How Joseph Lister Changed Surgery Forever (Invention of Antiseptic Surgery) | Patrick Kelly

This video was made possible by your support on Patreon. A hospital was 3-5 times more likely than if the same procedure was done at someone's house. Not because of blood loss or underdeveloped surgical skill, but because of infection. One of the biggest killers after surgery was sepsis, a series of inflammatory events due to infection that can result in organ dysfunction or death. Sepsis is still around in modern day, but it's way less common than it used to be. We have a few key players to thank for this, but for today we're going to focus on Joseph Lister. The British surgeon often accredited with inventing antiseptic surgery. But of course, no one works in isolation, and breakthroughs had to be made before Lister to set him up for a revolution. Just like how Ford needed to invent the assembly line before Tesla could produce the Roadster, a few things needed to happen before Lister could buff up medical hygiene. Before the early 1800s, surgery was usually the last resort. They were incredibly painful and invasive, so they were usually saved for life or death situations. These were big deal operations like limb amputations, not fine-tuned, highly precise surgeries like today. But something happened. It turns out that if you take the pain out of surgery, then more people are going to be okay with you slicing their abdomen open. And no, we're not talking about take a shot of whiskey, bite a leather hide kind of technique from the old west. We're talking real deal chemical anesthesia. Prior to the 1800s, doctors had played around with opium and nitric oxide for a while, which certainly reduced pain, but it was diethyl ether that stuck, hence anesthesia. The first anesthetized surgery was done in 1846 in America, but it would soon spread elsewhere. So the first step towards Lister's antiseptic revolution was anesthesia. And now that surgeries were painless, that meant doctors could do more surgeries. That meant they got more skills practiced, got to invent new tools, and developed a bunch of new procedures. Like, it's no coincidence that the anesthesia revolution also overlapped with the first Granted, we still had to figure out why the immune system was rejecting body parts, but at least we were getting started. Now in surgery, just like any other skill, the more you hang out with people who are more skilled than you, the better you get. So a few universities sprang up that became very focused on improving the quality of medical education, particularly in Europe. Now medical training back then wasn't nearly as much biochemistry as it is today, partly because that science hadn't been invented yet. Back then, becoming a surgeon meant doing an apprenticeship, maybe even skipping university training altogether. Medical schools existed to train students in anatomy and get them used to seeing death. And of course, becoming a doctor has always had some kind of clinical piece to it, so medical students at the time had to gain exposure to working in hospitals, literally the filthiest places in the world at the time. Loads of medical students died from tiny cuts that got infected or from being around diseased corpses. And disease was everywhere, especially in big cities. Remember where you are in history here. The Industrial Revolution was about to kick off in Britain, which meant an improvement in life expectancy, but also in population density, and London would be hit hard. Over the 19th century, London grew from 1 million residents to 6 million, with its peak population density around 1911. The city physically couldn't keep up. Cemeteries were overloaded with rotting corpses. Feces and urine from people and animals coated the streets, food handlers didn't do anything for sanitation, and with higher population density, you ensured there would never be a lack of pathogen. If you wanted a massive, filthy population to fill your disease-laden hospitals, you would find it in London. So medical schools in big cities had their work cut out for them, but luckily, these universities tended to attract some talented surgeons. And it was at University College in London that a particularly skilled surgeon, Robert Liston, was working on some new surgical techniques. He would be responsible for one of the first uses of ether during surgery. And he was already fast, efficient, and good with a blade, but he adored using ether later in his career. And it was Liston who would become the Dumbledore to Lister's Harry. Between the painless surgery, the revamped medical education, the highly urbanized setting of London, and the mentor, the stage was set for a revolution. Lister was a good student, don't get me wrong, but his grades weren't what made him important. What made him weird is what got him remembered. And I don't want to get all, this dude was the messiah of microbiology on you, but here's a quick bio. Lister was born in England to a super religious Quaker family, so one of his childhood hobbies was looking through microscopes and growing weird cheekbeards. As a kid, he was super curious about anatomy and the natural world. He would dissect frogs, draw out muscles, and even prepared sheep skulls for display. It was clear from a young age, this kid was going to med school, and in 1844 he did exactly that. He showed up to University College London where he got to room with another Quaker med student named Edward Palmer, an assistant to Robert Liston, who I mentioned earlier. Lister got to sit in on one of those first anesthetized surgeries, which was probably really inspiring and all, but it was his environment that raised him. Remember, super dense housing, overrun hospitals. These doctors could not escape infection, so they had to start tackling the problem with science. There were two conflicting theories about infection at the time. The one that's closer to what we believe today was called the contagion theory. Disease was passed from host to host via chemicals or animalcules, a catch-all phrase for microorganisms. This worked for explaining visible diseases like smallpox, but not for diseases like cholera, which spreads through feces. On the other hand, the anti-contagion theory, or pythogenesis, said that disease came from filth and decay and spread through the air. That rancid smell throughout the hospital? That was the disease. The leader of University College Hospital at the time was an anti-contagionist. It would be a couple decades before we started proving that theory wrong, but in the meantime, patients kept showing up, so as a young med student, Lister was thrown in with the wolves. One night in 1851, Lister was alone working the late shift and a woman came to the hospital with a stab wound in her abdomen. Yeah, domestic abuse was super common back then. She's got intestines hanging out, she's in bad shape. Now, many surgeons at the time would have just watched and waited, maybe cauterized the wound at most. But Lister slices the abdomen open a little bit more, shoves her guts back inside, and sews her up. I repeat, he sutures up the stab wound. For the time, that was bonkers. Why was that so wild? Well, sutures were a really common site of infection, so doctors usually wouldn't suture up an abdominal wound because it was more likely to get infected. But Lister's impromptu experiment worked and the woman lived. Now that his career has taken off