However, it could be seen that Lister was merely the catalyst for modern antiseptic and aseptic technique rather than the pivotal figure, and that it was an accumulation of inventions and ideas over time that have resulted in the current methods used in modern day hospitals in developed countries. For example, in Lister’s operating theatres, though the carbolic acid was being sprayed surgeons would still be wearing their blood and pus stained gowns, undermining Lister’s whole premise of keeping the germs away from the wound.
It is only due to other developments, which arguably are unrelated to Lister, that have meant surgeons and doctors today wear clean gowns worn only for the purpose of patient contact.
There are, however, two examples where Lister was paramount in the development of two features of modern antiseptic technique; the autoclave and disposable medical gloves. In 1876, after hearing Lister speak at the Philadelphia Centennial Exposition, Robert Wood Johnson (along with his brother James Wood Johnson) decided to publish ‘Modern Methods of Antiseptic Wound Treatment’, a manual on sterile surgery by Fred Kilmer.
This was mass produced, and meant surgeons could follow the manual to perform sterile surgery, making it more attainable. Johnson & Johnson also improved the preparation and manufacturing of aseptic dressings. The front page of the first Johnson & Johnson medical dressing catalogue can be seen in Figure 5. By developing new ways to sterilize and package the sutures, they were given a longer shelf-life, which was a vast improvement upon the less stable home-made methods.
Additionally, they were the first to make cotton have absorbent properties, so that it was of better use in surgical dressings. These resources gave surgeons the necessary supplies to adopt the practice of sterile surgery, and were a direct consequence of Lister acting as an inspiration to the Johnson brothers. Johnson & Johnson also pioneered the steam sterilization technique, also known today as the autoclave, which is used to clean medical equipment, for example scalpels and the surgeons’ gowns, with incredibly hot steam before use. An excerpt from Johnson & Johnson’s reply to a letter from Lister in 1891 reads; “We cheerfully give herewith our processes in detail, feeling this is due to you, both in answer to a proper request and in recognition of the fact that the whole system of modern wound treatment and the manufacture of materials for the same have been made possible, largely by your labours.”.
Moreover, before rubber gloves became common practice in medical examinations and in surgery, surgeons would suffer from chapped hands from the carbolic acid spray, which many surgeons disliked. Carbolic acid was an irritant not only to the surgeons but the patients too, and was so caustic that it could sometimes act as an accidental poison. The irritation was often worsened when using corrosive sublimate (mercury perchloride) as the antiseptic for sterilizing the instruments to be used in surgery. Due to how uncomfortable Lister’s antiseptic method made him and his fellow nurses, Professor Halstead, American surgeon in the 19th century, ordered a rubber company to make protective gloves. It was not with the intention of protecting the surgeon and patient from contaminating each other in mind that rubber gloves began to be worn in surgery, but merely to benefit the surgeon in the sense that their hands would become less irritated. In this way, despite Lister directly causing the invention of rubber gloves in surgery (albeit unintentionally), it was coincidental that they themselves acted as a barrier to infection – it was not their intended purpose initially. Lister’s significance can be seen in the development of wearing rubber gloves, but the lack of Halstead’s intention to help asepsis whilst wearing them in surgery somewhat diminishes Lister’s significance.
Arguably, Lister was not the first to use carbolic acid with the intent of it acting as an antiseptic agent. Antiseptics have been used since “time immemorial”, such as those of alcohol, glycerin, iodine and chlorine, but before Germ Theory it wasn’t known exactly why these worked, they were merely used because they had been tried before and had appeared to have some success. For example, in 1851 carbolic acid was used in England to preserve cadavers .
Carbolic acid’s usage in treating sewage in Carlisle acted as inspiration to Lister. However, the intention in this case was not for the carbolic acid to disinfect the sewage in any way, merely to dampen down the smell; linking back to the idea of miasma. Lister’s approach was different in the sense that, since it was after the publication of Pasteur’s Germ Theory, he was aware that there were microorganisms within the air, and that it wasn’t just the ‘bad smell’ or the oxygen in their air, which would cause disease. It is unclear, however, whether Lister actually had the knowledge, or made the now logical connection, that the action of carbolic acid would in fact kill these pathogenic organisms.
Before Lister’s work, it is clear that carbolic acid and other antiseptics were used largely as a form of treatment, and not prevention, of disease. This is what generates a uniqueness to Lister’s approach when using antiseptics; once he started to spray the carbolic acid into the operating theatres he had the aim of preventing microorganisms from entering the wound in the first place (similar to the premise of asepsis today), as opposed to most other surgeons’ suggestions of using antiseptics as a form of treating a disease which had already developed. In this sense, Lister was the first to use carbolic acid as an antiseptic, against sepsis, by aiming to prevent its development in the first place.
Louis Pasteur, a French biologist and chemist, hypothesised in 1862 that there were small organisms living in the air which could cause disease, after several experiments involving varying the air exposure of a distilled broth contained within swan-shaped flasks. Pasteur’s experimental aim was simple; to see if the microbes were spontaneously generated or were pre-existing in the air, and hence caused bacteria to grow on top of the broth. The results of his experiments conclusively demonstrated that microbes were in fact already present within the air, since no bacteria grew on the boiled broth which had been kept in an in-tact, sealed swan neck flask, undermining the theory of ‘spontaneous generation’ which had been so prevalent in the 18th century . In 1864, a professor of chemistry and colleague to Lister introduced him to Pasteur’s findings, and from these he learnt that disease was not caused from the air itself, but from the particles floating within it . After learning this. Lister became convinced he therefore had to clean the air in order to keep the wound clean of these organisms which Pasteur had talked about.
Although Lister’s work was fundamentally based upon Pasteur’s ideas, arguably it was Lister’s own ‘genius’ to take these ideas and conceptually apply them in a surgical setting, and “to take on the etiology of fermentation and envision this process as the same that was causing infection and gangrene,” . It was Lister, and Lister alone, who made the connection that putrefaction of wounds, i.e. gangrene, was the result of these ‘germs’ in the air.
One must therefore also analyse whether those after Lister, such as Johnson & Johnson, would’ve used their own initiative to create their inventions and aided the progress of scientific knowledge as much as they did without Lister’s influence. It seems that the progression of antisepsis into eventual asepsis much be looked at as a chronological timeline rather than on an individual basis, as it is only then can we see that each scientific discovery in antisepsis is as important as each other. This is because if Pasteur had not created Germ Theory, Lister most likely would not have used his surgical skills to practically apply the theory by using antiseptics, and those after him would not have utilised Lister’s work to create their own ideologies, methods and inventions which went on to develop into the current model of disease prevention – asepsis. By approaching the question in this way, it becomes clear that yes, Pasteur was of crucial importance in antiseptics’ development, but not more so than Lister himself, since Lister extended Pasteur’s ideas to create a basis for which others could work upon, and in doing so saved countless lives. In support of this, Pasteur himself stated, in reference to Lister, that ‘the future belongs to him who has done the most for suffering humanity” .