what’s this?

Q. Here’s an invention from after the 1860s, a significant object in medical history, but what is it? 

Have a play on the 3D image. Twist it around, zoom in and out. Which parts do you think move? What might it be used for?

To investigate our object in a 3D visualisation, please use the Google Chrome browser.

It is a carbolic acid spray used during operations to provide a mist of carbolic acid over the operation area.

We already know that surgery performed before the middle of the 1800s was riddled with problems which might cause the death of a desperate patient.

Let’s remind ourselves of the three major problems:

• Pain

• Blood loss

• Infection

FACT

Originally miasma, or bad air, was thought to be the cause of disease and putrefaction of a wound. 

Believe it or not, this humble-looking spray device resulted in a paradigm shift in the world of surgery. How? It solved the final risk of surgery: INFECTION.

It is a carbolic acid spray. Bathing all parts of the surgical field in a mist of carbolic acid virtually eliminated the potential for infection.

pasteur and koch - germ theory

In the 1850s, Louis Pasteur (1822-1895) discovered it was something IN the air causing putrefaction, and he demonstrated how, in an open swan neck flask containing sterile liquids, tiny micro-organisms couldn’t find their way in.  

In Germany Robert Koch (1843-1910) took Pasteur’s idea further and developed Germ Theory - he proved the existence of micro-organisms invisible to the naked eye were the cause of disease.

Such an important piece of information that we all take for granted today.

Miasma was finally rejected as a cause of disease. by the end of 1800s. 

joseph lister’s story

Sir Joseph Lister (1827-1912) was born in Kent but went to study in Edinburgh under Europe’s leading anatomist, James Syme, for six months. He was still there seven years later and married Syme’s daughter, Agnes. Agnes was Lister’s secretary, lab partner and much of his achievements and success came from her support and dedication, including her desire to make him more punctual!

Interestingly, Lister was present at the first demonstration of anaesthetic (ether) in the UK by Robert Liston (1794-1847) in December 1846. He was just 20 years old.

In 1869, Sir James Young Simpson (1811-1870), an advocate for cottage hospitals and smaller wards which could help to provide personalised care, noted

A soldier has more chance of survival on the field of Waterloo than a man who goes into hospital…

Something had to be done.

Joseph Lister was leading the medical team at Glasgow Royal Infirmary, which was built near a burial ground of cholera graves. This was described as a putrid location, and it is thought this contributed to the hospital’s high death rate. It stimulated Lister in his work to remove any potential diseases in the air. Fortunately he read of Pasteur’s discoveries, which also happened to coincide with him noticing the sweet smell of Carlisle sewage works. He found out they were using carbolic acid to combat the smell. Could it also remove invisible bacteria identified by Pasteur as causing putrefaction? He began to experiment with carbolic acid to wash surgical instruments, spray fingers and introduced it as a spray over a patient’s wound.

The first patient case study he published was of an eleven year-old boy called James Greenless who had a compound fracture (bone through the skin) on his leg, which would normally have resulted in amputation. Instead, he reset the bone and used carbolic to create a barrier around the wound. It was successful and the child’s leg never became infected. 

Eventually, Lister invented a steam driven machine to spray consistently instead of an assistant having to do it by hand. This machine was called a donkey and produced a mist of carbolic spray around the operating theatre. He also soaked bandages and instruments in carbolic acid as well as using it to wash hands before surgery - great for the patient, not so good for their hands!

Did you know, rubber surgical gloves were originally introduced for the benefit of the medical team’s hands, rather than for the patient’s benefit!

This ‘antisepsis method’ uses chemicals - antiseptics - to prevent germs that cause infections from reaching the wound.

Lister was very grateful to Pasteur and they had a long correspondence.

Q. why don’t we still use carbolic acid today?

Lister abandoned the spray in 1887 when he found that bacteria on his fingers still posed a danger to patients.

Other surgeons were not on board because:

• Pasteur’s germ theory was not accepted,

• Washing hands with carbolic acid led to very sore hands, and  

• It slowed down surgery because of all the required prep!

This image is from William Stirling Anderson notes, a student attending Lister’s lectures at Glasgow University.

Lister and his wife Agnes carried these flasks to explain his new procedures. They travelled miles on numerous train and coach journeys keeping them steady to avoid spills and prevent the delicate necks from breaking. 

Find out more about how Louis Pasteur used a swan neck flask for his research and see one on display at the museum. 

a few quotes from from joseph lister

Success depends on attention to detail.

There is only one rule of practice: put yourself in the patient’s place!

lister’s legacy

Over time, and with a wider acceptance of Germ Theory and Lister’s hard work travelling the world to share his procedures, our modern medical theories around aseptic procedures were born - leading to smaller operating theatres, containing only those involved in the work, sterilisation techniques, and the invention and use of surgical gloves. The aseptic operating room was born. And, with the help of developments in anaesthetics, surgery could progress to technical internal procedures like hip replacements and heart transplants! 

Antiseptics are no longer used in operating theatres. Instead, we strive to not have any infective agents in theatres to begin with - an aseptic environment (sterile, free of bacteria).

At Pasteur’s 70th birthday celebrations in Paris, Lord Lister declared:

Truly there does not exist in the wide world an individual to whom medical science owes more than to you.

Pasteur on Lister

…science and peace must triumph over ignorance and war, that nations will unite not to destroy but to instruct one another, and the future will belong to those who have done most for suffering humanity, I refer to you, my dear Lister…