to the problem of infection. He had heard about it being used to remove the smell from sewage and he new that the organisms decaying the matter in those sewers caused the smell. The carbolic spray would be set up next to an operation and carbolic acid sprayed over the patient, the incision and inevitably the surgeons as well. After the operation the operated area would be carefully bandages and this meant that the risk of gangrene or other infection was greatly reduced.
Opposition to the use of antiseptics
There was much opposition to Lister’s proposals for a number of reasons. Firstly, he was often see as a fanatic, the carbolic spray seemed ‘extreme’ as it soaked the patient and surgeons as well as the acid in the spray being strong enough to crack the skin. Surgeons believed that speed was the most important thing and due to the problem of bleeding it often was, they felt that Lister’s methods slowed down operations. Other surgeons tried to copy Lister’s methods but not always correctly resulting in incorrect use of the spray and varying results – Lister still got criticised. Others believed that the spray also stopped the body defence mechanises working properly and others still refused to believe Pasteur’s germ theory.
The impact of antiseptic surgery
Lister’s discovery was a turning point in medicine and his ideas were given a boost by the discovery of the bacteria that caused septicaemia by Koch in 1878. The use of antiseptics greatly reduced the number of deaths from amputation operations, in 1864-1866 45% of people dies on the operating table, once antiseptics became widespread in the late 1860’s the percentage of deaths plummeted to just 15%. After his death in 1912 people paid great tribute to the man who had made internal and more complicated operations possible, but there was still the problem of bleeding.
The development of aseptic surgery
The practice of aseptic surgery was quite different to that of antiseptic, the discomfort of surgeons called for a new way to fight infection. In the process of asepsis equipment was produced to sterilize all equipment as well as clothes and sheets. All doctors and nurses started to ware gloves, masks and later hats as they realized all these areas could lead to the spread of germs. These methods are still used today and even the air in modern theatres is treated to remove any possible organisms.
There is a big difference between antiseptic and aseptic surgery. Antiseptics are used to kill organisms that are there in the theatre so that they don’t infect whereas asepsis is used to remove any germs from the theatre in the first place and stop germs coming into contact with the body at all. This is why so many methods of sterilization and protection for the doctors were developed so that germs originating from many different places were prevented from effecting the operations.
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