V102 No 3 BULLETIN American College of Surgeons
thrived in wounds treated with carbolic acid. He
advocated the use of pressurized steam to sterilize
anything that came in contact with the patient, from
instruments to the surgeon’s garb, an approach that
proved effective in controlling surgical infection.
Within a decade, asepsis supplanted Listerism. 10
Why is Lister celebrated in the history of surgery? He was
not the first to use carbolic acid or to apply antisepsis. In
1901, Dr. Kelly wrote that Jules Lemaire, a Paris, France-
based physician, was the first to use carbolic acid in
surgery in 1864, three years before Lister’s papers were
published. 11 In 1970, Owen H. Wangensteen, MD, FACS,
opined that Ignaz Semmelweis’ use of hypochlorous
acid in 1847 to prevent puerperal fever was rightly the
first use of antiseptic in preventing surgical infection. 12
Michael Worboys, former director of the Centre
for the History of Science, Technology and Medicine,
University of Manchester, U.K., argues that Lister’s
contribution to the evolution of surgery is based on how
he incorporated Pasteur’s findings into his practice of
surgery. 13 His exacting techniques of wound dressings
and antiseptic mists, however ineffective, were based
on his understanding of science. Lister’s work showed
that surgery had evolved from the heroics of Scottish
surgeon Robert Liston’s bravura 30-second amputations
and its 300 percent mortality rate—the patient, the
assistant who lost a finger, and a bystander who died
from shock after nearly being sliced by Liston’s errant
scalpel. Perhaps Lister’s contribution to modern medicine
can best be summed up by Rev. Thomas Gariepy,
CSC, professor and chair of healthcare administration,
Stonehill College, Easton, MA: “Antiseptic surgery…
fostered the alliance between science and medicine.” 14
While carbolic acid vaporizers are now relics, Lister and
Lemaire based their practices on Pasteur’s revolutionary
discoveries. When Professor Koch, the next great figure
in microbiology, determined that bacilli caused human
disease, the field was thus prepared to accept asepsis
as the next significant development in surgery. ♦
1. Lister J. On a new method of treating compound
fracture, abscess, etc. With observations on
the conditions of suppuration. The Lancet.
2. Worboys M. Spreading Germs. Disease Theories and
Medical Practice in Britain, 1865-1890. Cambridge, UK:
Cambridge University Press; 2000.
3. Ellis H. The first “antiseptic” operation. J Perioper
Pract. 2015; 25( 4):87-88.
4. Anderson T, Bateman JF. Report on the Means of
Deodorizing the Sewage of Glasgow. Glasgow, Scotland:
University Press, 1858. Available at: archive.org/
details/b21467316. Accessed January 20, 2017.
5. Report from the Select Committee on Sewage of
Towns; together with the Minutes of Evidence and
Appendix. Ordered by the House of Commons
to be printed, April and July, 1862. Br J Psychiatry.
1863; 9( 45):143-144. Available at: bjp.rcpsych.org/
content/9/45/143. (Password protected). Accessed
January 23, 2017.
6. Lister J. On the antiseptic principle in the practice of
surgery. Br Med J. 1867; 2(351):246-248.
7. Lister J. On a case illustrating the present aspect
of the antiseptic treatment in surgery. Br Med J.
1871; 1(524): 30-35.
8. Kelly HA. Asepsis not antisepsis. A plea for
principles, not paraphernalia, in laparotomy.
Transactions of the Obstetrical Society of
Philadelphia. Am J Obstet Dis Women Child.
1886; 19( 10):1076-1081.
9. Greenwood A. Lawson Tait and opposition to germ
theory: Defining science in surgical practice. J Hist
Med Allied Sci. 1998; 53( 2):99-131.
10. Schlich T. Asepsis and bacteriology: A realignment
of surgery and laboratory science. Med Hist.
2012; 56( 3):308-334.
11. Kelly HA. Jules Lemaire: The first to recognize the
true nature of wound infection and inflammation,
and the first to use carbolic acid in medicine and
surgery. JAMA. 1901; 36( 16):1083-1088.
12. Wangensteen OH. Nineteenth century wound
management of the parturient uterus and
compound fracture: The Semmelweis-Lister priority
controversy. Bull N Y Acad Sci. 1970; 46( 8):565-596.
13. Worboys M. Practice and science of medicine in the
nineteenth century. Isis. 2011;102( 1):109-115.
14. Gariepy TP. The introduction and acceptance of
Listerian antisepsis in the United States. J Hist Med
Allied Sci. 1994; 49( 2):167-206.