WHY IS LISTER CALLED THE FATHER OF MODERN SURGERY?
WHY IS LISTER CALLED THE FATHER OF MODERN SURGERY?
Prof. Dr. H. Kadircan KESKİNBORA
Bahçeşehir University Faculty of Medicine
HBT Magazine Issue 105 – 30 March 2018
Famous English surgeon Joseph Lister was born in the town of Upton in Essex on April 5, 1827, as the son of a cultured family. He set his mind on becoming a surgeon when he was only 14 years old. After graduating from medical school, which he started in London in 1844, in 1852, he began to pursue a career in surgery in Edinburgh, Scotland. In 1860 he became professor of surgery at the Royal Infirmary in Glasgow, Scotland.
During his years as a medical student, he watched the first surgery in England in which ether was used as an anesthetic. The anesthesia method, which allowed patients to undergo surgery without experiencing terrible pain, was a big step forward in the development of surgery. However, as the number of surgeries performed increased, the postoperative mortality rate also increased rapidly. Lister, who started working in Scotland as a newly qualified surgeon, was horrified to see that one in every three or four patients operated on soon died.
In 1865, Lister read studies by Louis Pasteur about pouring wine into patients' wounds and open parts of the body. When he learned from Pasteur's studies that bacteria caused fermentation and putrefaction, he realized that the inflammation in wounds was caused by microbes, and therefore microbes had to be killed before the wounds could heal. Deciding to apply Pasteur's germ theory, Lister began researching ways to destroy germs with chemicals called antiseptics.
Lister thought it was airborne microbes that caused the spread of diseases in hospitals. People who had surgery because their bodies were weak were especially vulnerable and weak. Germs could find a place in the body more easily and quickly because the patient's body was cut and the area was open. He focused his research on tissue inflammation and microbes. Since Pasteur's solution for killing germs with heat could not be applied to the human body, Lister was considering trying a new chemical to destroy germs. He boiled all the surgical instruments he used in phenol; He also sprayed phenol vapor into the operating room to kill airborne bacteria. These measures were indeed helpful, but the phenol was strong enough to damage tissues. Therefore, Lister tried to obtain a milder and more useful antiseptic by mixing phenol with other liquids. Additionally, because he realized the importance of keeping wounds very clean, he pioneered the use of thin dressings, such as cheesecloth, called gauze. In 1867, he published a detailed report on the use of antiseptics in surgery.
One day, while reading a newspaper, he read that carbolic acid destroyed parasites and reduced diseases in animals. He also studied the details of the antiseptic method and continued his research. developed a successful method of applying carbolic acid to open wounds. He used the technique of spraying air into the operating room with carbolic acid, covered his patients' wounds with cloth soaked in carbolic acid, and gauze dressings began to be used.
In the past, blood vessels cut during surgery were tied with hemp or silk threads, and these threads, whose ends were left hanging from the wound, were later cut and removed. Realizing that this method could cause wounds to become infected, Lister discovered a natural solution that can spontaneously decompose in the body. He thought of using a substance, He developed the surgical use of a sterile (germ-free) thread to close wounds. Even today, the surgical thread called catgut, which is used to stitch surgical wounds and is called. "catgut". in English, meaning "cat intestine", is actually made from sheep intestine. It has entered the field of surgery as routine practice.
Antisepsis became a fundamental principle for the development of surgery. Death rates dropped by nearly 90%.
Lister did not bring a new invention to the medical world, but thanks to his studies, he noticed the lack of cleanliness in hospitals, took precautions for those who died from infection after surgery, and discovered the method of spraying antiseptic spray, in which a germicidal substance is applied to the wounds during the operation. The sterilization (decontamination) methods used in modern operating rooms today were born from these efforts of Lister. These discoveries and applications are considered the beginning of modern surgery.
Thanks to these works, he was deemed worthy of a great honor in the field of medicine and surgery around the world. He was awarded honorary doctorates from many universities. Lister, who was professor of surgery in Glasgow and Edinburgh, moved to the Royal College in London with the same position in 1877. He has published 15 articles in some sources and more than 30 articles in others. Lister retired from the Royal University Hospital in 1893. He founded the British Institute of Preventive Medicine. This institution later became the Lister Institute. In 1897, one of his patients, Queen Victoria, made him a member of the House of Lords with the title "Lord". He is the first medical professional to receive this title. Lister died in the town of Walmer on 10 February 1912, aged 84.
Can Cleaning an Open Wound with Antiseptic Prevent Amputation?
In the history of wars, tens of thousands of legs and arms must have been amputated. The record holder in amputation is Dr. Dr., who was a surgeon in the French army and performed 700 amputations in four days in the 1794 Sierra Negra battle. It was Larrey. Assuming he amputated that number of limbs over four days, that was roughly four minutes per leg/arm. He achieved this thanks to his invention, which is still known today as the "Larrey retractor". The retractor is a scraper that can be opened to accommodate the bone and fold the skin up in one powerful stroke to make room for the saw. Thus, the rasping step was skipped. These unfortunate patients were probably laid out side by side in a row, and one by one, an assistant with his tourniquet, Larrey with his knife and retractor, an assistant with his saw, and finally an assistant came for the bandage.
We owe the fact that the standard treatment described above is no longer applied to an innocent 11-year-old orphan who was subjected to a chilling experiment. Little James Greenlees was run over by a car wheel in Glasgow, his fibula (shin) bone broken and protruding through his skin. The wound was filled with street filth. If amputation was not performed, he would die. Gangrene was inevitable. Despite this, Joseph Lister deprived the boy of life-saving amputation and did not amputate his leg. Instead, he soaked the wound with a caustic substance called carbolic acid. The incident took place on August 12, 1865. The experimental treatment had worked well; James lost neither his life nor his leg. The history of antisepsis (germicide) in medicine had officially begun. No one cared whether the intervention was done according to procedures. It was commonplace at that time to conduct experimental treatments on children.
Thus, Lister changed the treatment of open fractures from amputation to "limb-preserving treatment". It also paved the way for abdominal and other intracavity surgeries.
Resources:
1) 1) Metchnikoff E. The founders of modern medicine: Pasteur, Koch, Lister. Freeport (NY): Books for Libraries Press; 1939. Reprinted 1971.
2)Joseph Lister https://www.msxlabs.org/forum/bilim-ww/207555-joseph-lister.html#ixzz58IfWucMX Access: 11.12.2016
3) Van de Laar A. Under the Knife: A History of Surgery in 28 Surgeries. Trans. Gürer E. Istanbul, Koç University Publishing, 2016, p.125.
4) Pitt D, Aubin JM. Joseph Lister: Father Of Modern Surgery. J Can Chir 2012;55:8,9.