Antisepsis pre-Lister

According to a quick Google search, antisepsis was invented by Joseph Lister. A number of study sites make this claim, so it must be right. True? No, false. Lister pioneered the widespread use of carbolic acid for surgical instruments and operation theatres. That’s true. But the history of antisepsis is older and much more interesting.

Antisepsis is the use of special cleaning practice for cleaning a sick, delivery, or operating room and any wound. Anti=against and sepsis=the presence of harmful bacteria and their toxins in human tissue (or, in other words, infection).

And human beings have been fighting infection by various means since the dawn of time.

A little of what you fancy

Observation gave our ancestors lots of information about what happened when a person had an open wound, how likely the patient was to sicken and die, and what the carers could use to improve the odds.

The Ancient Greeks, the Egyptians, the Chinese, and the doctors of the Muslim World all wrote about and practiced antiseptic techniques. They used various substances to clean rooms, clothes, equipment, and people. They covered wounds with dressings coated in other substances. And all long before Lister. Wine or vinegar or alcoholic spirits. Honey. Certain muds. Mouldy bread. Distillations of sulphur, silver, or mercury. Herbs and mushrooms. Green tea. Lime and iodine. Even fire, to cauterise a wound or burn away a corpse or a patient’s clothing and dressings.

Something in the air

They were disadvantaged by not knowing the enemy they fought.

From the time of the Ancient Greeks, western medicine believed that wound infection was caused by air; that wounds became inflamed and then full of pus and eventually gangrenous because they were exposed to air.

It made sense. A person with a simple fracture healed with no infection. A compound fracture that broke the skin frequently led to infection. Similarly the difference between an internal wound and an exterior one. A person might die of some internal ailment, but their chances of infection were hugely increased by surgery to fix it.

So what was it about the air? Our medical pioneers had a couple of theories.

One was that cold was the precipitating factor. The inside of the body is a nice warm place. If the person has an injury or surgery, cold air gets into the wrong place and makes the person sick. So get the wound covered as quickly as possible with something that will keep the air out.

The other was to do with smells. Everyone could see for themselves that more people got sick in bad smelling places. And fewer of those who were sick survived. Moving a soldier out of the hospital where everything smelt awful and into a tent or barracks increased his chances of survival.

Hence the plethora of techniques to counter the smells of disease and corruption.

The techniques worked. Sort of. Some of the time

It was all very hit and miss, and how could it not be when germ theory had not yet been imagined, let alone proven? But mouldy bread, if it is the right kind of mould, will help to prevent infection in wounds, as will honey, and washing instruments in alcohol or boiling water or even simple soap will also help, as will thoroughly washing hands, changing bed sheets, and wearing clean clothes (rather than, for example, going straight to an operation from changing a dressing on a patient whose wound is infected).

The eighteenth century was a time of codification and discovery, laying the groundwork for the great advances of the nineteenth. The word ‘antisepsis’ appears in print for what was probably the first time in 1721, and both British and French doctors explored a variety of ways to prevent wounds from going bad.

My personal hero is Dr Alexander Gordon, a naval surgeon on half pay who became a general practitioner at Aberdeen Hospital, specialising in obstetrics. He wrote compellingly of the connection between contagion and puerperal fever 50 years before the pioneer Semnelweiss, and who even suggested parallels with the type of fever that appeared in wounds or after operations. His Treatise on the Epidemic Puerperal Fever of Aberdeen said:

By observation, I plainly perceived the channel by which it was propagated and I arrived at that certainty in the matter that I could venture to foretell what women would be affected with the disease, upon hearing by what midwife they were to be delivered, or by what nurse they were to be attended during their lying-in; and in almost every instance my prediction was verified.”

Touchingly, he admitted:

It is a disagreeable declaration for me to mention, that I myself was the means of carrying the infection to a great number of women …

What a guy. Clear headed, not so stuck on doing things by the book as to miss what was happening in front of his eyes, and ready to take responsibility when he realised that women only suffered from the illness if they were attended by nurses, midwives, or doctors who had attended a previous sufferer.

Not long after he published his theory, Gordon was called back to sea, where he contracted tuberculosis. He died in 1799.

Link with A Raging Madness

In A Raging Madness, my heroine was the daughter of an army doctor. As a girl and young woman, she had worked alongside her father, and she uses the skills she learned to operate on an abscess to save the hero.

She mentions her father’s agreement with Gordon’s theories to explain why she insists on cleanliness while operating. How did she and her father hear about them, since they were away overseas at the time? Ella’s father died in 1797, and the Treatise was not widely known.

Fortunately for me (but not for Aberdeen), the second of two epidemics of puerperal fever in Aberdeen was in 1792. I’m assuming that Gordon and Ella’s father were friends; perhaps they served together at the same hospital when they were training. And perhaps they corresponded after Gordon joined the navy and Ella’s father the army. It’s all possible, right?

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