How Joseph Lister’s Revolutionary Hand-Washing Practice Changed Medicine Forever

The novel concept of using soap and water to clean hands and instruments saved countless lives and altered the course of global healthcare.

Yes, Listerine was named after this guy.

No, he didn’t invent mouthwash.

But he did inspire another physician, Joseph Lawrence, to create a formula for an alcohol-based antiseptic for hospital use… which Lawrence later licensed to a pharmacist who began marketing it as a cure for halitosis, named for the man who inspired the process in the first place.

And yet, though mouthwash bears his name, oral antiseptic is not the greatest contribution that Joseph Lister made to the world of medicine and hygiene.

Let’s back up a little.

In the middle of the nineteenth century, hospitals — which should have been places of healing — were widely regarded as places of death. Those who entered their doors were lucky to make it home again. Infection ran rampant, disease spread like wildfire and fevers killed victims within hours in many hospitals. Europeans and Americans alike feared to send their loved ones into these places where approximately 40% of patients died after that butchery called surgery — one-quarter of these deaths resulted from shock.

But all this changed in 1867 when Dr. Joseph Lister published an article in the British Medical Journal, titled “On the Antiseptic Principle in the Practice of Surgery.” This article detailed the surgical breakthrough Dr. Lister had made in the practice of antisepsis and began the revolution that was to reform surgery forever.

Joseph Lister was born to Quaker parents on April 5, 1827 in Essex, England. He aspired to be a surgeon from a young age. His scientifically minded family did not disapprove, though surgery was not yet a socially prominent occupation. In the nineteenth century the practices of medicine, surgery and pharmacy were in a great state of confusion. Many practitioners were unlicensed and quack doctors selling sham drugs ran rampant.

Despite the problems that he knew he would face in a physician’s career, Lister did not hesitate. He began studying under the tutelage of James Syme, an eminent surgeon at the Royal Infirmary in Edinburgh. A dedicated student, Lister took a calm and deliberate approach to surgery. This was unusual in an era when surgeons were timed during operations and would frequently race each other.

Surgeries had to be performed quickly if they were to be at all humane —before the days of functional anesthesia, there was little that doctors could do to control the agonizing pain. Blood coagulation was still a problem for surgeons. Ambrose Pare’s introduction of tying off ligatures in 1536 had partially accounted for control of bleeding, but patients still frequently bled to death after a successful operation. No one knew why.

When James Young Simpson introduced chloroform to the medical world in 1847, surgery changed radically. Ether had been the most commonly used anesthetic before the advent of chloroform, but chloroform proved to be far more efficient and less harsh than ether had been. But infection, the biggest obstacle of all, still remained to stump Victorian surgeons.

“Indeed, the use of chloroform contributed to an increase in the overall number of fatalities,” Jerry L. Gaw wrote in A Time to Heal: The Diffusion of Listerism in Victorian Britain, “because surgeons became more willing to use the knife in spite of the fact that infections remained as prevalent as ever.”

In 1865, Thomas Anderson, a chemistry professor at the University of Glasgow, introduced Lister to the discoveries of Louis Pasteur. Pasteur had recently published a work detailing his theory about the transmission of disease through airborne pathogens. Excited, Lister began to think that there might be a connection between airborne pathogens and hospital sepsis.

Infection rates were appalling in the mid-nineteenth century. Mortality from amputations was about 40 percent — mainly the result of open fractures or osteomyelitis (which was at the time known as necrosis of the bone). Open fractures were extremely susceptible to contamination and infection: they were often the result of street accidents and easily became contaminated by the filth of the streets.

Many surgeons believed that the infections were caused by mysterious “miasmas” that floated, invisible, through the air. Others were sure that infection was the fault of the patient, and that only the wounds contaminated by “bad blood” would succumb to putrefaction.

The atmosphere in the typical 1860’s operating room was far from sterile. Most surgeons wore dirty, well-used frock coats because they represented seniority and experience. Blood was rinsed off instruments in jugs of water that had stood at room temperature. The formation of pus in a wound was considered a necessary part of the healing process. And unfortunately, few surgeons realized that it was their actions in the operating room that were responsible for thousands of patients’ deaths. (During the Crimean War, Florence Nightingale was instrumental in setting standards for hospital cleanliness, but she did not believe that microorganisms caused infection and instead concentrated her efforts on simply getting rid of filth.)

Joseph Lister, however, after reading Pasteur’s work, became confident that germs were the reason behind hospital infection. Furthermore, he was sure that if germs were living organism, they could be killed. The question was, how?

Jules Lemaire, a Parisian doctor, had published a work in 1863 about carbolic acid (also known as phenol), a coal tar derivative that prevented fermentation and was useful as a disinfectant. Lemaire suggested that Pasteur’s germ theory might explain putrefaction, just as Lister had surmised. Lister reasoned that if the carbolic acid could be used to prevent fermentation, it might also work as an antiseptic.

