Ignaz Philipp Semmelweis (1818–1865), Joseph Lister (1827–1912)
Two major drug-related advances propelled surgery forward in the middle of the nineteenth century: The first was the discovery of the general anesthetics ether and chloroform (1846–1847), which extended the range of the surgeon’s scalpel from rapidly performed crude amputations to extended operations involving internal organs. The next major advance was the reduction of fatal postoperative complications, particularly after childbirth.
Childbed (puerperal) fever was such a common cause of death that many women wisely believed it safer to have midwives deliver their babies at home than to give birth at teaching hospitals. Medical students commonly traveled directly from pathology labs to maternity wards, where they performed vaginal examinations on expectant mothers without pausing to wash their hands. After the Hungarian-born obstetrician Ignaz Philipp Semmelweis insisted that his students and assistants disinfect their hands in a chlorine solution before administering to expectant mothers, the incidence of childbed fever precipitously fell in his Viennese hospital. Nevertheless, the medical establishment rejected his classic 1861 monograph, The Etiology, Concept, and Prophylaxis of Childbed Fever. This, coupled with personal and financial losses, led to his mental deterioration and commitment to an asylum, where he died within weeks from either a beating by an attendant or, ironically, from sepsis originating in a hand wound.
Joseph Lister, by contrast, was lionized for extending the teachings of Semmelweis. In 1867, while a professor of surgery at the University of Glasgow, Lister instructed his assistants to use phenol (carbolic acid) solutions to wash their hands and surgical instruments before operating and to bathe their patients’ incisions after operating. He was, thus, a pioneer in promoting the use of antiseptics—chemicals that kill bacteria—and later the modern preventative approach of asepsis.
Lister may not be a household name for his surgical advances, but he is remembered via the antiseptic mouthwash Listerine, which first appeared on the market in 1914. The product, marketed to “kill germs that cause bad breath,” contains antiseptics, ethanol (alcohol), and flavoring agents but—despite its namesake—no phenol. Phenol is damaging to the skin and has long been replaced by far safer antiseptics.
SEE ALSO Ether (1846), Chloroform (1847), Hexachlorophene (1961).
After the introduction of general anesthesia, the next major challenge for the advancement of surgery was the control of postoperative infections, which claimed 50–80 percent of surgical patients. Adoption of Lister’s use of phenol and his principles of antiseptic surgery reduced the death rate from infection to virtually zero.