Abstract
Joseph Lister OM, FRS (1827–1912) is distinguished as the pioneer of effective antiseptic surgical technique based on phenol prophylaxis for wounds. Believing harmful organisms floated in the air (the miasma theory), part of his technique involved spraying the wound area with dilute phenol, initially by means of a rubber bulb spray designed for local anaesthesia and subsequently by a cumbersome machine manipulated by a long pump handle, nicknamed ‘the donkey engine’, and finally with the steam spray with integral burner (Figure 1) requiring much less effort on the part of his assistants. The cloud of phenolised steam was irritant to lungs and skin for all in the theatre and hence much criticised and also ignored by many as unnecessary. Lister recognised these disadvantages to pronounce the spray ‘a necessary evil, incurred to attain a greater good’ and did not abandon the spray until 1887.
1
Lister’s steam spray with oil heater and glass container for diluted phenol.
1
Lister was born at Upton House, Plaistow, Essex into a distinguished Quaker family; his father Joseph Jackson Lister FRS (1786–1869) designed the achromatic microscope. Educated at the Quaker School in Tottenham and University College, London he graduated MB and, enthused by surgery, gained the FRCS of England in 1852. Advised to visit James Syme (1799–1870) in Edinburgh, the leading surgeon of the era, he soon became Syme’s House Surgeon, later marrying Syme’s daughter Agnes in 1856 when made Assistant Surgeon to the Royal Infirmary. Appointed Professor of Surgery in Glasgow in 1859, he noted Louis Pasteur’s (1822–1895) discovery that wine fermentation was not a pure chemical process but precipitated by minute organisms in the air and thus he deduced wound sepsis was caused by similar organisms. His resultant antiseptic regime for patients was published in 1867. 2 It is often claimed his successful but elaborate management was superseded by thermal asepsis in the early 1890s but neither the patient’s nor the surgeon’s skin can be autoclaved and their sterilisation by antiseptics remains obligatory. Lister introduced many operative procedures including excision of tuberculous wrists instead of forearm amputation and the wiring of fractures of the olecranon and patella; he also devised many instruments and spent much time improving the durability of catgut. He was ennobled in 1883.
Lister’s attempts to counter organisms in the air were and are ridiculed by many. Yet today we know, through the ‘green-house’ experiments of John Charnley (1911–1982) and the development of ultraclean air theatres, that total hip replacement wound infections can be reduced to 0.75% from 3.7% in conventional theatres. 3 Lister was right and criticism of his spray merits correction in the history books.