His first experiment with carbolic acid (on a woman with a tuberculous wrist) was a failure, but Lister was not discouraged. He decided to try again with an open wound, specifically a compound fracture, one of the deadliest injuries known to surgeons.

The opportunity came on August 12th, 1865. Eleven-year-old James Greenlees had been run over by a wagon and suffered a compound fracture just below the knee. Lister anesthetized the boy with chloroform and washed the wound with carbolic acid and linseed oil, covered it with a mixture of putty and carbolic acid and bandaged it. Then he waited. Infection usually set in on the fourth day after an injury such as this. After four days, the wound was not inflamed and the patient’s temperature remained normal. The boy was discharged from the hospital a mere six weeks later.

Over the next eighteen months Lister treated thirteen more wounds with carbolic acid and lost only two patients — an amazing statistic, considering what the rates had been in the past.

“The treatment is now rendered so simple and easy for anyone to put into practice, that it really charms me,” Lister wrote to his father in February 1867. During the spring and summer of 1867 he wrote several articles about carbolic acid and published them in The Lancet, a medical periodical. Unfortunately, he did not do a very good job of explaining how his method all but abolished infection in compound fractures. His writings focused more on the chemical properties of his antiseptic drug, carbolic acid, and did not clearly communicate his breakthrough.

But in September of 1867, Lister wrote an article entitled “On the Antiseptic Principle in the Practice of Surgery” and submitted it to the prestigious British Medical Journal. Excitedly, he wrote,

“Carbolic or phenic acid ... appears to exercise a peculiarly destructive influence upon low forms of life, and hence is the most powerful antiseptic with which we are at present acquainted.”

This new idea caused a commotion in the scientific world. Most doctors had never even considered that unsanitary operating techniques might be the cause of infection — rather, the control of bleeding had always been considered more important than cleanliness. As for infection, the general belief was that only people who were already in poor health succumbed to infections after being wounded. As an 1853 physician’s manual stated,

“The most trifling scratch or the simplest cut, has been followed by bad sores, loss of limb and even life, in persons of extremely morbid blood, foul secretions, and reduced vitality … After [tying off arteries] nothing but cold water dressings [are] generally required.”

When Lister addressed the British Medical Association in Dublin on August 9, 1867 he had the wholehearted support of his mentor James Syme. Other physicians were not so encouraging. Sir James Young Simpson, private physician to Queen Victoria, who famously introduced the use of chloroform as an anesthetic, believed that the procedure was unsafe. But Lister was prepared for antagonism. “I cannot, however, expect my professional brethren to follow my advice blindly on such a matter,” he had written in his article.

However, the use of carbolic acid quickly caught on in Germany. During the Franco-Prussian War (1870–71), the Prussians used Lister’s methods to treat the wounded after battles. In those days, the infection that followed battle wounds was often more deadly to soldiers than the wounds themselves. (During the American Civil War, for instance, nearly two-thirds of the casualties were a result of infected wounds and disease and not death on the battlefield.) The French, however, vehemently opposed Lister’s methods and refused to use his antisepsis treatments on their wounded.

Subscribing to the belief that most wounds could be contaminated from bad air in the operating room, Lister created a carbolic acid spray that he diligently utilized in his operating rooms. But the spray proved to be toxic when inhaled, and by 1870 Lister had realized that the spray was too dangerous to be useful.

In 1876 Lister traveled to the United States to attend the International Medical Congress. American doctors were a bit skeptical about his discovery, viewing it as a “passing fad and without merit,” but eventually the idea caught on. “Between 1870 and 1890, antiseptic surgery became almost universal, and Lister’s influence was widely recognized,” Elaine Larson wrote in “Innovations in Health Care: Antisepsis as a Case Study.”

On December 26, 1883, Queen Victoria knighted Lister in recognition for his work. His fame was spreading. By 1895 the antisepsis method was referred to as the “Listerian method.” In 1898 the New York Times spoke of Lister as “the man to whose discoveries and labors modern surgery, with all its incalculable benefits to humanity, may almost be said to owe its very existence.”

Joseph Lister’s discoveries led to a revolution in surgery. He conducted a methodical and radical overthrow of archaic techniques in a practice that once claimed the lives of more than two-thirds of its patients, consequently saving countless lives and reforming medicine forever.

“Asepsis — the absence of germs — proved to be the linchpin of safe surgery,” John G. Simmons wrote in Doctors and Discoveries: Lives That Created Today’s Medicine. Joseph Lister’s diligent research and dedicated experimentation led to a breakthrough in controlling infection, providing a solution to a frequently fatal problem in medicine. His work has made it possible for surgery to be the lifesaving operation that it is today.

So today, when the CDC tells you to wash your hands with soap to stop the spread of disease, you can rest assured that over 150 years of science — and one man who did not invent mouthwash — is backing up that claim.