one had died, and
that was through a complication that was nothing to do with Lister's
wound-dressing technique.
Now, for the first time, patients with compound fractures were
likely to leave the hospital with all their limbs intact. The next stage
was to apply the technique to surgery. Operating theatres had
changed little since Liston's day. The stained wooden operating
table was usually surrounded by a raked gallery. When surgeons
were operating the spectators would often gather close around the
table, their outside boots grinding the dirt of the street into the
timber floor. Light was provided by gas lamps or even candles.
Devising an antiseptic operating technique under such conditions
was quite a challenge, so Lister decided to rely on carbolic.
Before the operation he washes everything in a solution of
carbolic. Hands, instruments, sponges and dressings are all dipped
in the diluted acid. The patient's skin is brushed with carbolic, and
towels soaked in carbolic are placed around the wound. To keep the
air free of germs Lister employs a special contraption heated by a
spirit lamp to send a spray of high-pressure carbolic steam over the
operating table. The spray has to be adjusted to ensure the droplets
are small because large ones could burn the eyes.
Once the patient has been put to sleep with chloroform, Lister
rolls up his sleeves and the operation begins. The procedure takes
place in a cloud of carbolic. Everything quickly becomes soaked. A
fog covers the table and those surrounding it. Lister turns up the
collar of his coat to avoid the acid reaching the skin of his neck. It
is like operating in a rainstorm. When the time comes to close the
wound, Lister uses sutures of catgut (made from the intestines of
sheep) that have been soaked in carbolic. In the days of suppurating
wounds it had been easy enough to pull out silk threads through
the slush of decaying tissue. Now, as there is no infection, removing
such sutures or ligatures could prove difficult. Not only is catgut
sterile, but because the threads are organic, they are reabsorbed by
the body and will not have to be removed later.
Operating under these conditions was deeply unpleasant, but
the results spoke for themselves. Before antiseptic operations were
introduced at the hospital, there were sixteen deaths in thirty-five
surgical cases. Almost one in every two patients died. After antiseptic
surgery was introduced in the summer of 1865, there were only six
deaths in forty cases. The mortality rate had dropped from almost 50
per cent to around 15 per cent. It was a remarkable achievement.
Not everyone was so easily impressed. 'Listerism' was dismissed
by some as nonsense. Despite the evidence, surgeons failed to
accept the very idea of infection being caused by germs. They
dismissed these 'little beasts' as a figment of Lister's imagination.
Even those surgeons who understood the scientific basis for germs
were not convinced by Lister's techniques. Operating under a spray
of carbolic was inconvenient and unpleasant. New York surgeon
William Halsted was even forced to operate in a tent because
Bellevue Hospital staff hated the fumes from carbolic so much.
Other surgeons had been getting good results of their own simply
by keeping their operating theatres clean and washing their hands
properly. Lister rinsed his hands in carbolic but was still operating
in his old, bloodstained coat.
Lister eventually abandoned the carbolic spray, realizing that
there was a greater risk of infection from his hands or his instruments
than from any germs in the air. It took more than ten years,
but gradually Lister's ideas started to be adopted and operating
theatres began to change. The rooms were scrubbed, the old
wooden tables replaced by shiny metal, the floors sealed with
linoleum. Surgeons hung their old operating coats up for the final
time and started wearing clean linen shirts and operating gowns.
They washed their hands and sterilized their instruments either
that was through a complication that was nothing to do with Lister's
wound-dressing technique.
Now, for the first time, patients with compound fractures were
likely to leave the hospital with all their limbs intact. The next stage
was to apply the technique to surgery. Operating theatres had
changed little since Liston's day. The stained wooden operating
table was usually surrounded by a raked gallery. When surgeons
were operating the spectators would often gather close around the
table, their outside boots grinding the dirt of the street into the
timber floor. Light was provided by gas lamps or even candles.
Devising an antiseptic operating technique under such conditions
was quite a challenge, so Lister decided to rely on carbolic.
Before the operation he washes everything in a solution of
carbolic. Hands, instruments, sponges and dressings are all dipped
in the diluted acid. The patient's skin is brushed with carbolic, and
towels soaked in carbolic are placed around the wound. To keep the
air free of germs Lister employs a special contraption heated by a
spirit lamp to send a spray of high-pressure carbolic steam over the
operating table. The spray has to be adjusted to ensure the droplets
are small because large ones could burn the eyes.
Once the patient has been put to sleep with chloroform, Lister
rolls up his sleeves and the operation begins. The procedure takes
place in a cloud of carbolic. Everything quickly becomes soaked. A
fog covers the table and those surrounding it. Lister turns up the
collar of his coat to avoid the acid reaching the skin of his neck. It
is like operating in a rainstorm. When the time comes to close the
wound, Lister uses sutures of catgut (made from the intestines of
sheep) that have been soaked in carbolic. In the days of suppurating
wounds it had been easy enough to pull out silk threads through
the slush of decaying tissue. Now, as there is no infection, removing
such sutures or ligatures could prove difficult. Not only is catgut
sterile, but because the threads are organic, they are reabsorbed by
the body and will not have to be removed later.
Operating under these conditions was deeply unpleasant, but
the results spoke for themselves. Before antiseptic operations were
introduced at the hospital, there were sixteen deaths in thirty-five
surgical cases. Almost one in every two patients died. After antiseptic
surgery was introduced in the summer of 1865, there were only six
deaths in forty cases. The mortality rate had dropped from almost 50
per cent to around 15 per cent. It was a remarkable achievement.
Not everyone was so easily impressed. 'Listerism' was dismissed
by some as nonsense. Despite the evidence, surgeons failed to
accept the very idea of infection being caused by germs. They
dismissed these 'little beasts' as a figment of Lister's imagination.
Even those surgeons who understood the scientific basis for germs
were not convinced by Lister's techniques. Operating under a spray
of carbolic was inconvenient and unpleasant. New York surgeon
William Halsted was even forced to operate in a tent because
Bellevue Hospital staff hated the fumes from carbolic so much.
Other surgeons had been getting good results of their own simply
by keeping their operating theatres clean and washing their hands
properly. Lister rinsed his hands in carbolic but was still operating
in his old, bloodstained coat.
Lister eventually abandoned the carbolic spray, realizing that
there was a greater risk of infection from his hands or his instruments
than from any germs in the air. It took more than ten years,
but gradually Lister's ideas started to be adopted and operating
theatres began to change. The rooms were scrubbed, the old
wooden tables replaced by shiny metal, the floors sealed with
linoleum. Surgeons hung their old operating coats up for the final
time and started wearing clean linen shirts and operating gowns.
They washed their hands and sterilized their instruments either
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