a little bit, the hospital boss, Erickson, starts taking him under his wing, which is great, but the hospital's still got problems. With such a small holding capacity compared to the population, they'd have to turn away people that they deemed incurable. Like they had to turn down a man with tuberculosis and just, you know, send this dude with an incredibly contagious disease back into one of the busiest cities in Europe. So what was Lister doing about it? Well, not surprisingly, his nerdy streak lasted well into adulthood, so he did what he did best, looked at body parts under his microscope. A few months later, Lister had been put in charge of a patient who had developed gangrene, an infection that, believe me, if you've never seen it before and you're about to eat lunch, do not go google it. Okay, you can go google it, it's gross. He scraped some of the brown, necrotic tissue off the top, then cleaned the wound with a very toxic, very caustic solution of mercury pernitrate before wrapping it up with bandages. Sure enough, the wound healed. From this case, Lister concluded that something in the wound itself, not the air, was responsible for infection. So like a good scientist, he took some of that gangrenous pus and threw it under a slide on the microscope and looked at the bacteria underneath. This is so gross. Oh my god. All of this very impressive work is while he's still technically a med student, so this all culminated with a job offer in 1853 up in Edinburgh with a surgeon named James Symey. And even though cities in Scotland weren't as packed as London, infection was still everywhere. This new environment, plus his mother's unfortunate passing due to a bacterial skin infection, led Lister to investigate what other scientists were doing to approach the infection problem. There were a couple scientists reporting similar theories, but none of them were really getting popular. They were all some variation on morbid substances being passed from person to person, and that's how infections spread. It started to sound closer to modern day germ theory, but not quite. So Lister started upping the cleanliness standard in his hospital, which basically meant sweeping the floors and washing off instruments with water. It was a good start, but not enough. Now one scientist in a completely different field in a completely different country would prove to be the most impactful for Lister's research. In 1864, everything changed when he heard of the work of Francis Louis Pasteur. If you didn't pay attention in junior high science, Pasteur was like the founder of microbiology and among other things, found that cells must come from other living cells. An infectious bacteria didn't just spontaneously generate out of a pile of poop, but instead had to come from a parent bacteria. Plus one for the contagion theorists and for Lister's microscope work. Since Lister couldn't always prevent exposure of a wound to germs, he focused on destroying existing germs before they multiplied too much and caused an infection, and he figured he could either do that with heat, filtration, or chemicals. Obviously he couldn't boil the patient's injury and the filtering technology didn't exist yet, so chemicals it was. And at the time, the chemicals that would have been used to kill these microorganisms were antiseptics, were used once the sepsis had already set in, not as a method of prevention. One of his first proper experiments was on an 11 year old boy presenting to the hospital with an open compound leg fracture. Lister saw his shot and decided to take it. Okay, the number one priority is making sure that this kid doesn't die. So he could have either amputated the boy's leg, which is heartbreaking, but it would have prevented infection, or he could try to prevent infection with antiseptics and let the bones heal over time, which is what he chose. He tried a solution of carbolic acid and water first. There was some success at reducing pus, but there was still inflammation. Lister decided to mix carbolic acid and olive oil and that worked. The boy made a full recovery, no amputation was needed, and Lister was finally onto something. It takes an overwhelming amount of evidence to start a revolution, and Lister was about to get it. That 11 year old boy had an open fracture, a broken bone with an open wound, but Lister and other surgeons knew that infections usually didn't pop up in closed fractures. Okay, so maybe the key was in the wound. Lister recreated the carbolic acid method for abscesses, which basically become open wounds once all the pus is drained out, and once again, he had success in preventing infection. But an even bigger test came when his sister developed breast cancer and she asked him to perform her mastectomy, or breast removal. Obviously a big chance of infection with that surgery. Knowing full well that hospitals were still filthy, he covered his dining room in carbolic acid and performed her surgery at his house. She lived another three years before developing liver cancer, but she never got sepsis. And that's awesome, but the greater medical community still wasn't having it. They were having a hard time getting his methods to work on their home turf, even to the point of accusing Lister of fudging his numbers just for notoriety. Lister didn't care. He still had trust from his hospital staff and students, and importantly, the Queen. Queen Victoria developed an abscess in her armpit, and in 1871, asked Lister to do the surgery. Knowing how important this operation would be for his career and possibly life, he put a little bit of extra work into his prep. He went as far as developing a carbolic acid atomizer to disinfect the air in the room, which is funny because the pathogens in the air usually don't contribute that much to sepsis, but he gets an A for effort. Now after surgery, the Queen started draining pus. Not a good sign. On the spot, Lister tweaked the new device and made it an impromptu suction machine. The Queen lived, and Lister gained a heck of an endorsement. After that surgery and a bit more time for the anti-contagionists to die off, Lister's antiseptic methods would become much more popular in the medical community. But not all at once. He still saw pushback from doctors in America, which is to be expected. Paradigm shifts take time. Germ theory still needed adopting, and word needed to spread out past Western Europe, but clearly, it did. Lister's story is cool because of course, it's terrifying to think of a world where surgeons don't care about cleanliness, but I took away something else from this story. Lister would never have made the same breakthroughs if he gave up his childhood passion of looking through microscopes. His story is a cool science story, but it's also a lesson in staying true to yourself. If you're in the position of starting a new career, or if you're at a new school and you feel like there's something about it where you don't quite fit in, embrace it, enjoy it, and be a nerd about it. You might not revolutionize your industry, but you will absolutely bring a new perspective. And that might be just what your community needs. This video was adapted from The Butchering Art by Dr. Lindsay Fitzharris. There's a link down in the description to go buy the book, I super recommend it. Otherwise, go follow her on social media and support her work, she's really awesome. Have fun, be good, and I'll see you next time.