Method
Lister developed his technique whilst at Glasgow, publishing his ideas in the paper “On the Antiseptic Principle in the Practice of Surgery” in 1867. Based upon Pasteur’s ideas of micro-organisms in the air, Lister wrote of his realisation that “decomposition in the injured part might be avoided without excluding the air, by applying as a dressing some material capable of destroying the life of the floating particles.” Pasteur’s own theory had disproven the notion of “spontaneous generation” – that is, the growth of mould or decay on material as the product of the material itself – and introduced ideas of germs and micro-organisms existing in the air. Lister, in applying this principle to surgery, sought to exclude infection-causing organisms, protecting the site of the wound with assumed chemical germicides, and stressed that the introduction of a single germ into a wound could potentially cause infection.
Lister’s initial dressing of choice is described in his paper: “a piece of lint dipped in [carbolic] acid, overlapping the sound skin to some extent, and covered with a tin cap, which was daily raised in order to touch the surface of the lint with the antiseptic” (Lancet 21 Sep 1867). In the case of large wounds, Lister added carbonate of lime mixed with carbolic acid and linseed oil, forming an antiseptic putty, which could be rolled between two pieces of calico and wrapped around wounds. The putty would be removed when discharge had stopped, but the lint would remain until the wound had scabbed over.
Throughout his professional career, Lister espoused scientific principles as forming the basis of medical and surgical practice. He sought to base his innovations on observable and recordable experimentation, and was an active researcher in both laboratory and clinical settings. From 1867 Lister constantly revised his principles and practice, usually as a result of his own research. He refined the carbolic solution used, immersed all instruments in carbolic acid, cleansed patients’ skin around the wound, and developed new dressings. He introduced the carbolic spray apparatus which became so famous a symbol of his approach, and modified the technique of many operations, introducing the use of absorbable ligatures and of drainage tubes in the treatment of wounds, and catgut for ligatures which would ultimately would be absorbed by human tissue.
In 1893, Lister advocated the boiling of sponges for sterilisation and continued to experiment with antiseptic agents, and during his time in London trialled both corrosive sublimate and double cyanide of zinc and mercury as impregnations for dressings.
As early as 1870, Lister was concerned with demonstrating that it was not the carbolic acid itself that was responsible for his results, but the technique and method by which it was applied: “whatever the antiseptic means employed...use them so as to render impossible the existence of a living septic organism in the part concerned” (Lister, quoted in Granshaw, “Upon this principle I have based a practice”). Lister attributed any failure in his method to the personal misapplication of his strictures by the surgeon, and remained convinced of the germ basis of infection throughout his life.
Although Lister’s techniques evolved throughout his career, they remained true to the fundamental notion that infection is caused by germs, and that prevention of germs from entering the wound (asepsis) coupled with precautionary measures if they gained entry (antisepsis) is the surest method of avoiding infection. He later abandoned the carbolic acid spray completely, deciding that airborne microorganisms were of less consequence than those on the surgeon’s hands and instruments, and in fact rued that he had ever advocated it (Granshaw 45). As many published sources on Lister show, LIsterism was both a product of and inspiration for a raft of antiseptic techniques and methods, based on the new science of germ theory emerging from continental Europe. Lister, however, remains synonymous with antiseptic surgery