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Unlock This CourseChloroform and ether had taken away the pain of operations. But surgery was still deadly. After an operation, wounds often became infected, turned septic and filled with pus. Many patients with this kind of infection died days later.
Joseph Lister (1827-1912) was a surgeon who became Professor of Surgery at Glasgow in 1860, working at the Glasgow Royal Infirmary. He hated losing patients. In his male accident ward, between 45 and 50 per cent of the patients who had limbs amputated died of infection between 1861 and 1865.
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In 1865 Lister read about Louis Pasteur's germ theory. Pasteur had shown that microbes in the air cause rotting and fermentation. Lister made a link: if microbes make food rot, perhaps they make wounds rot too. If so, the answer was to kill them before they got in.
Lister knew that carbolic acid was being used to treat sewage, where it seemed to stop the smell and the rotting. So he tried it on wounds.
In August 1865 a boy called James Greenlees was brought in with a compound fracture of the leg. Normally this meant amputation, or death from infection. Lister cleaned the wound and covered it with lint soaked in carbolic acid. The leg healed without infection.
Lister washed his hands and instruments in carbolic acid and put carbolic dressings on wounds. From 1870 he also used a machine that sprayed a fine mist of carbolic acid over the patient and the operating area.
Lister published his findings in the medical journal The Lancet in 1867. In his Glasgow ward, deaths among amputation patients fell from between 45 and 50 per cent to about 15 per cent. Wounds that would once have turned septic now healed cleanly. Surgeons could also attempt longer, more complicated operations, because infection was less likely to kill the patient afterwards.
Out of 40 amputation patients, a death rate of 50 per cent means 20 die. At about 15 per cent, only about 6 die. That is around 14 more patients surviving in every 40.
Lister's ideas did not win quickly. Many surgeons refused to use them, for these reasons:
Over the 1870s more and more surgeons were persuaded:
Not every part of the method lasted. Lister himself later dropped the carbolic spray. The next step was to keep germs out of the operating theatre altogether, which you can study in the lesson From Antiseptic to Aseptic Surgery.
This was a big change in surgery. Anaesthetics had solved the problem of pain. Antiseptics began to solve the problem of infection. But surgery was still limited: bleeding was still a danger and many operations stayed risky. So surgery improved, but step by step.
Explain two causes of the growing use of antiseptic surgery in the 1870s. [8 marks]
Remember: one cause on its own can score no more than half marks, so give two. For each, give precise facts and explain how it led to the outcome.
One cause was Lister's results. After he began using carbolic acid in 1865, deaths among his amputation patients in Glasgow fell from between 45 and 50 per cent to about 15 per cent, and he published his findings in The Lancet in 1867. Surgeons who followed his method properly saw fewer patients dying of infection. This was clear, practical evidence that antiseptics worked, so more surgeons were willing to try them.
A second cause was Lister's teaching. He moved to Edinburgh in 1869 and to King's College Hospital in London in 1877, and he showed students and visiting surgeons how to apply the method. These students took antiseptic surgery to other hospitals, so it spread beyond Glasgow even though many older surgeons still resisted.
What lifts this to the top level: both causes are supported with accurate dates and figures, and each paragraph explains how the cause led to the spread of antiseptics.
For a "two causes" question, write two separate paragraphs. Start each with the cause, add a date or figure, then finish with a sentence that links it back to the outcome in the question.