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• At the start of the 1800s, surgery was extremely dangerous. There were three key problems - pain, infection and blood loss.
• In 1861, French scientist Louis Pasteur published his germ theory . This was the idea that disease was caused by microbes .
• Joseph Lister, a surgeon and medical scientist, used Pasteur’s ideas to find a way of reducing the risk of infection during surgery.

At the start of the 19th century, surgery was extremely dangerous. There were three key problems.

Surgeons had to work quickly. Patients were awake during operations. Blood transfusions, where patients are given blood from a donor to replace what they lose in an operation, were not possible as blood groups, were not discovered until the 1900s. If a patient lost a lot of blood during surgery they could bleed to death. It was also highly likely that surgical wounds would become infected during or after surgery.

In 1861, a French chemist and microbiologist, Louis Pasteur, discovered germ theory. This was the idea that disease was caused by tiny microbes in the air infecting someone and making them ill. Germ theory challenged the idea of spontaneous generation. This was a belief that microbes appeared at the location of an infection, rather than being the cause. Pasteur’s theory was a crucial turning point in the fight against disease.

Joseph Lister was an English born surgeon. He studied medicine at University College London, before moving to Edinburgh and then to Glasgow, where he was appointed as Professor of Surgery at the university in 1860.

It was while working in Glasgow in 1865 that Lister read about Pasteur’s work on germ theory .

This encouraged Lister to consider how germ theory might be used to reduce patient mortality rates during and after operations.

Lister had such an impact on the advancement of antiseptic surgery that he is referred to as the ‘father of modern surgery’.

Lister had heard that a substance called carbolic acid was being used to clean foul smelling underground sewers – which were used to transport human waste. It was made from coal tar, and Lister wondered if the same substance could be used to clean wounds and equipment being used in operations to reduce the risk of infection.

This became known as antiseptic surgery. Lister found that mixing a solution made up of 5 per cent carbolic acid and 95 per cent water was effective in killing germs. The carbolic acid killed germs present in and around wounds - preventing them from being infected.

In 1870, Lister wrote about the results of his operations using carbolic acid in a medical journal, ‘The Lancet’. He recorded the impact of carbolic acid use:

• Before using carbolic acid, 16 out of 36 patients had died - a mortality rate of 46 per cent.
• After the introduction of carbolic acid, only 6 patients out of 40 died, a 15 per cent mortality rate.

This proved that antiseptic surgery significantly reduced the risk of infection during surgery and encouraged other surgeons to adopt Lister’s methods.

Lister worked on other ways of developing antiseptic surgery. He used carbolic acid to sterilise ligatures that were used to tie blood vessels following an operation. This also helped to reduce infection rates.

Despite Lister being able to prove the effectiveness of carbolic acid in reducing the risk of infection and therefore mortality rates in surgery, many other surgeons were reluctant to use it for several reasons.

• Carbolic was an acid, which meant it was an irritant. It dried and cracked surgeons’ hands. This was a challenge when trying to carry out delicate surgery.
• Carbolic acid was sprayed into the air during an operation. This made everything wet, so surgical instruments were slippery and harder to hold.
• Some surgeons complained that the machine that sprayed the carbolic acid during an operation was noisy and got in their way.
• Lister's ideas were new, and many influential and well-known doctors wrote against Lister, and Pasteur’s, ideas and still supported the theory of spontaneous generation.

These problems were eventually solved as surgery further improved. Surgeons and nurses in operating theatres began to wear rubber gloves to avoid the irritation caused by the carbolic acid. The use of carbolic acid itself was eventually phased out as aseptic surgery was developed.

At the end of the 1800s, surgeons began to develop the idea of preventing microbes being present in an operating theatre, rather than just using carbolic acid to clean a wound. This idea was known as aseptic surgery, so trying to prevent any microbes being present that could cause infection.

William Halstead is regarded by most historians as being the pioneer of aseptic surgery. He was an American surgeon and believed surgery was safer if steps were taken to prevent germs being able to infect a wound.

One of his assistants, Caroline Hampton, had complained that carbolic acid irritated the skin on her hands during an operation. Halstead contacted Charles Goodyear, owner of the leading rubber company, who produced gloves that could be worn during surgery.

Halstead realised this created a more sterile environment for operations to take place in. He believed that surgeons and their assistants wearing gloves and sterile gowns instead of their normal clothes would reduce the risk of infection.

Over time the principles of aseptic surgery replaced antiseptic surgery. It removed the need for carbolic acid and meant by sterilising equipment used and ensuring the surgeons wore gloves and gowns, surgery could be carried out with minimal chances of a life-threatening infection.